Admission/Discharge nurse

pk1 · Nov 9, 2005

Lori, where are you located? I'm in rural Virginia, in a small hospital also. Our unit is telemetry with 24 private rooms. We have a discharge planner that helps coordinate home care needs and transfers to nursing homes. We are interested to trying an admission nurse to try to take some of the load off the staff. We have a big turn over in patients almost every day. Working the nurses to death. What is your nurse to patient ratio? Do ya'll have to float to other units? This is also an issue with us. Due to call outs on other units, we get pulled frequently.

sweetielin · Nov 9, 2005

we do not have an admission nurse. an er nurse comes up to help if they are not busy. sometimes a nurse from 1st floor comes up.(we only have 2 floors.) also if the nurses from the other end are not too busy, they pitch. everyone on our shift helps out when they are able.

pk1 · Nov 9, 2005

You are lucky to have others who willingly help, from other units. I saw that more years ago, but less often these days. Everything is so rush-rush!

ljds · Nov 10, 2005

I'm in northeast Kansas.

We have quite a bit of floating that goes on between floors; mainly between medical, surgical, rehab/skilled nursing and ER, occasionally ICU. Mother/baby, nursery, and peds is all under one department, so that everyone who works there spends six months in every position, then picks two areas of specialty (so I've been told).

No one *likes* to float, though honestly, it's not that terrible. I think it's just disconcerting to be suddenly put somewhere that you weren't expecting.

On night shift, our nurse to pt ratio is usually 3-4 pts per nurse. Sometimes more, depends upon the admits. It used to be that I would start out the night with 4, then get one or two admits; we have had a change of directors, and now they really try hard to keep it at 3-4 pts per nurse, with additional staff called in if things get too crazy.

Our pt turn over is crazy. It's somewhere like 85%. I work three 12s in a row, and rarely do I have the same group of pts those three nocs. I think our pts must average 1.5 days on the floor; maybe a bit more, but not much. It's common that I admit someone during one shift, and by the time I come back the next night, they have already been discharged. We have alot more obervation pts than we used to.

I think some of that has to do with improved outpt opportunities for treatment. We have an observation unit for tele pts that is part of the ER, staffed by ER nurses. It's for those pts who need to be on a tele for a while, maybe while their waiting to complete their cardiac marker panel. Pts who probably didn't have a heart attack, but who they arne't comfortable sending home yet. We also have newer outpt dialysis and chemo units; these pts aren't admited to the floor anymore, either, like they were 5-10 years ago. And I think we are sending people home sicker. They are using more home health and home therapy than they used to.

I run my bum off most nights, but I don't feel overwhelmed, just steadily busy. And some nights are down right slow (slap my face, I can't believe I said that, I cursed myself for sure now).

I just started back to this hospital after a four year hiatus. I can honestly say I am really loving it. Don't know how I'll feel a three months from now, during the height of the pneumonia/flu season, when like everyone else our census goes up to near capacity. But for now I feel relatively well supported by my director (she was a nurse on our floor for about 10 years until just recently; so I feel like she has our back. Our other directors never came directly from the floor; all were RNs who had long ago hung up their scrubs. It means alot to me that our director regularly wears scrubs instead of a business suit). I feel like we are decently staffed. I do wish we didn't float so much; but in part that is the nature of the beast, don't you think?

adidas99 · Nov 10, 2005

Have to say, a pharmacist on the floor would be great. It stinks to have pharmacy leave at 9pm and they miss your msg about needing medicine, so then an Rn has to go to the "night room" on peds and get it out of the pyxis(which carries other drugs the usual floor pyxis doesn't) up there.

We don't have a nurse that's called the admision/discharge nurse,but bascially the floating nurse(which 2 of them work 11-7p) helps the charge nurse with it. Day shift always utilizes the float nurse for admissions, if they aren't dealing with outpatient blood transfusions. They sometimes, if has time, will write out ur discharge orders, but usually the nurse then gives the discharge papers to the patient after reviewing what the float nurse wrote. If no one is scheduled from 11-7 or one of the 3-11 nurses doesn't float, then the charge nurse does all the admissions, and on 3-11 we're responsible to do the discharge instructions unless someone else offers to do it for us.

HelloKittyRN · Nov 12, 2005

We have an admit nurse that works 11a-11p M-F and a rescue nurse that works from 7a-11p every day. Since our hospital started doing this it has helped immensely. The admit nurse strictly does admits, but the rescue nurse can help with whatever you need. She can do discharges, pass meds for you, hang blood, etc. They are lifesavers! The only thing I wish is that we had a satelite pharmacy so we don't have to wait for stat and now meds.

NYRN05 · Nov 29, 2005

Our unit has a admit/discharge nurse. She works from 2 to 1230 am....which helps a lot. Not that you wouldn't get a discharge or admit but she covers them which leaves you more time to get things done with your group.

veegeern, BSN, RN · Dec 1, 2005

My unit has a clinical coordinator who acts as our charge nurse from 7a-3p. If we have at less than 13 patient's on the floor or if we are short staffed, then she has a team. If she does not have a team, then she does admissions to include hx, assess, initiate care plan, and IV access. If she has time, she will also insert foleys, etc...if ordered. If she has time, she will assist with discharges by making appointments, dc attachements, and typing dc instructions (computerized). The primary care nurse is responsible for teaching, giving instructions, documenting in notes...It's a team effort that takes a lot of communication.

n tisdale · Dec 7, 2005

Does anyone utilize an Adm./Discharge nurse during the peak hours that adm./discharges occur? We stay on diversion alot, and were trying to think of a way we can speed up these processes. Possibly create a position for a nurse to work these busy hours with their focus on the adm/discharges. Has anyone tried this, is there a job description for this?

YES! I am an admissions nurse in a cardiac hospital.It is a new and very successful position. We also have discharge nurses for our CHF patients and all cardiac surgery pts. Heart transplants have their own set of discharge nurses. I love the idea of a general discharge nurse in the morning. that always takes SO much time! transfers to skilled facilities and rehab or nursing home takes forever. The paperwork. PM me.