Admissions during change of shift

thatone · Dec 2, 2011

I do as much as I can while still getting my other work finished. If I can manage to get the whole thing done, great! If all I manage is to get the patient settled in the room, well, that's ok too. We don't have a policy on it but if you don't get the admission done and they've been on the floor for an hour you better have a very good reason cause that makes folks very cranky.

A friend of mine works in a neighboring hospital and they have a 30 minute window on either side of shift change where they don't get admissions or transfers. If ER has a pt to send, they know they have to send it by 630 or they are keeping it till 730. I'm not sure if the hospital did their own evaluation of errors or if there is solid evidence but she said the rule came about a year or so ago and was put in place to reduce the number of errors made with new admissions. She couldn't tell me if it actually worked for that but she said it did reduce the number of patient complaints about the admission process.

JDougRN, BSN, RN · Dec 2, 2011

I used to work as a floor nurse, and it would really upset me to get a patient (or several) from the ED close to change of shift. I often complained that it was unfair, or unsafe.I figured it was the ED's way of holding on to a patient so they wouldn't have to take another one. THEN I bacame an ED nurse....WHOOOO was I wrong! First, ED has NO controll over when we get bed assignments. In fact, often we get stuck with ED holds all shift, in addition to our regular ED patient load...only to have a bed "suddenly" become available at 0600- WHY???? Because the "floor" wasn't staffed enough to take the patient...Ummm...so WHY is it OK to expect the ED to keep these pt's? We also have no controll over what pt's go to what floor- I get MONSTER attitude from the floors in the shape of "This is our 3RD ADMISSION from you in the past hour!!!!" I, as an ED nurse, have NO CLUE what else has come to you, or when...again, it's bed management, NOT US! And lastly- We, in the ED have NO CONTROLL over who/what comes through our doors- Sometimes it is safer to get a patient out of our unit to you, because no matter what time of the shift it is, or how understaffed you feel you are, or how "unfair" or "unsafe"it is to get a pt at change of shift....it's STILL MUCH SAFER than leaving them in the ED. You are getting ONE patient, we just got 3 ambulances from an MVA, a stroke alert, and 2 seperate pt.'s walk in having active chest pain. Oh yea, and my shift is supposed to get over in 30 minutes. AND the floor is calling me AGAIN to ask questions about WHY pt. x didn't get a medication, or DEMANDING that I put that Foley in the patient BEFORE I sent them up...Really, we aren't slackers down here! We do understand that every admission is about 2-3 hours worth of work for you, and I understand how hard your job is- I used to do what you do. But please cut the ED some slack about admissions. As far as who should take the patient- if the pt. physically arrives less than half hour before it ends, I believe it is perfectly acceptable to tuck them in, get VS, and check any stat issues, then pass it on to the oncoming shift. That's the way it is n most facilities I've ever worked in.

noyesno, MSN, APRN, NP · Dec 2, 2011

I hate change of shift admissions! The worst days are those you start out as the first person getting an admission at shift change #1 because you are very likely going to getting another admission during the shift. Usually this second admission comes during shift change #2. Makes for a crappy shift.

Also, on my floor, day shift usually passes the whole admission to PM's and nights freaks out if you don't have the whole admission done (even if the patient came at 10:30 pm). FML.

Recently, I had a change of shift admission with a hemoglobin of 5.5, positive for occult blood in the stool, and an order to transfuse 2 units but we didn't have her blood type in the hospital. What a great idea! :down:

classicdame, MSN, EdD · Dec 2, 2011

ER does get blamed a lot for holding patients. We found out that one of the ER docs was waiting to do his final dictation and write orders till he had a "bunch" to do at once. So patients were D/C from ER all at once. The CEO stopped that. As for whose job it is to admit----nursing is a 24 hour job so both shifts ought to be able to work together.

turnforthenurse, MSN, NP · Dec 2, 2011

If the ER/other nursing unit is trying to send a patient up at 0645, we tell them that we are in report and the primary RN taking the patient will call back. Cath lab, however, is an exception; they are not allowed to hold patients. This happened to me last night...called right at 1850 and I told the unit clerk I was in the middle of report, can they call back in 10 minutes...she said no, I had to take report NOW. Patient was up by 1910. Very hectic.

Usually we try to help each other out. We also communicate with our charge RN on what should be done. If an admit comes at 0600, I can usually get the general admission paperwork and admission assessment completed. Sometimes I can only get half of the paperwork done or really none at all for whatever reason (language barrier, AMS, sedated, poor historian...something that requires family input). I do what I can and just communicate it with dayshift. I know I *HATE* getting stuck with an admission right at shift change so I always try to do as much as I can before the next shift so they aren't running around like crazy in the beginning. Most of the time dayshift will do the same.

vanburbian · Dec 2, 2011

I work ED, and as others have emphasized, we have no control over when we get a bed assignment. My rooms get filled or not based on how many people are in the WR. If I have an empty room, you bet your behind I'm helping with the code or the stroke pt in someone elses pod.

However...have been the floor RN as well, thinking WTH is wrong with the ER nurses, and why are they sending me 3 pt.'s at once?? Why didn't they put the darn foley in, or draw the lab, or hang all the Abx??

We don't do floor orders. If it was written for the floor, either as a "holding/transition" order, or by the attending-we don't own that.

Also, at the hospital where I work, we do not transfer between 1845-1915 and 0645-0715- change of shift is either 1845 or 0645- so we do in fact hold pt.'s until report has been given and care transitioned.

I can not explain how very much I LOVE the day shift nurse who actually calls me to get report at 1830, knowing we are full, and is willing to accept the pt RIGHT NOW...

I LOVE, LOVE, LOVE that nurse......

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

Our ED actually TRIES to dump pts at that time. That way the ER docs can clear house before their shift ends.

Lynx25, LPN · Dec 2, 2011

My co-worker, who works the 7-3 shift, thinks it's cute to ask the hospital to hold admissions, "Just a little longer" until after two. Usually if they come after two, she gives me the packet, tells me she doesn't know anything about them, and wanders off.

It's a reoccuring issue... and it wouldn't be if we could work together on something, but it's just not an option to her. Meh

Bringonthenight · Dec 3, 2011

I don't think admissions should come up at change of shift time personally but in my mind it always makes sense to let the oncoming nurse take it because they will be the nurse looking after the patient for the next 12 hours, no point in making the previous nurse stay past their shift time.

Morainey, BSN, RN · Dec 3, 2011

It's so aggravating when PACU or ER or whoever is trying to call report during shift change, but it happens. I try to get everything done that I can *before* the patient arrives, such as acknowledge meds, fill in report sheet, etc.

I work with a nurse who insists that the patient be fully, entirely admitted before she accepts responsibility for them. I was on the phone with the doc 45 minutes after my shift ended, getting ACHS blood sugars ordered for my patient, while she sat on the computer. F.

godbless-yute · Dec 3, 2011

At my hospital, there is technically overlap built into our shifts. Ur supposed to be there at 45 after and stay till 15 after. Working in the ER I can say we generally don't hold pts because most of us gate having admit pts because the longer u have them, the more non-ER stuff u end up responsible for. We are required to do stat and now orders only....more if u have the time. There are times pts get delayed because of a change in the pts status (ex. BP too high or low). My hospital has a no call time where the floors don't take report between 6:30 and 7:30.....plenty time to change shift. In the ER, we don't get a no call time. We can't tell chest pains and gsws that were changing shift

hiddencatRN, BSN, RN · Dec 3, 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?

At my hospital the floor won't take report "close" to shift change, so problem "solved".