Admits after 6:00 pm? Does your hospital do this? - page 5

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

  1. by   blueheaven
    You may have the same problem that we have in the facility I work, ER or the nursing unit keeps em ALL day and then decides later in the day that the pt needs to be admitted/transferred to the MICU. On the other hand, pts don't decide when they want to go from bad to worse and in my experience it is ALWAYS at the end of a shift!!! Sounds like as a new nurse you are allowing yourself to be used. Nursing is a 24 hour a day job, and if someone comes in late on your shift, next shift should pick up the slack so that you don't have to stay over.

    Momason is right! Good advice there!
    Last edit by blueheaven on Mar 26, '07 : Reason: cause I wanted to
  2. by   BrnEyedGirl
    "the er nurses were told by their manager to hold the pts as long as possible so they won't have to take anothe pt."

    as a new nurse to the er after spending 8 yrs on a stepdown/tele floor, i have to say i can not imagine any manager anywhere, actually doing this, let alone saying it out loud!!! we are nurses folks,.we take care of sick people,.in the morning, at night, while we're trying to eat lunch, the begining of the shift, the end of the shift, christmas day, easter, and even on our birthdays!!!!! it's a 24/7 job,...holding a pt to try to keep from taking another one??? please!!!!,.i work in a 25 bed trauma center, plus a fast track,.we also have 8 "hall beds",..there is always another pt waiting to be seen!!! our focus is to stabilize pts and move them on,.be it home, or,cath lab,nicu,ccu, wherever. there is even someone in an office, somewhere (w/a window i'm sure) that keeps track of how long our pt's are there, how long from door to ekg, or to ct scanner or to floor,.many of our accreditations are based on these times,..holding pt's doesn't benefit anyone,.er staff, floor staff, the hospital or the pt! i understand that the hospital is often full and short staffed,..i understand sometimes pt's need to be moved around to make room for the er admit,.it isn't uncommon for us to wait 3-4 hrs for a bed assignment from admitting,.then by the time we get the room clean, and actually get the pt to the room another hour has gone by,.at that time i really don't know what time it is!!!!! then if you throw in a code, or a couple of traumas durring this process,..well you can see what might happen!!! (those pt's don't make appoinments btw)

    why are we, as nurses, so quick to place "blame" and complain of "unfairness",. when we are all just trying to do our jobs!! i see this from both sides now, and i agree some er nurses are rude and very unprofessional to floor staff when trying to move pt's out,.as are many floor nurses just as bad to the er staff. it seems there are many people who feel they are the only person in the hospital working their tail off, missing lunch,.not getting everything done,.trying to make everyone happy (and failing miserably),.and working under less than desirable circumstances!!! we are all in this together folks!! can't we just all get along??!!!!

    okay,..off my soap box,....i really do love my job,..but honestly,.sometimes i feel like i'm in the 8th grade again!!!
  3. by   TinyNurse
    have you ever worked in the ER??? The ER often has wait times of over 8 hours, and are holding admitted patients up to 3 days......................not to mention ambulances arriving left and right.................
    That is why 6pm no longer matters.............. if the patient can go upstairs to a more comfortable area then they can ............gand this is in the patient's best interest.............
    it's all about the patient,remember................
  4. by   BBFRN
    Quote from rn-cardiac
    "the er nurses were told by their manager to hold the pts as long as possible so they won't have to take anothe pt."

    as a new nurse to the er after spending 8 yrs on a stepdown/tele floor, i have to say i can not imagine any manager anywhere, actually doing this, let alone saying it out loud!!! we are nurses folks,.we take care of sick people,.in the morning, at night, while we're trying to eat lunch, the begining of the shift, the end of the shift, christmas day, easter, and even on our birthdays!!!!! it's a 24/7 job,...holding a pt to try to keep from taking another one??? please!!!!,.i work in a 25 bed trauma center, plus a fast track,.we also have 8 "hall beds",..there is always another pt waiting to be seen!!! our focus is to stabilize pts and move them on,.be it home, or,cath lab,nicu,ccu, wherever. there is even someone in an office, somewhere (w/a window i'm sure) that keeps track of how long our pt's are there, how long from door to ekg, or to ct scanner or to floor,.many of our accreditations are based on these times,..holding pt's doesn't benefit anyone,.er staff, floor staff, the hospital or the pt! i understand that the hospital is often full and short staffed,..i understand sometimes pt's need to be moved around to make room for the er admit,.it isn't uncommon for us to wait 3-4 hrs for a bed assignment from admitting,.then by the time we get the room clean, and actually get the pt to the room another hour has gone by,.at that time i really don't know what time it is!!!!! then if you throw in a code, or a couple of traumas durring this process,..well you can see what might happen!!! (those pt's don't make appoinments btw)
    this was the reality when i worked in the er. i have never known a manager anywhere to approve of sand-bagging beds. nurses who were known to do so where reprimanded and then fired, if they didn't comply with through-put. i have only known a couple er nurses who would even want to hang on to a patient any longer than they had to, and they never got away with it. if something wasn't said by the other nurses or the er docs, it would be shown in the numbers- which were posted monthly.
  5. by   Tweety
    Quote from rn-cardiac
    "the er nurses were told by their manager to hold the pts as long as possible so they won't have to take anothe pt."

    as a new nurse to the er after spending 8 yrs on a stepdown/tele floor, i have to say i can not imagine any manager anywhere, actually doing this, let alone saying it out loud!!! we are nurses folks,.we take care of sick people,.in the morning, at night, while we're trying to eat lunch, the begining of the shift, the end of the shift, christmas day, easter, and even on our birthdays!!!!! it's a 24/7 job,...holding a pt to try to keep from taking another one??? please!!!!,.i work in a 25 bed trauma center, plus a fast track,.we also have 8 "hall beds",..there is always another pt waiting to be seen!!! our focus is to stabilize pts and move them on,.be it home, or,cath lab,nicu,ccu, wherever. there is even someone in an office, somewhere (w/a window i'm sure) that keeps track of how long our pt's are there, how long from door to ekg, or to ct scanner or to floor,.many of our accreditations are based on these times,..holding pt's doesn't benefit anyone,.er staff, floor staff, the hospital or the pt! i understand that the hospital is often full and short staffed,..i understand sometimes pt's need to be moved around to make room for the er admit,.it isn't uncommon for us to wait 3-4 hrs for a bed assignment from admitting,.then by the time we get the room clean, and actually get the pt to the room another hour has gone by,.at that time i really don't know what time it is!!!!! then if you throw in a code, or a couple of traumas durring this process,..well you can see what might happen!!! (those pt's don't make appoinments btw)

    why are we, as nurses, so quick to place "blame" and complain of "unfairness",. when we are all just trying to do our jobs!! i see this from both sides now, and i agree some er nurses are rude and very unprofessional to floor staff when trying to move pt's out,.as are many floor nurses just as bad to the er staff. it seems there are many people who feel they are the only person in the hospital working their tail off, missing lunch,.not getting everything done,.trying to make everyone happy (and failing miserably),.and working under less than desirable circumstances!!! we are all in this together folks!! can't we just all get along??!!!!

    okay,..off my soap box,....i really do love my job,..but honestly,.sometimes i feel like i'm in the 8th grade again!!!

    we don't sandbag beds. but our manager knows how many patients each nurse can safely handle and there comes a time when we have to put our foot down and say "enough is enough". yes, i do know that the er does not have this option when there's an ambulance at the door, but our manager's concern has to be the safety of the patients on her unit, the rention and satisfaction of the floor nurses who get burned out with the constant bombardment of unsafe ratios, and keeping "customer service" scores up. i'm sorry that the er gets busy and they get gridlocked when the floor is busy and they don't have the luxery of saying "i'm maxed out and can't handle another patient", but fortunately i do and don't hate because of that.

    however, there is also a time when it's unsafe in the er and our directors have a "never divert" policy and they admit patients to the floors and we are not allowed to refuse.

    we are also not allowed to object an admission, no matter what the time.

    it's tough to get along, but we have to maintain a spirit of cooperation, while looking after our own interests.

    99% it works where i work. every now and then be bump heads, but for the most part it works.
  6. by   mamason
    Ok....let me just say, " Not all ER's hold pts." I was only talking about the armpit that I use to work at. As I said, the manager was fired for this. I really don't know why I'm even trying to explain myself. I believe that people are just taking this personally instead of trying see the whole picture.
  7. by   queenjean
    I don't mind finishing an admit left over from day shift usually. The exception to this is that they don't tell their charge nurse or the night shift charge that there is an unfinished admit, so sometimes I get stuck with two at once. My other beef is that the patient has been there for over an hour, but the day shift admission nurse had several admits and couldn't get to it--hello, even though you have an admit nurse on days, you still are capable of doing an admit! Do the stinking admit (this especially smarts if you are brushing off the crumbs of the birthday cake you just ate in the back room prior to shift change--ya got time to eat cake, ya got time to do the frickin admission!). If an IV goes bad, a patient is waiting for a PCA, and you know that IV therapy can't get there for over an hour, you start the freakin IV yourself, of course. This is no different.

    That's what irritates me. Shift change admits from ER? Nahh, I don't care anymore. If I get an admit at shift change, it just means I'm not up for an admit for a while. In my most humble opinion, it's never a good time to get an admit!
  8. by   flashpoint
    I've noticed that things get crazy at chift change no matter where you work. I work in an LTC and from 1700-1800, we have supper, supper meds, pharmacy comes in, and doctors who put us off all day finally call back with orders. From 0500-0600, we have a HUGE med pass, rounds, and we have three residents who have to get up for dialysis. The dialysis patients need weighed, dressed, and fed...and we have to cook their breakfast. It's just a really busy time.

    I don't mind having something from the previous shift passed on to me unless the charge nurse is outside smoking when I pull into the parking lot and she sits eating a sandwich before calling her husband to see what he wants before supper and finally gives me report. If they are calmly smoking, eating, and talking on the phone ten minutes before shift change, they can calmly put the order they just received on the MAR. I don't think they should be running like crazy to get my help, but they shouldn't be taking an extra break either.

    Off my soap box...back to our regularly scheduled topic...
  9. by   caroladybelle
    Quote from queenjean
    Do the stinking admit (this especially smarts if you are brushing off the crumbs of the birthday cake you just ate in the back room prior to shift change--ya got time to eat cake, ya got time to do the frickin admission!).
    Honey, the other day, I spent every stinkin' minute (for 14 hours, after having assignments redone every 20 minutes for 3 separate times because of staff that got pulled/reassigned/didn't show up, and having to redo report) running ragged...on a floor that I was floated to.

    I did not get a bite to it, or more than a sip of water from the fountain, from 0615 to 1900. But I did get some cake at 1900, while waiting for the assignment to be rearranged AGAIN. It was the only thing that I had to eat since.....2000 the night before.

    If somebody had shot their mouth off about some crumbs, I would have probably gone postal on them.

    Don't gripe about cake crumbs...that may have been the ONLY thing that day nurse has had all shift.
  10. by   Quickbeam
    This thread has given me waking nightmares of my years in pediatrics....8 hour night shifts in a central city hospital. 75 % of our floor admits were midnight to 7 AM. No... we, weren't staffed for it (10:1 per RN, no aide, no RT). I'd get 2-3 admits a night, sometimes 4 or 5. My philosophy was safety, comfort and as much paperwork as I could possibly get done. I left on time. I never got much guff because I worked as hard as I could.

    For the original poster, you have my sympathy and understanding. Admit overload was one of the reasons I left hospital nursing for community health. Many times, frustration with admits masks a serious staffing shortage or schedule problems.
  11. by   burn out
    Learn what the rules are at your facility and play by them. First they can not send any patient that report has not previously been called on...If it is at the end of the shift and I am tied up and I am the one to take the patient then they may have to wait until I get back to the phone to call for report...sometimes that is not until 7p.m. By that time night shift is there and can take report and the patient. If I end up having to take the admission the assessment is the only thing that has to be done in 20 minutes after arrival (in ICU) so I hook the patient up to monitors with help of my coworkers and write a short admit note and fill out the assessment form, the next shift can fill out the rest of the admission stuff and do all the lab , meds etc. Do only what has a time factor and the patient needs and make sure your other work is done before you take the admit that late.
  12. by   BrnEyedGirl
    AARRRGGGGHHHH,......trying to be nice,.really do understand we are all very busy,...called the floor at 0610 gave report,..night shift Rn (very nice) says "if you can hold this pt 20 min or so, so I can give report to ongoing shift it would sure make things smoother up here",..great,.have a few empty rooms, pt is stable, meds given,.all tucked in,.my dayshift relpacement shows up,.give her a quick report,."report is called, chart is copied,.ready for a tech to take her upstairs",..0725 get a phone call, on my cell phone, in my car on the way home,.it's the dayshift charge nurse on the floor,..'it isn't acceptable to leave a pt "in limbo" dayshift RN on floor had questions,.ER dayshift Rn "hadn't really seen the pt",.....what do you do??
  13. by   queenjean
    Quote from caroladybelle

    If somebody had shot their mouth off about some crumbs, I would have probably gone postal on them.

    Don't gripe about cake crumbs...that may have been the ONLY thing that day nurse has had all shift.
    It's fairly easy to tell whether someone (or the entire floor in genera) has had an easy or a difficult shift. No one is going to be grumpy to anyone who works hard and has had a long and difficult day.

    If you are *always* passing off tasks to do, though, when every other nurse was able to get everything done; if you are always taking smoke breaks; if you are always sitting on your a$$ eating cake or cookies when I get there, then, yeah, I'm going to give you a hard time about taking time to eat goodies instead of getting the admit done that's been here for an hour. If you ran your a$$ off and were shoving cake in your hole to keep yourself conscious while you typed at the computer trying to finish up your task list and charting, heck no am I going to be ungrateful.

    We have hard nights on nightshift, too, we really do understand.

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