...and spend hours cleaning up the mess left behind by the previous nurse, find several orders that were not addressed, causing delays in diagnostics, medications, labwork, etc., do you write an Incident Report? When I was on the floor, I would have, because it was widely understood that the purpose of IRs is not punitive, but for process improvement. In the ED I work in, the culture seems to be that when you write an IR, you are "writing up" another nurse. Since all IRs must be investigated, the nurse responsible for the errors/delays/omissions will know who wrote the IR, and the risk is that they may retaliate by not having your back, making life difficult, etc., especially if they are a popular and well liked person. It is highly likely that word will get out that you are "one of those" nurses who cannot be trusted. Anyone else ever faced this dilemma?
Is there a way to eyeball the patient's charts prior or during report? Do you ask if there is anything left over or not done during the other person's shift?
Maybe by getting that information during patient report, you'll already be aware of potential situations. It would also make the other nurse acknowledge what wasn't done. When working in the ED, I try to get it all caught up before shift change, but as you know things can turn on a dime. I always tell the oncoming nurse what was and wasn't done, so they'll know how to proceed from the start of their shift.
Otherwise, like others stated here, I would have a talk with the nurse first and follow the chain of command if the situation didn't correct itself.
I haven't run into SEVERE cases of this, but what I *do* do to cover my butt is document when a patient is handed off to me... I don't ALWAYS do this, but I do when taking over for certain nurses, or when it looks like there have been orders on a patient for 20-30 minutes prior to hand-off and the ED isn't so busy that they wouldn't have time to at least start some of the orders... I feel like that documents the time I actually took over responsibility for the patient, and if ever questioned, explains why orders were not initiated until I started as their nurse.
I'm not quick to "write people up," I prefer to address issues directly and professionally. Some people aren't able to do that, and that's OK, but I think it would be wiser to try vs. writing an incident report unless the patient was somehow endangered, or a specific policy/procedure was deliberately not followed.
My feeling about incident reports/writing people up is that in my observation, it almost always creates tension and bad karma, and often makes people take a look at you and make a point in looking for something to write YOU up for in retaliation. Is it right? Nope! But, I try to avoid those situations.
Just my opinion!
(Sidenote: in my ED we have a 30-minute overlap where we do handoff/report, so if I come in and am taking report at 6:30, and it looks like there were some orders that could have been done, I have no problem saying to the nurse I'm taking report from something like, "hey, I see there's orders for this patient... would you mind doing a, b, and c while I go do x, y, and z for this other patient?" and usually they get the hint and are very willing to do that...) :)
Is there a way to eyeball the patient's charts prior or during report? Do you ask if there is anything left over or not done during the other person's shift?
Maybe by getting that information during patient report, you'll already be aware of potential situations. It would also make the other nurse acknowledge what wasn't done. When working in the ED, I try to get it all caught up before shift change, but as you know things can turn on a dime. I always tell the oncoming nurse what was and wasn't done, so they'll know how to proceed from the start of their shift.
Otherwise, like others stated here, I would have a talk with the nurse first and follow the chain of command if the situation didn't correct itself.
Our handoffs consist of a verbal report and include what has been done and what still needs to be done. In this instance, there was no mention of the diltiazem gtt order, even though it had been written an hour before I took the patient assignment. Our ED is pretty spread out, so the room was down the hall and around the corner, and we do not make a practice of going over charts at handoff. Perhaps we should. We have an electronic system where the doc is supposed to highlight the nurse's name if there are new orders on a patient, but some of the docs are inconsistent with this. This could also be a factor here. The CXR order was noted off by the previous nurse as if it had been done, when it hadn't. I think that was most likely an error/oversight on her part, and the fix for that would be to double check that orders have been entered at handoff. This, however, takes time, and that day, it was like a war zone. It was one of those days where I did not feel I could give my best care.
This is what my concern is, because as I mentioned, they are talking about cutting staff, and if they do, I am concerned that these types of incidents will increase in frequency. I don't think TPTB have any idea what the frequency of these types of delays in treatment really is, because nobody writes IRs because it is seen as "writing up another nurse".
Here's an example. At one point in time, when I still worked the floor, TPTB decided to cut costs by taking away the stocked meds from the satellite pharmacists. Our main pharmacy is down the road on a separate campus, and so when a med was missing, we had to fill out a form, fax it to the pharmacy, and wait for it to be delivered, whereas before, we could just walk down to the pharmacist's office and get one dispensed from their med cart. So, all the nurses wrote an IR any time a med was delayed because of this. TPTB were so overwhelmed with IRs that within 24 hours, the pharmacists had their med carts back. They're probably still sifting through those IRs.
When i worked the floor, I filed IR often for things that I felt were necessary, and the other nurse, decided it wasn't. (i.e giving LR at 150ml/hr to a pt with known CRF/on hemodialysis with history of increased K; or a pt w/ d/o c/p and h/o MI, but not a tele monitor; and the worse...IVF infusing at 150cc/hr to a CHFer, and increasing crackles in the bases!). Thankfully, being in the ER, I haven't dealt with this yet, and hopefully won't have to, since most, if not all of the nurses have proven themselves in knowledge.
I will agree that most of the IR made are used to degrade or accuse other staff. Rarely are they used to benefit the education/knowledge level of the staff.
I dunno...I've seen actual procedural changes implemented as a result of IRs, and I've never seen anyone disciplined/fired over one. We are reminded that the IR system is for the purpose of process improvement, yet the mentality that it is "writing up" another nurse persists. I wonder why that is?
Specializes in PICU, NICU, L&D, Public Health, Hospice.
IMHO, incident reports are for incidents...not for reporting incomplete work by a staff member.
Talk to the nurse. Nurses work together on a shift to accomplish the required care in a unit. Nurses work together across shifts to do the same thing. If you routinely follow a nurse who leaves you and your coworkers a "mess" speak with her/him about it. Perhaps they are inexperienced and having a hard time prioritizing when things get hectic?
In the ER I go over the chart and all the orders with the off going nurse before I let her go. The things most often not done (that I see) Ivs not started, catheters not placed, urine not obtained, I ask about. If there is a lot left I too say "I'll do this, if you'll do that"
Sometimes you know the shift was horrible and I feel that I come in fresh and ready to relieve the tired nurse and don't mind playing a little catch up. But of course there are those nurses that you follow and soon see that certain things never get done by them.
The most important thing that we often seem to forget is that nursing is a 24 hour job and there are always things that need to be done. We need to look on it as a continuum of care, rather than tasks to be accomplished before the end of each shift.
IMHO, incident reports are for incidents...not for reporting incomplete work by a staff member.
A diltiazem drip on a patient with new onset A-Fib, not started for two hours after the doctor wrote the order IS an incident, IMO. So is a CXR on a septic patient that was never ordered, and not discovered until 3 hours into the patient's ED stay.
Incomplete work, IMO, is when the nurse is going off shift and the doc has just written some orders, or when the patient has just been tucked in and nothing has been started yet. This is normal, to be expected, and part of the "continuum of care" mentioned by Gonzo1.
Specializes in Medsurg/ICU, Mental Health, Home Health.
IMHO, incident reports are for incidents...not for reporting incomplete work by a staff member.
I agree. I guess a lot of hospitals utilize these reports as punitive? I think my healthcare system is similar to VirgoRN's. When an incident report is completed, it's used as a learning tool to avoid making the same mistake. And incident reports run the gamut from falls to IV infiltrations to blood transfusions not being completed and much much more that I never knew could be considered as such until I actually saw a list of the choices!
I will say this, though. These situations described by VirgoRN are incidents.
Medic2RN, BSN, RN, EMT-P
1,576 Posts
Is there a way to eyeball the patient's charts prior or during report? Do you ask if there is anything left over or not done during the other person's shift?
Maybe by getting that information during patient report, you'll already be aware of potential situations. It would also make the other nurse acknowledge what wasn't done. When working in the ED, I try to get it all caught up before shift change, but as you know things can turn on a dime. I always tell the oncoming nurse what was and wasn't done, so they'll know how to proceed from the start of their shift.
Otherwise, like others stated here, I would have a talk with the nurse first and follow the chain of command if the situation didn't correct itself.