I work 7p-7a. Last night I got a patient from a nurse who was leaving at 11pm. He didnt bother to tell me I was getting a patient from him and didnt bother to give me a shift report. The charge nurse who assigned this patient to me didnt bother to tell me that I was getting this patient either. I find out that the patient was mine at 130am by the PCT who was reporting a sky high blood sugar. I was LIVID!!!! Nurses on that floor tell me that its my responsibility to check the shift assignments at 11pm and that is my responsibility. At that time I was running around like a chicken trying to keep up with my patient care.
This is NOT RIGHT. I feel the charge nurse and the exiting nurse could at least tell me that I was getting this patient. The exiting nurse just left a telephone shift report and then took off. What makes it more aggravating was this patient was in DKA and suicidal and I find out about it 2 1/2 hrs later from the PCT?????
This is a large floor in which I work in the back area and the charge nurse works up in the front area. The charge nurse could have called my cell phone to tell me I was getting this patient (if she didnt feel like walking all the way to the back area where I was) and the exiting nurse could have told me I was getting a pt from him with a face to face shift report.
Im still fuming about it. Am I right to be angry? If something had happened to the patient it would be my behind that would of got nailed.
I think patient abandonment was on the part of the off going nurse not the OP.
National patient safety goals requires standardized patient handoffs with the on going nurse given the chance to ask the off going nurse questions. So even if you do taped report there still has to be some face to face even if all it is is " I have 222c Mr. Jones I don't have any questions do you have anything else you need to tell me?"
This will also prevent accidentally not assigning a patient to any nurse. Years ago a patient went through 3/4 of days shift before it was determine the patient hadn't been assigned to any nurse.
This could also be a performance improvement project for your unit or hospital.
OP, I don't believe that any of this situation falls on your shoulders. Your charge nurse blaming you is just shirking her responsiblity. Bottom line, Offgoing nurse abandoned his patient and can lose his license for this. As an RN it is our responsibility to accept or deny a patient, ask questions, etc. You were not given this opportunity.
Should you have checked the assignment board? O.k. fine, sure. Should the Charge nurse be coordinating and making sure everyone is aware of how there assignment will change? yes, and it should have been done before 11p. She is wrong and offgoing nurse is wrong unless he reported to charge nurse. It falls on them not you!
My advice: Report the charge nurse and the offgoing RN to the director of your unit and risk management. I hope you generated a pt. safety report for the pt. abandonment and elevated blood sugar. If you haven't already done so, you need to. The pt. was probably (o.k. definitely) harmed by the elevated blood sugar (didn't you say it was 1100+?). With that high a blood sugar pt. belongs in the unit. Was the pt. on an insulin drip prior to you "receiving" the pt? Imagine if pt. was on an ins gtt and got TOO MUCH insulin?!? The PCA could have found a dead pt. rather than one with an extrememly high BS.
What was the outcome for the patient?
I'm sorr this happened to you. REPORT IT, REPORT IT, REPORT IT!!!
Why wasn't the patient in the ICU if they were in DKA?
Lots of hospitals keep pts in DKA that are not comatose on the floor with the genral population. I've worked in two different hospitals and this is how both of them handled DKA's.
Suppose a nurse you work with gets sick or has an emergency and has to leave at midnight or 2 a.m. or 6 p.m. but you don't know about it. Now whose responsibility is it to clearly communicate the assignment to each nurse?
The time isn't the issue. The issue is what I said above.
Of course the time is the issue. I'm not saying I agree with the practice, but if the norm is that some nurses just leave a taped report when they get off at 11:00PM, it would behoove the nurse that is staying to check her assignment. Again, I am saying I don't agree with this practice. But the O.P.'s choices are to try to change the practice (which I would strongly suggest) or cover her XXX (not to mention the patient's) and check her assignment again at 11:00PM. Once again, I don't agree with the current practice at her facility.
Someone leaving sick or for an emergency at any other time is not the norm and doesn't apply to what I wrote about the situation.
BTW, did I mention that I don't at all agree with the practice at that facility?
Lots of hospitals keep pts in DKA that are not comatose on the floor with the genral population. I've worked in two different hospitals and this is how both of them handled DKA's.
That's really not fair to expect a floor nurse with 7 other patients or what not to be handling an insulin drip, cardiac monitoring, fluid resuscitation, potassium infusions, frequent ABGs, and frequent glucose checks- all which are part of the standard of care for true DKA.
I have had this happen to me once after that I decided that at 11p I would just make a quick copy of the staffing sheet check it fold it to my back pocket - its handy in a big unit when you are walking by a room and need to find out "who has 32" ect.. this also gives you a record prevents any "additions" after the fact, wich shouldnt happen but lets face it - in the cover they backside world we run in - could
Specializes in CV-ICU, Rehab, Med-Surg, Nursing Home.
I agree with everyone else....definetly file an INCIDENT REPORT! What if this patient would have commited suicide? Where I work, these patient's are generally on 15 minute checks. This needs to be reported, it is a big patient safety risk. The nurse who left, as well as your charge nurse, need to be held accountable and more importantly need to be aware that this type of situation is not tolerable. Good luck!
I'd definitely be writting an incident report. Thank God this patient didn't kill themselves, fall, etc. during that time. It's absurd that the nurse didn't let you know and even worse that the CN is defending it. Shame on both of them.
RNKPCE
1,170 Posts
I think patient abandonment was on the part of the off going nurse not the OP.
National patient safety goals requires standardized patient handoffs with the on going nurse given the chance to ask the off going nurse questions. So even if you do taped report there still has to be some face to face even if all it is is " I have 222c Mr. Jones I don't have any questions do you have anything else you need to tell me?"
This will also prevent accidentally not assigning a patient to any nurse. Years ago a patient went through 3/4 of days shift before it was determine the patient hadn't been assigned to any nurse.
This could also be a performance improvement project for your unit or hospital.