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

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
    Shift change admits are not cool. I had the misfortune to go into labor and present to the OB dept at shift change. They just put me in a room, did a brief assessment and didn't give me a call light (too big a hurry to get the hell out of there) went from 5-10 in record time. Door was closed, hubby stepped out to get a cup of coffee. I almost had my daughter by myself! A little too close for me, this momma don't do her own midwifery!

    On the other hand, all of us in the MICU get used as the hospital float pool more than the other 2 ICUs. We get pulled all over the hospital and unfortunately have to go to the ER. If we are working with certain irregular ER staff, we know it's not going to be a good day. The irregular staff will hold their patients as long as they can and those of us who are pulled or work agency are working our butts off. Do the irregular staff help when we are in a bind?? NOO! They have a new charge nurse there and I hope she can light a fire under some of them. NM got fed up with trying to deal and she resigned.
  2. by   PANurseRN1
    Quote from 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!
    We do not sit around in the ED "La di da, la di da, oh well, I have nothing better to do, I guess I'll ruin the floor nurse's day by holding my pt until it's the most inconvenient time for her to take him, then I'll call with report."
  3. by   PANurseRN1
    Quote from Baptized_By_Fire
    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.
    I found that claim extremely hard to believe as well. We are constantly told about wait times. Oh yeah, and what with all of the "no fly zones" the floors have about when you can't call report and with ED holding pts, you had better believe the second we can get a pt upstairs, they go. An ED is no place for a pt to be held waiting for a bed.
  4. by   PANurseRN1
    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!).
    Wow. Really, sometimes the things I see here just amaze me.
  5. by   Daywalker
    Quote from DusktilDawn
    The most frequent time my unit receives admissions and transfers: SHIFT CHANGE. OH and Admitting assign beds just before shift change (that way Staffing can understaff the unit). We're lucky if we even receive report on patients from RR or ER.
    You must work at my hospital! The pt's usually arrive on the floor with labs and ECG's pending, too (my biggest beef, since ER is supposed to do those things, and I'm busy enough as it is). Our place does admits even in the middle of the night, but that doesn't mean you should regularly put in an hour or more of OT on this. That's why there's another shift.
  6. by   Roy Fokker
    I like how we on nights are expected to deal with admits - but they won't even send us a unit secretary (or let us have a charge nurse!) for our night shift.

    And it really chaps my hide how we keep getting medical patients (I work on a surgical floor) - and when we check the board, we see that medical has one or two beds free. :stone I won't bother griping about how medical gets better staffing than we do.

    I need to really push my Director about this - oh wait! I forgot! The director for both floors is the same person
  7. by   jw62
    PICKME, I hate to hear how frustrated you are, but know the feeling. I have been a nurse for almost 22 years and theproblems stay the same.

    Sometimes the later admits can be because the Dr offices are closed and therefore the patient comes to ER...

    I can't speak for other hospitals, but I know at ours the admits just happen when they happen...last night they had 5 admits on the night shift...

    Please try to hang in there...it IS frustrating, but this can maybe be a way to help make an improvment...grab the bull by the horns and go to yoru leaders with a fiscally responsible plan that might help you all...maybe having someone stagger shifts? or someone who is just dedicated to admits and procedures (that type of thing)....

    We need good nurses, and I can understand your frustration but it really is 'that way all over' or so we all hear that...
  8. by   rn undisclosed name
    It is the same where I am at. I got an admit at 6:30 pm yesterday and actually didn't mind BECAUSE I was working the 3pm - 11pm shift (I normally work 7am-7pm). When I get an admission 95% of the time it is at change of shift. How freaking ironic. Yes, I don't appreciate it at all. I know that ER claims they don't hold patients, etc. but I'm not a believer. Maybe at their hospital they don't but I'm sure the ones who claim this aren't at my hospital. Also, 95% of the time I am told a patient is on the way up and they will maybe be there an hour later. If it's going to take that long I would like to know.

    No, they don't have to wait for the docs to come from the clinic because our ER docs do all the orders and admissions, etc. Depending on which doctor is working the ER depends on how many admissions we get. Certain docs are notorious for admitting everyone. The docs who do rounds (attending and specialists) tell the ER docs not to admit certain patients and lo and behold they admit them anyways. These docs also round at other hospitals and they say this doesn't happen at other hospitals it's only this particular group of ER docs who admit. We received a pt the other day. The family couldn't pick him up so they sent him up to a telemetry floor (of all places) so we could babysit him. He had no criteria to be admitted and was told by the primary and consult to not admit. As soon as he got to the floor he was discharged as soon as his family could get him. How freaking inappropriate is that? Why did they send him up at change of shift? Oh because that is when this attending was no longer on call and it would be a different doctor who wouldn't know what was going on.

    We do have an admission nurse in the ER. I'm not sure of the exact hours but she does fill out the admission assessment which is a huge help and makes me not mind the admissions later in the day. I wish they had another nurse who did those too for other times of the day. It would save the nurses up on the floor a ton of time.

    I am not lumping ER nurses into this statement but on one particular day this week all this occurred with our admissions. A patient came up with no IV site (this is a tele floor and this is hospital policy) and no the patient was not a hard stick, another admission came up and the patient was filthy (quite obvious they had been laying in their own stool for hours), and the 3rd admission did not have their admission stuff done (the admission nurse was working this day) on the patient we needed to babysit and the patients old chart was in the ER and they did not bring it up with them and wouldn't bring it when we called so we could get some history on the patient. The patient had a previous head injury and couldn't give us a good history.

    It is unfortunate that this happens. I have had things said to me in the past about how the ER doesn't hold patients and shouldn't have to hold patients because it is change of shift etc. Well when I am told I am getting a patient I shouldn't have to wait an hour or longer after I have already received report. I can understand this happening occassionally but not the majority of the time.
  9. by   PANurseRN1
    No, and we shouldn't have to hold pts in the ED because the floors have so many "no fly zones" when you can't call report, in addition to the game of "catch me if you can" during the times when you actually can call report. Not to mention that rarely does anyone ever offer to help when I get the pt upstairs. OB/Womens' Health is the worst offender for this; heck, they don't even acknowledge you when you come, half the time the room isn't set up, and then they expect you to stop and repeat the report that you just gave 15 minutes ago.

    I'm sorry, but it cuts both ways.
  10. by   dazey71
    If I get an admit after 6, I go in, peek at them, and if they are stable, thats about it. I'm too busy trying to get out on time to worry about a new patient. I'm grateful that we have a charge nurse that helps out with late admits.

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