- 0Jan 4 by SleeepyRNHow in the world do you manage an admit on PMs when you have 35 skilled residents? How do you have time to pass all the meds, do all the treatments including wound care, document medicare residents and those on ABTs and document on things such as skin tears, page the M.D. or NP when labs come in (unrelated to the new admit) AND enter the new orders they give based off the labs. Then there is printing the pharmacy requisition, faxing it to them... At my SNF, PMs are NOT to endorse labs to the next shifts. We are expected to page the MD/NP and page and page again if they don't call back. How do you all do it?
- 0Jan 4 by SleeepyRNPS: I wasn't quite clear. How do you all manage to do all that I posted PLUS everything that needs to get done for a new admit. I had my first admit last night and had a lot of labs come in for existing residents that I had to call the MD on and enter the new orders. My shift started at 3pm. I didn't leave work til 5am! My shifts are only supposed to be 8 hours. Lordy help me.
- 1Jan 4 by VivaLasViejas, ASN, RN GuideI'm surprised you don't have an admissions nurse. That's what I did for the last six months, and believe me it was needed. Our admissions forms were over 15 pages between the physical and psychosocial assessment pieces, consents for side rail and psychotropic use, vaccination records, POLST, initial care plan and in-room care plan. It took me about 2 1/2 hours to complete the full admission process for the average SNF patient......much longer if they had dementia or a new CVA and no family to supply information. And of course the hospital never sent a complete set of orders---I always had to call for diet orders, TB tests, wound care etc.
So I have NO idea how you do it during the average nursing shift. Maybe your paperwork isn't as involved?? Ours required information that used to be gathered by the RCM, but ended up being given to the admissions nurse because it was so time-consuming. I didn't mind it because some days I didn't have a med pass and admissions were all I did, but there were also times when I had two or three admits---sometimes at the same time, on both the SNF and LTC halls. What a cluster-mug THAT was. I can't even imagine how a charge nurse would have managed it. You have my sympathies!
- 4Jan 4 by TheCommuter, ASN, RN Senior ModeratorWhen I worked in LTC on the evening shift, I only spent 10 minutes doing a quick assessment on newly admitted patients before leaving their rooms to care for my already established residents.
Of course, it helps if the new admit doesn't have family present who wants to breathe down your neck and keep you in the room with a million redundant questions when you've got other places you need to be.
- 0Jan 4 by BandagesHmm.. at my other place I also worked the 3-11 shift and thats when the admits mainly came in. When the report came in for the oncoming patient and it was a patient that was coming under a main doctor for the facility I would notify them and ask what medications will be given? Continue with the same orders from the hospital? etc etc that helped out alot! Because I was able to get the meds faxed to the pharmacy and be done with that part way before the patient would come in. Then with the labs also, I would prioritize which labs needs the most attention from the MD and fax those out then the rest. Then when the patient came in I would do my initial assessment and providing orientation to the room and then have the aides assist the resident/ patient with any other things they needed help with so you can finish the admission paperwork. Hopefully that helps but then again I'm not sure how your facility policy is on admissions and what needs to be filled out at the time of an admission.
- 0Jan 5 by amoLuciaViva - Your previous place was incredibly lucky/fortunate/blessed to have an Admissions Nurse!!! My last places did away with the position for budgeting reasons and regular staff was expected to do the admissions. And the next shift was expected to help finish an admission if nec. I even took admissions on 11-7 (want to talk about fun!).
Admissions were time consuming but I could get through most of the paperwork and again, what I couldn't complete the next shift was expected to. The advantage to that was that there were several levels of staff able to double check for completeness and fine details. It would cut down on omissions or errors.
To OP - typically the 3-11 staff gets slammed. Teamwork helps as does having a supervisor pitch in if poss. Because you're new, EVERTHING takes a bit longer for you and you're being hit with all the ROUTINE floor requirements AND admissions. Even experienced nurses take longer when they're new employees to a new place. It takes time to adjust.
But admissions are the revenue makers. And as much as it pained me, I recited "we don't get paid for empty beds" and grit my teeth.
Having some help would definitely be a plus. I realize you may be stretched to your max so you have my sympathies, but just a word to the wise - be careful about your overtime or the higher-uppers will be grousing about that.
- 0Jan 5 by sunshyne17I am do admissions for my short term rehab floor. And when there are no admissions, I clear out the orders at the desk, various assessments and treatments for both halls. Admissions take an insane amount of time. We typically have 1 or 2 a day because the turn over is so great.
No way I could get done in 10 minutes! Especially if that person has a wound, SI (which they most times do bc it's rehab).
I would say pass your critical meds when you know an admission is imminent. Then do the admission. Then hand out your vitmins and artificial tears, etc.
- 0Jan 5 by TheCommuter, ASN, RN Senior ModeratorQuote from sunshyne17I'm in rehab. My admissions take a lot longer than 10 minutes to do, but I only spend a grand total of 10 minutes with each new patient at the most. I finish the admissions after passing meds and doing treatments on my other patients.No way I could get done in 10 minutes! Especially if that person has a wound, SI (which they most times do bc it's rehab).
I had two new admissions last night. One was a total knee replacement and the other was admitted for debility. I quickly looked at their skin, dressed any wounds and moved on...
- 0Jan 8 by Vernie08That's the reason I left LTC/nursing facility and never looked back. Dangerous and down right impossible expectations. Awful awful awful. No offense to anyone who loves it. I worked in at least 4 facilities and believe me they were all the same if not worst. Hopefully things get better for you and good luck in your career.
- 1Jan 9 by SleeepyRNOur nurses and CNA's...heck ALL staff, bust their butt. (We have "Bed Makers" in the AM. How awesome is that?) But that doesn't help much when we are short staffed. It's so disheartening seeing that if we had just ONE more CNA on each shift and unit, that it would make a world of difference in our resident's lives, the CNAs lives, and the nurses', but greed keeps the money from being in the budget for it. Our unit needs a sitter. Misnomer since the role would be contantly on their feet getting fall risks to sit back down. After activities after dinner the biggest fall risks, about 15 of them, are parked at our nurses station. Oh how wonderful it would be to have a "sitter" so to speak to free up the CNAs and nurses' time. The idea is wonderful. I'll continue to dream of that. I spent an hour and a half just forcing residents to sit back down last night. I was TRYING to chart, but it was chaos. Our Internet went out by the time most residents were in bed, so I couldn't finish charting. Now I have to go on my day off to finish charting. Big shock, one of which is a fall I have to finish charting on. I have a love/hate thing with LTC/SN. I can be called an angel and a racist in the same hour. I can be smiled at and patted on the hand and kicked and spit at in the same hour. I know you all know what I'm talking about.