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Discussion

Admissions!

Liked by few, feared by new grads, and despised by all. Yes, I'm talking about admissions! Nursing admissions can be daunting. There are many things to be done, they can be time consuming and stressful. They can be the bump in your day, the thorn on your rose, or that pesky fly during a picnic.

What is the admission process at your facility?

Questions:

What is your specialty?

Do you have an admissions nurse that strictly does all admissions?

How many nurses/techs are in the room at the time the admission rolls in?

How many nurses/techs are in the room 10 minutes after the admission rolls in?

After 20 minutes are there nurses/techs in the room still (excluding primary RN)?

How long does it take the doctor/provider to come to the bedside?

What are greatest challenges of admitting patients in your unit?

I will answer these questions myself, but would also like others to join - as i am a very inquisitive nosey person!

My specialty is ICU. Typically we have anywhere from 4 nurses to 6 nurses in the room depending upon the admission. A CABG will usually have 6 nurses in the room.

In my ICU nurses and techs are there with you well into the first 10 minutes, however the number goes from 6 or 4 to 3 or 2. You will have help especially with traumas and CABGs/thoracic surgery/etc.

At the 20 minute mark in my ICU I still notice anywhere from 1 extra RN to 3 extra RN's depending on how stable or unstable the patient is, maybe even more help (it depends).

In my experience, no matter what ICU admit it is, the doctors are immediately at bedside and are in and out for the next hour or two or even three.

I feel the greatest challenge of admitting ICU patients are two things: The sheer volume of tasks to complete (setting up sedation, giving anywhere from 5 to 7 IV piggy back antibiotics, verifying all your drips, making sure ancillary staff tasks are followed through (X-rays being taken, RT setting up the ventilator and running ABG's) & the next challenge is balancing doing all these tasks with assessing and understanding the patient and their baseline. As the ICU nurse you are held responsible for managing all the hemodynamics within the parameters provided.

I feel the moment of admission can be the most dangerous, especially for surgical (particularly thoracic surgery patients). They come in from anesthesia with up to 6 or 10 drips. All these drips must be verified and you have to ensure you back ups and correct concentrations because concentrations used in anesthesia may differ from the ordered concentrations. Sometimes switching concentrations can't be done until the patient is stable, and that's just the nature of the beast. I feel that a lot of thoughts and suggestions are also up in the air at moment of admission for these patients. You have anesthesiology at bedside and you have cardiothoracic surgery. Ultimately the primary team has the last word but sometimes you have to be the middle man.

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    • Expert

    1. I work rehab and palliative care. Plus I float to med/surg.

    2. No we do our own admissions.

    3. One nurse (me) unless we need help transferring the patient.

    4. One

    5.One

    6. Usually within 24 hours

    7. Admitting confused patients that can't give you a history.

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    I'm in the NICU. Everyone does admissions. There are usually 2-4 nurses (including the primary) and an RT. One nurse charts while the others do. You'll still see the same number of nurses until all of the admit stuff is done, up to an hour... The physician or NNP will have either been at delivery or will meet us in the room at admission. Most difficult thing is shift change admits, but it's mostly because it's inconvenient.

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    Because I work for a consultation hospital team I have no admissions but the documentation is very long and intense ..

    When I worked critical care / cardiac surgery ICU we usually had 2 RN and the ICU physician in the room for the admit but sometimes it turns into more people if there are problems. Also, the anesthesiologist who would come over with the pat would stay for a while to ensure pat is ok.

    After 20 minutes pat were usually connected and settled unless bigger issues like IABP, not stable, bleeding, what not.

    Regular tele floor - admissions just one nurse and the CNA, sometimes the charge nurse would "settle" the patient while the primary nurse does other things.

    Admissions can interrupt the work flow - preparing as much as possible before the pat rolls in is the way to go..

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    I work nights on a busy tele floor and admissions are often at shift change, or worse, roll up at 6 AM. It is a tedious process and a big interruption to already having 4 patients (won't complain about that, the other night I was supposed to have 6). If you have an admission plus someone coming back from cath or OR it feels like having 2 admissions, getting everyone settled. One night (this was as a relatively new nurse) I had 2 admissions. I have been there a year now and while I don't like that scenario it is not as intimidating as it used to be. I try to do as much of the database as possible. Irks me when I get it going and come back that night and nothing else got done.

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    Usually myself and a tech a bedside at time of admit. Sometimes, it's just me and transportation. Other nurses may come in if patient cannot walk and we have to slide patient over. Admit process takes around half an hour. Takes doctors sometimes up to an hour to see patient if they didn't see them in ED. There was one day where in the last 3 hours of the shift, every nurse got 3 admits each. There was definitely no help from other nurses that day.

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    I work inpatient psych. We have an admissions nurse who floats around the hospital doing admissions. When we need her, we give her a call-- especially if it's going to be complicated and time-consuming. If she isn't already tied up with several admits, she'll do them. If not, we thank her anyway and do it ourselves. Sometimes, if our team is light and the admit is an easy one, we won't call her so we don't over-stress her... because we love her.

    She is a wonderful person and we are so grateful to have her. When we aren't having admits, she comes into the units and spends time interacting with the patients. She is a phenomenal worker with a big heart and a dash of spice. She is gold and we always let her know it.

    I know what it's like to have a heavy assignment and have to take a difficult admit, and I know we are so blessed to have this service that so many nurse don't. Yes, indeed, she is golden and her work ethic and personality is a bonus.

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