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!!!!!
At my facility, we are "supposed" to not have any ER admits between 0630/0730 and 1830/1930. This is our shift change time. Of course almighty ICU can transfer at any time even if they've been sitting on it all day.
ANYWAY, this is the way I and most nurses I know do things. If an ER admit gets there less than an hour from shift change, we get a set of vitals, get the patient settled in, and look for stat orders. That's it. We (just like everyone seems like) have extensive paperwork that has to be done for an admit. However, we have 24 hours to complete most of that paperwork. So I have no problem leaving what I have to for the next shift and I have no problem receiving leftover admission paperwork from the offgoing shift. Nursing is 24 horus. It will get done.
We take ER patients whenever they come up. It has never been a problem during report times. Our report consists of about 20 minutes of looking at your patient's charts (computerized) and then a 10 minute report from the previous nurse. The previous nurse will settle the patient until the following nurse is done with report. It is not a big deal. Nursing is 24/7. I know a busy ER can't hold patients until it is convenient for the floor nurse. On the other hand, it drives me insane when ER calls to give report one minute after they receive the room assignment and the charge nurse hasn't had a chance to tell the receiving nurse they are getting an admit.
I don't know why 75% of our ER patients show up on the floor at ahift change. It is a fact that they do. So it has to be something about the way ER is handling things. I think they are "cleaning up" before their own shift change. It is very hard on the floor. We CAN'T just tuck them in and leave the admission "paperwork" for the next shift. The admitting dr. will come by or call and wants to know everything pertinent then and there. We don't know when they'll come. Plus the patient and family want food,meds, etc. and we often have to call, at which time we get grilled. I would LOVE to leave these admits to oncoming shift but we can't because we know none of the floor patients will be ok if we do. So a change of shift admit means we stay over an extra hour, in addition to the hour or two overshift we always have anyway. And no, there's nothing "wrong" with our time management skills. It's a bad deal for everyone, especially because few of us will come to help when we're off, since we know that however many hours they ask us to agree to it will almost certainly be double that.
At my facility, we are "supposed" to not have any ER admits between 0630/0730 and 1830/1930. This is our shift change time. Of course almighty ICU can transfer at any time even if they've been sitting on it all day.
ANYWAY, this is the way I and most nurses I know do things. If an ER admit gets there less than an hour from shift change, we get a set of vitals, get the patient settled in, and look for stat orders. That's it. We (just like everyone seems like) have extensive paperwork that has to be done for an admit. However, we have 24 hours to complete most of that paperwork. So I have no problem leaving what I have to for the next shift and I have no problem receiving leftover admission paperwork from the offgoing shift. Nursing is 24 horus. It will get done.
That sounds reasonable, I don't see why the admission paperwork has to be done right away. In our hospital, we have an admission nurse who does the admission paperwork while the patient is still in the ED. The floor nurses are eternally grateful.
I have for years attempting to get the powers that be have the ED work ofset shifts from the rest of the facility. If I'm working 7-7 they should be working 6-6 or 8-8. I don't see where it would be any difference in cost to have the folks there staggered. I am quite confident that if they were leaving an hour earlier or an hour later it would change the time they sent up their patients. I suppose the only way it's going to happen is when someone takes the lead and JAHCO or some other rating agency decides,"Hey that might be something to look at". Between that and HCAHPS I am sure something is going to have to change.
Specializes in ICU,ED, Corrections, dodging med-surg.
How about, ed nurse gets what she can get done, explain the need to get the pt up due to needing the bed, and work as a team. I have never felt dumped on. Everyone likes to go home on time if possible, so share the responsiblity. It is a 24 hour facility. Unless the pt is actively coding, teamwork is necessary without all the grudges. Give eachother the benefit of the doubt. It staves off bitterness. "pass the baton and keep running"
I haven't read all these posts cos gotta go to work soon, but when I get late patients, I deal with any emergencies and then do what I possibly can for them. The next shift will have to deal with paperwork etc.
I've only done a few shifts as agency in the ED/ER, but from the insanely busy shifts I did (some with no orientation at all), they wouldn't have room at times to keep patients, but it's a good suggestion.
Ed admits, transfers, it's always the same . We get notification of an ER admit or a floor transfer at 4 pm, they almost always call with report at 1815.
I have the same issue in my facility. I've also had days where they call up the admission at 1230 and I don't get the patient until 1800-1830. It never fails. We don't call up report. They fax us a report sheet and call up to see if the nurse got it. We have one unit clerk who tends to say the RN has gotten it and I have never seen it. Ugh drives me crazy. Nightshift tends to get ***** when I leave them with the admission. Sorry if they come up after 6 I put em on a monitor and get vitals. With 4-6 other patients that I have to give 6p meds to and finish feeding my feeds since the norm now is no tech to help out I dont know what else to do
I have the same issue in my facility. I've also had days where they call up the admission at 1230 and I don't get the patient until 1800-1830. It never fails. We don't call up report. They fax us a report sheet and call up to see if the nurse got it. We have one unit clerk who tends to say the RN has gotten it and I have never seen it. Ugh drives me crazy. Nightshift tends to get ***** when I leave them with the admission. Sorry if they come up after 6 I put em on a monitor and get vitals. With 4-6 other patients that I have to give 6p meds to and finish feeding my feeds since the norm now is no tech to help out I dont know what else to do
Is it still common to do a stand alone paper report? I thought an "interactive" report was a Joint Commission patient safety standard? Particularly if they are just confirming receipt of the report with the UC and not with the RN, in my state that is patient abandonment. (We define patient abandonment solely as the failure of a handing off RN to confirm "receipt and understanding" of the report).
ChristyRN2009
146 Posts
At my facility, we are "supposed" to not have any ER admits between 0630/0730 and 1830/1930. This is our shift change time. Of course almighty ICU can transfer at any time even if they've been sitting on it all day.
ANYWAY, this is the way I and most nurses I know do things. If an ER admit gets there less than an hour from shift change, we get a set of vitals, get the patient settled in, and look for stat orders. That's it. We (just like everyone seems like) have extensive paperwork that has to be done for an admit. However, we have 24 hours to complete most of that paperwork. So I have no problem leaving what I have to for the next shift and I have no problem receiving leftover admission paperwork from the offgoing shift. Nursing is 24 horus. It will get done.