Just recently, I was informed by a co-worker that my manager had stated that an orientee (new hire) is not allowed to take OT pay. They need to arrive on time and leave on time, even if it means patient care isn't done. That means that the trainee RN leaves at 0730, regardless if report or patient care are not done.
Now, I usually do not leave or give report late unless the oncoming nurse arrives late. My patient care is done way before 0700. Two nights ago, we received report for an admission from ER at 0615. Hgb of 5.7 at 0145. No order for more PRBCs at that time. My orientee asked if the MD was informed of latest Hgb and the reporting RN said yes. Well, patient arrived at 0650. Lo and behold, an order for 2 units of PRBCs was ordered at 0630 stat. I told my orientee since it was a stat order, that was our priority. The next shift would do the admission. ER dropped the ball on that one, but that's beside the point. We finished up with report around 0800 after the first unit was started. My charge tells us to sign for OT, but the day shift nurse informs us about the OT and orientees ordeal.
I wanted to open this up for discussion. I'm focused more on teaching the new RN patient care priority. Do you think it is right that the orientee has to leave at 0730 tpo avoid OT and leave all patient care behind to the preceptor? My rationale is that it is not because once they are on their own, they won't be able to leave without finishing up what they need to do.
The ER gave you report at 0615 BEFORE the order for blood was placed. The order for blood was placed after that. The pt was probably already packed for transfer. Perhaps the blood wasn't even available at that point to transfuse. We only have so much time before bed assignment until pt leaves the room or the ER nurse will get into corrective action. One of the main purpose for the ER is continuous thru-put. Without that, the whole hospital gets backed up - which means the ER sees less patients - admits less patients - that means less money for the hospital AND administration HATES that. The ER staff gets into hot water with administration if we don't move patients quickly.
Please don't think the ER "dropped the ball" - if anything administration dropped the ball.
Back to topic, yes, send the orientee home at the given time. That or risk of getting corrective action for disobedience.
Good luck, wish you the best.
Just recently, I was informed by a co-worker that my manager had stated that an orientee (new hire) is not allowed to take OT pay. They need to arrive on time and leave on time, even if it means patient care isn't done. That means that the trainee RN leaves at 0730, regardless if report or patient care are not done.
Now, I usually do not leave or give report late unless the oncoming nurse arrives late. My patient care is done way before 0700. Two nights ago, we received report for an admission from ER at 0615. Hgb of 5.7 at 0145. No order for more PRBCs at that time. My orientee asked if the MD was informed of latest Hgb and the reporting RN said yes. Well, patient arrived at 0650. Lo and behold, an order for 2 units of PRBCs was ordered at 0630 stat. I told my orientee since it was a stat order, that was our priority. The next shift would do the admission. ER dropped the ball on that one, but that's beside the point. We finished up with report around 0800 after the first unit was started. My charge tells us to sign for OT, but the day shift nurse informs us about the OT and orientees ordeal.
I wanted to open this up for discussion. I'm focused more on teaching the new RN patient care priority. Do you think it is right that the orientee has to leave at 0730 tpo avoid OT and leave all patient care behind to the preceptor? My rationale is that it is not because once they are on their own, they won't be able to leave without finishing up what they need to do.
Please don't think the ER "dropped the ball" - if anything administration dropped the ball.
Sorry. I'd like to clarify. I think the ER nurse might have dropped the ball in informing the MD of the latest Hgb. The first two units of PRBCs had been given and the post-transfusion CBC was drawn at 0156. That's a 5-hour difference from that critical result to when the next 2 units were ordered. On the floor, we have to inform MD of a critical lab result within the hour. How do you handle critical lab results in your ER?
Back to to the topic, I will talk to my charge to ask her and then have her bring it up to our manager because this needs to be addressed to everyone and not just day shift.
Was this patient boarding in the ER? So the the H&H was lower upon er arrival- pt then given two units of blood - then repeat CBC shows the H&H level that was provided to you.
In our Er - critical labs are notified a couple of ways to the charge nurse. They are sent over a pager, via phone, and then theres a program over the computer we have to acknowledge. MOST of the time we are still getting the results of initial lab work they are still being cared by the ER docs. If they are boarding, we have to notify attending doc for any critical lab results.
Without knowing the details about the patient - perhaps the patient was at risk for fluid overload. Ive had anemic boarded pt's that had to have lasix between each unit of blood. If they hadn't put out " XX mLs" of urine - I couldn't hang another unit of blood until a certain number had been reached. Not saying this was your patients reason.
Perhaps the ER nurse DID notify the attending doctor and for some odd reason …forgot to place order, timed wrong, became overwhelmed with critical patients …I don't know, Im just throwing out reasons.
Just please be more open minded besides "ER nurse dropped the ball". Perhaps ask her if there was a specific reason for the delay. Take it as a learning moment.
Perhaps the ER had an influx of codes or traumas. Sometimes, crap happens and we can only try our best.
My hospital will just pay you the OT but the nurse manager has to have a reason why the orientee is getting the OT. They would never want you to drop everything and leave though. We are also non-profit so that probably makes a difference. They would rather pay you a little overtime then have something happen because you were worried about staying late.
Question for you guys - I am about to start with my preceptor in a couple days - I feel like if something is happening around shift change, such as this situation or even simply that it will take me ridiculously longer to give report, record voicecare, ect than it does you experienced nurses, can I stay over? Chart? School is being pretty strict that we can do more than 12 hours in a day. I get it, they don't want us frontloading and knocking out a bunch of 16 hr shifts and then lounging for the last couple weeks. No problem. But realistically, if I have a preceptor who expects me to be a brand new nurse for a few weeks, I am NOT going to be done right at 19:30. New nurses and the RNs orienting them are NEVER done on time (on my unit, in my experience.) If I am ok with being signed off at 19:30, but actually geting more hours than I technically need, is there a reason that I can't stay and finish the shift, like a real nurse would? Our malpractice insurance through the school covers us 24/7...that's the only reason I could imagine they would be strict about it. And no, I will not set myself up for exhaustion with only a few hours of sleep. Don't mean to take away from the focus of the OP, I thought the two situations were related :).
I agree with management on this. No need for OT for two people if you could handle the situation alone. The critical thinking was done before the blood was actually hung, so the newbie got the max benefit of the situation.
Guest03/15/15, BSN, RN
69 Posts
Just my 2 cents.
The ER gave you report at 0615 BEFORE the order for blood was placed. The order for blood was placed after that. The pt was probably already packed for transfer. Perhaps the blood wasn't even available at that point to transfuse. We only have so much time before bed assignment until pt leaves the room or the ER nurse will get into corrective action. One of the main purpose for the ER is continuous thru-put. Without that, the whole hospital gets backed up - which means the ER sees less patients - admits less patients - that means less money for the hospital AND administration HATES that. The ER staff gets into hot water with administration if we don't move patients quickly.
Please don't think the ER "dropped the ball" - if anything administration dropped the ball.
Back to topic, yes, send the orientee home at the given time. That or risk of getting corrective action for disobedience.
Good luck, wish you the best.