The Admission Process: Make sure you actually say something of importance! - page 2

by pinkiepieRN, ADN | 6,877 Views | 19 Comments

I work in LTC so this may not be applicable across the board, but here goes. We've picked up some new grads on 3-11 and I'm not exactly happy with them. The one that's off of orientation and working the floor had an admission... Read More


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    We have a complete packet that addresses all those individual things not in the admission note. We also have a check list of what each shift are to handle on admission. What the first shift receiving has to complete, until three shifts have done their part in 24 hours. Our admission noted is very basic, the diagnosis are listed in the PCC (electronic record), if someone can in for something like a hip replacement, I will address that with the size of surgical site and amount of staples, I will mention if alert or confused, ambulatory status isn't mentioned until PT assesses. It sounds like more education in this arena needs to be clearer, every facility does things differently.
    1feistymama and jalyc RN like this.
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    I think It is good to know where to start with writing admission note and when to stop depending on unit policy. Generally It should be focused.
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    When I worked an LTC in the 90's I spoke with the DON & administrator about orientation problems like this. I was then paid to put together a notebook with ALL of our paperwork, showing appropriate documentation for nursing, housekeeping, laundry, dietary, & maintenance. One was on each unit for reference and one was the master for HR. HR made copies of each blank and filled in paper for orientees. With that we knew EVERYTHING was covered in orientation and they always had a reference to turn to anytime day or night. Charge nurses were then responsible for updating new forms.
    We also had packets with a checklist premade for admissions, discharges, and hospital transfers so nothing would be missed there. Just some ideas.
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    Nursing school is focused on useless APA style papers, not teaching things that matter.
    1feistymama and Marisette like this.
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    I wonder if the OP realizes it was stated a nurse just off orientation was ORIENTING a new grad. I suspect it is the facility and the experienced nurses who work there that is the problem . My facility wants the basics in NN, such as why they are there and if they're attending PT and what nursing is doing for them. What they do not want is a H&P. BRIEF assessment only. As it was said earlier, all facilities are different and new to the facility nurses, new grad or not, rely on experienced nurses and protocol to learn the ropes.
    Last edit by sas05 on Feb 13
    SE_BSN_RN likes this.
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    I understand your frustration, I feel for the new grad too. One of my favorite quotes is, "The single biggest problem of communication is the illusion that it has taken place" -George Bernard Shaw. I think you'd be surprised by how eager the new RNs are to do things correctly and earn the respect of peers. You'd be an advocate for them if you shared your expectations. And you might also make some lifelong friends.
    -2nd Time Around but Soon-to-Be 1st Time New Grad
    1feistymama, SE_BSN_RN, and pinkiepieRN like this.
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    Quote from SlightlyHumerus
    I understand your frustration, I feel for the new grad too. One of my favorite quotes is, "The single biggest problem of communication is the illusion that it has taken place" -George Bernard Shaw. I think you'd be surprised by how eager the new RNs are to do things correctly and earn the respect of peers. You'd be an advocate for them if you shared your expectations. And you might also make some lifelong friends. -2nd Time Around but Soon-to-Be 1st Time New Grad
    Thank you. I know you're right. I think it's crazy because I seems like I'm the only person in the building to really care about them, and they're not even on my shift!
    boogalina and SlightlyHumerus like this.
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    Quote from adnrnstudent
    Nursing school is focused on useless APA style papers, not teaching things that matter.
    Really? In what world? Certainly not in mine! The first thing I was taught was a head to toe assessment! 8 years later I still do them.
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    That admission note looks like something I would have wrote just off orientation, too. I did a full head to toe assessment on each admission I got. What happens if you overlook something that could potentially be important? If they were stable, they would be at home, not in a facility! I can do a quick focused assessment in 5 minutes.
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    We normally get report and a discharge summary from the hospital so there's a lot of information readily available. I'm guessing you figured out ambulation and cognitive status when you brought him to the bathroom. (And minor things like race and bowel troubles.) I don't know what kind of paperwork you guys have but generally I would know exactly which sections to skip to to find the information that I need. I would then do my best to put a note together, call his dialysis center in the morning if they are open or ask the oncoming shift to do so. (And it's not necessary to play the blame game, "we need to figure out which days he has dialysis" would suffice.) And sure, if there needs to be a change with the orientation process (new grads and new grads training new grads) or whatever the situation may be, you can easily fix it since you know the right people to talk to. This situation doesn't sound too critical to me. Struggling new grads will be fine in a few weeks with training.
    Altra likes this.


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