ED Admissions Right At Shift Change - page 3

by chordringer

11,357 Views | 27 Comments

Hello everyone - I am interested in getting some feedback on a problem we incur rather routinely at our hospital: ED admissions right at shift change. I currently work on a Surgical ICU Stepdown unit and our patients aren't... Read More


  1. 1
    Quote from CCL RN
    However, as an ICU nurse, I can take a pt with minimal to no report and still know what to do. ED nurses don't do head-to-toe assessments. The do focused assessments. The head to toe assessment is our job.

    You should, should, know how to care for any patient, with minimal report (and when I say you, I don't mean anyone specifically). Think about rapid responses, ED admits, codes, etc. We can care for the patient now, and fill out our report sheets later.

    And other ICU nurses need to be understanding if you get a shift change admit, that you won't have everything filled out. Do your best to stabilize the patient, and ensure that they are safe.

    Btw, 3:1 ratios are ridiculous. Thats where a lot of your problems stem from. No ICU should have greater than 2:1 IMO...
    Yes! So true! In a perfect world, we would get the perfect report and not receive admits between 6-8. But this probably won't happen. I worked at a hospital where report from the ED was faxed to us and it was only minimal info: diagnosis, resp status, most recent vital signs, IV access and of course anything important like if they were coded. It worked pretty well for us. Most of the time our best source of information was the MD him/herself. We have hospitalists and intensivists that do the admissions and they usually come up to the unit anyway to see the patient, so any questions about their history I ask the MD.

    In the facility I work at now, our charge nurses don't take patients. So they are available to help get new admits settled in. This isn't an admission team, but it's an extra set of hands to help you. If this isn't possible, then you have to rely on each other. When someone gets an admission, hopefully another nurse is able to keep an eye/ear out for the other patients. We all get busy, but you can only do so much and keep your patients safe at the same time. Just remember that the other floors and units are going through the same craziness you are, if not more.
    CCL RN likes this.
  2. 0
    How about icu nurses do 6a-6p and ER nurses do 8a-8p & bed control at a different start/end hour shift if it is that much of a problem?

    Or half of scheduled icu nurses do 6a-6p & the other half 3p-11p wih some type of bonus incentive to work them hours

    In-service Doctors, nurses, housekeeping/bed control on issues...

    I dont know much but it seems like if this has been an ongoing problem for decades...Shouldn't there be some type of resolution to the problem outside of admit teams that may or may not be able to handle all of the admits at change of shift time.....

    Come on experienced nurses...What really needs to be done in order to satisfy all er,floor, & icu nurses?
  3. 0
    Quote from gcupid
    How about icu nurses do 6a-6p and ER nurses do 8a-8p & bed control at a different start/end hour shift if it is that much of a problem?

    Or half of scheduled icu nurses do 6a-6p & the other half 3p-11p wih some type of bonus incentive to work them hours

    In-service Doctors, nurses, housekeeping/bed control on issues...

    I dont know much but it seems like if this has been an ongoing problem for decades...Shouldn't there be some type of resolution to the problem outside of admit teams that may or may not be able to handle all of the admits at change of shift time.....

    Come on experienced nurses...What really needs to be done in order to satisfy all er,floor, & icu nurses?
    That would be good, except ER staffing runs all kinds of crazy hours. For example: 7a-7p, 10a-10p, 11a-11p, 12:30p-1a, 3p-11p, 3p-3a, 7p-3a, 7p-7a, 11p-7a... and all the other goofy shifts I missed.
  4. 0
    Quote from LegzRN
    That would be good, except ER staffing runs all kinds of crazy hours. For example: 7a-7p, 10a-10p, 11a-11p, 12:30p-1a, 3p-11p, 3p-3a, 7p-3a, 7p-7a, 11p-7a... and all the other goofy shifts I missed.
    Okay, So do you know what I interpreted from this response?

    The fault or issue mainly lies moreso with the ED rather than the other departments....

    However, bc the ED may have issues that may take precedence etc... it's not logical for other departments to expect (a controlled & routine environment) patients sent up at convient times for icu/floor nurses....

    The only thing I can think of next is that there must be a way of detecting routine abuse on the ED side especially when things in the ER shouldn't be so otherwise predictable (aka, the dumping of what seems to be almost all admits around shift change)

    Any productive ideas?

    Correct me if I'm wrong because I have the slightest idea of what goes on both sides (er/icu), I'm acting as a mediator, LOL!

    One last thing..Ive heard bed control being used as a legitimate excuse or scapegoat.....What could eliminate that problem? Should management hire more nurses @ 20+ an hr or do they just need more of housekeeping at 10+ an hr?
    Last edit by gcupid on Feb 23, '11
  5. 0
    I've finally had the chance to get back and read through everyone's ideas and comments. I really appreciate the feedback, some truly great and real issues being tossed around.
  6. 0
    I am not an ED nurse, but I totally agree with you. It's just one of those sucky things that have to be dealt with. I know that when I get a change of shift admission, it's not b/c ED nurses want to make my life miserable. It's just gotta be done. I have great respect for ED nurses. I always tell the nurses that bring the patients up how much I appreciate that I don't have to be first to see the patient. Patient usually stablized by the time I get them.


    Quote from piratern
    Let me come at this from the ED side of things. What you are describing is not a unique situation. Many of the issues result from a misunderstanding of what each other does and the type of nursing required for each area. Any ED nurse would take offense at being referred to as "functional". Any ED nurse would tell you we can't stop the ambulances from coming during our shift changes. Any ED nurse would tell you we'd love to have a stable 3:1 ratio but can not turn patients away. Therefore we must make room for them and that means getting admitted patients upstairs to admitted rooms. We just got a group together to discuss this very issue and improve our report process. ED nurses should be reporting on those they are assigned to care for. What you describe is unacceptable. However, the "no fly zone" between shift change presents a problem. ED nurses change shifts at the same time as well. If you hold admitted patients in the ED, you are forced to have the off going nurse stay over or the oncoming nurse give report and they don't know the patient. Determining how to handle this requires a concerted effort by all involved. Until we all view this as a system problem and not an ED problem or a floor problem, we won't be successful. When we begin to think outside the box, we'll all come up with some really good ideas and solve this situation. One more thing... always think about this from the aspect of what's best for the patient and let that be your guiding principle. Good luck to us all!
  7. 0
    I think this is a problem everywhere! And I haven't come up with a good way to fix it. I work in med/surg ICU and we do not get along really well with the ED because of these issues. Several times I have recieved a patient from ED with severe dyspnea that had to be intubated as soon as they were moved off the stretcher. Not sure if it is just a nursing problem but pobably physician too.
  8. 0
    we get that all the time from the ED - or they call report and the pt won't show up for hours... so when they come, the nrse who received report is gone/leaving and the next nurse takes the admit. The ICU is notorious for sending us change-of-shift vented patients as well... you know you're going to get at least an hour overtime when you get one of those


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