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.
