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?
I agree wholeheartedly for non-urgent situations. I recently had a situation with potential for a really bad outcome during change of shift report. I work on a 25-bed subacute rehab unit that cares for a large number of orthopedic patients on anticoagulants. Typically we have two nurses on days and evenings each (we run three shifts) and split the number of patients down the middle. On this particular day I was the only evening shift nurse. I had gotten report on the first half of the unit already when an INR of 9.1 came in on a patient I'd already gotten report on, but I'd just started getting report on the second half and it would be a good half-hour before I'd be able to address the INR with the attending. There was still the other day shift nurse on the unit and my thoughts were that she could've called the attending while I still in report since the INR was critical. Thoughts, opinions?
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!!!
My favorite is the bone dry bags when I come on, yay! I always try to leave fresh bags hanging. Also try to always have an extra heparin bag, etc in the fridge because that sucks when your bag runs out and you get to wait for pharmacy. Also tubing changes.
The only time I've passed on a central line lab draw is if blood is running or if all labs are to be drawn with methotrexate levels on some of our patients.
Our new policy is PIVs only have to be changed when they start leaking, get red or cause discomfort. As long as they work, they can stay in 10 days.
Specializes in Critical Care; Cardiac; Professional Development.
I get pretty irked by dry bags, Unacknowledged orders ( often from 9PM the night before. wtheck?), not prepping the patient for an 8AM CABG (no chlorhexadine shower the night before, chest not shaved, etc) and no refills on drips or tube feeds. I will indeed ask the off going to address these prior to signing out, but I do that during report. I also ask them to notify the physician themselves if they failed to do something that affects a scheduled procedure. I am not getting yelled at for their omissions. Once he/she gets up from report it's all on me and they get to go home. Interestingly the above issues almost always get taken care of appropriately after once or twice of requesting them to do it before they leave.
Our new policy is PIVs only have to be changed when they start leaking, get red or cause discomfort. As long as they work, they can stay in 10 days.
Really! Your policy changed recently? Is it possible for you to provide the EBP showing that it's ok for a PIV to go 10 days? Would love to read it and give it to the powers that be to consider. TIA.
not prepping the patient for an 8AM CABG (no chlorhexadine shower the night before, chest not shaved, etc)
Why ANYONE would feel that is acceptable is beyond me.
I've had off-goings that didn't get informed consent for a planned procedure. They've told me the procedure, what time it is planned, the patient is NPO, and you know what the excuse was? "Well, the residents didn't put in a 'verify informed consent' order." Yeah, I still don't have one, and transport just called to take the patient. Do you really need an order for common-effin'-sense?
Really! Your policy changed recently? Is it possible for you to provide the EBP showing that it's ok for a PIV to go 10 days? Would love to read it and give it to the powers that be to consider. TIA.
It's been awhile, maybe 6-8 months? I'll look through my work email and see if I can find what they sent about it.
Why ANYONE would feel that is acceptable is beyond me.
I've had off-goings that didn't get informed consent for a planned procedure. They've told me the procedure, what time it is planned, the patient is NPO, and you know what the excuse was? "Well, the residents didn't put in a 'verify informed consent' order." Yeah, I still don't have one, and transport just called to take the patient. Do you really need an order for common-effin'-sense?
At my hospital in Texas, we were responsible for getting consents for things like blood transfusions and procedures. Here in NY, we aren't to do it at all, the residents do it. It's weird.
Nope, not your problem. The issue occurred after your shift is over. If it had happened at 0700 and you don't actually leave until 0730 (overlap for report), I'd page the dr. and talk to him/her if s/he calls back before 0730. But like others have said, 1) she can't expect everything to be nicely resolved at change of shift, 2) you don't want to get spoken to about OT (because you don't work for free!!), 3) you don't want legal repercussions for working off the clock, 4) Nursing is a 24-hr job--there are 2-3 shifts for a reason.
At my hospital in Texas, we were responsible for getting consents for things like blood transfusions and procedures. Here in NY, we aren't to do it at all, the residents do it. It's weird.
We are not allowed to get consents either at my current hospital system here in MI. I am glad. I feel if the physician talked to the pt about having a procedure or blood transfusion it is their responsibility to obtain consent.
LesMonsterRN, ADN, RN
300 Posts
I agree wholeheartedly for non-urgent situations. I recently had a situation with potential for a really bad outcome during change of shift report. I work on a 25-bed subacute rehab unit that cares for a large number of orthopedic patients on anticoagulants. Typically we have two nurses on days and evenings each (we run three shifts) and split the number of patients down the middle. On this particular day I was the only evening shift nurse. I had gotten report on the first half of the unit already when an INR of 9.1 came in on a patient I'd already gotten report on, but I'd just started getting report on the second half and it would be a good half-hour before I'd be able to address the INR with the attending. There was still the other day shift nurse on the unit and my thoughts were that she could've called the attending while I still in report since the INR was critical. Thoughts, opinions?