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?

[AutumnApple]

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

In that case, all we need is the guidelines for what is acceptable to gripe about and what is not............with an avenue to vent implemented as well.

Either way, the culture of the unit needs fixing. If the current state of things is such that people are bickering about who should be cleaning an incontinent pt..........I believe looking at the bigger picture is necessary.

[Silverdragon102, BSN]

To me this is where team work should come in and both could do it (oncoming and offgoing) nurse. Good way to do assessment and 2 hands are quicker than one. Now if the shift had been a quiet shift then there shouldn't have been anything but when things are manic then work as a team and help each other..... really helps moral as well

[hppygr8ful, ASN, RN, EMT-I]

Where I work a nurse usually charge (if no other nurse is available like shift change) rounds with the Doctor, but they don't leave messes because we do psych. Still it's a 24/7/365 facility and we all clean and tidy rooms - We do a bed check/head count with bot on-coming/off-going nurse and if the rooms are messy we tidy them up together. I love going into the OCD rooms where everything is folded, clean bounce a quarter off the bed etc.....

Hppy

[canigraduate]

Jeez, KK, you are a bit of a control freak. This is a stupid situation. A) The doc shouldn't have made a mess, B) if the off-going nurse was just then charting, then the oncoming nurse didn't need to be a jerk about it, and finally, C) what is presented in this vignette is a simplified slice of what was probably a hugely complicated pie.

This is a stylized example of disrespect and incivility.

[Cowboyardee]

In that case, all we need is the guidelines for what is acceptable to gripe about and what is not............with an avenue to vent implemented as well.

Either way, the culture of the unit needs fixing. If the current state of things is such that people are bickering about who should be cleaning an incontinent pt..........I believe looking at the bigger picture is necessary.

There is no officially codified list designating which things are acceptable to gripe about. There is, however, a kind of unofficial etiquette that most ICU nurses who have been around a while pick up on. If you're familiar with that etiquette and read between the lines in the OP's situation, it's relatively clear who was in the wrong.

- The mess was made after the start of the oncoming shift.

- The off-going nurse was already staying late and had probably 30-60 minutes of charting still to do if she just started charting. While hopefully this is not an everyday occurrence, it does occasionally happen in an ICU setting, especially to nurses recently off orientation. It doesn't necessarily mean that the off-going nurse did anything wrong.

In my initial response, I mentioned that if I were the off-going nurse and were angrily and rudely confronted in similar circumstances, I would have refused to clean up and told her to write me up. That's because I know that just about any ICU unit director would see such a complaint as reflecting poorly on the writer-up rather than the up-written. Your unit director does not want you staying later when you'll already be around for an hour of OT to clean up a mess made after shift change.

Most likely, the more experienced oncoming nurse decided to throw a hissy fit precisely because the off-going nurse was newer and didn't know the etiquette well enough to stand up for herself.

[AutumnApple]

There is no officially codified list designating which things are acceptable to gripe about. There is, however, a kind of unofficial etiquette that most ICU nurses who have been around a while pick up on. If you're familiar with that etiquette and read between the lines in the OP's situation, it's relatively clear who was in the wrong.

- The mess was made after the start of the oncoming shift.

- The off-going nurse was already staying late and had probably 30-60 minutes of charting still to do if she just started charting. While hopefully this is not an everyday occurrence, it does occasionally happen in an ICU setting, especially to nurses recently off orientation. It doesn't necessarily mean that the off-going nurse did anything wrong.

In my initial response, I mentioned that if I were the off-going nurse and were angrily and rudely confronted in similar circumstances, I would have refused to clean up and told her to write me up. That's because I know that just about any ICU unit director would see such a complaint as reflecting poorly on the writer-up rather than the up-written. Your unit director does not want you staying later when you'll already be around for an hour of OT to clean up a mess made after shift change.

Most likely, the more experienced oncoming nurse decided to throw a hissy fit precisely because the off-going nurse was newer and didn't know the etiquette well enough to stand up for herself.

We had to distinguish a list of what was worth upsetting the flow of report over and what is not. We kept it simple: If it's not unsafe, save it for later.

Then we added the anonymous reporting option to give people an outlet for when the felt an assignment was not unsafe...... but poorly managed none the less.

It was a M/s unit so, yes, they might be different. In M/s, even the good nurses, from time to time, don't catch that incontinent pt in time before shift hand off.

We had nurses though that were just out of line. They literally would storm around during the unit (while they were suposed to be getting report) complaining about things like "There are large gloves only on my med cart, I don't use them. No way I am starting report until I have a med cart I can work with." Ugh

[dec2007]

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?

In the given circumstances, I would expect to clean up on evening shift. It is everyone's job around the clock. Nursing is a 24/7 business, and no one shift can do everything. That's why we have more than one shift. We are supposed to support each other, and anyone who doesn't know what it's like to have no charting time until they are off shift hasn't been around very long. I will add a disclaimer: if you follow a nurse who is chronically lazy and leaves a mess every time, that is a different matter. And almost all institutions have at least one person who spends most of their time at the desk or on their phone. That is the exception.

[dec2007]

Got no time for kid stuff.

This! In so many ways!

[dec2007]

The physician who MADE the mess should do the clean up.

Yeah...does that really happen where you work? It sure doesn't happen where I work.

[Rose_Queen, BSN, MSN, RN]

Yeah...does that really happen where you work? It sure doesn't happen where I work.

Each and every one of the anesthesiologists I work with clean up after their own invasive line and epidural insertions. They are also rather tidy during the lines- sharps are kept together in a designated area and the container the line kit came in is used as a trash bin.

[dec2007]

Each and every one of the anesthesiologists I work with clean up after their own invasive line and epidural insertions. They are also rather tidy during the lines- sharps are kept together in a designated area and the container the line kit came in is used as a trash bin.

Nice!

[nrsang97, BSN, RN]

I agree that the physician that made the mess should clean up. When I worked in the ICU and now on rapid response the docs clean up after themselves.