[SeaTracer75]

hey all... im curious to know from those who work in pacu how your "system" works for admissions...who takes what patient and when...based on staffing , lunches, ratios, acuity (dont rly exist where i am unfortunately) etc....

im my pacu they number the order in the am (1234 or 123456789 depending on staff lol)... but when your shift starts, anyone at any time, (we have many swing shifts, so silly) you AUTOMATICALLY get next admission...even if the patient literally comes in at the same time u do and before u put ur bag down...(and sometimes before u even got there b/c someone is trying to scr*w u)..then the rotation resumes.... until lunch.. then when u come back from lunch u auto get 1st admission if (and only if) those who came in the meantime got one patient each.....

after 3pm the rotation changes with the 3pm person auto getting 1st admission, then based on how many pts per nurse they have a new and almost backwards rotation based on who got last admissin prior to 3pm (they would go last).

enuff said.... its HORRIBLE... and we are slways sooo busy its almost dangerous @ times..

please tell me there is a better way..

PS there are also those who manipulate the order by switching lunch breaks and endorsing patients to each other so they wont have to take the icu cases... its truly pathetic at times anthe "older nurses" and their clique is just the DEVIL

[tnd511]

I used to work outpt and there you were assigned bed slots ONLY. Basically, as the pt's came out the charge would just say send them to what ever # slot and she would try and give them out evenly....like if you just got an admission then someone else would get the next and so forth. The main problem was, there were certain people who would sit on their pts and not try to progress them, therefore they always got less admissions. And I want to mention that yes sometimes someone would get a pt before they were actually there. If all of us had our 3 slots full then they would get put in a slot of someone who isn't there and we would all take care of the pt until they got there, usually only a few minutes.

I now work in a inpt PACU and we don't assign pts or slots or anything. We all work well together and basically when a pt comes out whoever isn't busy takes the pt. And when we are really busy people just watch each others pts and chart vitals and medicate as necessary....does that make sense at all? It is sort of an odd system, but it works for us and as the charge nurse in the evenings it makes my life so much easier to not have to beg people to take admissions.

[starae]

Hello. I work in a large PACU and I think we have a pretty good system.

When people come in to work in the morning, their spots are added to a running list. Usually they will put one spot at the top and the other at the bottom to help eliminate getting doubled up with patients. As patients come out they go to whatever spot is top on the list. When there is a big case or ICU case due to come out they try to give it to someone without patients or will look around for whoever can handle it. Our secretaries are very good at their job and management is closely involved. Also, they are pretty good about skipping our turn or holding an open spot if we let them know we need time to settle things down with another patient.

For lunches we have people who come in at 11am, and it is their designated job to give lunch breaks. This means that nobody has to cover multiple patient assignments at once, and that patient flow is not interrupte. By 3pm everyone has gone to lunch and those lunch break people will start taking over for people who get off. It is a very fair system and I actually enjoy getting a lunch break off the unit!

Our system is not perfect, but works well for us. Unfortunately there are some who will try to manipulate the system to avoid taking certain patients. I think you have "those" people in any unit.

[cowpoke_rn]

Our system is similar to starae....but we have a "float" nurse on both sides of our PACU that will relieve the nurses in slots for lunch breaks. The floater also helps with checking in the patient, putting in orders, and then transporting when the patient is ready to go to room.

If we have a ICU case come out, then the nurse who gets that patient will be skipped until they get their patient to the ICU. That way they only have one patient. Hope this makes sense.

We have nurses that work 8, 10, and 12 hour shifts that come and go at various times. I work in a 18 bed PACU in a level 2 trauma center.

Now all PACU's have certain nurses who try to cheat the system or "hold" their patients. Mostly, I work with some great people and it's usually not a poblem. Like I said, usually...(unless it is almost time for them to go home) Sometimes nurses have to stay late if the OR is still booming and 1/2 the staff is already gone home. After hours we have on call teams.

All in all our system works very well. Hope this helps.