admission/transfers during shift change

Seaofclouds, BSN, RN · May 6, 2015

This varies from place to place, so you need to ask your manager what the expectations are when these things happen at shift change. At my current employer, our policy is that if an admission arrives after 6pm, the day shift are responsible for getting the patient settled in bed, a set of vitals, height, and weight. The night shift nurse is responsible for completing the rest of the admission paperwork. If it were a transfer, it would depend on what still needs to be done for the transfer. If nothing has been started yet, then the next shift would complete everything. For discharges, the oncoming staff would be responsible for completing everything rather than the leaving shift staying late to do it.

Galendria · May 6, 2015

I also work from 7am to 7:30pm. The unofficial "rule" for both shifts is that if a admission comes before 6:30 am/pm the previous shift will attempt to do most of the admission. If they arrive after 6:30am/pm the previous shift settles the patient, gets crucial stuff such as height/weight, vital signs, allergies, and stat orders done, makes sure they are safe, and then oncoming nurse takes over.

As with all things we are only human. Because what goes around comes around...and because I know extra work is hard at the beginning of a shift...I do try to do as much as I can for the oncoming nurse. But I won't stay past the end of my shift to do a last minute admission or discharge either. Also, it goes without saying, work left for the next shift is taken better if previous shift nurses aren't all sitting around the nurses station on their phones or gabbing at 6:45 am/pm

On a final note though, the one time I always stay (even past time to leave) is my patient suddenly becomes unstable at end of shift, of if that last minute admission that arrived at 6:55 pm looks green around the gills. Usually by 8 pm the emergency response team has arrived and been given all pertinent details, the doctor is at the bedside, oncoming charge RN knows the scoop, oncoming bedside nurse is more organized, and I can head home then.

~PedsRN~, BSN, RN · May 6, 2015

I think shift change transfers and admissions should be banned. Ugh. They are such a pain in the butt. Anything that comes after 6:30 (I work 6:45 to 7:15) I do a "check and settle". We have 24 hours to get an admission history completed and I am not going to kill myself at change of shift! I don't expect my teammates to do it either. that's crappy that your management makes you feel like crap about it. You have already worked your hours. I do not stay late if at all possible. :)

Dranger · May 6, 2015

This pisses me off to no end. I send an incident report every time this happens to me. ED is offset by and hour, we start at 7 they start at 6, so they ALWAYS send the patient at 7.

Swellz · May 7, 2015

This happens with ED patients all the time coming to us. It's infuriating. I do as much as I can do. I don't think a policy is fair because sometimes I can get someone with an hour left in my shift and I genuinely don't have time to do the admission history, but sometimes they come and I can get all that done in 15 minutes.

I used to tell the ED we couldn't take report between 6:45 and 7:15 2/2 change of shift, but then you just end up with report from a nurse who doesn't know the patient. I don't know what the solution is. I'm sure there is a reason they always get sent up at change of shift, but it better be good.

dudette10, MSN, RN · May 7, 2015

When you're talking getting someone that late/early in the shift, I always switch to patient safety mode and don't worry about the paperwork. Get them settled, do an assessment, vital signs, put on a tele monitor if ordered, quick orientation to admission routine and call bell and phone usage, nonslip socks on, check ability to ambulate to bathroom independently and safely. Write a quick note.

Often I can ask the nursing admission questions while I'm doing all this and enter them into the appropriate flowsheet within a few minutes. Honestly, admissions don't take that long. Discharges take longer because there is always something I need to call the resident about.

A couple day ago, I had someone come in very late (~1800), and I had finished almost everything, including meds she had needed to take and implementing other admission orders entered by the admitting team while the patient was still in the ED waiting for transport. The oncoming nurse had to only do her usual assessment flowsheet to get the system to recognize that all admission required docs were done. I told her that, and she still said, "Ok, I'll finish the admission." I said, "No, you don't have to 'finish the admission'; you only have to do what you would normally do for any patient at the start of your shift--the assessment flowsheet.'" She looked at me like I had 3 heads, and I just gave up.