Admits after 6:00 pm? Does your hospital do this? - page 2
I'm a new grad and I've been working where I am for almost a year. I work 7-7 days. One of my main reasons I'm throwing in the towel on this job is be because of the 6:00 admits, ER, or some other... Read More
Mar 22, '07Quote from PickMePlzethen stay away from L&D and M/S..I'm well aware its a 24 hour job but I'm not a freaking robot, either. Nurses need to eat sleep and rest just like everybody else. I can't be allowed this then I need to move on, which is what I intend to do.
maybe look into home health. Its usually an 8-5 job
Mar 22, '07This topic has been discussed ad nauseum here. I've worked both M/S and ED and I see both sides of the coin. Basically, it's going to be anywhere you go and if you are having to stay until 9pm specifically related to change of shift admissions, then you are either doing the next shifts work or possibly you need some assistance with time management. That is not intended as an insult, but being a new grad, I think it's definitely a possibility. Good luck with whatever you decide.
Mar 22, '07I work 7:00pm-7:30 am. Any patient that comes to the unit after 6:00 am is not for the night shift to be admitted. What we do is take the vital signs, wt, and height and record it. Our rush hour starts at 5am, so we just can't do admission as per our union contract agreement. We also do not take endorcement for admission during the change of shift unless if it is a real emergency. Some nurses will volunteer to admit a patient after 6am if they are less busy.Last edit by RNLULULABAMBA on Mar 22, '07
Mar 22, '07[quote=Critterpuss;2123695]Nursing is a twenty four hour job. Things dont flow according to the rhythms of the unit.
No one is plotting to find the most inconvenient time to send a pt to the floor for an admit. The nurse needs to anticipate this WILL happen. It isnt going to change.
Welcome to Nursing.[/quote
Nursing is a twenty four hr job means one shift picks up and continue after the previous shift. It does not mean that one should continue working after their shift ends because of an admission. The right thing to do in this situation is to take the endorcement and pass that admision to the next shift. This is done in well organized places.
I am on nurse PickMePlze side, there are better hospitals and she should look for another job.Last edit by RNLULULABAMBA on Mar 22, '07
Mar 22, '07Where I used to work, on a floor, the next shift was notorious for the "well didn't you do XYZ<condescending look>" on an admission I'd gotten at 1810. The answer... "nope sorry. VS are fine, here's the admit paperwork". It IS a 24 hour job.
Now I work ER, and I know why those late admits happen (thanks docs who give orders late) and I do my best to make sure when the patient hits the floor, there's nothing immediately pending (like an EKG or lab draw right away). The idea is to try to make sure the floor nurse can just eyeball, grab a set of VS and pass them on to next shift, when possible.
Don't stay late after your shift for this kind of thing, seriously. If you always do your best job, and aren't forever leaving junk for the next shift that you truely could have done (like don't not take off orders written at 11am), then the next shift shouldn't have anything to grumble about. If they do, their problem not yours.
Learn not to feel guilty for passing on a very late admit. Go HOME. And don't grumble when you get report on a patient who was admitted 45 minutes before your shift, cause that paperwork will be yours!
It gets better and faster with time, honest. Hang in there.
Mar 22, '07Quote from TraumaICURNWe go through this all the time and say the same thing.When working on a med surg floor, every patient we had admitted from ER came right before shift change.
I don't know how true it is, but I was told it was because if the ER nurse sent the pt up before shift change, then he/she would get another pt.
ETA: If we have an admit that comes up right before or at shift change, vitals are done and the admit is endorsed to the next shift. I do not stay over my time unless we are already in a code or some other emergency (or I have to finish up some charting).Last edit by LuvaNurse04 on Mar 22, '07
Mar 22, '07You nurses who can hold off admitting a patient for the next shift are lucky We need to do the admitting, check the doctor's orders, assessment, etc. on any patients that come in on our shift--even if they arrive at 6:55--and they regularly do.
I wish they had a hold on patients for that hour around shift change and kept patients wherever they were because it's not ideal for the patients (or the nurses either, heh). We get a lot of post-ops and so there are almost always pain issues that we can't put off until after report. It's difficult to meet the needs of the patient at that end of the day when you need to be giving/getting report--esp. if the pt only has a PCA which needs to be set up and monitored Q15 initially.
Hope I don't sound cranky, but we were slammed with admits last night and I'm beat. ER was hopping and we ended up with almost twice our average pt load by the time we got to go home. I can't tell you how happy I was to see that first day-shifter walk in
Mar 22, '07Quote from TazziRN:yeahthat:Well, from an ER point of view, we often have admitting docs telling us to hold the pt in ER until they come in to write orders, and they don't show up until after office hours. We are not doing this on purpose, we want the pt out of the ER as soon as possible but it's not always possible.
When I worked in the clinic, a lot of times, the provider would go to the hospital, order labs, x-rays, etc, and then come back to the clinic until everything was done. (We don't have 24/7 ER coverage...the providers cover in between seeing patients in the clinic). Then they would go back to write admission or discharge instructions...if it was close to the time the clinic closed, they would wait until after hours. Also...a lot of people come to ER after they get off work, so from 1400-1800 is a pretty busy time and the people who come in between 1400 and 1600 end up being admitted around 1800. Just one of those things.
Admissions are a part of the job...get used to it. Every nursing job I have ever had gets hairy around shift change.
Mar 22, '07Another reason patients come up sometimes near shift change.... If you have been taking care of a patient since 7AM and they get a bed assignment, it is silly for you to give report to the night nurse, who in turn is just going to have to call report, not really knowing the patient. When the happens to me, I try to call report asap and get the patient up well before 7PM, or keep them until 7:25 so they are to thier new unit after shift change, but I still technically am there to take care of them, so I don't have to give report again.
I work in a unit where all of our patients are transfered in from outside hospitals and they eventually get transferred to another unit in the hospital when a bed opens up. We try not to send patients near shift change, but sometimes it just cannont be helped.
Mar 22, '07People come into the ER at all times of the day, so they hit the floor at all times of the day. I work 7P to 7A, there are plenty of times one of my assigned patients is one that just got to the floor and wont have admission done, or I will be notified almost immeditely that I have one coming. However, they are good to make sure it's not both. Then, I will usually have one after 2300, including inconvienent times like when I'm trying to take my luch. Many times the ones that come up during the night are banged up and I end up helping my fellow nurses with lifting, logrolling, general hygiene matters, ect....we're hopping all night long, but lucky for me, very few discharges.
Mar 22, '07Quote from PickMePlzeI think that if it is happening on a continuous basis and is disruptive to your life maybe it IS time to "step over".I sure its not always greener, but you wont know for sure unless you step over to see if it is in fact greener.
Im a single parent whose child is also suffering because I can't get home at a decent hour to help him with homework and spend time with him. Im willing to make that step for him.
Thanks for the insight.
There are plenty of other nursing positions where you will get off at a reasonable hour. I did bedside for 7 yrs and our day nurses almost always got out on time. And we were a very busy floor too.
Something doesn't seem right.
Mar 22, '07This is why there are two (or three) shifts. Babies/patients come when they come - whatever point in the shift that may be. If I get an admit at the end of my shift, I tell the oncoming RN in report what I have done and what still needs to be done. On the other side, if I am coming in to work and one of my babies just came through the doors within the hour, I consider the baby to be my admit and take over where the prior shift left off.
Mar 22, '07We get them @ 06:00 a lot. What I wind up doing is telling the pt. I'll be their nurse for the next ___ minutes until my shift's over, do a quick assessment, get them settled, and then try to address the things that are most pertinent. (Bloodwork(lab is usually on the floor anyway for morning blood draws and it winds up saving them a trip back after they've just left), abx it they're septic or neutropenic, etc.) Stats. Everything else can wait. If I have time, I try to get the admission paperwork started, but I certainly don't stay late to do it.
What ticks me off is when a pt gets to the floor after 18:00 and the nurse giving him to me has not even looked at the patient or his orders. I mean, it's one thing if they literally just got to the floor in the last 15 minutes. But if the pt's been on the floor for an hour, you should be able to give me a heads-up. Do I expect everything to be done? No, but if there's something stat, please do it or tell me if you didn't get to it so that I'm not caught like deer in the headlights or finding it later when I do my chart checks.Last edit by NurseyBaby'05 on Mar 23, '07