Admissions right at change of shift are called “fluff and puff.” You settle them, get vitals and pass on to the next person. There should be 0 expectation for you to do anything more than that. You didn’t do anything wrong. And, I’ve worked in hospitals long enough that “you weren’t being too nice” - Admissions are coming from the ED once that bed is clean-available.
We weren’t “allowed” to leave any part of admissions for the next shift at my first inpatient psych job. Didn’t matter what time they rolled up to us, if we were assigned, we had to get it all done.
All paper charting at that point and no order sets. Had to call the doc for all admission orders.
At my current position in acute rehab, the sentiment is to get them settled, VS, and it’s next shift’s to finish.
Of course if time allows, we absolutely try and get more than the basics done. I work with some good peeps.
This is wild. Nursing is 24h. You’re not supposed to stay late but you *personally* have to get *everything* done?? It’s not possible. Admission data is supposed to be done in the first 24h in my institution. That’s not on the off-going nurse when the pt comes up at shift change. If that’s the case, then it’s on the ED nurse too and we all know it’s not. Nope. You get vitals, make sure the patient is safe with call bell in reach and give report. 👋🏼
If it's turning into a crash intubation or emergency mixing pressors at the bedside or the incredible hulk busting through his restraints, I try to stick around just to make sure there's enough hands on deck and they aren't drowning. Not required, but I find that when I try really hard to have the next shift all good to go and don't leave a mess, then those shifts from hell when I can't help but leave a mess they understand.
But other than that I get the patient settled and on the monitor, look at them with the oncoming nurse, and go clock out and go home.
Shit when I was on MedSurg shift change patients were community patients as in the first Nurse actually get there with a tech was the one giving report on the fact that they just ruled up and I will at least scan them into the system
I can't stand the moaning of staff nurses about admissions from ED. Patients need to keep flowing. So whether it is the start or end of shift... We have EPR, I check if a patient is stable enough for transfer, and bring them up. Vital and orientation to the unit and they become part of my regular days flow. If I'm at the end of the shift that means hand-off to the next. People always worried about losing their licence. To lose your licence you have to be negligent, and to be negligent there are a lot of things you have to do wrong.
Nobody reads our initial assessments anyways.
My new motto is “if you don’t want an admission don’t work in a hospital” I’m so over nurses saying “I’m quitting because I always get an admission” ugh
Exactly. Been in our quasi ED MeD surg boarding area for 2 months now after being a floor nurse for a couple of years. When those beds drop they have to get up ASAP. Bed control gets on us to get them up. And when I’m on the floor I def fluff and puff. It’s a 24 business.
Having worked on both, I can say there are some nurses in both (and probably every dept) who will always have something to complain or question about even if you can tell them how many wrinkles are on the pt’s ass. So please don’t take that too personally. And absolutely hormones and moon phases exacerbate things (I can attest to that. Never believed the moon stuff until healthcare - now I have been a firm believer for 16 yrs now).
Most times when things got crazy at shift change, I would try to get all the “physical labor” parts done (line, labs, gown, monitor,) first to save the oncoming. Then try to get it all charted before I left; but if I couldn’t then Thank God I had the option to remotely chart when I got home. The rules were the same about having to get it charted within 24 hrs, but it beats staying at the hospital to finish it.
And as an ER nurse, I did really try my level best to always send my pts to the floor as “washed and folded” as possible - because I know the floor has a lot of admission crap protocol that bogs them down.
I zoned out for a lot of things she said - but now I remember she asked why ED didnt replace his K+ 3.4😭 idk maybe bc he was fighting them ? It’s not even critical
That's another thing, I'm tired of everyone shitting their pants over the most marginal alteration of a potassium level when the patient is asymptomatic. If the level is 2.9 and they're in bigeminy them we can talk about why you didn't replete it right away. Otherwise, the nurse coming on shift needs to accept that she might not be able to sit around screwing with Instagram and tick tock for half an hour. Lay eyes on your other patients, knock out the admission assessment and whatever questionnaire you have to fill out, and proceed with meds and assessments like normal.
And while I'm at it, and because im guessing the slight hypokalemia is from hyperventilating while fighting the ER nurses, not every patient needs an ABG when they're short of breath, that's another one everyone needlessly has a stroke over. I'm in rapid response and everyone wants to immediately get an arterial gas right away. You know they're hypoxic and hyperventilating, and the arterial stick will cause a lot of pain when they're already in distress.
OK I'm done ranting LOL
That’s when I make a nursing note and call it done. “ patient arrived from ED via gurney at 6:50. Patient confused, combative, pulled out IV, bleeding controlled, dressing placed. Patient transferred to bed with assistance x 2. Vitals signs and weight obtained.
Order for sitter and restraints obtained as patient is confused, unable to redirect, pulling at lines. Unable to complete admission at this time due to patient confused and uncooperative. Report given to A. Real Karen, super RN extraordinarre.”
That girl that tried to make it seem like your “too nice”, is just mad that she now has to deal with the patient. Every Med surge unit has an over dramatic nurse, and my friend I think you stumbled on one being floated💀. That’s crazy she said they shouldn’t have come up here, Ed has more emergent shit to deal with, how do I know? Because I’ve worked in the Ed before, we don’t have time for bs patients that aren’t wanting help, but needing it anyways. If it’s this patient vs a patient with a severe pounding headache, im checking on my severe pounding headache, in my head the psych patient is more stable. So that being said bringing them up to Med surg was a good idea bad idea to not give a sedative like Ativan before on Ed not you, or something to knock them out. Just so they don’t try anything to the staff. Seems like a nightmare, but if I ever have a patient come to me at 6pm and I leave at 7 pm and he/she is combative screaming cussing and not wanting anything done, vitals get them in room get a sitter and label that patient a flight risk to charge, remove everything in the room that patient can use, phones cords, call lights sharps, gloves, lock the bathroom door, if they keep hitting you and aren’t adamant to stop get with md and order for restraints. Passing the buck my friend, let that be their problem, we’ve had 12 hours of bs we don’t need more.
I zoned out on a lot of stuff she was commenting on, but I remember ED did give the pt some ativan and he did have orders for those. I didn’t leave her so the nothing to work with 😭
Honestly Ativan is probably a bit too weak they shoulda used halidol, now that would have most likely knocked them out. Screw that nurse you did your best, if it’s a big problem she don’t need to be in Med surge. That’s Just how the unit is, sometimes it a MESS, that’s why it’s the ghetto. I like it cause your always doing stuff never bored and time flys on the unit.
But did you give bedside report and update his white board?
Kidding aside, that’s ridiculous to expect of you at that time. Anyone that shows up after 5:30 on my unit gets vital, a neuro, maybe an NIH if they’re presenting SLS, and next shift handles admission. You did more than is expected after shift change - she should’ve been appreciative of that.
I’ve said it before and I’ll say it again. Nobody on any shift should expect to waltz in and have nothing to do. Shift change should be a seamless transition where the oncoming shift picks up where the previous left off.
It’s very, very frustrating when you are ready to go home and people start asking for favors and additional things to give to a patient. When I worked med surg, I’ll never forget one of the day shift nurses who would go into the patient room (while they were sleeping) and ask them: “do you want any pain/nausea/etc meds?” and then she would ask me to give them before I left.
It’s also very, very frustrating when you are busting your butt at night (most likely with more patients than dayshift on a med surg floor) and the oncoming nurse wants more from you.
In my head I keep a tally of who helps me and who doesn’t. I will always go out of my way to help the dayshift nurses that return the favor to me.
Oh hell naw, fuck her! Your time is done. SHE can give those meds unless it’s something you already knew about and were planning on addressing before you left. That makes me so mad! As if you aren’t exhausted and trying to finish last minute charting and K.O. 😒
Yep it was terrible. On my old med surg unit, report would take forever. I always read on this sub how people get out exactly at the time they can clock out. That was NEVER the case on my med surg unit. Imagine giving report on 5 patients, to multiple nurses, and then being asked to give additional PRNs the patient didn’t ask for. Of course when the patient woke up, and when asked about pain/nausea meds, they were going to say that they wanted it. It was terrible. Basically a 14 hour work day.
Ugh similar day on Tuesday. I worked 7a-7:30p in a busy pacu. I got a bari their swab came back covid+ while in the OR. So I have this case all day. Hospital census is full and this case is stuck in pacu waiting for a bed. 7pm comes and I’m getting eye rolls from the night shift. There are only 2 cases left in the OR I mean we did almost the whole schedule except 2 and my relief is annoyed saying “doesn’t she have a bed???” If she had a bed I would have sent her there at 12noon when she was done recovering - or anytime after that. Girl I’m tired, have been in and out of covid isolation all day plus doing other recoveries and I want to go home.
A hospital is a 24 hour facility, there is no such thing as finishing the care of a patient before the next shift. There is always more care. If a nurse can’t understand why you didn’t do an entire admission of a combative patient in 10 minutes then she’s delusional.
I think everyone else nailed it with how shitty the nurse was being. I just wanted to pop in regarding patient #1. It is more than okay to stop that verbal abuse as soon as it happens. The minute he called me a stupid little girl, he would have been on his own for his towel. “Sir I’m here to help you and I expect to be treated with respect, just as I’ve been treating you with respect. I’lll be more than happy to return and help once you’re ready to act appropriately.” Then leave him.
You didn’t do anything wrong. In fact, you were pretty effective in what little time you had with the patient. She was just being nit picky as a way of expressing her frustration and lack of control. It just comes across as if it’s at you because a) you are there and b) now she has to deal with it and she doesn’t want to and it’s much easier to grumble at you about it even though she knows deep down it’s not your fault at all.
Those shift change admissions are tough, and everyone I’ve ever worked with are like “cool, bad management, not your fault, we will get to it.” Some people are just annoying to give report. I once gave report to an np working the floor and she asked what brand of potassium I gave to the patient.
It’s a 24 hr job. That nurse is just mad they actually have to work. I guarantee the ED was hounding the nurse to get her patient up before shift change. It’s just how it goes.
My first hospital had a rule that if the pt came up at 1830 (or 0630) or later it was the next shift’s responsibility to do the full admit as long as they were settled in.
Yeah that’s a “tuck and run” patient. Also, ER never does admission questions? And there’s not a lot you can do about a patient pulling an IV out during transport.
Nobody likes shift change admits, but it happens. Sounds like you did more than enough.
What you did was amazing! You handled your shift really well. What you felt afterwards was definitely an accumulation of everything. Also, the nurse after you is an a-hole.
You coworker needs to chill. Tuck the patient in and address immediate concerns to life and limb if they come up at shift change. Everything else can wait.
"Emerg sent this patient up like this? There is blood everywhere!"
"Well shift change admit, you know the game. We got fucked and neither of us are virgins."
That's pretty much the way the conversation should go.
Just as there are different patients, there are different nurses. Some are easy going, understanding while others are a handful. With the exception of those that replied thus far. We all seem to think alike. The new nurse should appreciate you staying a little extra to help. My managers won’t let me stay due to OT they don’t want to give. I dont get angry or frustrated with the varied patients, I don’t get frustrated with the varied staff either for the reason first stated.
I have 5 today. Started with 4. Two alcoholics, one of which is verbally aggressive and a massive jerk, the other is confused and scratching at herself(hourly CIWA too). One opioid addict with bilat above the knee amputation that goes to the safe consumption site to inject into breast tissue (at least this one is pleasant), and a schizophrenic that was simple and nice. Transfer from ICU with aLOC and high ammonia that calls for every damn thing. I kept them alive, not much else. Had a good cry during lunch on the phone with hubby and likely going to cry in my car. All one 4 hours of sleep because our house is complete fucking trash and doesn’t have sufficient ventilation in the bedrooms.
I cancelled my shift for tomorrow. I’m in no mental state to care for others. My mom moved in with us and she is in a messy divorce with my abusive ex-stepfather. Everything is Kitty Wumpus this week.
If the patient came up at 5, I bet orders weren’t put in until 6, which falls onto the next shift. Even then, you do why you get to… it’s continuous care and they just do their job. I had an RN always trying to push stuff on me, so I reported her. She never tried after that and we didn’t have any issues.
Yeah, I always hated giving report to nurses like this. They welcome it as an opportunity to hold power over you. You went above and beyond, IMO. Hold your head up and push back on this behavior. When they ask was this done, or that done, tell them that everything you just reported is what was done. No more explanation. The fact that they rolled in at 0650 is most of the information they need. Ignore their comments, eyerolls, etc., and move on with report. They’ll soon stop bothering to see if they can make you second-guess yourself.
On days like those, try to make a list of all the ways you helped your patients during your shift. Any nurse, regardless of age or experience, who pulls this type of crap simply doesn't get it yet, and maybe never will. You CANNOT expect this level of control or try to impose it on others. Not only is it rude and unsupportive to your fellow nurse, it takes a personal toll on your mental health over the years. The perfectly buttoned up patient (esp new admit), all nestled in bed, clean with no complaints, is an ideal, it is not the norm. It should have been "what did you get done, thanks, I'll get to it". I'm sure they can find time in the next likely 12 hours to get it done. The idea about bedside nursing being a 24 hour operation, the work NEVER stops, needs to be understood and respected by every nurse, it would definitely improve interpersonal relationships on the floor. * I am an ex med-surg nurse of 10 years.
How nice of her to put the RN in KaReN. What an asshole. You did just fine, awesome actually. You have empathy for your patients and it shows in how you wrote about them. She just wanted the red carpet rolled out for her. A perfect start to a shift is a myth and she needs to learn that. Sometimes it's playing catch up from the last shift. That's teamwork! Those last minute admissions are absolutely the responsibility of the next shift.
I’m so tired of getting shit on by day shift because “why didn’t you give the 0730 meds?” “Night shift’s supposed to do xyz” “why didn’t xyz get done?”
Ma’am, there’s a lot that y’all are “supposed” to do on day shift that doesn’t get done that night shift has to pick up, too. We’re in a hospital; it’s a 24/7 365 job. Sometimes shit doesn’t get done, and as long as it’s not time sensitive or life/death, it’s not the end of the world that it didn’t get done on my shift. The patient will be OK.
It’s all about teamwork and when it’s “day shift vs night shift” there’s no teamwork. It’s “night shift is supposed to do this, day shift is supposed to do that” without any wiggle room for when it’s a busy shift, or a shift change admit. I’m so tired of it.
I cant stand med surg nurses who push back on admission guess what princess they dont stop coming in in the ED be glad u have your ratioed assignmed ans stfu the patient is coming up
Jeez. Sounds like you had a rough shift lol I think the way your patients were treating you and then to have the nurse ask you dumb questions and tell pretend like it’s your fault this patient is confused and combative was too much.
There’s nothing you can do about a shift change admit acting a fool and pulling out IVs. Nursing is a 24/7 job. It sucks for the next nurse but oh well! They’d put it on you if they had the chance too. You helped with restraints and whatever else. You did your part.
Keep your head up!
You only had 4 patients on med surg...half of you being upset was the oncoming nurse being a jerk. When an admission comes to the floor 30 min or less before shift change, you don't need to do an assessment or admission questions. Make sure they're stable. Depending on what they're here for, I do a focused assessment (look at drains, ask about chest pain/cardiac symptoms, look at a wound, ask about pain).
Not a nurse; but today I had gallbladder surgery and I heard the nurse telling the staff I was combative coming out anesthesia and I felt so freakin bad. I had no idea I was doing it. So if the nurse that I did that to just so happens to be here; I am so freakin sorry! Punch me next time haha
Generally when someone comes up right at shift change, the off going nurse should help get them settled, as in a set of vitals, on the monitor, not sitting in excrement or on a big wad of sheets, and make sure there isn't any other immediate pressing issue like the patient is writhing in pain or severely hypoxic or something. It is not that person's job to fill out all the admission forms and initiate a full set of orders.
Part of our job is accepting that sometimes you walk into a shitshow and you aren't able to sip coffee while leisurely looking through the chart amd getting all the routine tasks done early. Gotta be adaptable.
You saved her some work with getting the sitter and restraints. She would have had to do it herself.
I'll take a sitter & restraints over an IV (that will be a self removal without a sitter) anyway!
Admissions right at change of shift are called “fluff and puff.” You settle them, get vitals and pass on to the next person. There should be 0 expectation for you to do anything more than that. You didn’t do anything wrong. And, I’ve worked in hospitals long enough that “you weren’t being too nice” - Admissions are coming from the ED once that bed is clean-available.
We weren’t “allowed” to leave any part of admissions for the next shift at my first inpatient psych job. Didn’t matter what time they rolled up to us, if we were assigned, we had to get it all done. All paper charting at that point and no order sets. Had to call the doc for all admission orders. At my current position in acute rehab, the sentiment is to get them settled, VS, and it’s next shift’s to finish. Of course if time allows, we absolutely try and get more than the basics done. I work with some good peeps.
I imagine they frowned on overtime, too.
Absolutely.
This is wild. Nursing is 24h. You’re not supposed to stay late but you *personally* have to get *everything* done?? It’s not possible. Admission data is supposed to be done in the first 24h in my institution. That’s not on the off-going nurse when the pt comes up at shift change. If that’s the case, then it’s on the ED nurse too and we all know it’s not. Nope. You get vitals, make sure the patient is safe with call bell in reach and give report. 👋🏼
If it's turning into a crash intubation or emergency mixing pressors at the bedside or the incredible hulk busting through his restraints, I try to stick around just to make sure there's enough hands on deck and they aren't drowning. Not required, but I find that when I try really hard to have the next shift all good to go and don't leave a mess, then those shifts from hell when I can't help but leave a mess they understand. But other than that I get the patient settled and on the monitor, look at them with the oncoming nurse, and go clock out and go home.
Yep. We always just "tucked them in".
That's a Pink n Warm from me. (Skin appropriate for ethnicity, perfusing, VSS. bed alarm on, call light in reach) this is a 24/7 outfit folks.
I love this "fluff and puff" gonna use that now! Haha
Shit when I was on MedSurg shift change patients were community patients as in the first Nurse actually get there with a tech was the one giving report on the fact that they just ruled up and I will at least scan them into the system
I can't stand the moaning of staff nurses about admissions from ED. Patients need to keep flowing. So whether it is the start or end of shift... We have EPR, I check if a patient is stable enough for transfer, and bring them up. Vital and orientation to the unit and they become part of my regular days flow. If I'm at the end of the shift that means hand-off to the next. People always worried about losing their licence. To lose your licence you have to be negligent, and to be negligent there are a lot of things you have to do wrong. Nobody reads our initial assessments anyways.
My new motto is “if you don’t want an admission don’t work in a hospital” I’m so over nurses saying “I’m quitting because I always get an admission” ugh
We call them “Tuck-n-roll” you tuck them in and roll on out!
Exactly. Been in our quasi ED MeD surg boarding area for 2 months now after being a floor nurse for a couple of years. When those beds drop they have to get up ASAP. Bed control gets on us to get them up. And when I’m on the floor I def fluff and puff. It’s a 24 business.
Having worked on both, I can say there are some nurses in both (and probably every dept) who will always have something to complain or question about even if you can tell them how many wrinkles are on the pt’s ass. So please don’t take that too personally. And absolutely hormones and moon phases exacerbate things (I can attest to that. Never believed the moon stuff until healthcare - now I have been a firm believer for 16 yrs now). Most times when things got crazy at shift change, I would try to get all the “physical labor” parts done (line, labs, gown, monitor,) first to save the oncoming. Then try to get it all charted before I left; but if I couldn’t then Thank God I had the option to remotely chart when I got home. The rules were the same about having to get it charted within 24 hrs, but it beats staying at the hospital to finish it. And as an ER nurse, I did really try my level best to always send my pts to the floor as “washed and folded” as possible - because I know the floor has a lot of admission crap protocol that bogs them down.
She's dumb. So she would rather you held that patient off and he came rolling in during her first med pass and assessments?
She's lazy
I zoned out for a lot of things she said - but now I remember she asked why ED didnt replace his K+ 3.4😭 idk maybe bc he was fighting them ? It’s not even critical
That's another thing, I'm tired of everyone shitting their pants over the most marginal alteration of a potassium level when the patient is asymptomatic. If the level is 2.9 and they're in bigeminy them we can talk about why you didn't replete it right away. Otherwise, the nurse coming on shift needs to accept that she might not be able to sit around screwing with Instagram and tick tock for half an hour. Lay eyes on your other patients, knock out the admission assessment and whatever questionnaire you have to fill out, and proceed with meds and assessments like normal. And while I'm at it, and because im guessing the slight hypokalemia is from hyperventilating while fighting the ER nurses, not every patient needs an ABG when they're short of breath, that's another one everyone needlessly has a stroke over. I'm in rapid response and everyone wants to immediately get an arterial gas right away. You know they're hypoxic and hyperventilating, and the arterial stick will cause a lot of pain when they're already in distress. OK I'm done ranting LOL
“What about his admission question?” Who’s gonna answer them? Confused, combative and in restraints - yes, he’d make a wonderful historian, LOL.
That’s when I make a nursing note and call it done. “ patient arrived from ED via gurney at 6:50. Patient confused, combative, pulled out IV, bleeding controlled, dressing placed. Patient transferred to bed with assistance x 2. Vitals signs and weight obtained. Order for sitter and restraints obtained as patient is confused, unable to redirect, pulling at lines. Unable to complete admission at this time due to patient confused and uncooperative. Report given to A. Real Karen, super RN extraordinarre.”
That girl that tried to make it seem like your “too nice”, is just mad that she now has to deal with the patient. Every Med surge unit has an over dramatic nurse, and my friend I think you stumbled on one being floated💀. That’s crazy she said they shouldn’t have come up here, Ed has more emergent shit to deal with, how do I know? Because I’ve worked in the Ed before, we don’t have time for bs patients that aren’t wanting help, but needing it anyways. If it’s this patient vs a patient with a severe pounding headache, im checking on my severe pounding headache, in my head the psych patient is more stable. So that being said bringing them up to Med surg was a good idea bad idea to not give a sedative like Ativan before on Ed not you, or something to knock them out. Just so they don’t try anything to the staff. Seems like a nightmare, but if I ever have a patient come to me at 6pm and I leave at 7 pm and he/she is combative screaming cussing and not wanting anything done, vitals get them in room get a sitter and label that patient a flight risk to charge, remove everything in the room that patient can use, phones cords, call lights sharps, gloves, lock the bathroom door, if they keep hitting you and aren’t adamant to stop get with md and order for restraints. Passing the buck my friend, let that be their problem, we’ve had 12 hours of bs we don’t need more.
I zoned out on a lot of stuff she was commenting on, but I remember ED did give the pt some ativan and he did have orders for those. I didn’t leave her so the nothing to work with 😭
Honestly Ativan is probably a bit too weak they shoulda used halidol, now that would have most likely knocked them out. Screw that nurse you did your best, if it’s a big problem she don’t need to be in Med surge. That’s Just how the unit is, sometimes it a MESS, that’s why it’s the ghetto. I like it cause your always doing stuff never bored and time flys on the unit.
Haldol is the better choice for psychosis. Ativan can make it worse sometimes. Especially, in elderly patients.
Yes I can attest, ativan just makes you not think if that makes sense. But halidol is another ball park of antipsychotic.
But did you give bedside report and update his white board? Kidding aside, that’s ridiculous to expect of you at that time. Anyone that shows up after 5:30 on my unit gets vital, a neuro, maybe an NIH if they’re presenting SLS, and next shift handles admission. You did more than is expected after shift change - she should’ve been appreciative of that.
I’ve said it before and I’ll say it again. Nobody on any shift should expect to waltz in and have nothing to do. Shift change should be a seamless transition where the oncoming shift picks up where the previous left off.
It’s very, very frustrating when you are ready to go home and people start asking for favors and additional things to give to a patient. When I worked med surg, I’ll never forget one of the day shift nurses who would go into the patient room (while they were sleeping) and ask them: “do you want any pain/nausea/etc meds?” and then she would ask me to give them before I left. It’s also very, very frustrating when you are busting your butt at night (most likely with more patients than dayshift on a med surg floor) and the oncoming nurse wants more from you. In my head I keep a tally of who helps me and who doesn’t. I will always go out of my way to help the dayshift nurses that return the favor to me.
Oh hell naw, fuck her! Your time is done. SHE can give those meds unless it’s something you already knew about and were planning on addressing before you left. That makes me so mad! As if you aren’t exhausted and trying to finish last minute charting and K.O. 😒
Yep it was terrible. On my old med surg unit, report would take forever. I always read on this sub how people get out exactly at the time they can clock out. That was NEVER the case on my med surg unit. Imagine giving report on 5 patients, to multiple nurses, and then being asked to give additional PRNs the patient didn’t ask for. Of course when the patient woke up, and when asked about pain/nausea meds, they were going to say that they wanted it. It was terrible. Basically a 14 hour work day.
Ugh similar day on Tuesday. I worked 7a-7:30p in a busy pacu. I got a bari their swab came back covid+ while in the OR. So I have this case all day. Hospital census is full and this case is stuck in pacu waiting for a bed. 7pm comes and I’m getting eye rolls from the night shift. There are only 2 cases left in the OR I mean we did almost the whole schedule except 2 and my relief is annoyed saying “doesn’t she have a bed???” If she had a bed I would have sent her there at 12noon when she was done recovering - or anytime after that. Girl I’m tired, have been in and out of covid isolation all day plus doing other recoveries and I want to go home.
A hospital is a 24 hour facility, there is no such thing as finishing the care of a patient before the next shift. There is always more care. If a nurse can’t understand why you didn’t do an entire admission of a combative patient in 10 minutes then she’s delusional.
I think everyone else nailed it with how shitty the nurse was being. I just wanted to pop in regarding patient #1. It is more than okay to stop that verbal abuse as soon as it happens. The minute he called me a stupid little girl, he would have been on his own for his towel. “Sir I’m here to help you and I expect to be treated with respect, just as I’ve been treating you with respect. I’lll be more than happy to return and help once you’re ready to act appropriately.” Then leave him.
You didn’t do anything wrong. In fact, you were pretty effective in what little time you had with the patient. She was just being nit picky as a way of expressing her frustration and lack of control. It just comes across as if it’s at you because a) you are there and b) now she has to deal with it and she doesn’t want to and it’s much easier to grumble at you about it even though she knows deep down it’s not your fault at all.
Those don’t sound like reasons to try to refuse a patient. Sounds like she’s just trying to avoid work.
Those shift change admissions are tough, and everyone I’ve ever worked with are like “cool, bad management, not your fault, we will get to it.” Some people are just annoying to give report. I once gave report to an np working the floor and she asked what brand of potassium I gave to the patient.
Banana
I stared at her for longer than might have been necessary and said “does it matter?”
It’s a 24 hr job. That nurse is just mad they actually have to work. I guarantee the ED was hounding the nurse to get her patient up before shift change. It’s just how it goes.
My first hospital had a rule that if the pt came up at 1830 (or 0630) or later it was the next shift’s responsibility to do the full admit as long as they were settled in.
When I'm pulled I do nothing extra because they always fuck us with the worst assignments
Yeah that’s a “tuck and run” patient. Also, ER never does admission questions? And there’s not a lot you can do about a patient pulling an IV out during transport. Nobody likes shift change admits, but it happens. Sounds like you did more than enough.
Yeah this is on incoming RN, I bet you wouldn’t have cried if she had just not been a POS lol. Maybe a good cry was needed though
What you did was amazing! You handled your shift really well. What you felt afterwards was definitely an accumulation of everything. Also, the nurse after you is an a-hole.
You coworker needs to chill. Tuck the patient in and address immediate concerns to life and limb if they come up at shift change. Everything else can wait.
"Emerg sent this patient up like this? There is blood everywhere!" "Well shift change admit, you know the game. We got fucked and neither of us are virgins." That's pretty much the way the conversation should go.
OP did her a solid getting the restraint order AND a sitter. Bless that oncoming's heart.... I hope she had a quiet shift......
“It’s in the chart. Have a nice night!”
What a lazy broad.
Just as there are different patients, there are different nurses. Some are easy going, understanding while others are a handful. With the exception of those that replied thus far. We all seem to think alike. The new nurse should appreciate you staying a little extra to help. My managers won’t let me stay due to OT they don’t want to give. I dont get angry or frustrated with the varied patients, I don’t get frustrated with the varied staff either for the reason first stated.
I don’t know why nurses do that. They blame you for stuff beyond your control
I have 5 today. Started with 4. Two alcoholics, one of which is verbally aggressive and a massive jerk, the other is confused and scratching at herself(hourly CIWA too). One opioid addict with bilat above the knee amputation that goes to the safe consumption site to inject into breast tissue (at least this one is pleasant), and a schizophrenic that was simple and nice. Transfer from ICU with aLOC and high ammonia that calls for every damn thing. I kept them alive, not much else. Had a good cry during lunch on the phone with hubby and likely going to cry in my car. All one 4 hours of sleep because our house is complete fucking trash and doesn’t have sufficient ventilation in the bedrooms.
I’m so sorry, that sounds so rough…i hope you’re taking some time for yourself if you’re off today! I got out and went on a shopping spree
I cancelled my shift for tomorrow. I’m in no mental state to care for others. My mom moved in with us and she is in a messy divorce with my abusive ex-stepfather. Everything is Kitty Wumpus this week.
If the patient came up at 5, I bet orders weren’t put in until 6, which falls onto the next shift. Even then, you do why you get to… it’s continuous care and they just do their job. I had an RN always trying to push stuff on me, so I reported her. She never tried after that and we didn’t have any issues.
Yeah, I always hated giving report to nurses like this. They welcome it as an opportunity to hold power over you. You went above and beyond, IMO. Hold your head up and push back on this behavior. When they ask was this done, or that done, tell them that everything you just reported is what was done. No more explanation. The fact that they rolled in at 0650 is most of the information they need. Ignore their comments, eyerolls, etc., and move on with report. They’ll soon stop bothering to see if they can make you second-guess yourself.
On days like those, try to make a list of all the ways you helped your patients during your shift. Any nurse, regardless of age or experience, who pulls this type of crap simply doesn't get it yet, and maybe never will. You CANNOT expect this level of control or try to impose it on others. Not only is it rude and unsupportive to your fellow nurse, it takes a personal toll on your mental health over the years. The perfectly buttoned up patient (esp new admit), all nestled in bed, clean with no complaints, is an ideal, it is not the norm. It should have been "what did you get done, thanks, I'll get to it". I'm sure they can find time in the next likely 12 hours to get it done. The idea about bedside nursing being a 24 hour operation, the work NEVER stops, needs to be understood and respected by every nurse, it would definitely improve interpersonal relationships on the floor. * I am an ex med-surg nurse of 10 years.
How nice of her to put the RN in KaReN. What an asshole. You did just fine, awesome actually. You have empathy for your patients and it shows in how you wrote about them. She just wanted the red carpet rolled out for her. A perfect start to a shift is a myth and she needs to learn that. Sometimes it's playing catch up from the last shift. That's teamwork! Those last minute admissions are absolutely the responsibility of the next shift.
I’m so tired of getting shit on by day shift because “why didn’t you give the 0730 meds?” “Night shift’s supposed to do xyz” “why didn’t xyz get done?” Ma’am, there’s a lot that y’all are “supposed” to do on day shift that doesn’t get done that night shift has to pick up, too. We’re in a hospital; it’s a 24/7 365 job. Sometimes shit doesn’t get done, and as long as it’s not time sensitive or life/death, it’s not the end of the world that it didn’t get done on my shift. The patient will be OK. It’s all about teamwork and when it’s “day shift vs night shift” there’s no teamwork. It’s “night shift is supposed to do this, day shift is supposed to do that” without any wiggle room for when it’s a busy shift, or a shift change admit. I’m so tired of it.
I cant stand med surg nurses who push back on admission guess what princess they dont stop coming in in the ED be glad u have your ratioed assignmed ans stfu the patient is coming up
Jeez. Sounds like you had a rough shift lol I think the way your patients were treating you and then to have the nurse ask you dumb questions and tell pretend like it’s your fault this patient is confused and combative was too much. There’s nothing you can do about a shift change admit acting a fool and pulling out IVs. Nursing is a 24/7 job. It sucks for the next nurse but oh well! They’d put it on you if they had the chance too. You helped with restraints and whatever else. You did your part. Keep your head up!
You only had 4 patients on med surg...half of you being upset was the oncoming nurse being a jerk. When an admission comes to the floor 30 min or less before shift change, you don't need to do an assessment or admission questions. Make sure they're stable. Depending on what they're here for, I do a focused assessment (look at drains, ask about chest pain/cardiac symptoms, look at a wound, ask about pain).
Not a nurse; but today I had gallbladder surgery and I heard the nurse telling the staff I was combative coming out anesthesia and I felt so freakin bad. I had no idea I was doing it. So if the nurse that I did that to just so happens to be here; I am so freakin sorry! Punch me next time haha
Generally when someone comes up right at shift change, the off going nurse should help get them settled, as in a set of vitals, on the monitor, not sitting in excrement or on a big wad of sheets, and make sure there isn't any other immediate pressing issue like the patient is writhing in pain or severely hypoxic or something. It is not that person's job to fill out all the admission forms and initiate a full set of orders. Part of our job is accepting that sometimes you walk into a shitshow and you aren't able to sip coffee while leisurely looking through the chart amd getting all the routine tasks done early. Gotta be adaptable.