Off going or oncoming responsibility

[sistrmoon]

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?

[Karou]

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?

I have had to tell pre-op or the oncoming RN that I am waiting for the physician to put in a "witness consent" order before the patient signs consent. The reason being that if the surgeon has not put in an order (or a very detailed note) then I don't have enough information to fill out the procedural consent form. If the surgeons notes were very clear with the indication/diagnosis/necessity that's requiring procedure, the EXACT procedure, and their added risks/benefits (we have standard ones on our forms, but sometimes they add specific ones) then I might get consent. I never get anesthesia's until they put in their own note. However, if I don't have all of the information that I need then I can't witness consent or fill out the consent form.

If it's not clear then the consent can be obtained in pre-op. They don't like it (and I don't like it) but if it's not clear then I am not putting my name to it. In actuality this happens very, very rarely. I've had to do it less than a handful of times.

[dexm]

Sounds like a day shift problem!

Now if this was happening DURING report (like so many things do), that's a different story. I'd definitely page the doc and let them know what was going on and maybe get meds, etc. while the oncoming nurse stays at the bedside with the patient. Usually though the charge nurse or team lead (or other experienced nurses) are at the bedside helping out and they don't need me to stay. It just depends on how busy everyone else is and how experienced the oncoming nurse is.