Shift change Chaos!!

[TracyR]

Change of Shift; Controlling the Chaos.

You've just stepped off the elevator on your floor. You round the corner and start heading toward your unit. You're full of anticipation for what lies ahead. You've gotten plenty of rest from your last shift (yeah right!), and you know that this shift will be a little better. All of your patient outcomes will be positive.

You now start to hear the phones ringing non-stop. You see two or more sets of transporters with stretchers and wheelchairs in the hall. There's a small group of 'white coats' standing in front of the clerks desk explaning to her just what exactly it is that they have just written in the chart, because of course their handwriting sucks.

There's a group of nursing students mulling about and there are twice as many Registered Nurses present. Everyone is anxiously awaiting their patient assignments from the charge nurse who, by the way, doesn't recognize half the names on the assignment board.

There's the orientees, the float nurses, the Dieticians, the wound care nurse, the psych evaluator, the chaplain, the JCAHO team, the new transfer, the new admit, lions and tigers and bears, Oh My!

And suddenly over the intercom; "CODE BLUE!", and of course it's across the hall from your nursing station. Sound familiar?

The following statement by Groucho Marx was once used to describe Chaos Theory; "Time flies like an arrow, fruit flies like a banana!"

As silly as that may sound, there is a small amount of simplistic genious to that statement, and without going into the many complexities of Chaos Theory, I think that you will agree that shift change is nothing short of Chaos.

Well, if you're a seasoned veteran and are master of your domain, chances are that 90% of the time, your shift change experience will be swift and complete. You already know that nurses run the show, and that nothing can stand in the way of the swift completion of your appointed rounds. You are like an arrow, straight and true.

The fruit fly, on the other hand, buzzes around from clipboard to clipboard, from chart to chart, from nurse server to nurse server (I had to throw in the Nurse Server part! ); anyway, you get the drift. The fruit fly seems to be the busy little beaver, but lacks any focus.

But that's not entirely true, because the fruit fly is really looking for that easy team. You know, the team with all the 'walky/talkies'! This type of person is not a team player and is a disruption to the change of shift process and to the unit as a whole.

The banana is the nurse who is either new or has lost their confidence somewhere along the way and is waiting to be eaten alive. And change of shift can be the one time that this nurse can be easily overwhelmed. An over-zealous charge nurse can really 'dump' on this person.

While there are hundreds of personality traits, and millions of circumstantial variables, there comes a time when all of the disruption and chaos must be tamed and the team begin to function as a cohesive unit. This is where your professional skills can shine and you can show some autonomy. (More on autonomy in an upcoming issue.)

If you are the 'take charge' type, you should waltz onto the unit and let everyone know that you are there to help. Be sincere, not ****y. If your charge nurse appears to have their hands full, offer your assistance before the chaos gets out of hand.

Steer the loiterers away from the nursing station, answer the phone, assume temporary care of a few patients while the off-going shift finishes their charting.

If your charge nurse has things under control, do what they ask and steer yourself away from the nurses station. Just do something, and do it quick. In the long run, the life you save may be your own.

Tracy Rigdon RN
From the No FLUFF Zone Newsletter
www.nurseserver.com

[Aaron C.]

Stop scaring me

[All41]

Great "true life" story. Things like this do happen and that is where the opportunity to be "proactive". Now there's an unfamiliar term for most nurses. This is an opportunity to have a multispecialty meeting and plan ahead. If the 11-7 staff understand they are not to leave if a code is being called and the duties are clearly defined among staff, this should aleviate some stress. Hey, codes are gonna happen in our line of work. Setting priorties and using critical thinking skills are a must for nurses in high stress areas. Critical thinking skills are somewhat inate and much taught. I think this is a great area to have a yearly inservice or as needed.

[Gayla RN]

Thanks for reminding me of why I left bedside nursing!

The only thing you failed to mention was that, oh yeah, is that the floor you work on has an uneven number of beds. So, as it goes, each nurse gets 6 patients except you ---- you get 7. The charge nurse explains to you that everyone has to take turns getting the 7th patient. Yet, you seem to remember having 7 patients the last 5 times you have worked with this particular charge nurse. Hmmmm.... This lucky night you have 4 fresh post-op's and 2 total care "gorked" patients and that new admit on the stretcher in the hall with the transportation crew ---- oh yeah, that one is yours too.

Personally, I feel that I am sincerely a good nurse. Taking care of the patients is not my problem. My problem is just what Tracy outlined in his post ---- the chaos.

Trying to work efficently amid chaos, with too heavy a patient load, a charge nurse who "hangs you out to dry", lack of teamwork in general and administration that just doesn't care --- those are my problems. It makes the job unbearable. And the shame of it all is that I miss caring for the patients. I miss the actual patient care.

Signed,
Nurse Who Stays Home Now Instead of Working

[cassioo]

sounds like just why I left the surgical unit at our hospital until I could get full time peds (continued part time ortho/neuro at a more organized hospital) Was getting report at 11pm. 1st I was going to report room and an evening shift aid says oh yea MR Jones pulled out his IV, says this as the elevator door is shutting and all evening shift is going down (they gave taped report) so I go to see if he's bleeding and they left him. As I pass the first room there's a lady yelling I have to pee I have to pee. Continue to see Mr Jones not bleeding just confused and his family there..guess that IV had been pulled long ago. Stop to place pt I don't know on the bed pan. Then go back to report. Get the report I have 15 patients with an LPN to pass meds (new grad) and a new NA. (I wasn't too far out of school myself) the other nurse also has 15 pts that night (she's been out 1 year) with a new LPN and an NA who's been there 100 years. Go to get the lady off the bedpan and start her assessment. She has not peed but still saying I have to pee I have to pee...Turns out she's an alzheimers patient who they did a cardiac cath on that morning. Her leg is all over the place and black from the ankle down. Can't feel a pulse can't hear a pulse I get everyone's opinion and 1 LPN thinks she can hear a faint pulse. Check the chart. Nobody charted her foot was black. She got back to the unit at 2pm and her output since then is ZERO. She has 3 fluids going and still saying the whole time I have to pee. I say I'm going to get a cath...the other RN says oh you can't do that without a docs order (it's a standing order at the other hospital I worked) By the way the pts lungs also sound nasty. Fine I'll call the doc. He says no cath give her lasix IV and stop 1 fluid. Fine I give the lasix, put her on the bed pan and go restart the IV for Mr Jones. Come back a few minutes later no pee but she still says I have to pee. Call the doc back...tell him no pee he says give something else (of course we don't have that on the unit and pharmacy is closed at night so get the house supervisor on the phone tell him to meet the secretary in ER) also ask doc when to put that cath in he says if this other doesn't work. I go to see another patient till the secretary gets back. Here she comes I draw up the med and go to the room...Great..I hit the call button and call the code so we code the poor lady for another hour. Her doc of course didn't show up for that. Then the house supervisor tells me to tell her family when they get there she's passed away and to fill out the varience etc. So I don't want to leave the hall wide open for the family to head straight to the room (her family is a nephew and his wife who had to come 30 miles) By the time I'm done with all of that it's about 3am and I still hade 12 other patients I'd never laid eyes on and the other RN wasn't much better of then me as being there were just us and the LPNs and NAs with 30 pts we'd all been busy. That was enough of that for me. However the supervisor that was there at the time has changed jobs and staffing is a bit better on that surgical unit now (this was 12+ years ago) Now I stick with my L&D

[mercynurse]

I guess I thrive on chaos...this sounds like what I do and I still love it!! OK so what does that say about me? That was a retorical question guys!!!!

[HemoStat]

Chaos motivates me and I simply thrive in it!!! It's those slow nights with a few patients, no admits, no orders, no one in pain, every one asleep, that kill me. It's like a night of a thousand deaths, MINE. I can't get anything done. Start my night out with a code and see what gets done!!!

He hehehehehe.. Another pro for Hemodialysis..LOL NO shift change....Usually. And no shift bashing either.. Yes some units do have an evening shift but alot of nurses are working 12-16 now..


JMI

WR,,, three commas for Becca

[nursinghumor]

These are a few other resources I came across dealing specifically with happenings during a Nursing Shift.

An Exploratory Study of Supportive Communication During Shift Report, Mary M. Hays, DSN, RN:"This article describes supporting behaviors, one aspect of an exploratory study of the interactions of registered nurse (RN) leaders and followers during shift report in a hospital setting. The purpose of the article is to describe the observed supporting behaviors of RNs as they listen and respond to each other during their usual shift report. Supporting behaviors were selected as a significant reporting entity for the initial analysis of the video recorded reports in keeping with the American Nurses Association's Cabinet on Nursing Research's goals for the new century."
http://www.snrs.org/members/SOJNR_ar...iss03vol03.htm
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Story of A Nursing Home Shift, by Jeff Danger, LPN, MSW:"2:50 PM Nurse Marsha, an LPN with 2 years nursing experience, arrives at Anywhere Nursing Home, a 150 bed capacity facility. She is 10 minutes early but the time clock will not allow her to clock in (the corporation doesn't want to pay anyone to begin work early) so instead of starting work she just stands there with several other employees in the basement waiting, wasting time. After clocking in at the top of the hour, she is met by Amy, the supervisor, "Hi Marsha. Because of a sick call, you'll have to work the 4th floor. Stacy (the regular day nurse) agreed to work a double only if she could stay here. There's an admission coming at around 5 PM. I'll try and get up there to help you with the paperwork. Thanks alot." Irritated because this seems to happen too frequently, Nurse Marsha takes the elevator to the 4th floor where she is not familiar with the residents.
http://www.jeffdanger.com/newpage62.htm
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Andrew Lopez, RN
http://www.4nursing.com

[cassioo]

Had the shift chan chaos tonight...giving report and it's 1915 and the fire alarm goes off and this time it's real and it's in the stairwell at the end of our unit. Keep the visitors in the rooms...oops we're just starting a c-section, oops got one delivering, open the security doors to let the firemen in, go to the lobby to keep people from wondering around the hospital, get the doors shut again when people keep coming out and get out late again So checking this site at 2222 have to be up at 5 and at work where my shift starts at 7 and have a c-section scheduled to cut at 7 so really have to be there a little early... maybe I should go to bed but gotta finish reading and putting in my 2 cents.