Why do nurse managers refuse to hire admission/discharge nurses?

jadelpn, LPN, EMT-B · Jul 26, 2015

Because hiring a nurse who is exclusive to admissions and/or discharges would take money. Money that is "better" spent on a nurse or 2 who will do it all.

All about the dollar, and little sense...

jrt4 · Jul 30, 2015

Typically adding more people is not going to fix the root of the problem. This also just adds one more handoff in patient care which is one of the greatest risk for an error to occur. A reasonable amount of incidental overtime is expected in healthcare and adding an additional body is not going to solve the problem.

owensmommy · Aug 7, 2015

Admission/discharge nurses are most often only successful in very high volume hospitals. The hours worked have to be justified by the number of admissions or discharges. At organizations I have worked for, this model has been tried numerous times and has been unsuccessful. One barrier is that one complicated admission can tie up the admissions nurse for an extended period of time and then makes it impossible for them to be productive for the day. I think it is important for nurses to realize we work in a 24/7 environment. We need to build a culture where it is acceptable to hand off an admission to the oncoming nurse, even when it is not completed in its entirety.

SummerGarden, BSN, MSN, RN · Aug 8, 2015

I think it is important for nurses to realize we work in a 24/7 environment. We need to build a culture where it is acceptable to hand off an admission to the oncoming nurse, even when it is not completed in its entirety.

That happens in my hospital. If the admission is within an hour of change of shift, then the outgoing nurse need only get the patient settled: take basic information to include reconciling meds, check orders, take care for things that have to happen right away, takes vitals, assesses the patient, and reports concerns; anything else that is not urgent is handed off to the oncoming nurse. Plus, where I currently work, nurses help each other out.. If the nurse accepting a patient from ED is busy, for example, another staff nurse, the break nurse, or the Charge Nurse jumps in to assist. So I agree that it is important to develop a culture that supports nurses, who can then support patients.

With that said, even if an entire hospital does not have a supportive culture, one department can be supportive... For example, a nurse can let his/her manager know that he/she is busy and will need to hand-off the rest of the admission to the oncoming nurse. Without support, complicated admissions and discharges are still possible.

For instance, a nurse having to complete a long admission process should be able to time manage and prioritize. I once worked on a floor with 8 patients at night and had 30 pages (paper world) to complete in order to complete an admission. So I did it in parts. The important parts were completed first and as my shift went on I completed the rest. I did not spend an entire hour to two hours doing an admission complicated or not. In fact, being able to handle long admissions became apart of my time management skill set.

As for discharges... that was broken down too. If it was a complicated discharge, I started it and then left it.... Some discharges can take hours because you need equipment, teaching, meds from pharmacy... whatever... I did not spend all of my time waiting... I went to see other patients and did what i could to move the discharge along... In fact, I notice that in my current place of work, although a much better environment because there is a nurse to patient ratio based on acuity and it is supportive, the discharge process is the same... It can take hours... so my advice to all nurses in any enviroment is to move on to other patients until you can actually complete the discharge.