Ever since I was a little RN, admitting would call and tell me that my patient had been Observation status for too long and today, right now, it had to be changed to Inpatient status, meaning I had to call the MD and get that changed. The first few years, I was working nights, and I would get this hassle heaped upon me near to midnight. I recall the charge nurse enforcing that view, making me call an MD at midnight to change to Inpatient. He was not pleased.
Now I'm a bigger RN and nothing has changed. My hospital recently changed from non-profit to for-profit, and they are noticeably more disagreeable regarding the Observation topic. Case managers chase after the RN and stress her out about this "changing to Inpatient status," and if that doesn't work, they bully the charge nurse.
My question to you: whose job is this? The MD admits to Observation, yet Admitting won't call them. Case management won't call them. Everyone dumps on the RN, like it's her job to do everything (another topic). This thing must go on in your hospitals, how do you handle it?