Off going or oncoming responsibility

Nurses Relations

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Specializes in Inpatient Oncology/Public Health.

If a patient spikes a high blood pressure at change of shift, or similar issue, who should address it? I've always felt if I've already given report, it's up to the oncoming nurse to address and if not, I will page the dr.

This morning as I'm finishing up charting because our staffing was less than optimal last night, it's 7:40(I'm 11-7) and the patient has already been reported off. The oncoming wants me to address this before I leave. I page the md but no call back.

I'm of course not talking about an emergent situation. If I'm still there of course I'd jump back in. But having all loose ends tied in a neat bow simply doesn't happen. Time for you to take over. What do you think?

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Specializes in LTC, med/surg, hospice.

If I've already given report, then the nurse who assumed care of the patient should address it. That is one reason that I like bedside report, the nurse can see the condition of the patient and have some familiarity with them.

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Her call 40 minutes after shift end. Legal implications when you are off the clock, or should be off the clock.

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Nope, you've been there long enough, it's her game now. Go on home.

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Nursing is a 24 hour a day job. Patient issues do not fit in neatly during designated shift hours. Other than a emergent situation, rapid response, code etc. the next shift needs to take over. Also would your manager want you to be on overtime for this?

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Specializes in Critical Care.

It's the oncoming shift's responsibility, you need to firmly nip that one in the bud.

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Specializes in Pediatrics, Emergency, Trauma.

On coming shift can handle it. :yes:

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"I can not address this before I leave, as I was to leave 10 minutes ago."

Do you have a day charge nurse who can page the MD? Never the less, once the patient is reported off, the patient becomes the responsibility of the day nurse.

Could this have been some passive aggressive "you should have dealt with this on your shift" thing?

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Specializes in Med-Surg.

You are right. You paged the MD once already, she can page again if there is no call back. As another poster said, nursing is 24/7.

Our lab results always come back at about 06:20... Right before shift change. I always page over critical values, and usually significant changes/lows/highs, but sometimes I will ask the oncoming nurse if they want me to page.

Example: potassium is 3.3, I can page the on call physician, but the patients attending will be back on at 08:00. A lot of times the nurse will prefer to call the attending themselves at eight than have to answer a return call from the sleepy on call doc (after I page) who the nurse will have to explain the patients entire history to.

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Specializes in Inpatient Oncology/Public Health.
"I can not address this before I leave, as I was to leave 10 minutes ago."

Do you have a day charge nurse who can page the MD? Never the less, once the patient is reported off, the patient becomes the responsibility of the day nurse.

Could this have been some passive aggressive "you should have dealt with this on your shift" thing?

Possibly a passive aggressive thing. But considering the patient didn't spike a serious BP until the vitals were taken at 7:30, I don't know how I would have addressed it. Psychic nursing? Apparently she couldn't reach a doctor until one came strolling in at 10am. Guess I should have waited around til then?

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SUCH a common scenario! I knew a number of nurses, once they received report, would come back in while the off-going nurse was finishing her charting and announce "Mr. X pulled his IV/Foley/NG out, can you put one in?" or "Mrs. X says she wants pain meds, can you call the doc for new orders?".

Sorry, no. You can bet that when those same nurses GAVE report 12 hours before they weren't leaving a perfectly tidy night good-to-go. Crap happens! But just like THEY expect the next shift to handle whatever comes up....so should the next.

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Specializes in Med/Surg, Academics.

In general, an abrupt change in patient condition seen during first assessment/vitals is the oncoming's responsibility.

An ongoing issue that it's clear the off-going has been dealing with for some time should also be smoothly transferred to the next shift. In that case, asmile, a thank you for the progress she's made, a "Go home, get some rest. I got this!" is also a nice gesture for your bleary-eyed co-worker!

A rant: what should not be pawned off are:

1) two empty IVF bags that the patients are starting to get upset about the beeping,

2) a meal order that the off-going promised to help the patient with but didn't,

3) a central line draw for morning labs,

4) a PIV that is TWO DAYS overdue has not been changed (really?! Four nurses never changed it?!)

5) a central line that is 24 hours old but never documented

No, those should never be pawned off. Although someone tried. This morning. To me. However, I did numbers 1, 2, and 5. It took me all of 15 minutes. And no, it wasn't a crazy shift for the off-going as I took all of his patients, so I knew what was done overnight. Argh!!!

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