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.
Patient comfort comes first. To me, leaving a hospice patient sitting in a chair because his nurse who was assigned his admission seems unfathomable, but that’s just me.
Why not just assign the ‘more complicated admission’ to the other nurse who was initially assigned the hospice patient? As the hospice patient arrived first.
Patient comfort comes first. To me, leaving a hospice patient sitting in a chair because his nurse who was assigned his admission seems unfathomable, but that’s just me.
Why not just assign the ‘more complicated admission’ to the other nurse who was initially assigned the hospice patient? As the hospice patient arrived first.
In hindsight, that's what should have happened. There wasn't any particular reason why we couldn't have switched admissions. I thought taking the more complex patient would be helpful, but it turns out what I did was not helpful at all. In reality, the other nurse present has many years of experience as a nurse and would have done just fine with the lengthier admission.
OK...here we go again. I've seen your point of view many times, and many times found reason to agree, at least in part. But this time? No way no how. It's not OK to "decline" to help transfer an uncomfortable patient under any circumstances.
Especially so for a new admit. What a wonderful first impression the nurse manager made to that new resident and his family, not! If that were my loved one I'd be immediately questioning the decision to place him in your facility if that's the level of caring he could be expected to receive.
OK...here we go again. I've seen your point of view many times, and many times found reason to agree, at least in part. But this time? No way no how. It's not OK to "decline" to help transfer an uncomfortable patient under any circumstances.
Especially so for a new admit. What a wonderful first impression the nurse manager made to that new resident and his family, not! If that were my loved one I'd be immediately questioning the decision to place him in your facility if that's the level of caring he could be expected to receive.
I would agree, actually. I was at fault in this situation. On one hand, I wasn't aware that the patient was uncomfortable at the time (I didn't find that out until later after I was scolded for not helping). The patient/family didn't specifically ask me to help him get into bed; they asked the social worker, who passed it along to me. They weren't aware at all that I was delegating the task to another nurse. Also, the social worker didn't state anything about the resident being in pain, she just stated he was hoping to get into bed soon, so I thought it was just a routine transfer that could wait for his assigned nurse. I knew she would be with him in a few minutes.
With that said, I feel like all I'm doing is making excuses at this point, none of which are justifiable. I probably could have assisted the patient into bed in less time than it took for me to delegate the task off to someone else. We wouldn't even be discussing this right now if I'd just stepped away from what I was doing at the moment to help out for a few minutes. I could have easily chosen this moment to do an assessment on him, and done his admission instead. I didn't need to try and keep the cardiac surgical patient for myself.
I also feel bad, knowing the hospice patient was left uncomfortable for longer than I originally realized. At the same time, I really didn't need to know his exact pain rating to help out; I should just assume that if someone is wanting to go into bed, there is a reason for it, and likely an immediate need to be met. For example, a patient wanting to get into bed might be tired or in pain. In this person's case, it was both. Clearly, waiting for someone else to assist wasn't the answer. My position requires me to delegate sometimes, but, in this instance, that wasn't the right approach.
I agree that we did not make a good impression on the family. The family/patient may not have been aware that I had delegated the task to another nurse, but they were aware that their father/grandfather was waiting for far too long to be assisted. They were aware that there did not appear to be any attempts to relieve his anxiety or pain in a timely manner. I wouldn't doubt that they, too, were questioning whether or not this was the facility they wanted him in.
Certainly, this isn't my proudest moment as a nurse.
amoLucia
7,736 Posts
renata - this was a legit episode that OP experienced. She did take a lot of heat for it. I think she saw the fault in her approach to the situation.
You're so correct that poor staffing adds stress to nsg processes on the job.