New to acute psych night shift - feeling discouraged

[proudauntie415, LPN, RN]

Hey everyone!

I have recently started working night shift (usually on evenings) and also started a new job and in a new field (acute psych).

I've been nurse about 3 years now and have a Type A personality. I like to be organized in my care (almost obsessively, lol) and tend to be the one who "does to much", but I believe in really trying to help my patients.

Since I am on overnights I am getting nervous about making sure things are followed up on. For example: lab draws are at 5 AM. It was a Saturday and I had received new results for LFT's which were abnormal. Not critical, but abnormal. Reviewing history I saw he had elevated LFT's in the ED the day before, and the doctor ordered an Hep C aby which was positive, and also ordered more LFT's.

They had decreased by a few points, but were still elevated. The patient did not have any s/s of jaundice or liver dysfunction. I knew calling a doctor at 5 AM for abnormal labs that the doctor was already generally aware of was not critical. But I also wasn't sure he got the positive ABY results the day before because there weren't notes stating it was reviewed/reported.

Anyhow, in shift hand off, I reported to the oncoming nurse and printed out the current labs, and previous labs for reference and asked if she would contact the doctor. Well I returned that evening (7P) and found the labs stuffed under the computer. (I was given a different assignment so didn't have that patient, but found those results stuffed under the computer) Nothing documented in the computer or otherwise. So, I of course contacted the doctor at that time and he stated he would be in the next morning to assess the patient and provide the diagnosis.

This is what bothers me, I am running into instances where calling the doctor in the middle of the night is not critical. Such as a patient requests a med change, or to d/c orders that are in still in the computer that don't need to be there (like neuro checks for a detox patient that is no longer detoxing). It almost feels like I am "passing the buck". What is the best way to chart you notified oncoming nurse in shift report? Do you say it just like that?

For the liver patient, I was really bothered the nurse just blew it off. 1. We failed to properly notify the doctor in a timely matter 2. It was me who received the result so I assume I would be in trouble for that if the doctor would have not got that result till later in the week.

I just hate the feeling of "passing the buck" onto day shift for some things and that in the end it's my fault if it doesn't get followed through. I hate this feeling. I hate how I find errors often and am told, "well they just need to deal with that in the morning". It's like :/

Just being in a new job, I get told 20 different ways to do things and with psych there are so many issues I question, but am told "it's how its done". They PRN people like crazy. They pull PRN's with their regular meds without any actual issues, they advise me "if you keep them PRN'd it makes it 10x easier then dealing with outbursts". I just don't think it is right.

I like the night shift because it's lower stress and it's perfect while I'm in school for my BSN, but I'm just nervous that I am setting myself up for errors/problems. Maybe it's just nerves of being in a new field and trying to figure out my rhythm in acute psych.

I don't know :/ feeling discouraged. I mean one minute I'm told if you have to assist another nurse giving a shot by supporting an arm - you need an order for therapeutic hold. But one day I had a patient who is MMR, and was becoming agitated/aggressive and shouting "give me my shot, give me shot". So, I went to give him his shot and he became frightened by the needle and started acting out. He asked the PCT's "hold me, hold me", so two PCT's secured his arms but he started squirming as I was giving him his shot. I was told I didn't need to get a therapeutic hold order because he asked to be held. But to me the PCT's had to really hold each arm because he started pulling away. I just worry the cameras saw it as therapeutic hold. I charted, "pt requested to be held and was assisted by PCT's to help calm patient". Is that right?

Sorry for the long rant, I'm just a stickler for rules and want to do my best but if I'm not guided correctly I worry I set myself up for liability or errors un-intentionally.

Thanks guys!

[Pangea Reunited, ASN, RN]

I would not have called about that, either. You can note that you endorsed the results to day shift for follow-up, but keep in mind that the ordering MD is fully capable of looking at the labs he/she ordered without being called by nursing staff.

[mrsjonesRN]

Whenever I have to "pass something on to day shift,"which I HATE doing as well, I document in the chart what I passed on to the oncoming nurse, whether it's a need for a consult, lab work, etc.

[mrsjonesRN]

Plus, anytime I am unsure of something, I look up the policy. I am like you in the sense that I like to do things correctly as well. When I started the job I am at now, 5 people told me 5 different ways of doing things, so I always made sure to look up the policy not only for my liability but for the safety of the patient.