nursing endorsement, when does it start and when does it end?

[fuyuojo]

From the title above, I need your answers. When are you liable in your shift? Is it starting from your shift, without the endorsement yet? Or after endorsement? Thanks.

Probably it is more accurate to say your nursing liability.

[chloecatrn]

Do you mean report? As in, from when one caregiver hands off patients to the on-coming caregiver? Our practice is that when you receive report, you assume care of that patient.

[Asystole RN]

In what context are you referring?

[fuyuojo]

Do you mean report? As in, from when one caregiver hands off patients to the on-coming caregiver? Our practice is that when you receive report, you assume care of that patient.

@asystole I am referring to this. Sorry if my statement is ambiguous. What I am trying to ask is that when are you liable for your patients? Is it after the previous shift had endorsed the patients? Or you are liable still if your shift is already on but the previous shift were busy carrying out orders? Thank you for your replies.

[Asystole RN]

Technically as a Registered Nurses you are ALWAYS liable.

You gain specific control over your patients when you accept report and you leave specific control when you give report.

BUT

This does not mean you are not still legally liable if you witness something.

For example.

You give report, clock out, walking out of the door and on your way out you witness a patient fall. It is still your responsibility to provide care until relieved.

[Flying ICU RN]

I have always privately maintained that nursing report is overrated. As an ICU nurse, all I need at any given moment is an ambu bag, suction, and a crash cart, to be able to perform to the maximum level of my clinical privileges. As far as I'm concerned, the previous nurse can simply walk out.

Why?, because I would be using the same skills I would be if the hospital was suddenly flooded with the victims of an airliner crash.

That scenario aside, at any level of nursing you are responsible for the timely and appropriate interventions for the current patient condition the moment hand-off does occur. So if the patient has been decompensating over the previous six hours prior to your arrival, you are now responsible to initiate the appropriate timely interventions.

If you are timely and the patient suffers a bad outcome anyway, the ball now falls squarely in the other guys'/girls' court.

[luvthegsp]

what does "endorsing" mean??

[fuyuojo]

the thing is, a doctor texted that the patient can go home the following morning. the message was received during my shift, and i showed the text message to the nurse from the previous shift. she told me that it is okay already, since she already talked with the doctor on the phone, giving discharge orders so the patient can go home that day. endorsement came after that. my shift is from 2pm-10pm, but endorsement started at around 2:50pm. that particular patient left on my shift.

the following day, my supervisor called me and told me that the doctor is fumed because the patient went home and she was not informed. the previous shift didn't tell me to inform the doctor. and now, a grievance meeting is set.

have i known that that would happen, i should have not let the patient out. tsk.

[chloecatrn]

the thing is, a doctor texted that the patient can go home the following morning. the message was received during my shift, and i showed the text message to the nurse from the previous shift. she told me that it is okay already, since she already talked with the doctor on the phone, giving discharge orders so the patient can go home that day. endorsement came after that. my shift is from 2pm-10pm, but endorsement started at around 2:50pm. that particular patient left on my shift.

the following day, my supervisor called me and told me that the doctor is fumed because the patient went home and she was not informed. the previous shift didn't tell me to inform the doctor. and now, a grievance meeting is set.

have i known that that would happen, i should have not let the patient out. tsk.

If you have conflicting information like that; i.e: a message that was received saying the patient could go home the next morning AFTER the physician had given orders that the patient could leave that day, I would call the doc and clarify. Sometimes, we rely on technology too much, and texting an order to say when a patient can leave is just out of control in my (not so humble) opinion.

I don't think the doctor's problem has anything to do with you not informing him that the patient left. I think the problem is that the doctor specifically said the patient could leave the NEXT MORNING. There should have been a telephone call for clarification, not an assumption that you and the off-going nurse knew better than the physician what was meant, to be honest. Perhaps the physician had decided an extra day in the hospital would benefit the patient. Perhaps labs had come back that were slightly off, and the physician wanted an AM redraw. There are a million reasons that day's discharge could have been pushed to the next morning. This isn't so much about preventing you from a grievance hearing... it could potentially have been about patient safety.

[fuyuojo]

her main attending physician ordered a go signal that she can go home.

i did not understand the text when i read it, and i gave it(the phone) to the previous shift. the fact is, she doesn't understood what it meant either. the reason why the doctor had postponed til the following day is that she can't make rounds that day and she needed a closure with the patient.

yeah, i learned my lesson well.