Shift change department transfer errors

You are soooo right,....we know which floors really mean it when they say they are swamped and need a few minutes and which floors are just trying to get their smoke breaks in. I'm all for everyone getting their breaks but it is very frustrating to be running your butt off, trying to hold on to a pt so the floor nurse can play catch up, then see that very same nurse walk out the ER doors to smoke! (I work nights, the only way in/out of the building is through ER to the sidewalk where everyone smokes). Please don't tell me you have a pt crashing and need to get them to the ICU then walk out the ER doors to smoke!

I don't care much for end of shift admits either. Beginning of the shift, well, I'd rather have them then than at the end.

It doesn't matter to me though what time the patient comes, I do an assessment on them, make sure that they get vitals, and make sure that their monitor is on and a strip run. The only time I don't is if the day nurse getting the patient is already there and we go in together to get the patient settled in and she/he does the assessment at that point instead. As far as I see, there is no excuse for a patient to go for an extended period of time without an assessment and care regardless of when they hit the floor (barring a code situation). But I am lucky enough to work on a unit where if I'm dealing with a situation with another patient when my new admit rolls up, another nurse will willingly take over so that I can tend to my new admit. I guess if this wasn't the case I might have a different point of view.

I really don't want to see this turn into an ER vs floor nurse bashing session,.and as I said earlier I have been on both sides of this debate. I honestly feel that it doesn't matter who changes shift when. The hospital must function consistently 24/7. Patient care cannot slack off a certain times of the day, certain days of the week etc. We must take the very best care of our pts at all times. If a pt has orders for admit and the bed is available the pt should be transfered.

Under most circumstances there are other pts in the waiting room waiting for that ER bed. Those pts in the waiting room are just that, our patients. Patients we are responsible for and must care for. Would you want your sick child/mother/father etc to wait an additional hour in the waiting room to be "fair" to the staff? How "fair" is that?

I came home just this morning from a hellish midnight shift in the ICU, ranting and raving to my husband how shift change transfers of critically ill patients are unsafe and putting my license in jeopardy! I have decided to protest but need some information/evidence to plead my (our) case.

For the second night in a row I received a transfer from the ER at shift change. They called report 10 minutes prior to my shift as I walked in the door, and hadn't even hung my coat up. I was pressured (ordered) by my charge nurse to take report, so I didn't have a choice. I requested both nights that they wait to send the patient so I could at least gather what I NEEDED for the patients arrival, and assess my other critical patient, and both times patient arrived to the floor within 10 minutes. In the meantime, I have ANOTHER critically ill vented patient trying to constantly extubate himself because for some reason we can't sedate the poor guy..... that I don't even have time to assess prior to the new critical admission.
The other nurses in my unit are GREAT however when there are two other admissions and two transfers going out to other hospitals because they are too critical for us to handle, they were busy with their own messes and help was somewhat limited. I was tied up with my patient with no blood pressure etc..., (she had already arrested and was coded for 45 minutes in ER, and was in cardiogenic shock) for easily 2 1/2 - 3 hours. Then had to leave her to take care of my other patient who was being transferred out to another hospital. Thank GOD he didn't extubate himself while he was being somewhat "babysat" by us all. As soon as he left the floor I had to pick up another patient. She was at least stable and not vented, but she was neglected for most of the night as well.
If I could have had just a 1/2 hour to: assess my first patient, run his strips, zero his line, make sure his IV's are correct and working etc... you know just a quick but NECESSARY assessment, and gather what I need for the crashing patient on the way it would make a HUGE difference. It isn't safe or fair to either patient to not have that time to devote to them. They are in INTENSIVE care for a reason. I can't tell you how many times I've followed another nurse and found drips hanging that were incorrect or running at the wrong rate etc... we all make mistakes. Imagine not being able to identify a mistake like that until three hours into YOUR shift, under YOUR license because you were too tied up with a shift change transfer to find it. THANK GOD AGAIN, that my patient's were fine and didn't have anything going on that I needed to fix!
If anyone can point me in a good direction to research policy at other facilities or evidence based practice on this topic I would greatly appreciate it!
Thanks for letting me vent!