Who Should Clean Up, Offgoing Shift or Oncoming Shift?

[Kooky Korky]

You are the Day RN 7-3:30.

You see Docs come in to Round about 1515. You do not see which patient they see first.

You go in to Report Room a moment later, come out at 1528, sit down to chart (first chance all day to do so). You have had no break that day except a quick potty run, including no lunch. You have about 1/2 hour's worth of charting to do and you will be on overtime, which is highly discouraged.

3-11 RN comes to you at 1540, tells you that Room 3 has a mess in it and you have to clean it up. She is loud and angry and speaks none too calmly.

Docs had done some procedure on Rounds while you were in Report and had left the aftermath (trash, sharps, bloody stuff - this was a long time ago when blood and sharps were left wherever).

On the one hand, you did not know there was a mess because you did know the docs were on the unit, but you did not know what they were doing because you were in Report. Also, you still had to chart and were already on OT.

On the other hand, is it right for the 3-11 nurse to walk into a mess which, she argued, happened before she was on duty? She was on duty, technically, at 1500, came out of Report about 1528.

So who should do the clean-up?

[Baviary]

I've been in this situation before. I worked 11p - 7a. I made sure EVERYTHING was neat, clean, etc before the next shift came through so that when giving report (we did bedside reports), the next shift would see things were neat, etc. One day during report a patient we had not seen yet had a problem and the bed was a mess. Mind you I had just cleaned her up about 1/2 hour prior. Anyway, when we went into the room the RN to whom I was giving report pointed it out (I saw it the same time she did) and walked out saying she'd be back when I cleaned things up. I was not new. I NEVER left my patients in a bad situation or left things for ANYONE to clean up after me. The AM RNs ALWAYS thought we 'night nurses' left 'everything' for them and that we were lazy, etc. THIS is the problem I saw when an RN on the floor.

[Beldar_the_Cenobite, CNA]

3-11 RN comes to you at 1540, tells you that Room 3 has a mess in it and you have to clean it up. She is loud and angry and speaks none too calmly.

You know who Ray Kroc is right? He's the father of McDonalds. He once said "if you got time to lean, you got time to clean." This is a golden work ethic I ALWAYS hold myself to. Stay busy.

He also once said "Are you green and growing or ripe and rotting?"

[oceanblue52]

When I was a CNA, we always tried hard to clean up, toilet patients, check glucose, and fill water for the next shift. Sometimes things get crazy though. Staff should not be required to stay over 12 hours, especially when they have to come the next day. And in my experience, doctors have always cleaned up their own mess, talk about infection control! It's very frustrating that we don't have control over that.

I I like other people's suggestions that the OP invite the oncoming nurse to help clean up while doing shift report. Yes, it would be great for OP to be superwoman, but this is ridiculous. Good teamwork is essential to any floor.

[TriciaJ, RN]

To me it's about pride. I wouldn't dream of handing over a mess unless I was in the middle of a crashing patient situation. I took pride in the fact that when I handed over a patient in the ICU that they were bathed, had fresh sheets, that all lines were labeled and within expiration date, all drips were labeled and had a spare bag hanging if they were due to run out, trash was emptied and CRRT bags changed, mouth care done, fresh gown and new dressings. I would clean the rooms to my liking when I took over the shift because I can't work in a mess, but I would do the same before the next shift came in regardless. I'm a neat freak and I despise mess.

It's sometimes a bit soul destroying because you get to know the nurses who are slobs and handing over the patient to them was disheartening because you know you'd come back tomorrow to a bomb site. Clean as you go, restock as you go, and always make sure the necessary things are done. There's always those occasions when you can't keep up because the patient is very sick, but if you've built a good reputation others will get to understand that that's not your normal. I'd never want the reputation of being the slob. I used to get so mad at one nurse in particular because I'd walk on the unit and invariably she was sitting at the desk on her phone or chatting and obviously had time to clean, but I'd walk in the room and there was mess everywhere, dirty table top, dressings out of date, patient looking disheveled and trash overflowing. No excuse for that.

I can't "like" this one enough. I always took pride in leaving everything squared away for the next shift. On days when it was impossible, I acknowledged and apologized. I tried to cut slack for the previous shift, but when I find the same person reading magazines and their pt rooms are landfills, I get a bit peeved.

[AutumnApple]

Is there a "neither" option? lol

I guess that's not the right word maybe. It does need done. But, I'm going to say this, and I'm fully aware this will raise the hair on the necks of more than a few readers: If we're talking about the nurses, the answer in neither. If we're talking about the CNA's, the answer is both.

I've been part of a committee that was dealing with poorly executed hand-off reports. The crux of the problem was shift to shift aggression.

We implemented a number of interventions and they were effective:

1. Stagger CNA and nurse schedules so they aren't changing shifts at exactly the same time.

To further things, we also educated the CNA's on what was an emergency and justified interrupting report and what was not.

We also put a stop to CNA's doing any sort of "report off" to one another at all. They fought more than the nurses did, and would take two hours figuring out the new shift's assignments if you let them. We started with a new system where CNA's went to the nurses for report.

2. Be more clear on when one can refuse to take report and not. Too many "I'm not taking the assignment until bed five is cleaned" types on the unit.

Nurses can refuse an assignment for it being unsafe. They can not refuse it because a patient needs something they don't wish to do.

We also initiated an anonymous system to report problems that were found after shift hand off. While shift hand off report time was not the place to be complaining about linen drawers not being stalked, there had to by a way to respond to those who were not doing their part.

You'd be surprised how many of the shift hand off complaints were things the person found almost two hours into the shift. They started at 0700 and were mad about a patient being "messed".................when it was close to 0900. First rounds anyone? How about not taking the first 45min. of your shift to finish your Starbucks?

Those were the big ones.

Point is, for nurses to give an effective hand off report and for shift change to happen smoothly, everyone has to "know their place" and have an outlet to vent if they think something is unfair.

So, my answer to this question is: Where are the aids?

If this place is one of those places that likes to go with one aid for thirty patients, I can understand this falling on the nurses. If the aids are staffed more appropriately though, it's time for delegation.

[Cowboyardee]

So, my answer to this question is: Where are the aids?

If this place is one of those places that likes to go with one aid for thirty patients, I can understand this falling on the nurses. If the aids are staffed more appropriately though, it's time for delegation.

It's an ICU. Many ICUs don't have nurse aides.

[Sour Lemon]

It's an ICU. Many ICUs don't have nurse aides.

Ah ...the catch. There's always a catch.

[imbatz, BSN, RN]

First, if it happened on your shift, then it is your mess to clean up. That being said, I work nights and I can't tell you how regularly I am left cleaning and picking up from the previous shift. Personally, I like to leave things the way I want to find them and I am not going to start a

fight over full laundry bags. Pick your battles. Bedside shift report is the time to hash this out. If there are surprises waiting in the room, then all will be revealed by bedside shift reports. If you choose not to do bedside shift report, and there is a mess, its yours.

[Here.I.Stand, BSN, RN]

Back then, docs made messes, never were expected to clean up after themselves.

Back when? Did this happen in the days when it was expected that the nurse give up her seat for the dr.? Nothing in the post indicates this was a decades-old incident. And if it is....why are you still dwelling on it enough to need to post online about it?

I'm confused.

[klone, MSN, RN]

Understood. Please address the specific stated situation, though.

They did, did they not?

[RNGPS]

CLEAN UP AFTER YOURSELF. Why would you even think to leave a mess for someone else? Your workplace is not the home you lived in when you were 12. You are an ADULT now and a LICENSED MEDICAL professional who should not only appreciate a clean and orderly environment, but require it.

I've worked every shift in a hospital for significant amounts of time each. I clearly recall complaining about one shift or another until I worked them. Try each of them out before judging any. Still, you should be supporting each other and relying on each other in shift change as the most valuable assets you both have anyway.

By the way... in case you might have forgotten...it's not about you or the other shift nurses. It's all about maintaining a clean environment for the patients.

[Rocknurse, MSN, APRN, NP]

My ICU introduced a new practice of giving report at the desk but then both nurses would walk into the room and do a bedside check. We'd take the opportunity to help each other turn the patient, check their perineum/pad and all the hanging meds to make sure everything was correct. If the room was a mess we'd get a chance to talk to the other nurse right there and then, but usually on my unit the offgoing nurse would tidy up before they left. Everybody happy. Taking responsibility is good thing to get a handle on and making people accountable works too.