My facility sounds a lot like yours. We used to do the admissions/discharge nurse thing but that stopped.
Presently,, we have our Nurse Manager that is there most of the time during the day. She works 8-3ish.
Say we have 15 patients on the floor,, we will have 2RN care managers, 2LPN's although i have seen LPN's routinely taking 15 patients depending on scheduling, 2CNA's.
Rn does all daily assessments for her team of patients, IVP to central lines, etc.
LPN does meds/treatments/dressings as well as helps CNA's with ADL's when possible.
CNA's do baths, feeding, toileting etc.
Dishcharges and admissions are done by the RN staff (care managers) that are assigned to the new patients team. We do our own discharges,admission assessments and detailed interview of patient or family, post ops, and all MAR information and calling doctors etc.
LPN will document home meds, surgical history, etc. Subsequent post op checks after the intital check by the RN. Along with daily duties.
CNA's do admission vitals, post op vitals, room setup and room/hospital orientation. Along with daily duties.
I have seen days when each team may end up with 11-12 patients which is boardering unreasonable and dangerous, however i know we cant have staff sitting around waiting. And they try to staff with a 3rd RN if they know it will be a heavy surgical day, she would be assigned a team, splitting the 15 between 3RN's. No more than 2 LPN's, possibly another CNA if a heavy day is expected or patient acuity is REAL bad.
Our nurse manager acts as charge nurse on days, so there is one position you carry that we dont. She will do patient bed assignments, team assignments, make/take calls if needed, and manages the administrative aspects of the floor.
We dont utilize a discharge/admissions nurse. It looks as though the staff you would have in your admissions/discharge position is doing exactly what we do as RN care managers in our team nursing. We usually have one RN with an assignment that acts as resource nurse and if that hasnt been delegated then we usually will put an admission where it "fits" within the mix of patients we have. Our unit clerk will call one of us to the phone or take info and we call admissions back after we have made the assignment.
Getting staff to cooperate with changes is dependant on your staff. Some will work with it and make adjustments, others will have a very difficult time taking on duties they have historically seen as someone elses responsibility.
Actually the RN of the team doing her own discharges and admissions only makes sense. They know the patients presentation, course of treatment since admission, she should have been collaborating with the doctor when he made rounds and knows what other directions he made to the patient that can be incorperated into the discharge instructions or to pass on to the next shift. When you have a discharge/admissions nurse doing just that, there is to much room for communication breakdown between admission and team leader takeover of that patient. Ive worked med/surg for 13 years and have never seen a discharge/admission nurse on our unit.
Things go pretty smoothly this way. Occasionally there is some discrepancy about where the admission should be placed. And we have a "house supervisor" that tends to be a control freak and makes things difficult by "placing" patients all on one team through a shift (you know what we think of her). We have days when we work our behinds off but for the most part it works.