Admissions at shift change

  1. I am interested in knowing if other facilities have a policy of holding admissions at shift change. I work 3rd shift and a shift change admission is difficult at best. I try to weigh the benefits for the patient on having them settled on the floor as early as possible against rounding on my patients, passing midnight meds, and putting out "fires" after a busy 2nd shift. I feel if I can get enough time to pass meds and peek in on my patients ( will play catch-up on assessments as the night progresses), I can spend more time with a new admission and get them settled with less interruptions. We are considering proposing this to our administration and would like to know whether this works at other facilities.
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  2. 20 Comments

  3. by   susanmary
    We do not hold admissions during change of shift. The admission will be preassigned to an RN for the next shift. When post-ops/admissions come near the end of shift, the current shift RN will settle the patient & will always get a manual BP on the post-op patients. The PCA will complete the vitals. The next shift "owns" the admission -- but, in reality, we try to pitch in with change-of-shift admissions -- great teamwork on my unit.
  4. by   SmilingBluEyes
    Nope. We deal.
  5. by   jevans
    We have admission constantly without consideration for shift change.
    if you check vitals and get next of kin .hang on you don't say where you work!!!!!!!

    most of the paper work can be done at a later time. Don't we provide 24hr care???????
    j
  6. by   RNforLongTime
    We do provide 24 hr care but nobody likes to get dumped on and when that happens then people get bytchy towards eachother. It's just the name of the game. We all know that women are catty people and backstabbing, worse than men, in my opinion. This is what is holding us back as a profession. Just my two cents
  7. by   SharonH, RN
    Unfortunately we don't have this policy. It's not a problem unless the patient that is sent up is somehow in bad shape(crying for pain meds, family very demanding) then it's a bad deal because you're not able to give them the full attention they need. I can never understand why they can't either bring them 15 minutes before or hang onto them just a few minutes later. I honestly think it's a quality of care issue.
  8. by   thisnurse
    i wish we would hold them at change of shift...at least give us some time to change over without the added "insanity" but we dont.
  9. by   shootemrn
    In our hospital we have a 30 minute blackout period at shift change. Works out well and I work in the ED
  10. by   tripletmom
    We have an unwritten policy on this... Our shifts are 7-7 so if an admission arrives on the floor after 6 The current shift gets the patient settled and any other immediate things that need to be done then the next shift will do the admission assesment and physical and paperwork. Of course the patient is informed of this procedure so they don't feel like they are "dumped" in a bed. It also requires teamwork and we all know some are better at this than others
  11. by   dianah
    I work on the other end of things: I'm the one transporting patients post-procedure to the floors/unit. When we have a full schedule, patients back-to-back all day (and you're the one on call, so you stay 'till the work is done, no matter what time that is, and your smiling(!!) face reports at the same time every morning regardless of how late you worked the night before), and each nurse asks me to wait 20-30min to transport, or the PACU is full and "can't recover" my pt and I have to recover pt while the rest of the cases wait . . . that time adds up during the day, and I get a tad frustrated and tired, to say the least. I'm not so far removed from med/surg or ICU to forget what things are like there: things are hoppin' all over, and yes, sometimes more time IS needed to prepare for the post-procedure pt. or just to take a breather before plunging in again. I'm not sure a hard-and-fast rule is the answer; let's balance this out, work together for the good of the pt. However, I do realize each facility is different and each will hopefully reach the solution for their institution that IS in the best interest of the patient and considers all elements in the patient flow equation. Hmmm, have I offended anyone?? Hope not. Just the other side of the coin. Courage! -- Diana
  12. by   nurselopez
    Hi,
    This is my first post. I am an older new nurse. I just graduated in December. Now that I'm off precepting, I don't say I'm a new nurse, now I'm "inexperienced".
    Anyway, while still precepting I got an admission (GI bleed) at 6:00pm (shift is 7a-7p). I had learned the routine of grumbling about a late admission. Anyway, to make a long story short, her loc deteriorated rapidly, at 6:45 she started having difficulty breathing and vomited A LOT of blood. Family started screaming, rescinded the DNR, chaos (did I mention this is my first code) and finally pronounced by the physician at 7:10.
    I finished the paperwork by 9:00.
    I have decided that I will never complain about a 6:00 admission again, even if it takes me two hours to finish my paperwork, as long as the pt is still there when I leave.

    I have been reading the posts for months. It sure has given me lots of encouragement to face another hectic day. Thanks to all of you.
  13. by   dianah
    thanks for the reminder. You had a bad day; the patient had a REALLY bad day. A hug for you, a prayer for the family. --D
  14. by   MPHkatie
    Bless your Heart, NurseLopez- sounds as if you were very efficient getting out by 9 pm.

    I work ED. All of the floors refuse report at shift change, which is ok by me- the RN's up there have a ton to do at shift change. Now, if report has already been called, on most floors we are free to send the pt up even at 1900 on the dot. I don't do that however, unless the patient is familiar with how hospitals work, and is totally pain free and hanging out, and the ED is packed to overflowing, and I call and let the Charge up there know the situation...

    The policy of holding admissions at our hospital is only for 30 min at shift change. It works, but not when the ED is stacked. What I found, however, is that as we have respected the shift change rule, and held patients when we aren't busy and the floor is having staffing issues or a night of codes, is that when we are smack up against the wall, the floor usually lets us bend the rules a bit. It seems to be about mutual respect and understanding- which is often sort of lacking between floor and ED RN's.

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