Change of shift admissions

[kittymom]

Hi to everyone. I need help. After my last three shifts, I have left work so-o-o-o frustrated due to admissions being sent to my floor during the last hour of my shift. I work on a critical care unit, and the paperwork alone needs at least twice that to complete! Last night there were 2 nurses and 1 tech, and 2 admissions came up within 10 minutes of each other between 6:00 pm and 6:15 pm. Report is supposed to start at 6:45. One was vomiting coffee-ground emesis, and the other was pale as a sheet and shaking from hyperglycemia. Neither got the care they deserved, but we did the very best we could, then handed off to the next shift.

There are plenty of reasons NOT to accept a patient during the last hour, but when the Nursing Supervisor and your Charge Nurse say do it, then we have no choice. However, what do other hospital do? Does anyone out there limit admissions at shift changes? I've heard of hospitals that send only emergency admits between 0600 and 0730, then again from 1800 to 2030 . . . but my ER nurses tell me, "That's impossible!" Why is it impossible? Am I missing something? If a patient has been in the ER for 8 hours, why can't they be handled there for another hour or so? Is it just me? Am I barking up the wrong tree?

By the way, I was an ER nurse for 2 years, so I know the Docs are the biggest problem with admission times, not the nurses. Can't they be educated?

Help -- I'm thinking of putting together a research study to help with these times, but I need to know what other places are doing. Thanks for letting me vent!!!!!

[rn undisclosed name]

Yep, you're barking up the wrong tree. All you're going to do is make the er nurses mad. I've been told it's the docs. Could they be educated? I dunno. Would it be like teaching an old dog new tricks. You're right I don't think it's fair from a floor nurse perspective but unless we're down there we don't know what it's like in the ER at that very moment so I guess it's easier for us to say this. Whenever I complain about this at work I'm always told it's the ER docs. I don't understand why so many patients sit down in the ER for hours especially when all they had done was a CXR and a couple of labs. Surely you don't need 8 hours for that. I also don't understand why I can get report on the patient and not see them for a couple of hours cause they're still sitting down there in the ER. Has something changed? Did the pt leave AMA? I have to call and find out what happened. If I don't call and do get the patient I don't get an update on them. Instead I have to dig through the chart and find out what else was done.

[mianders, RN]

I worked the ER for a long time and most of the time you have a lobby full of patients waiting on an ER bed. Some of these patients can be very ill. The nurse in ER would probably like to hold on to that patient so she/he does not have to bring back a new patient that they will have to start at the change of shift also. When you have sick patients that have been waiting in the lobby for hours it is not fair to them to say sorry the floor nurse wants us to wait another hour or two so she does not have to get an admission right now. How would you feel if this was you or a family member. What it comes down to is what is best for the patients.

[Snow1278, RN]

I work on a telemetry unit night shift and this happens a lot to us. We do not accept admits during shift change, so pts can be brought to our floor until 7 pm or 7 am. Between 7 and 7:30 we don't accept them though due to report. It is difficult when they bring patients and drop them off at 6:50 and we have so much left to do as far as paperwork goes. Good luck I know how frustrating it is.

[time4meRN]

I've worked many years in the ICU and ER. There are two sides to everyting. Though I have to say ICU nurses get in a rutt with the paper work thing. The charge RN should be taking admits and starting the paper work. If enough things are done paper work wise and in the computer so that the pt can start getting admitted , the next shift can do all the other little things that need done. There is no shift change in the ER, if a coding pt comes in at 1555 then we can't say, oh wait there a few while I get report. Let alone the 49 other pt's waiting 5 or 6 hours for a bed, we don't stop bring pt's back because it's shift change. Like I say I've been on both sides, most of experience has been in ICU and I really get sick of ICU and floor nurses whining about taking pt's. They complain if they are empty and have to go home and they complain if they get busy. Go figure. Come down the the ER, we are always busy.

[nghtfltguy, BSN, RN]

LOL...now this is some funny stuff!!

i worked ER staff and flight for many years... now im just part time flight and full time ER.. i work in an LTC part time and do PRN work... wherever... pretty much everywhere...*agency*

if your shift is getting ready to end and you get an admit... you can do the initial stuff... assessment, h & p.. blah blah... but you should be able to pass the other stuff on the the oncoming nurse... at least that is what i have always been taught.. well.. mostly because im the one that has to do the rest of the admission... i get a lot more passed on to me that i pass on....

it pretty much depends on the facility i guess...

don't blame the ER for turfing pts to a bed @ a particular time...

when someone is about to get off their shift or come on their shift is of no concern...

we just wanna get that person out of there cause we need the bed so we can stick one of the 50 ppl in triage in... and get them out of there too..

[TiredMD]

don't blame the ER for turfing pts to a bed @ a particular time...

Don't be so quick to let them off the hook.

ER docs are notorious for dragging their feet getting patients admitted, then try to dispo the entire ED in the two hours before their relief comes in so that they don't have to turn anyone over or stay late.

One more reason I thank God that I will never have to do another shift in the ED.

[EmmaG, RN]

Our policy was that the paperwork and admission on any patient who arrived on the floor after 6am, 2pm, 6pm, or 10pm would be passed to the next shift (our reports start at quarter to the hour). The off-going shift would be responsible for getting them settled into bed and taking a set of VS. If there was nothing urgent to be done immediately upon arrival, the on-coming shift took care of things. That seemed to work out very well.

[NurseLatteDNP, MSN, DNP, RN]

ER docs are notorious for dragging their feet getting patients admitted, then try to dispo the entire ED in the two hours before their relief comes in so that they don't have to turn anyone over or stay late.

That's how our ER is. Right before they finish their shifts, they decide to send all the admits at one time. We don't have any policy regarding the hours of admission, so it is very common to get them between 0600 and 0700.

[Mobeeb, RN]

In our ED, most of the delay does come from the housestaff residents and the admission process. When the ED MD's determine the need for admission, the appropriate service is consulted and we go ahead and place a bed request, but.....the patient placement center will not assign a bed to the ED until they receive the written admission orders. And this is the time consuming part....it takes forever for the Medicine and Family Practice residents to come down, see the patient and write orders. The other services are pretty quick, especially Trauma and Critical Care Medicine.

Now....the fly in the ointment for the floor staff and for the ED is that....the patient placement person will call the floor, get a room assignment but not share the room number with the ED, so that hours later when we are calling the report, the nurse asks why we "held" the patient so long before sending upstairs.

To help keep the peace ( and, realizing that change of shift is a really bad time to call report) the powers that be have established the rule that no reports, with the exception of emergency unit admits, can be called between the hours of 0630-0730 and 1830-1930. This gives the oncoming floor staff time to receive their own shift reports. Yes, it is a headache, because those 50 patients in the lobby want to get a bed in the ED, but everyone's hands are tied by the system. So, we, in the ED, just gird our loins and take the verbal abuse from the folks that are waiting to come to the treatment area.

Nuff said..

[angel337, MSN, RN]

in our ED, the docs have very little to do with when a patient gets a bed. the nursing sup. gives us the admission and unfortunately if the patient gets a bed at shift change we have to get them up. we have no choice. the nursing sup. sometimes holds onto beds at shift change until the last minute because of staffing issues. i truly feel bad when i bring a patient at shift change, because i know it can be overwhelming, but try telling your charge nurse "oh, i will take that patient up once the next shift comes"....not happening. i never have any intention on making life miserable for the floor nurses. the ED is always hopping with even more admissions so we have to keep moving whether we want to or not.

[Burnt Out, ASN, RN]

On our unit, if we get an admission after 6 am or 6 pm, we get the patient settled in bed; get a set of VS; check the orders for anything stat (meds or labs). Sometimes we will start the admission paperwork but it just depends on what else is going on at the time.