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What do people really think of RRT right after change of shift?

Nurses   (441 Views | 8 Replies)
by Adrian007 Adrian007 (New) New Nurse

24 Profile Views; 6 Posts

I was just looking for opinions. Sunday I was 15 minutes into my shift finished getting report and my patients BP was 62/36 after the previous RN told me she was dropping to 70’s SBP overnight and got some orders from a Dr. (none of which involved a pressor) so I had to call a rapid response and transported her to ICU (which left me with not seeing any of my other patients until 9:30am). The previous RN did stay to help, and my only real thought was “Why didn’t she check a BP more frequently?” but that was about it because I know things can change.

Then today (other side) right after my handoff to the oncoming nurse, the patient I had the last 2 days suddenly had an increased work of breathing when I glanced in the room when respiratory was in there. She had complained of SOB a few hours prior but after minor interventions she was fine (COPD’r, no cardiac issues)  Her vitals were stable and sats 97-98% But while I was giving report to a different nurse I overheard the respiratory therapist say to the oncoming nurse (20-25 mins after my report) “she’s in respiratory distress” and put her back on bipap. I couldn’t help but feel guilty in some way although the oncoming nurse already saw the patient and wasn’t concerned because her spo2 was still good. But my patient was not in that condition when I had her. She did not call an RRT though. 

So my question is what do people really think when scenarios like that happen? Do you sometimes feel like the previous nurse dropped the ball, or let it go realizing that things can change quick and don’t think of it?

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Sour Lemon has 9 years experience.

3 Followers; 4,447 Posts; 33,506 Profile Views

I've been on both ends. I'm understanding when I'm incoming and feel horribly guilty when I'm outgoing (I do stay to help).

I'd only have "bad" thoughts if the nurse before me always leaves their patients train-wrecked. And thank goodness I've only know a couple of nurses like that over the past ten years.

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HiddenAngels has 7 years experience.

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Same, I've been on both ends.. I usually do stay to help realizing the oncoming nurse doesn't know the patient as well as I do.  I do get pissed when someone gives me "the patient is fine" report and they are a hot mess when I walk into the room...Yes I've had to call RRT and yes the downside is you are behind for the next3-4 hrs.  But once the moment is passed I'm good.

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K+MgSO4 has 12 years experience as a BSN and specializes in Surgical, quality,management.

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There is the useless nurse that keeps the pt vitals just the right of RRT for the whole shift not recognizing that someone ticking along with an SBP of 82 for 12 hrs is just as sick as the one with an SBP of 78 and in critical response criteria, and an RRT should of been called hours ago or a proper review. 

There is the nurse that will falsify documentation to the criteria mentioned above simple to avoid the "effort", "annoyance " of an RRT. 

There is the pt who has been totally stable all night that tanks 15 min into your shift.  The nurse is under n obligation to stay and has responsibilities outside of the hospital, is tired, back / feet hurt, is going to see her doctor about her own health concerns, just doesn't want to stay.

I have had a night shift (rotating shift worker) where I came on and got report. Went and seen my first priority patient.  Called an RRT, 60 min later off to ICU.  Went and seen the next priority - post op patient who had an emergency laporotomy, evolving full body stiffness - rang NOK, turns out he had been having investigations into a possible Parkinson dx but neither the pt or wife thought relevant to tell the surgeon or anaesathist.  Off to resp unit for NIV. 

Third patient who I had glanced at while dealing with pt 2 (joy of shared rooms).  Jist looked shocking.  Left that RRT in progress to do VS.  RAF at 160, day nurse had not recognised that someone draining 3L from an NG for a SBO  may be dehydrated and not absorbing beta blockers taken orally.  Off to ICU.

My 3 other patients were terrified of the "angel of death", got piecemeal care until 2 AM from my  colleagues and I was ready to slap the hospital night manager who turned up to the first call but saw it was me in charge of the ward (with a patient load) and left me to it.

Ironically that was my last night shift for 18 months as I was starting as the acting NM of the ward the following Monday and one of my first jobs was to answer to the quality team what happened as 3 RRT on 1 ward in 1 night all from the same nurse raised flags everywhere.  I had to counsel pt 3 nurse and the hospital nght manager was counselled as well. 

 

PS Sats can be a late indicator of distress in chronic respiratory conditions.  A resp rate, lung auscultation and asking the patient how their breathing feels shows up problems sooner.

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Kitiger has 40 years experience as a RN and specializes in Private Duty Pediatrics.

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On 4/24/2020 at 8:52 AM, K+MgSO4 said:

There is the useless nurse that keeps the pt vitals just the right of RRT for the whole shift not recognizing that someone ticking along with an SBP of 82 for 12 hrs is just as sick as the one with an SBP of 78 and in critical response criteria, and an RRT should of been called hours ago or a proper review. 

There is the nurse that will falsify documentation to the criteria mentioned above simple to avoid the "effort", "annoyance " of an RRT. 

There is the pt who has been totally stable all night that tanks 15 min into your shift.  The nurse is under n obligation to stay and has responsibilities outside of the hospital, is tired, back / feet hurt, is going to see her doctor about her own health concerns, just doesn't want to stay.

I have had a night shift (rotating shift worker) where I came on and got report. Went and seen my first priority patient.  Called an RRT, 60 min later off to ICU.  Went and seen the next priority - post op patient who had an emergency laporotomy, evolving full body stiffness - rang NOK, turns out he had been having investigations into a possible Parkinson dx but neither the pt or wife thought relevant to tell the surgeon or anaesathist.  Off to resp unit for NIV

Third patient who I had glanced at while dealing with pt 2 (joy of shared rooms).  Jist looked shocking.  Left that RRT in progress to do VS.  RAF at 160, day nurse had not recognized that someone draining 3L from an NG for a SBO  may be dehydrated and not absorbing beta blockers taken orally.  Off to ICU.

My 3 other patients were terrified of the "angel of death", got piecemeal care until 2 AM from my  colleagues and I was ready to slap the hospital night manager who turned up to the first call but saw it was me in charge of the ward (with a patient load) and left me to it.

Ironically that was my last night shift for 18 months as I was starting as the acting NM of the ward the following Monday and one of my first jobs was to answer to the quality team what happened as 3 RRT on 1 ward in 1 night all from the same nurse raised flags everywhere.  I had to counsel pt 3 nurse and the hospital nght manager was counselled as well. 

 

PS Sats can be a late indicator of distress in chronic respiratory conditions.  A resp rate, lung auscultation and asking the patient how their breathing feels shows up problems sooner.

OK, I do know some of these abbreviations (pt, ICU, SBP, NG, VS)

Some, I'm not so sure . . . this is what Google gave me:

RRT: Registered Respiratory Therapist

SBO: Small Bowel Obstruction (OK, that has to be right)

NOK: Nokia Oyj (stock market)

NIV: New International version 

RAF: Royal Air Force

 

NM: Neiman Marcus

Hey, I'm TRYING. I decided "NM" was nurse manager. And RRT might be Rapid Response Team? I have no idea about the others.

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6 Posts; 24 Profile Views

Yes I was talking about rapid response team in my question

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Swellz has 6 years experience and specializes in oncology, MS/tele/stepdown.

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I've been on both ends as well. In addition to what PPs mentioned, I also think there is something to be said about a new set of eyes on a situation. You have been working with someone for hours and watching a slow decline that you have been managing, but someone else comes in and sees that person at the level they are at and feels they need more care. It happens.

Or, more suddenly. We had a legit change of shift RRT the other day. Pt had just come up for the ED for bradycardia an hour before, but was stable in rate and rhythm. Until he wasn't, during report. RRT -> ICU. It was what it was.

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K+MgSO4 has 12 years experience as a BSN and specializes in Surgical, quality,management.

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9 hours ago, Kitiger said:

OK, I do know some of these abbreviations (pt, ICU, SBP, NG, VS)

Some, I'm not so sure . . . this is what Google gave me:

RRT: Registered Respiratory Therapist

SBO: Small Bowel Obstruction (OK, that has to be right)

NOK: Nokia Oyj (stock market)

NIV: New International version 

RAF: Royal Air Force

 

NM: Neiman Marcus

Hey, I'm TRYING. I decided "NM" was nurse manager. And RRT might be Rapid Response Team? I have no idea about the others.

RRT - rapid response team

SBO yes, small bowel obstruction 

NoK - next of kin

NIV - non invasive ventilation. 

RAF - rapid atrial fibrillation 

NM - yes, nurse manager. 

 

Welcome to Australia!

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Kitiger has 40 years experience as a RN and specializes in Private Duty Pediatrics.

1 Follower; 1,088 Posts; 19,489 Profile Views

23 hours ago, K+MgSO4 said:

RRT - rapid response team

SBO yes, small bowel obstruction 

NoK - next of kin

NIV - non invasive ventilation. 

RAF - rapid atrial fibrillation 

NM - yes, nurse manager. 

 

Welcome to Australia!

I feel better. 🙂

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