Admissions at shift change

Nurses General Nursing

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I am interested in knowing if other facilities have a policy of holding admissions at shift change. I work 3rd shift and a shift change admission is difficult at best. I try to weigh the benefits for the patient on having them settled on the floor as early as possible against rounding on my patients, passing midnight meds, and putting out "fires" after a busy 2nd shift. I feel if I can get enough time to pass meds and peek in on my patients ( will play catch-up on assessments as the night progresses), I can spend more time with a new admission and get them settled with less interruptions. We are considering proposing this to our administration and would like to know whether this works at other facilities.

Bless your Heart, NurseLopez- sounds as if you were very efficient getting out by 9 pm.

I work ED. All of the floors refuse report at shift change, which is ok by me- the RN's up there have a ton to do at shift change. Now, if report has already been called, on most floors we are free to send the pt up even at 1900 on the dot. I don't do that however, unless the patient is familiar with how hospitals work, and is totally pain free and hanging out, and the ED is packed to overflowing, and I call and let the Charge up there know the situation...

The policy of holding admissions at our hospital is only for 30 min at shift change. It works, but not when the ED is stacked. What I found, however, is that as we have respected the shift change rule, and held patients when we aren't busy and the floor is having staffing issues or a night of codes, is that when we are smack up against the wall, the floor usually lets us bend the rules a bit. It seems to be about mutual respect and understanding- which is often sort of lacking between floor and ED RN's.

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Thanks for all your support. I agree this relates to mutual cooperation between the ED and the floors. It seems that we are required to be mindful of what is going on in the ED but it never makes any difference to the ED what is happening on the floors, we are expected just to cope. I have had a pt. expire unexpectedly just after shift change while I was handling an admission. The "should ofs" and "could ofs" can haunt you for a long time. Though teamwork is great on nights, at shift start everybody is handling their own patients and that extra set of hands you need to pass a med to your assigned patients, or track down the 8pm and 10pm meds your new admit hasn't taken before coming to the ED are not available. Nice to see we are all in the same boat on this one. And though we are expected to give 24 hour care, it would be nice if I felt I gave all of my patients (including my new admits) the best care I could for every hour of my shift.

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Originally posted by SmilingBluEyes

Nope. We deal.

:chuckle Yup!

Heather

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Never worked anywhere were they held admits for any reason except not having a bed available. Unfortunatly, that has happened too. The poor patient ends up in the hall or treatment room until a room does become available. I also take the vitals and do a quick assessment on admits. I'll usually ask the family to stick around for a while until I can do the paperwork. I use family members every chance I get these days. They can sit with the patient and let me know if something is going wrong. Then if the pt is a/o, I ask the family members to leave during the admit. If confused, they stay, to answer my questions. No matter what time of the shift an admit comes, it always leaves me playing catch up later.

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Specializes in ICU/CCU (PCCN); Heme/Onc/BMT.

Realize that I work on an ICU/CCU at a very small hospital.

I do 9 hour shifts (get paid for 10!!!!. . . love my job!) When I come on board and there's a patient waiting in the ER to be transferred, I simply go down to the ER, finish whatever stuff needs to be done to medically stablize the patient and satisfy the "paper hounds" by making sure all "I's are dotted and T's are crossed" on the ER admission forms, and finally transport the patient up to my unit. That patient then becomes my patient for the rest of the night.

Same deal if there's a transfer from the med/surg floor.

At the end of my shift, I simply help out until the day nurses are all settled in with report.

I love this set up. I just think it's so cool. I probably wouldn't be able to do this in a big and busy hospital. Don't know how long my little hospital will be around, but I'm going to enjoy my stay there for as long as possible.

Happy nursing, folks! :)

Ted

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Hi, I work in a hospital in Minnesota. Sometimes admissions are held for a brief time during shift change. I also work 3rd shift. the ER is usually in a hurry to get psyche patients up to the unit as soon as possible.If the ER does need to send us a patient before shift change is over, the eve shift will settle the pt , get vitals and inform pt that the night shift will do the formal admission process. It is then our baby!!!

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Specializes in Community Health Nurse.

If the patient has to be admitted, bring them on and I'll admit them, get their vitals, start the IV (if ordered), administer a pain med if ordered and not already given from the other unit), settle them in bed, let them know the shift of staff has changed and their new nurse will be with them after report is given; to please be as patient as possible while the shift change is occurring. If they need help, a CNA will come to help them until the nurses have received report on all their patients. THEN, I go home. :)

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Specializes in ED, House Supervisor, IT.

Couple thoughts... For those of you that have a house supervisor in house... why are they not being involved in the situations you describe? As the house supervisor, I am responsible for bed placement. If it is shift change or the floor is busy with what have you, or ER is busy, I don't give out the bed assignment. It goes the other way too if ER is getting slammed, I will ask the floor if they can take it. Also some staff are guilty of using the computer to see the census on other floors. We know how up to date those are. I can physically go to the floors to see what is going on if there is a problem and help out if needed. If you don't have a house supervisor, then people need to act like adults and have better teamwork or guidelines need to set. Like the 30 minute blackout that was mentioned above, or no admits during codes.

Second, what about shift change in the ER. Is triage closed to patients for 30 minutes?

Finally, for those that have the "blackout", if a patient gets on the call light for pain meds who addresses that?

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