Admissions during change of shift

MN-Nurse, ASN, RN · Dec 2, 2011

The right thing to do is to communicate with the charge nurse and the other staff RNs to create a plan for admitting a patient during a hectic time.

It may make sense for the oncoming nurse to take the admit, it may make sense for the current nurse to do so.

Boog'sCRRN246, RN · Dec 2, 2011

If a patient comes at 6:30am/pm, there is WAY too much to get in order to just expect day/night shift to stay over to finish the entire admission. When I get patients that close to change of shift, I make sure the patient is comfortable, then I go verify and sign off on the transfer orders/meds and do what I can on the plan of care. The nurse I'm giving report to takes over on the actual admission assessment. That way the workload is split and no one feels like they are being dumped on.

beckster_01, BSN, RN · Dec 2, 2011

This used to happen routinely on my unit. PACU/ED would delay sending the patient up so they could avoid getting a new admission, so we got stuck with admitting patients at 1830/1845... ALL the time. It doesn't happen as often anymore, thank goodness.

Usually the day shift is responsible for doing as much of the admission as possible. Charge is usually helping with most of the work. If the day shift can get the patient settled, get vital signs, set up tele, sign paper work, and straighten out the new orders for me, then I am pretty happy. With two people that doesn't take too long. It is much easier for the day shift to get everything settled then it is for the night shift to settle everything AND make sure that all of their other 5 patients have been seen and taken care of at the beginning of the shift.

mappers · Dec 2, 2011

We tried to divide the work. Someone would settle the patient, review orders and get them entered, do vitals, etc. If there was time to start the admission stuff, then we'd try. Assessments had to be completed within 8 hours I think, so the next shift could do that and finish up admission paperwork. No one stayed over unless it was crazy all the way around. The charge nurse did a lot of the admission anyway.

carolmaccas66, BSN, RN · Dec 2, 2011

I don't stay back to admit any patient. I don't get paid for it & I'm not covered by insurance if I stay back. And I've done my long overtime shifts with no pay in the past.

All I do is ensure the patient is comfortable, then hand everything over. If the arvo/night staff don't have enough people to cope with it, then they need to alert their CN or NUM re the situation. Or like somebody says, get everyone to help out a bit till the patient is settled.

loriangel14, RN · Dec 2, 2011

Usually if I get an admission close to the end of the shift I take report, get a set of vitals and settle the patient in bed.If I have time for more than that I do it.If not I pass along in report what has been done.The oncoming shift doesn't have to finish the admission right away.We just get the admission done as soon as we can. Sometimes it's 2-3 hours later before it is fully completed.

apocatastasis · Dec 2, 2011

I'm an ICU nurse who didn't get how admissions worked until I started working ER. Most non-ER nurses don't get it. It's real easy to blame us for "holding" the patient until 645 to call report... but at least at the hospitals I've worked at, that is not the case. Hell... half of us don't even WORK 7a-7p or 7p-7a, many work 9a-7p or 11a-11p or 3p-3a or work 4, 6, 8, 10 hour shifts, or are floating because they begged us to come in because we're short.

We call report when we get a room. We have no control over that. Half the time, the ER is swamped and there are other patients waiting, and that patient has to GO.

Our shift does not revolve around how hard or easy your life is. We don't get to pick who knocks on our door and you don't either. Sorry... suck it up... that's what we do.

anotherone, BSN, RN · Dec 2, 2011

we get admissions ALL THE TIME at change of shift. that is whent he majority show up from pacu or er..........ahhhhhhhhhh. who ever is there has to finish it unless they come at liek 06:58 or something like that. yes that means sometimes you stay late. the worst is when report is given to the previous nurse at 06:25 and the patient is not sent up until 07:01..............

Do-over, ASN, RN · Dec 2, 2011

Its easy to say "suck it up" but I feel it is extremely dangerous to have admits at change of shift and should not be allowed. Alternatively, I really wish we had an admission nurse.

Back to the original question. I work nights, and if I get a "late" admission, I do what I can. I make sure the patient is safe, relatively stable, tele on, and a set of vitals. If I have my meds passed and my other patients taken care of, I will work on the history and med list. I usually leave the assessment to day shift, and POC to day shift, although I will do it all if I have time.

travkitty · Dec 2, 2011

As a former med/surg floor nurse, I used to get mad when an ER admit would arrive during change of shift. Yes, it can be dangerous. However, now that I'm in the ER, & work 3p-3a, I sent the patient up when they & the room is ready. My CSN is on my butt to get the room clear for the next patient. 90% of the time, I don't even notice what time it is. Then, after I give report & send the patient up, I look at the clock to see it's right in the middle of shift change on the floor. Woops. I've worked on both sides. I wish I had the time to sit on a patient until after shift change.

jtk57 · Dec 2, 2011

This happens all the time. Even if I get report on a patient at 16:30, I could bet the mortgage payment that patient will not be on the floor until 18:45. My patients who have been off unit getting CT scans, MRI, etc. also seem to magically re-appear on the unit at the "witching hour" of 18:00 to 19:00. I have had charge nurses who refuse to accept transfers between 18:30 and 19:30 and I personally appreciate the heck out of that. On some level I think that having one RN take report and rush to evaluate a new admission and then hand off to night shift during shift change and all that is going on, it's not the safest way to provide care to the patient.