Blood transfusion, hyperkalemia, hypertension, heart failure, conscious sedation... my day has been crazy enough.
Tasks to Do Before Shift Ends in 15 Minutes:
Patient 1: Pending transfer information to different hospital
Patient 2: Pending admit to the floor
Patient 3: Pending ability to ambulate steadily before discharge
6:45
- Finished belongings list on Patient 1. All the paperwork that can possibly be done for him at this point is complete. All the night shift nurse has to do is wait for other hospital to call for information on a new bed.
- I'm notified that a bed is available for Patient 2. Perfect timing because I had completed all her paperwork as well.
6:50
- Called the floor to give report for Patient 2. Receiving nurse was unavailable/trying to pass it off to night shift, and asked me to call back. Decided to take the time to have Patient 3 ambulate to bathroom and back to bed so I can see her walk.
6:55
- Patient 3 in bathroom.
- Called floor back to give report for Patient 2. Admit paperwork completed and printed. Patient 2 ready to be sent up to the floor.
7:00
- Patient 3 back from bathroom. Giving patient her discharge paperwork as night nurse walks in. I tell the night nurse to give me a moment as I discharge the patient.
After the discharge, I go to patient 1's room where the night nurse is looking at the computer. I'm feeling particularly pleased because all I'm leaving her with is one patient. I got everything done in FIFTEEN minutes before the end of my shift, and I also had only been able to do that because I had been on top of all the paperwork prior to all the craziness. She better be ecstatic.
And then... "Did you send his urine? He had an order for urine."
"Well I gave him a urinal at his bedside and he just hasn't gone up to now."
"Well you need to tell the doctor that and get an in-and-out because that was ordered 3 hours ago."
"No problem, I'll ask him."
I ask the doctor and he says in-and-out is not necessary, if the patient goes, he goes. I let the night nurse know and she stops me one more time, "What's this med? Have you given it?"
Confused because I was sure everything was done, I glance at the chart. There was a med ordered at 6:55pm, five minutes before my shift ended and mid-transfer and discharge of my other 2 patients. Seriously? Didn't she see me discharging one and the other leaving the room to go upstairs at the same time? Would she rather I made sure ONE patient peed and got meds in the 15 minutes I had left, and then she take care of discharging/transferring/admitting THREE patients? After feeling so satisfied with what I had accomplished that day, it was not a good feeling to be told it was not enough.
As a common courtesy, of course we do not want to leave unnecessary tasks for the next shift to do, and vice versa. We do the best that we can. The best that we can is not everything, but it is still something. Especially in a crazy ER, tasks don't end at 7 for the next shift to have a completely new slate. There will always be something more to be done. The hospital is a 24 hour service.
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