Admissions during change of shift

apocatastasis · 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.

We get large numbers of walk-ins, codes, EMS patients, admits, all of whom don't give a rat's you-know-what about our shift change. We shouldn't be the only ones who have to bear the brunt of it. Or, even worse, get it from both ends: the floor AND the outside world.

NeoPediRN · Dec 2, 2011

If an admission came within an hour of change of shift, the current shift would settle in the patient and take care of any stat meds, and the oncoming shift would be responsible for the admission assessment.

9livesRN, BSN, RN · Dec 2, 2011

We do 6 o clock deals, befor six am it's night and before six pm it is days. However we pick up where the other one has left off. Today I got one at 625PM and I did 80% before I left... Do onto others as you would like done onto you!

birdie22 · Dec 2, 2011

It's called teamwork. No one individual should have to do the entire admission. The current nurse does what they can get accomplished in a reasonable amount of time given the situation, and lets the new nurse know what still needs to be done. Thats our standard on my floor and we never seem to have any issues.

If everyone was on the same page about the rules, it wouldn't be such a big deal. If you do think it should be assigned to one nurse, make that decision as a floor, and that becomes your standard. You cant have half of the people thinking the current nurse should do everything and then the other half think the new nurse should. Its all about communication....

anotherone, BSN, RN · Dec 2, 2011

It is bad practice and bad for the patient because we routinely get change of shift admissions with stat orders never done in the ER to do on the floor ( have 15mins to do them so the pt can still get to the floor before the time is up)............ well at 1900 i am getting report......... the pt is in the room at 1905, ( report on 5-6 patients takes more than 5 minutes) who is supposed to be carrying out these orders etc. admissions can take up to an hour or more to get settled depending on the pt.(some are 20mins at most)but if it someone with stat ct scan, stat meds, stat this and that, it can be close to 2 hours into the shift before other patients are seen. i don't fault the er nurse but the whole thing still annoys me. this is why i try to get as much done as possible for the other nurse. have the room set up at least, do as much as possible etc.

Anna Flaxis, BSN, RN · Dec 2, 2011

who should take it, the day shift or night shift nurse? im curious about all your opinions. i think it could go either way. where i work, nurses work 6:45 am to 6:45 pm, and then 6:45 pm to 6:45 am. if a pt comes at 6:30, who do you think should do the entire admission? because if day shift takes it, they end up staying WAY past their time. and if night shift takes it, they get piled with work before they even stepped in the door. what do you think is the right thing?

The first problem I see is that there is no overlap built into your shifts. This is a setup for exactly this type of conflict. Having a half hour overlap would create a window of time for report and tying up loose ends.

Regardless, the offgoing shift should be responsible for tucking the patient in and doing a quick focused assessment to make sure the patient is stable, and the oncoming shift should do the admission.

When I worked on the floor, we used to utilize our house float to assist with admissions during busy times. The house float could come and do the admission assessment and med rec and start any stat orders, giving the primary nurse time to get her/his feet on the ground before taking over care of that patient.

Vinniesguy · Dec 2, 2011

When it happens (which is often) the day shift will do a set of vitals, get them something to eat if it's appropriate and order meds up from pharmacy. It makes sense for the next shift to actually admit them otherwise you end up handing over a patient you don't really know and haven't had time to assess properly.

Creamsoda, ASN, RN · Dec 2, 2011

If the patient comes 15 min before end of shift, get the patient settled, if anything STAT needs to be done do it, chart a basic assessment make sure the patient is stable and thats it. Go over the orders with the oncoming RN. Its not your responsibility to stay past.

That Guy, BSN, RN, EMT-B · Dec 2, 2011

Right now it really depends on who the nurse is on days before you. Some are really good about getting as much done as possible, others are just dicks and act like they dont even know there is someone in the room. We rarely get those early admits in the morning, but I at least try to get the first 4 sections done ( Height, weight, allergies, brief medical history, meds, fall risk )

Chaya, ASN, RN · Dec 2, 2011

Shift change for us is generally 7:00 with 30 min overlap. Official policy is if the admission arrives after 6:30, the off-going nurse has to get them settled and make sure they are basically stable, get vital signs and get them hooked up to tele. Even though the oncoming nurse will need to do their own assessment, for my own protection I do a basic 5-10 min head-to-toe directed assessment: mental status, pain, wound, respiratory, cardiac with emphasis on their admitting diagnosis, and a quick check of any lines/ tubes. Basically: are they breathing and not bleeding. However even in the simplest cases the O2 tubing needs to be changed immediately (ER tubing not compatible with our wall supply), the patient needs to jump off the stretcher IMMEDIATELY and run into the bathroom, they generally have not had dinner, may not have a diet order yet and the kitchen closes at 6:45, and they are inevitably accompanied by a few relatives who have been in the ER with them for hours and are hovering around the nurse's station as you are trying to give report, waiting to talk to you before they leave. Kind of a pain but I can deal with that.

The ones that really **** me off are when they send the total "train wreck" kind of patient to us at change of shift; confused, aspiration precautions with a tube feed running, complex wound issues, rectal tube (or not!) and oh yeah; forgot to tell you they're on contact/ droplet precautions. And they need pain medication right now, but as a transfer from the MICU all their orders need to be d/c'ed and re-written. Or just had a new order written-for a stat heparin/ diltiazam drip. More than just unconvenient and unfair to both nurses and the patient- THIS IS UNSAFE! It's not fair to the oncoming nurse who has 4-5 patients to assess and a med pass to do and it is not fair to the new admission who needs some focused time when just arrived.

dudette10, MSN, RN · Dec 2, 2011

On my unit, we have a set time. If the patient is physically on the floor before that time, the current shift gets the admission, even if it means staying over. If the patient comes up to the floor after that time, the next shift gets the admission, but the current shift does vitals and sets the patient up in the room. Of course, if there's evidence of instability (which sometimes happens), both shift nurses chip in to resolve it.

It works well because everyone knows the window of time and rarely does anyone complain. Yes, it does mean that I might walk into work with an admission waiting for me.

rr82080 · Dec 2, 2011

For those of you who have stated rules or policies, I think that is great. When everyone knows what they are supposed to do usually it gets done with minimal complaint. I have worked on a floor and now in an ICU and on the floor admissions always came at shift change. But often times my coworkers would hang on to discharges for a while to finish their other work, take a break or in hopes of delaying long enough to not get an admission. Well if your open room isn't ready until 1800 when do you think the admission is going to come? I would personally put my patients in a wheel chair and race them down to the front door in hopes of getting my next admission at 1600 not 1830. In the ICU we have to just take the patients as they come and often the OR brings them over between 1830 and 1930. We do what we can as a team to get them ready for the next shift. I will stay late to finish my charting. I also see people race to get patients out of the unit before the end of their shift. But working in an ICU if there is a very unstable patient coming from ER/OR they don't have time to wait, we race someone out of there and race the next patient in. Better to get it done ahead of time than play that rush game if you can help it. Even if it means transferring a patient at shift change. I always also let the nurse taking the patient know that the patient is stable enough that if you can't give them your full attention for 30 minutes they will be just fine. If not they should've stayed in the ICU.