Change of shift admissions

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    I work as a floor nurse on a med/surg floor and serve as president of our unit council. One of our main objectives is working towards a "no-fly zone," otherwise known as a period of time during change of shift when admits are not permitted to the floor. Our ED administrators have not heard of this concept and wanted more information. For those of you who have this in place can you please give me details such as the name of your hospital, the times it is implemented, type of hospital, etc.?

    Thanks for your help!
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  4. 7 Comments so far...

  5. 0
    I am an RN at St. John Hospital & Medical Center in Detroit, MI. We have the same exact problem but are just not sure what to do about it. I work on a busy gerontologicl med/srg unit where our average pt. ratio is 1 RN/8 patients (7 plus and admission usually).
  6. 6
    The problem from the ER point of view, is that shift change can block a transfer for as much as 2 hours. But the ambulances keep coming, the front door is constantly revolving, and I have people in the waiting room for as much as 4-6 hours. I need that ER bed. Most days when the charge is making assignments (we meet as a group, then go get indiviual report), part of the briefing is how many admits are waiting for orders or beds. Usually between 10 and 19. Takes up a lot of ER beds, not just the one I'd like to send to you.

    I have floor nurses resist report because it "almost shift change" "they are in report" (someone is watching the floor aren't they? it is just the verbal report you are passing on, and don't you want to know what is coming while making assignments?), or "we just got out of report, I have to assess the pts I already have". Yep, up to 2 hours of delay.

    Before I get flamed, I worked the floors for more than 15 years, I know it from both sides. Why do we wait until shift change? ah, we don't. That is when the bed was assigned, and if I have a delay, its because something else is going on that took priority (we are an emergency room).

    Had a nurse not want report, due to shift change, then demand I do things off the admit orders, because they were written at 1730, so I had over an hour to have done those routine things. Again, no, routine things are only done in the ER if there is a delay of many hours. Thing is, I had just come on, the previous nurse was still trying to keep her ICU pt alive and transferred, and I was helping out by doing the admit. But the floor nurse wanted to write me up about it (I spelled my name for her). Come on guys, we all care about the patients, and we all need to work together.

    So, if your no fly zone is actually only the half hour between 19 and 1930, yeah I can work with that. But that isn't the way it works out in reality, which is why our hospital went to no refusals. I have 45 minutes from the time the room is posted to send the written report to you, let you check it, verify with a quick phone call, and get the pt transported. Or get called in to explain why I am so slow on the admits. They track put through times in the computer.

    We are a 40 bed level 3 trauma center.
  7. 0
    One of the hospitals I did clinicals at had a policy where no patients could be transferred to the floor between 630 and 8. We were informed that this policy was instituted after a patient DIED. The patient was brought to the floor at 645pm from the ER. On the floor the day nurse was giving report to the night nurse, and the night nurse was getting report. The er nurse called to give report to the floor was put on hold for a long time, she hung up and called back and the secretary took a callback number to give to the oncoming nurse. The patient was already in the room and should not have been sent yet. The patient got overlooked in the shuffle, and it was some kind of cardiac death but it was not a cardiac floor. I am not certain all of the details, but this is what we were told during our clinical rotation. So basically what happened was, a group of admits at 625, and then a group at 805.
  8. 1
    As an ER nurse, I can't stress enough that people come in the ER 24/7. It doesn't stop because of shift change. Our hospital had a policy of no admits during shift change 7-730am, 3-30pm and 11-1130pm. What does the floor do? What has happened is that the floor tries to stretch the times. If you try calling a report at 10:30, they won't answer the phone, won't call you back, "didn't get the fax" because they don't want the patient. Now the patient is delayed until 11:30, report is given, tech found to take the patient up etc. and it's midnight. Our beds are turn and burn. You can't waste a bed like that! Multiple that by many, nurses who do the same thing and the ER rings to a halt, all the while the ambulances keep coming in and walk-ins too. The hallways are stacked. One the floor gets the patient the bed is full until discharge. In the ER, the next person is already in line waiting for that bed.
    Dixielee likes this.
  9. 0
    While I respect the opinions of the ER nurses on this forum, I want to point out I asked for specific information from those working in hospitals that have instituted a no fly zone policy---not your reasons as to why patients come at change of shift. I'd also like to point out I work at a very small hospital; there are no traumas here, there aren't patients stacked in the hallway. We have a unique opportunity here as we are not a large urban hospital. If those of you that work in a hospital with a similar policy could give me more details such as type of hospital, number of beds, timeframe, etc. it would be greatly appreciated. Thanks everyone for your comments!
  10. 2
    Hello. I'm a student nurse, but I've volunteered over a year at the local emergency room and have done my rotations through Med/Surge. I gotta say that I agree with JBudd 100%. You can't manage the ER as you please, the emergencies drive the department. Med-Surge and other areas just have to make it work.
    happyinillinois and Dixielee like this.
  11. 1
    I have noticed the main problem with getting admissions at change of shift is deciding who does what. What is the outgoing nurse responsible for in the admission? Do they stay until it's complete, or do whatever they can until change of shift? If the admission comes 30 minutes prior to change, then we do the arrival information, and initial assessment. Then I will try to do everything I can to help out the oncoming nurse. But this seems to be a problem everywhere. Maybe the problem can be solved by having a policy that states what each person is responsible for depending on the time the patient arrives.
    skad33 likes this.


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