Question re: patient handoff/shift change

Nurses General Nursing

Published

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.

Specializes in Med-Surg, & ED.

Don't take me wrong, but you'd be the last person I would want to work with. A team player in any department is always highly appreciated, for the sake of patients wellbeing and support towards our coworkers. Again, shame on you.

Up Vote Up Vote ×
Specializes in Hospital Education Coordinator.

nursing is 24 hours and, in my state, you have a duty to the patient even if they are not part of your assignment. Do what you can to help.

As for the unit clerk - if she really knew what was going on she would be a nurse

Up Vote Up Vote ×
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Don't take me wrong, but you'd be the last person I would want to work with. A team player in any department is always highly appreciated, for the sake of patients wellbeing and support towards our coworkers. Again, shame on you.
The OP is not a nurse yet. She is still a nursing student who will be graduating shortly, and is in the process of learning the patterns, routines, and culture of a particular unit. Since she is not a nurse and has never worked as one, I think her question is important and facilitates learning. She asked this question to enhance her knowledge, not to be shamed.
Up Vote Up Vote ×
Specializes in LTC, Memory loss, PDN.

I believe the (ethically) right thing to do is to take care of the pt., but for goodness sake make sure you make a short entry in the chart of your findings and who you reported your findings to. I'm saying this from experience (got burned).

Up Vote Up Vote ×

I can't tell you how grateful I have been for the night shift nurses who have stayed over after report if a patient takes a turn for the worse during report.

The night shift nurse knew the patient better than I did, so was able to communicate with the doctors more effectively.

The time it took was only about 15 minutes until I was able to take over the situation alone, but I remember, and I owe him the return favor someday.

Up Vote Up Vote ×
Specializes in I/DD.
Don't take me wrong, but you'd be the last person I would want to work with. A team player in any department is always highly appreciated, for the sake of patients wellbeing and support towards our coworkers. Again, shame on you.

Sorry, I can't hold back, but this just isn't necessary. Shame on her? It sounds like she is very new if this was the first time she was giving report. How is she supposed to know where the lines of her responsibilities towards her patient vs. responsibilities towards her co-workers are drawn, especially if she has inconsistent examples to follow?

For me, it completely depends on the situation. If I have finished giving report on all my patients then I will help out with little things like this because I know that when I work day shift, getting interrupted can really throw off my morning. On the other hand, if I am in the middle of report on another patient, or have a line of nurses waiting to get report from me, then I won't. In my opinion it is all about continuity of care. When I have to stop report several times to take care of other patient's then I forget to pass on key pieces of information.

I actually had a situation similar to this the other night. I was taking care of a patient and had been pretty active with the team on the weekend day shift in developing a good plan of care. Overnight she had a blood pressure of 196/84, went into rapid a-fib, and developed a temp of 40 C. Thank goodness it wasn't all at the same time. Since I had been working with the team over the weekend I rounded with them when the came in that morning. The nurse I gave her to was fresh off orientation (her first week), and had another acute patient. Since I had the best history on the patient and had a relationship with the team I made sure then knew what we had done overnight to find the source of the infection, and to convince them that she NEEDED a central line if antibiotics were in order. Was I there until 9 am? Sure. Was my patient well taken care of? You bet. But had the situation been different then I might not have stayed. Just use your nursing judgement ;)

Up Vote Up Vote ×
Don't take me wrong, but you'd be the last person I would want to work with. A team player in any department is always highly appreciated, for the sake of patients wellbeing and support towards our coworkers. Again, shame on you.

Don't take this wrong, but I think shame on you. :) She came and asked about it because she didn't think it was right. Look into some social psych and personality theories on conforming and why people do it - OP was in a not familiar situation and therefore more likely to conform to what her preceptor (the "model") was doing.

I'd be thankful she came to clarify a situation she wasn't sure about instead of just assuming it was always right to sit there and ignore things when call bells came on.

Up Vote Up Vote ×
Specializes in Med-Surg, & ED.
Sorry, I can't hold back, but this just isn't necessary. Shame on her? It sounds like she is very new if this was the first time she was giving report. How is she supposed to know where the lines of her responsibilities towards her patient vs. responsibilities towards her co-workers are drawn, especially if she has inconsistent examples to follow?

For me, it completely depends on the situation. If I have finished giving report on all my patients then I will help out with little things like this because I know that when I work day shift, getting interrupted can really throw off my morning. On the other hand, if I am in the middle of report on another patient, or have a line of nurses waiting to get report from me, then I won't. In my opinion it is all about continuity of care. When I have to stop report several times to take care of other patient's then I forget to pass on key pieces of information.

I actually had a situation similar to this the other night. I was taking care of a patient and had been pretty active with the team on the weekend day shift in developing a good plan of care. Overnight she had a blood pressure of 196/84, went into rapid a-fib, and developed a temp of 40 C. Thank goodness it wasn't all at the same time. Since I had been working with the team over the weekend I rounded with them when the came in that morning. The nurse I gave her to was fresh off orientation (her first week), and had another acute patient. Since I had the best history on the patient and had a relationship with the team I made sure then knew what we had done overnight to find the source of the infection, and to convince them that she NEEDED a central line if antibiotics were in order. Was I there until 9 am? Sure. Was my patient well taken care of? You bet. But had the situation been different then I might not have stayed. Just use your nursing judgement ;)

And I'm sure you r highly appreciated.

Up Vote Up Vote ×
Specializes in Med-Surg, & ED.
Don't take this wrong, but I think shame on you. :) She came and asked about it because she didn't think it was right. Look into some social psych and personality theories on conforming and why people do it - OP was in a not familiar situation and therefore more likely to conform to what her preceptor (the "model") was doing.

I'd be thankful she came to clarify a situation she wasn't sure about instead of just assuming it was always right to sit there and ignore things when call bells came on.

The social psych and personality theories ? Behavior? She didnt think it was right??? !!! Actions are more than words and obviously express the notion of doing something wrong as she had given that pt report off to the night shift and hence did not have to get up and check on the pt...because she had to finish documenting and leave. All I get from this is a guilt trip thinking a possible "getting in trouble" verbal conversation. Don't take it wrong OP , I don't mean harm, I am a patient advocate just like you . These situations are not random and it hurts me in the GUTT. GOOD LUCK IN YOUR FUTURE ENDEAVORS :)

Up Vote Up Vote ×
Specializes in Med-Surg, & ED.

Op, I was not aware of the situation in experience. I got off work and left work with a situation as you mentioned here . I didn't mean to offend you as though I understand my words were harsh. Don't mean any harm. Have a nice day and again, please don't take offense....I'd was tired and grumpy . I take it back if I could.

Up Vote Up Vote ×
Specializes in Critical Care; Cardiac; Professional Development.

No worries. Luckily Iam pretty secure in how much I do not know. ;) One starts growing a thick skin quickly once transition starts. I hope your day gets better.

Up Vote Up Vote ×
Specializes in ED/ICU/TELEMETRY/LTC.

It doesn't take a license or a certification of any kind to empty an emesis basin, get a cold washcloth, change a vomit soaked sheet, and report to the nurse coming on that the patient is vomiting and what you have done. You don't need an order and you don't have to document any of it.

Up Vote Up Vote ×
+ Add a Comment