Leaving issues for daylight shift

[rnto?]

I've been a supervisor at a SubAcute/LTC facility for the past 2 years. 2 months ago I became a night supervisor (after returning from maternity leave). Since I started as supervisor i've been told by the don/adon that non-emergent issues on off-shifts can wait until office hours to be handled by the physician. i've never had a problem determining what i needed to call on on an off shift vs what could be handled during office hours. recently one of the night turn nurses has been questioning this policy-specifically, she states I should call the MD for every single change in condition at 12am, even if the patient is stable and the change in condition is not emergent. i cannot find anything about the legal issues surrounding this. is it acceptable to wait until day turn to notify the md that, for example, mr. smith has increased edema but no other abnormal assessment findings. or jane doe has a cough but no fever, not in distress, etc? ADon told me yes, because the facility is 'thier home' and at home non-emergent issues would be handled during office hours. generally if the patient is stable w/ a minor issue and/or te appropriate treatment couldn't be started to daylight anyway, i defer.

[merlee]

Sounds like you know what is appropriate; what is 'emergent' and what can wait til the morning.

An increase in edema without concurrent changes in VS or SOB could just mean the pt's legs were in a dependant position longer than usual.

My best guess is that this nurse is either a nervous nellie, or is having issues with what wasn't dealt with on days.

You know what you are doing - maintain control, stay confident, keep smiling!

[Sparrowhawk]

Yeah..plus most doctors are going to pitch a fit if you call them at 12 am to tell them nonemergent issues.

[Debilpn23]

I agree with the above post. non emergent issues can wait until daytime

[sillyang]

Being a first shift nurse I can get irritated when the latter shifts leave everything for me. I have enough to do and it is a 24 hr work environment. Issues that are in control and not acute can be faxed to the physician; ie colace orders and etc. I have found that many nursed do not like to speak with physicians and will leave everything for 1st shift even acute stuff like incidents. Doctors can be grumpy at 1300 but I didn't choose there profession for them. I'll state it again, if its not emergent and its not everything that goes on after hours its ok to wait.

[caliotter3]

I worked night shift in more than one facility. We left non-emergent matters for the daytime.

[DizzyLizzyNurse]

I work midnights. We also leave non emergency issues for days. I'd listen to your DON/ ADON not a staff nurse.

[nurse2033, MSN, RN]

Sounds like you have the "pulse" of the work flow. That night nurse should be working as part of the team within your unit culture.

[tyvin, BSN, RN]

Have you been calling the docs at the wee hours of the morning for non-emergency concerns? Well where I am from we definitely don't do that. As an RN you should be able to decide when to call and when not to. That's why we have standing, PRN, and similar orders in place so you don't end up calling the docs every time a resident coughs. That's also why we're getting paid the big bucks.

All docs are different so it behooves you to get to know them. For example one facility I worked at didn't require we notify the doc about deaths until day shift; that the death certificate can be signed later at the morgue. But one of the doctors always wanted to know if one of his patients died regardless of time; I always called him. And then you have the docs who don't want to be disturbed at night unless the patient is in a true crisis. Calling a doc to tell them the blood sugar went up to 146 when you have PRN sliding scale orders on board already will infuriate most docs. It's when it goes over (or under) the parameter set by the doc or by our own nursing standards that the call is made.

IMO it's the docs who have your facility putting this into practice. They need their sleep too.

[sziq1]

Leave non-emergent things for day shift. We leave notes on the front of the chart for the md to see when they get there and also pass it on in report. I would have the nervous nellie find that policy and show it to you.

[tyvin, BSN, RN]

In addition to my other comment when or if you are going to call a doc outside of his office hours when you call have all pertinent info available to you. Sometimes they don't remember the patient or it can be an on-call. Anticipate what questions will be asked and have a plan ready for advisement in case the doc doesn't respond quickly. The docs like hearing what we have to say (well most of them that I've worked with).

I've had docs ask me what I want. I do really mean they ask you what you want them to do sometimes. That's why have a plan or a med recommendation ready and know why. Also the docs don't always prescribe the proper course of action/treatment so be ready to be an advocate for the patient.

As far as leaving "everything" for the day/evening shifts each shift has it's own individual duties and waking up docs for non-emergencies is simply ridiculous. If you take your colleagues advice "you" will have a bunch of doctors calling up the boss and complaining about you. What is good is have all the things that the docs need to be told about on a nice list (which was part of report in a place I use to work). Also the putting notes on the charts for the docs is a good one that can be done by night but in LTC the docs don't come in every day so calling or faxing the office is the only way.

[sillyang]

I have had a situation where the night shift nurse had made a med error at 0500, her shift didn't end until 0730 and I the 1st shift nurse ended up having to call the doc. That is the type of thing I don't want saved for me, 0700 isn't the middle of the night and everyone should take responsibility for their own actions. I've also ran into med issues where the 24 hr pharmacy line could have been called at night too. I know that not all night shift nurses hide from work but I have ran across a few that do and mabey the nurse refferred to in the initial post is complaining about that kind of situation. I would hope no one would expect you to call for a sneeze in the middle of the night.