Assigning Admissions Among Nursing Staff

[SilverBells, BSN]

For those of you who have any part of assigning admissions among nursing staff, what guidelines do you usually follow when doing so? 

For me, as a nurse manager, whenever my unit gets only one or two admissions, the floor nurses usually complete them regardless of acuity.  However, whenever there is a third (or more), I usually like to step in and take at least one of them.   Typically, I like to take the most medically complex admission.   My mindset in doing so is that this admission will likely take longer to complete, and the floor nurses are already busy enough.   I have more time to look through the patient's hospital dismissal summary to double check orders and make sure that nothing is being missed.  I also have more time to make sure that all wounds are measured, and the like.  

However, I am wondering if this is the best approach?  By taking the longer admissions, it sometimes takes me away from other tasks that as a manager I need to be taking care of, such as resolving patient complaints or attending Care Conferences.   It may also take away the floor nurse's chance to learn how to complete a more complex admission.  

Additionally, sometimes my approach simply isn't the most time efficient approach or what is needed at the time.   An example I have is from this last week.  We were having three admissions coming: an orthopedic patient, a cardiovascular surgical patient, and a hospice patient.  After reviewing the discharge summaries for each of these patients, I decided I would be taking the cardiac surgical patient since she seemed to be the lengthier one.   However, prior to her arriving to the facility, the hospice patient showed up first.  At one point in time, the family had requested the hospice patient be transferred into bed because he was uncomfortable.   The nurse who was assigned to be taking this admission was unavailable at the time, however, so I was approached to help with the transfer.  I declined at this point, as I knew his assigned nurse would be available soon.  This nurse had taken report on the patient, and better knew his transfer status.  In my mind, I also felt that assisting the resident to his bed would be a good opportunity for the assigned nurse to complete her assessment.  The CNAs had a difficult time obtaining his weight, and I felt that once he was transferred into bed, he likely was going to stay there for awhile, thus taking away from assessment time for the nurse.  I was also in the middle of completing a detailed medication order at the time the patient was asking to be transferred, so really didn't want to abandon this task in fear I may make a medication error. 

Now, I am questioning whether this was the right move.   The next day, I heard about the incident three different times by other staff members who didn't feel the hospice patient's admission was handled well.  They were concerned with the lack of teamwork that resulted in the patient sitting in his chair too long, causing him discomfort and anxiety.  They felt that more direction was needed from the RN on the floor, and I am almost positive they were referring to me, since the other nurses on the unit were LPNs.   

I am starting to wonder if the better approach would have simply been to assist the resident to bed and complete this admission in favor over the other one (who hadn't arrived to the facility yet).  I also could have possibly delegated the medication orders I was working on to someone else (at my facility, I've noticed it is easier to find someone who is willing to assist with a medication order than it is to find someone to assist with a nursing task).   On the plus side, this approach would have resulted in a patient's discomfort being relieved sooner.  On the con side, it would have meant that the more complex, lengthier admission was delegated to one of the floor nurses to complete (with that said, there was a floor nurse that I am almost positive would have been more than willing to take the cardiac patient).  

Anyway, I was wondering how other facilities typically assign their admissions.  Is it based on complexity? Nursing experience? Whoever is available? A mix of all three?  I am thinking it is likely a combination of all of the above and/or a case-by-case basis, but am just trying to come up with better ways to reassign admissions at my own facility when we have more than one.  The more I think about it, the more I feel I was in the wrong in the above case, and am wanting to improve things in the future.  

[CalicoKitty, BSN, MSN, RN]

On the hospital floors I have worked, admissions are assigned 1,2,3 or simply empty rooms. The most common reason for a change in that assignment would be if the next nurse has a lot going on (such as a rapidly declining patient).

Not sure what helping a patient into the bed has to do with the admission assessment. Anyone can help reposition or transfer a patient. If the patient is eager it can take all of 2 minutes.  Not sure what type of 'medication order' you were concerned with or why it would take such a long time to delay repositioning a patient to the point of a complaint.

Overall, it still seems your prioritization is a bit skewed. Immediate patient needs generally comes first. IMO, paperwork can be done after the shift is over.

Honestly, unless you were doing something urgent/critical, the fact that you would not help move the patient knowing the primary nurse was busy shows a lack of concern for patient care or teamwork. I'd be telling stories about you, just like the lazy nurses I've worked with before that were just "resting their legs" rather than assist when needed.

Perhaps you should completely leave bedside care and move on to a completely paperwork oriented job. As has been suggested ad nauseum.

[klone, MSN, RN]

You're the manager, you should not be taking admissions. On the other hand, if you're asked to assist with a quick task because everyone else is busy (such as moving a patient to the bed), you should do so.

Take care, good luck, best wishes for you.

[JBMmom, MSN, NP]

I'll bite.

What in the world does repositioning a patient, especially at the request of the family, have to do with taking an admission?! If I were one of those family members and a nurse "declined" to take the needs of my family member as a priority for action, I would have been in that administrator's office so fast someone's head would spin. And I might have ripped that nurse a new one before that. If you're standing in front of a patient, it is COMPLETELY inappropriate patient care to delay something like moving someone into a bed, especially a hospice patient, for any reason. You are a nurse, your priority is patients. You need to get over whatever administrative hang-ups you have and care for PEOPLE. 

[Emergent, RN]

I personally believe that if people do not want to engage with silver bells, they should just move on to other threads instead of this passive-aggressive best wishes stuff. And, I want to say I really like the people here who did that, but I am calling them out in this instance. If you don't want to engage with silver bells just ignore the thread instead of trying to make a point by essentially saying "Bless your heart,  I'll be praying for you ", like one of those Southern church ladies who gossip about people by starting a prayer chain.?

[summertx]

If the nurses know that the admissions are their responsibility,  assign admissions who is next in line to receive. For example one week one unit starts with the admissions, then if there are 3 admissions, all nurses will get one. If there is 1, then only the 1 nurse gets one. I would have admissions preassigned, and just help with the long tasks, such as putting in medication orders. 

[SilverBells, BSN]

18 hours ago, CalicoKitty said:

On the hospital floors I have worked, admissions are assigned 1,2,3 or simply empty rooms. The most common reason for a change in that assignment would be if the next nurse has a lot going on (such as a rapidly declining patient).

Not sure what helping a patient into the bed has to do with the admission assessment. Anyone can help reposition or transfer a patient. If the patient is eager it can take all of 2 minutes.  Not sure what type of 'medication order' you were concerned with or why it would take such a long time to delay repositioning a patient to the point of a complaint.

Overall, it still seems your prioritization is a bit skewed. Immediate patient needs generally comes first. IMO, paperwork can be done after the shift is over.

Honestly, unless you were doing something urgent/critical, the fact that you would not help move the patient knowing the primary nurse was busy shows a lack of concern for patient care or teamwork. I'd be telling stories about you, just like the lazy nurses I've worked with before that were just "resting their legs" rather than assist when needed.

Perhaps you should completely leave bedside care and move on to a completely paperwork oriented job. As has been suggested ad nauseum.

Thank for the brief feedback on the assignment of admissions. Seems as if a "you get what you get" approach might be the way to go in some cases. 

With that said, during our admissions, we always have to assess patient mobility.  The staff had already had difficulties obtaining this person's weight, so my thought was that once the patient got into bed, he probably wouldn't get out for awhile, thus hindering his nurse in that aspect of his assessment.

The medication order I was working on was actually orders for a different admission. This admission had four pages of medications that I was trying to enter carefully.  I ended up making a mistake anyway, due to all the distractions.  

With that said, I get where you're coming from with everything else.  I think most, if not all, others would agree

[SilverBells, BSN]

13 hours ago, klone said:

You're the manager, you should not be taking admissions. On the other hand, if you're asked to assist with a quick task because everyone else is busy (such as moving a patient to the bed), you should do so.

Take care, good luck, best wishes for you.

Actually, I am expected to take admissions from time to time, especially if there are multiple coming.  With that said, I need to be doing a better job helping out with other requests 

[amoLucia]

Dear SilverBells - I am sorry. And I apologize for my previous edited-out response. I shouldn't have sent the zinger. The old adage is that 'if you can't say something nice, don't say anything at all'. I just didn't follow it then.

But Girlfriend, you are so FRUSTRATING! On the one hand, I will say that you post very interesting situational dilemmas. You are very detail-oriented as you set up the scene with your explanation of things. And you start to detail your rationales for actions taken. But your rationales become your justifications for which you seek approval/agreement for them. And then you disregard most of those responses.

This is the frustrating part. You do the same things over & over & over in every post. Respondents offer you genuine, concerned, & well-meaning responses. Yet you pull your old ''yes, but ... " routine. And you'll rehash more denials and do as you choose. SO WHY ASK US?!?!?

I feel so disrespected, trivialized and USED. Time after time. Add demeaned, minimalized, taken-for-granted, etc, etc, etc.

So I spoke out with the zinger. Again, I apologize.

 

[SmilingBluEyes]

3 hours ago, amoLucia said:

Dear SilverBells - I am sorry. And I apologize for my previous edited-out response. I shouldn't have sent the zinger. The old adage is that 'if you can't say something nice, don't say anything at all'. I just didn't follow it then.

But Girlfriend, you are so FRUSTRATING! On the one hand, I will say that you post very interesting situational dilemmas. You are very detail-oriented as you set up the scene with your explanation of things. And you start to detail your rationales for actions taken. But your rationales become your justifications for which you seek approval/agreement for them. And then you disregard most of those responses.

This is the frustrating part. You do the same things over & over & over in every post. Respondents offer you genuine, concerned, & well-meaning responses. Yet you pull your old ''yes, but ... " routine. And you'll rehash more denials and do as you choose. SO WHY ASK US?!?!?

I feel so disrespected, trivialized and USED. Time after time. Add demeaned, minimalized, taken-for-granted, etc, etc, etc.

So I spoke out with the zinger. Again, I apologize.

 

Exactly.

Which is why I wished the OP the best.

[nursej22, MSN, RN]

As far as getting a weight on a hospice admit, I would consider deferring that if the patient's immediate concern was comfort. If they are coming from another facility, they likely have a recent weight. I would put getting weight at a lower priority than comfort or reconciling medications. 

Just my 2 cents worth. 

[amoLucia]

SBE - I'm still upset about this post (et al). And she now has a new one. Same scripting. I have other responses ready, but I don't want to get sucked into the same cross-fire. I still smart when I attempt to answer in good faith & sincerity, only to feel insulted.

Yours, mine, and others' responses are for naught. So I kept my response short & simple! I still wish her well.