Who should call family during ICU transfer? (did I goof up?)

[Ioreth, ADN, RN]

So I'm still a new-ish nurse. I've been working in the same unit since Aug 2019 and most of it night shift. I'm fairly recently day shift and in some ways I feel like I am starting over. I have had a total of 2 transfers to other units, one while orienting and one yesterday. I'm worried I "did it wrong". (Also I'm long-winded, so sorry for the length of the post.)

The patient was CIWA and rapidly going up in CIWA scores. The patient had been off unit a good deal of the day for a procedure and came back to us much higher in CIWA scores. In the hour that we were trying to transfer them to ICU for better CIWA management, the patient's scores more than doubled. A family member called right after I called report on the patient and was irrate because the family member wasn't listed as someone who was permitted to receive info on the patient and the patient was not at all in a condition to give permission to talk to that family member. It was a mess. Called a security alert and 4 staff assists due to combative confusion before I could get the patient out of there, all the while we were trying to clean up pee and poop. This took most of the floor's attention for a while, including our case manager and floor manager, neither of which are technically doing patient care.

My floor manager popped by to tell me that a med had come to our unit instead of ICU and that she was going to run it down. I told her about the phone conversation with the family member and she said that she would pass it on, but that ICU nurses deal with this all the time and will know how to handle that family member.

At 2 AM, I popped awake realizing that I had never called the family member that was listed on the patient's chart as the emergency contact. I feel like an idiot. I called the night charge, who I see as my mentor. She said that it really is too late now and not to worry about it, but she'll pass it on in the morning to the floor manager. 

So who should call family in these situations? I really think it should have been me. The one and only other transfer I've done to ICU, we really thought we were going to lose the patient, so it was a call to have the family come now. This wasn't really that because it was expected with this patient, but I do feel like I screwed up.

Trying to cut myself a little grace here. We're in the middle of a rapid uptick of Covid in our area and my unit is taking care of patients that are not at all our usual population. We're supposed to be taking all the medicals for the hospital right now, and I haven't seen our usual surgical patients in months. This shift was particularly rough and this patient wasn't my only emergency. Due to low staffing, acuity, and other factors, it qualifies as a "crisis shift". This isn't the first CIWA patient I've had, but the first that I've had to transfer to ICU. I'm also recovering from Covid myself from early Nov. Covid brain is real and not unlike pregnancy brain. Now I'm just spinning my wheels a bit and can't get back to sleep.

[canoehead, BSN, RN]

With a transfer to the ICU, the physician makes contact with the family, in all the hospitals I’ve worked in.

[Sour Lemon]

At my facility, it varies. ICU might ask if family has already been called, then I might offer, or they might say "don't worry about it".

If I've been in close contact with the family, I'll usually be the one to call and hand them off.

At times, my calls have been very delayed because I'm dealing with urgent situations and adequate assistance is not available.

[CalicoKitty, BSN, MSN, RN]

I think that since it involved a deterioration of medical condition, it should be a physician call.

[TheMoonisMyLantern, ADN, LPN, RN]

In my region the nurse sending to the patient to ICU calls the family to let them know about the change in condition, this can help receiving unit have time to assess the patient before providing further updates to the family.

Our docs don't tend to call family members unless someone with authority tells them to.

[Nunya, BSN]

46 minutes ago, TheMoonisMyLantern said:

In my region the nurse sending to the patient to ICU calls the family to let them know about the change in condition, this can help receiving unit have time to assess the patient before providing further updates to the family.

Our docs don't tend to call family members unless someone with authority tells them to.

Wouldn't want the doctors to do their job now, would we?

Edit: sarcasm

[NurseLy, BSN, RN]

For a transfer to the ICU it is always the physician who calls the family, in my hospital. 

It never hurts to ask them, just to be sure the ball isn’t dropped. Once the patient is transferred off you could ask the physician if they had a chance to call the family yet. 

[Emergent, RN]

Get out of the habit of losing sleep over things like that. With all you had going on, someone will sort it out down the line. I'm sure the family found out.

[Ioreth, ADN, RN]

Thank you all so much for your responses! It was all so fast and not nearly fast enough. I was having trouble lining things up for the transfer with our ICU full of Covid patients, while at the same time I couldn't get enough Ativan into the patient to slow the shooting up of the CIWA scores with the non-ICU order set. I was just hoping the patient wouldn't have a seizure on the way to ICU. Calling the family was the last thing on my mind.

Yes, I do need to stop losing sleep over things. My post history certainly reflects that. I think most of it is that nursing is still so new and with Covid and the change from night to day shift, I am having trouble getting my groove. I'll get there. Right now I'm going to bed so that I can be ready for tomorrow's shift.

[OUxPhys, BSN, RN]

I always have the physician call the family for updates. Family members will ask how they are doing and I will tell them that but when they start asking about a plan or test results I default to the physician. 

[JBMmom, MSN, NP]

Most likely the transfer to ICU involves medical diagnoses and  a major change in patient condition. These are both things that are generally communicated by physicians in my hospital. If family members call, we are told in our facility that we as nurses can give general updates, but nothing that reflects test interpretation, medical diagnoses or serious changes in condition. 

Glad you realize the need for a little better work/life balance. Nursing is a 24 hour job, things get passed along and sometimes things do fall through the cracks. This one wouldn't have amounted to any impact to patient care and while a family member might be annoyed, you didn't do anything wrong. Rest up and just do your best, that's all any of us can do. Don't sacrifice your sleep for work, they wouldn't sacrifice anything for you. Take care.

[LibraNurse27, BSN, RN]

I've called just to notify of transfer, especially when family only speaks Spanish since I speak Spanish. I let them know MD is assessing the pt and will call when available for a more thorough update. I can answer basic questions but nothing about test results, etc. But I don't think it's a big deal you didn't call. Emergency contact could call if worried. Out of control CIWA patients are extremely difficult and time consuming, as well as transfers to ICU can be busy. I think you have a lot going on: new nurse, changed shifts, recovering from covid. Give yourself some credit and some grace.