I’ve been a nurse for two years on a cardiac step down peds unit. As I’ve grown as a nurse, it’s hit me how much pushback I get from doctors, team members, and charge nurses to make changes in the middle of the night when my pt isn’t looking good. Unless my patient is actively crumping, I get a lot of “we’ll pass it along to day team.” Or “it’s not an immediate issue right now, we can wait a few hours to address that.” It’s so frustrating as a newer nurse though because a lot of the time it feels like my concerns are not being validated. Then day shift comes on and states they feel uncomfortable with the patient and the team does 20 interventions.
Sometimes it makes me feel incompetent even though I know what I’m doing at this point and feel comfortable on my floor, because of how much pushback I get. Yes, you can call an rrt if it’s bad, but i deal with a lot of chronically sick kids who always look bad. When “looks like crap” is your baseline, it’s hard to get you moved to icu.
Ive just been so frustrated lately with the lack of action on night shift/the lack of concern. I don’t know what to do anymore. Almost every shift I come home frustrated that we didn’t do something else for the patient.
I'll be honest- the doctors on night duty lack much experience, let alone the guts to make big decisions. We often feel like we are just babysitting the patients until someone in charge with a clue can come in and actually make a definite plan. Its frustrating but it never gets better.
You have much to learn o little one,not everything is really emergent and it is difficult to walk the tightrope.Learn from the more experienced nurses,the calm,cool ones.Teaching hospitals like to do all the major stuff daytime,when they can order the million dollar work up.
The night time docs are either moonlighters or part time,they might have been told "do not make any changes until Monday when the full crew is there rounding with the Director.
Some doctors have said the morning crew will complain when new changes have been made.
If you really have an emergent issue,you keep escalating all the way to waking the director at home and administrator on call,but it better not be for a normal chem strip.
I have always told my docs, I will never wake you for nonsense like a normal chem strip,but if I knock on your door you damn well better come out!! I have never been refused.
I probably would have the same perception as the OP, if my fiance wasn't a resident at a teaching hospital. At least in this particular hospital, the night resident is responsible for 80-100 patients that night on the floor by him or herself. He tells me that it's really about keeping someone stable until the day team comes in. For any emergent cases then something will be done, but with so many patients to look after and so many pages from nurses he has to prioritize. He says he gets about 100-130 pages from nurses on his shift.
I have so much empathy for residents now because of my fiance. They are truly overworked and underpaid. I make double than he does and I only work 36 hours a week while he works 70-80. I did not know how underpaid they were until he started residency! Like in nursing, you'll have great residents and bad ones.
I worked on a step-down at a very well known hospital. We had some very sick people up there at times. Sometimes the nightshift team that was covering would punt the decision to day team. Sometimes I got annoyed but other times I understand why. Depending on the patient's team they had 1 fellow covering 2-3 floors worth of cardiac patients (24-100 total) and the fellow may not know anything about the patient....hence the punt to day team. Keep in mind this same fellow was responsible for admissions to that particular team overnight as well.
Thanks for all your responses! So the situation was a kiddo in severe heart failure who couldn’t hold their temperatures. They kept dropping to 35C and at one point went as low as 33C. Most of the shift they were 34-35. I had utilized all warming measures I had available - increasing temp in the room, warming blankets, heat packs, etc. At one point the docs just stopped responding to my pages about the kids temps being low.
I understand that they have a lot of patients and they don’t want to make changes but in my opinion, temps this low need to be addressed/fixed, especially in a heart failure patient. What do you think?
The whole point of a specialized unit is for focused care. Pediatric units exist because pediatric patients can have medical issues unique to their population, can respond differently to changes in health, need ped sized equipment., etc.
If a facility has specialized units then they should staff and have appropriate backup. In the end, not only is the patient at risk but your professional license is at risk. You have a duty to respond as a prudent professional.
If the doc stops returning your calls, use your chain of command. Charge nurse -> House Supervisor -> then depending on your structure...Chief of Pediatrics for your facility. And, chart, chart, chart and then chart some more.
I can only use my experience on L&D for examples. It took almost a year before a provider answering my middle of the night call stopped asking, “who else are you working with?”, then talking with them to get confirmation that my info is correct. It did not offend me because I was new and they did not know me. Ultimately, the MD is responsible so they have to trust that the information I am giving them is accurate. The flip side is, when I call an MD in the middle of the night and inform them they need to come now, the act on my request.
I have also protected my license by saying ‘no’ to an assignment at the start of a staffing agency shift. I was scheduled to work a staffing agency night shift at a new hospital. When I signed in and met with the charge nurse, I was assigned couplet care. Well, I don’t take care of newborns. I can care for them at delivery and immediately after and even cover for nursery nurse in a delivery in rare circumstances. But a shift of newborns, I said no. The moms were not an issue. Newborns can go bad fast and I don’t have that experience (I have worked nursery and step down NICU at my home hospital paired with a strong RN in the unit). At my staffing shift, they were not happy but changed the assignments to traditional L&D and nursery. It all worked out for them because soon after the change, I was assigned to assess a new rule out labor of a mom who only spoke Spanish.....I’m fluent. Win/win.
flo136
47 Posts
I'll be honest- the doctors on night duty lack much experience, let alone the guts to make big decisions. We often feel like we are just babysitting the patients until someone in charge with a clue can come in and actually make a definite plan. Its frustrating but it never gets better.