Admits after 6:00 pm? Does your hospital do this?

cappuccino · Mar 23, 2007

i agree. that's a great idea having an admitting team that is. we get many admissions. it doesn't matter what time it is. sometimes from the recovery room and sometimes coming from the er. the other night i had 5 admissions between 3pm and 7pm. unfortunately you just have to do the best you can to deal with it. i've worked in other hospitals and it's the same deal. ............

oldiebutgoodie, RN · Mar 23, 2007

i agree. that's a great idea having an admitting team that is. we get many admissions. it doesn't matter what time it is. sometimes from the recovery room and sometimes coming from the er. the other night i had 5 admissions between 3pm and 7pm. unfortunately you just have to do the best you can to deal with it. i've worked in other hospitals and it's the same deal. ............

that's a lot of admits! isn't it sad that there are simple, common sense solutions to lots of these issues, but hospital management is so intent on the bottom line that they won't try some of these solutions? when you consider the thousands of dollars it costs to train and/or orient a new nurse, don't you think that the number crunches would see this?

but, noooooooooooooooooooooo.....

TXNurseBSN · Mar 23, 2007

I'm well aware its a 24 hour job but I'm not a freaking robot, either. Nurses need to eat sleep and rest just like everybody else. I can't be allowed this then I need to move on, which is what I intend to do.

Well said. Nursing is a 24 hour job. However, that doesn't mean that one nurse can work 24 hours straight. It should be teamwork between shifts. That is why there is 2 shifts. I threw in the towel because I was sick of staying until 9:00pm. At the floor I worked on, god forbid anything be passed on to night shift. But, it was perfectly ok for night shift to pass along to day shift. Now, I am a school nurse.....I usually leave about 5-10 minutes early everyday!! I work at a low income urban middle school and I do a lot for my kids but still get home in time to enjoy my own family!! Sometimes, the grass is greener on the other side!!

I have a friend who is in PACU. Several times lately she has worked 19 hour shifts. NO THANKS!

withasmilelpn · Mar 23, 2007

We actually have a house-wide admission team. They are present from 0700 to 2300 Monday through Friday. They will admit patients that arrived on the floor from 0400 until 1900 or so (just depends on how many nurses on duty and how many in line to be admitted) They don't do unit admissions. They take care of all paperwork, the initial assessment, start IV (if not already done), go through orders, and then give report on what's been done to the pt's primary RN. It's a good system and works great.

Great idea! How's your staff turnover? It would be nice if someone could do cost/benefit analysis of places like these so you could present it as something that works for all involved. I bet patient satisfaction is probably higher as well. For the OP, I know what you mean about staying over. Sometimes it really depends on whose following you. Right now I don't feel I can trust anyone to follow through (we have a lot of agency and per diem and I got burned) which is why I'm switching units. Good luck!

PickMePlze · Mar 23, 2007

Maybe a job as a school nurse or for an MDs office is for you. In a hospital, you are always going to have admits at all hours, whether or not it's convenient for you. I work 1500 to 2300. Last night I got an admission at 2230. You know what? I started the admission, gave report, did the narc count and the RN coming on at 2300 finished my admission. This is called teamwork...maybe your unit you work in doesn't work as a team. Maybe you are not a team player.

Liz, you don't even know me, so MAYBE you need to think before you type, how about that??

To everybody else who posted with intelligence and forethought, thanks so much for the input. I probably do need to work in a clinic or somewhere where the hours are doable.

jill48, ASN, RN · Mar 23, 2007

I didn't know there was some 6pm cutoff; or a cutoff at any time for that matter. Nobody is even thinking about the patient here; everyone is thinking about the nurse. Admits come at all hours and we have no control over that. I don't think anyone expects you to stay after your shift is over; I think they probably just expect you to WORK and do what you can UNTIL your shift is over. It's part of your job. I have never looked down upon a nurse coming off her shift after she did whatever she could to get the admission started. I don't mind finishing it. That is my job. But I do look down upon the nurses who get an admit that she feels is too close to the end of her shift and I find her sitting at the nurses station bitching and doing nothing:angryfire . If your facility expects you to stay late and finish the admission you started, then I don't blame you for being upset. But it's not too much to ask people start some of the work.

SmilingBluEyes · Mar 23, 2007

Lots of good advice in thread here. Like with anything, we can take what we need/can use and leave the rest. No need to get insulting in disagreement.

tutored · Mar 24, 2007

I'm still a student, but on the medsurg floor where I'm doing rotations, there were four admits in the middle of the overnight shift: 2 @ 1:00 a.m., one at 1:30 a.m., and another @ 4:00 a.m....the overnight nurse had to handle all of them herself, with 10 already under her charge. She said that night admits happen regularly

justavolunteer · Mar 24, 2007

I'm 'justavolunteer' on a patient unit. I've answered the phone before close to shift change & had an ER nurse say plaintively "can someone PLEASE take report, we need to move this pt on". The nurse on my unit will say "tell them to call back later, we are behind with the pts we already have" (and that's true, they are behind). Nothing like one code blue or something close to it to knock a schedule completely out of whack.

Sometimes it has come down to the house director actually taking report, then giving report to someone on the next shift. That way the pt can come to the unit sooner.

From a different perspective, I was a pt a few years ago. I actually came to the hospital around midnight. The nurse on the pt. unit did my admission about 4 AM. Most places, I imagine admissions can come anytime in a 24 hour period. An unfortunate fact of life, but true.

There are nurses working in hospitals 24/7. To all of you, I say "thank you"

RN34TX · Mar 24, 2007

To everybody else who posted with intelligence and forethought, thanks so much for the input. I probably do need to work in a clinic or somewhere where the hours are doable.

You don't necessarily need to jump ship and go to a clinic.

I've seen people post about codes happening at change of shift and yes that does seem to happen a lot. But a code is one thing, an admission is most definitely not a valid reason for a nurse to stay past their shift.

It's very unrealistic for the oncoming shift to expect that an admit that came at 6:15 am/pm will have the assessment pages completely filled out, orders taken off and labs drawn...that's insane and it's unrealistic on the part of the oncoming nurse expecting a late admission to be completely squared away for them like that.

Staying past your shift to do an entire admission is not teamwork, it's merely for the convenience of the oncoming nurse and completely inappropriate use and abuse of nursing work hours. Big waste of overtime.

I left med/surg for a multitude of reasons but one of them was my last job having a rule where if an admit hit the floor before 6:15 pm, you were expected to stay and do everything before you went home, care plan and all. Needless to say almost every day I got admits right around 6pm and almost never went home on time. They wasted so much money on needless overtime every day on all of us.

Not all units have these kinds of unrealistic expectations and up until my last med/surg job, 7:15 meant 7:15 and unless your patient coded or some other valid emergent situation occurred (not a new admit!), the next shift was to take over wherever you left off and you were to go home on time period and that's the way it should be.

Keep looking because you will eventually will find a job that has a manager with enough sense to know that she's not going to pay a nurse overtime to lighten the load of the oncoming nurse who's perfectly capable of picking up where the off-going nurse left off.

SharonH, RN · Mar 24, 2007

When I used to work the bedside I used to get the shift change admission dumps all the time. It's funny but when we worked primarily 8 hours shifts it would happen on the 8 hour times for years and then when we went to 12 hour shifts, gee it happened then too what a coincidence. I was always frustrated by this but I was told to basically suck it up because nursing was a 24-hour job pretty much like a lot of the replies you are getting here. And then one day, an ER nurse admitted to me in report that they sometimes would hold a patient until just before shift change and do you know why she was telling me? She was frustrated because now she was going to be getting slammed thanks to this practice. It does happen everywhere and but if I were you I would try to look at departments in the hospital where you could work without dealing with this hassle.

caroladybelle, BSN, RN · Mar 24, 2007

I'm a new grad and I've been working where I am for almost a year. I work 7-7 days. One of my main reasons I'm throwing in the towel on this job is be because of the 6:00 admits, ER, or some other department wanting to call report and transfer patients in the same hour that we have to give report to the night nurse. The floor I work on is already a zoo, and by the end of the day I AM DOG TIRED AND READY TO GO HOME. I get sooo pissed off, this is driving me insane. Im spending my days off looking for another job. Many a nights I don't get home till 9 pm because of this crap.
I can't understand why they wait till after 6:00 pm. Am I missing something here?

I work Oncology, so I know where you are coming from.

It generally is not the ER nurse's fault that this occurs. More often than not, it has to do with the admitting MD or ER MD.

When the ER MD comes down to the end of shift, s/he is under pressure to "clear the board". This means that they make the decision to admit or DC. The pt may have been there for a while, during which the MD has handled multiple critical issues and been harrassed by the nonemergent cases. About two hours before shift change, they try to sort the admits from the DCs. Which translates into admits getting called at 1 hour to shift change, especially for the iffy cases. You will be getting the "nonemergent" cases or the fresh cases that need obvious admission.

Also remember that the consults/attendings will either being seeing the admits after office hours or when they get up in the morning, if the patient is nonemergent. This occurs right around shift change.

While I do know nurses that play the "do not transfer until shift change, because I don't want to get another pt" game - on MS/ICU/ER, there are legit reasons that admits come at shift change.