Please-all experienced RN's reply to my question.
I am a new nurse that obtained a job in the nursing float pool. I work 11-7. B/c I am a new nurse-I will be floating between med surg, ortho, and sub acute (less critical) for six months before going to other areas of the hospital. This is my problem-I've been off orientation for a couple of weeks but because of low cencus-have been doing CNA work or one to one's (boring) This week has been my first, real nursing experiences and I have sooo many questions. I've asked at work and everyone has a different answer. Management is out-they have no REAL policies in place to help me. I'm turning to the experienced RN's and I could really use some good replies. Keep in mind I work nights (many on call MD'S)
1.) Do you call the MD for every panic lab level. For example-it was panic yesterday and the MD put in orders to take care of it such as fluid restriction for low Na+. It has come up today (4) but is still panic. Pt is asymptomatic.
2.) What do you pass on to the next shift. Some nurses will pick up where you left off, some are not so nice about things you leave for them.
3.) If you are in the middle of your shift assessments and you get an admission-do you continue to see the pt's or immediately address the admission.
4.) Do you call on call MD's in the middle of the night with all abnormals or just major one's. For example-I was chastised for not calling in a slightly abnormal UA (few bacteria and small WBC's in a symptomatic and yet-annoying hypochondriac pt) She had just finished a series of ATB's for UTI, drank huge amounts of fluid, and had clear, yellow, norm smelling urine. Afebrile-the works. Ultimately-I passed it on to the day shift to call the results in and they were irritated to say the least. On a positive note-the MD did not end up treating.
5.) If tele reports new problems (PVC's PAC's or Afib) in an asymptomatic pt that had triple bypass-would you call the oncall cardiologist?

Any other advice would be great. I know my biggest feat is my organization and the fact that if the pt's want to talk-I talk. I do not rush anyone and this seems to get me farther behind then my peers. Unfortunately-I'm too interested in what they have to say and....I like to get acquanted with the people I take care of (I was told this in one of my faults) On the other hand, I feel I do have common sense but get yelled at by the nurse following me b/c I didn't wake an on call (surgeon no less) at 3am for a slightly abnormal UA