Question re: patient handoff/shift change

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Specializes in Critical Care; Cardiac; Professional Development.

If the day nurse has given end of shift report to the night nurse and handoff has taken place, but the night nurse is still getting report from other nurses whose patients she/he will be taking over care on - and a patient (whose care was just handed off) calls to state they are vomiting (and patient was stable 20 minutes ago, nauseated, has a bucket in hand, has been given Zofran), who should handle the situation...the day shift nurse who has already given report or the night shift nurse who has taken and accepted report? This isn't a day vs night question as much as wondering what my proper actions should have been, as the unit secretary was pretty cutting toward me for not racing to the patient's room (I was finishing up entering I&Os into the chart and about to leave).

This is a scenario that came up for me last week in transition and I was uncertain what to do. I would have been happy to go see her, but just was a newbie-style deer in headlights. This was my first time giving report. My preceptor was right there and did not tell me I should go, nor did she seem to feel the call was urgent (patient had been anxious all afternoon and we had spent a lot of time with said patient) nor did the experienced nurse coming on the night shift, who was also standing there and heard this report, but the unit secretary was very cutting toward me when they walked away and I sat down to finish up my last I&O entries. I'd just like to know what my responsibility is in this kind of situation in the future. Going to see the patient would not have been a problem at all - I just didn't realize after giving report it was me who should have gone and am still unsure. Thanks.

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Once I sign off that I've given report the patient is no longer my responsibility.

That being said, if I have time and it hasn't been a horrible day and I'm not needed at home and the oncoming nurse truly is unable to help, then I would go help the patient. Some of our nurses use report as social time, and if the oncoming nurse is a chatty Cathy, I am less inclined to help. I know it's not the patient's fault that their nurse feels like everyone needs to know about her new gel nail polish manicure, but I've been taken advantage of enough in this situation to have learned my lesson.

The unit secretary has no right being bothered by your use of your time. If she has time to scoff at you, perhaps she should go help the patient, it sounds like there were plenty of people up at the nurses station who could watch the phones.

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Specializes in Emergency, Trauma, Critical Care.

Eh, it should have been anyone who was available. If the other nurse was getting report still than it's a nice thing to go at least hand a bin. If it was pretty severe vomiting I'd go ahead and get zofran or something else if the patient had it available. It's not an emergency, but I don't think I would feel taken care of as a patient if I'm throwing up and everyone is ignoring me.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Let me start by saying that I work night shift (1800 to 0630).

Once the night shift nurse has received report on the patient, any nursing care or concerns regarding that patient becomes his/her responsibility. However, if the night shift nurse still needs to receive report from a different day shift nurse on more patients, common courtesy would dictate that the other day shift nurse who cared for the patient all day do something to quickly smooth things over (assess the nauseated patient, medicate, etc.).

While receiving report at the place where I work, a common occurrence is when the unit secretary will walk into the report room and say, "The family member of room 101 has some questions." Out of courtesy, the day shift nurse will quickly answer the family member's questions since (s)he cared for the patient all day. While I could certainly answer the visitor's questions, it wouldn't quite be the same because I'd be giving secondhand information that I received during the report.

Of course, much of this is dependent upon the culture of your particular unit.

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Honestly, I'd have helped the pt. Its not infrequent while giving report for a pt to need to be changed, a flush put on a pump, pt family asking for something, etc... If I'm charting and the other oncoming nurse is getting report, I'll typically jump up and do it. It typically takes me 15 min or so after report to really get my bearings, so I like to extend the courtesy to the oncoming nurse of helping make it a smooth transition.

That said there have been times when I had a crazy shift and if I don't chart or finish up, I will be there another hour or so, that I will let it fall to the oncoming nurse, but that's rare.

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What's been said. It's the oncoming nurse's responsibility. But as a team player, I'll usually go ahead and take care of it. After all, if they go now, then more of my shift is stuck waiting for that nurse to give report. If nobody goes, then the patient has to wait, (which in some cases, isn't necessarily a bad thing, if for example the patient is in desperate need of having some limits set.)

I try to make things as easy for my replacement as possible. If they have to start off with a patient that's already mad because of a wait, that's not fun.

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Your preceptor didn't think it was urgent?? Or offer to go to the pt's room to check it out? Sad. If she was available she should have gone with you to check on the patient.

Like others have said - teamwork.

But the secretary has no standing in this, anyway.

Best wishes!

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Specializes in ICU.

Is this a question of accountability? It's OK to get a emesis basin, prime an IV line, get a drink, fluff a pillow, turn a patient after you have handed off. There are no legal ramifications.

Use teamwork.

This is the only culture I have known in the ICU. It doesn't matter whos patient. I walk past a bed, the pt is bucking a vent, I will suction the patient whether it's after my shift, before my shift, or not my patient. If the patient is vomitting, I will go in, elevate the head of the bed, get them a basin, until the report is done if I can.

Please, for the basic things, don't worry that it's "not your patient" anymore.

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Specializes in Med-Surg; Telemetry; School Nurse pk-8.

I have found that you can't go wrong if you apply the litmus test of 'how would I want it handled if the patient were my family member' or 'how would I feel if I were the nurse accepting this'? There's your answer.

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There were 2 of you (you and preceptor) and only 1 of her and she was still receiving report. I think you should have went to help (without your preceptor telling you to). Not to mention a patient should always be priority over entering something in the computer or charting.

Also, just imagine you are coming in and getting report and before you have even finished getting report you have to go deal with this situation and the night shift nurse did not go help, i'd be upset because this would put me so far behind.

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Specializes in Medical Surgical Orthopedic.

It's like pulling up to a four way stop at the exact same time as another car. After some very brief, non-verbal communication, one of you stays and one of you goes.

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Specializes in Critical Care; Cardiac; Professional Development.

Thank you all who responded. I will be better equiped to react next time. The patient already had a bin and I had already given her Zofran and Xanax not long before this. I spent a lot of time with this patient that day. I think the documentation question is what threw me on it since I had handed the chart over after documenting I had turned over care. I sincerely appreciate all of your guidance! It probably seems like a no brainer and I am thankful for the matter of fact replies.

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