Published Apr 8, 2004
How many of you have a change of shift admission for M/S patients from the ER and what criteria is there, if any? Ex. no admisions 15 minutes prior to end of shift nor during report.
RNPATL, DNP, RN
Randy - this is an issue that drives me nuts! Where I work, it never fails that we get 2 or 3 admissions just before end of shift. There is no criteria! It does not matter that we are changing shifts and the oncoming shift will not be in to see the patient for a while. They still bring the admission.
This whole issue is really sad for the patient. The other day, I had run for the entire day. Had about a 7 minute lunch. I was charting and finishing things for my shift when the charge nurse told me and another nurse that we were getting direct admits that were coming through the ED. My shift was over in 15 minutes. I asked the charge nurse if they could hold the patients in ED until the next shift was on the floor and she said no, they were on the way. So, I accepted the patient, made him comfortable, got a set of vital signs and told him the next nurse would be in to see him as soon as she was on the floor. Told him how to use the call light and made sure he had what he needed.
I really hate change of shift admissions. You would think that everyone knows when the shifts change, why send patients at that time?
I agree! Change of shift admissions are the worst, either just before the end of the shift, or right at the beginning. Both are difficult. With all of the paperwork involved and the assessment, they are very time consuming. I don't know the answer to this. It will be interesting to hear what others have to say about this.
Marie_LPN, RN, LPN, RN
We had such a problem with this that the new rules is no admissions to the M-S floors between the times of 6:30am and 7:30am (11-7 and 7-3 reporting) and so on. The patient was more on the back burner being pushed onto a floor and the nurse showing in the room 30 minutes later.
What really worries me is patient safety. A patient that arrives during change of shift is not likely to be seen right away, other than possibly to "settle them in" and grab a set of vitals. And with all the focus on customer service, how does our customer feel when they were admitted through the ER but the unit nurse didn't see them in a timely manner? There should be a rule: no admissions for 1/2 hour before and after report time. Our ER has been given permission to send the patient whenever...during report, during a code, doesn't matter. They have convinced everyone that the unit nurses are just trying to "stall" (which I'm sure happens sometimes, but it's not the norm). :angryfire
Absolutely the unit nurses are trying to stall. When you have a heavy patient laod and there is more coming, sometimes, it is nice to get your bearings before you accept another patient. What I think is interesting, is that all other areas of the hospital take precident over the units. I totally understand that outpatient surgery has a heavy caselaod and they need to turnover their beds quickly. I also understand the need for ED to move patients through the system so they can make room for more and I realize that PACU needs to move their patients also, but there really has to be a better way to transition the patient from one level of care to another. Just throwing the patient at the unit at any time of the day is inconsiderate of the nurses on the unit and is very poor customer relations. Perhaps the patient does not know what is going on, but you can bet the family is aware.
When I worked in PACU or ER, I always tried not to transfer during change of shift time to be fair to the reciving staff as well as the patient. Sure, if a problem arises, and OR was going to send out four patients in fifteen minutes then I would have no choice but to transfer. Or there was a large trauma coming in with several patients and I needed to empty some beds, that is a priority. But under normal circumstances, HOLD the patient.
I may have been more receptive to this because of having experience in working most areas. My motto still is: THE PATIENT ALWAYS COMES FIRST.
Tweety, BSN, RN
We frequently get admissions at the change of shift around 7pm that the day shift were unable, or unstaffed to take.
If our ER is busy we are not allowed to interfere with transfers at any time. If we don't take report, they fax one. We used to have a policy of no admits during shift change, but they dropped it in favor of the ER. However, most of the time, if you ask the ER to wait, they will, unless they are busy or have a trauma coming in.
Team work is the name of the game. :)
AMEN! to that.
MrsWampthang, BSN, RN
Randy - this is an issue that drives me nuts! Where I work, it never fails that we get 2 or 3 admissions just before end of shift. There is no criteria! It does not matter that we are changing shifts and the oncoming shift will not be in to see the patient for a while. They still bring the admission. This whole issue is really sad for the patient. The other day, I had run for the entire day. Had about a 7 minute lunch. I was charting and finishing things for my shift when the charge nurse told me and another nurse that we were getting direct admits that were coming through the ED. My shift was over in 15 minutes. I asked the charge nurse if they could hold the patients in ED until the next shift was on the floor and she said no, they were on the way. So, I accepted the patient, made him comfortable, got a set of vital signs and told him the next nurse would be in to see him as soon as she was on the floor. Told him how to use the call light and made sure he had what he needed.I really hate change of shift admissions. You would think that everyone knows when the shifts change, why send patients at that time?
First off, holding a direct admit in ER until YOUR shift shift changed?! You have got to be kidding! We have shift changes in the ER too and our nurses want to get out in a timely manner too. The main reason for a DIRECT ADMIT is so the patient won't have an ER charge. If they come to the ER then we have to evaluate and treat them. We are not a HOLDING AREA for the floors, we are an EMERGENCY ROOM! Direct admits are NOT an emergency! Why on earth would you have even thought about dumping a direct admit on the ER staff who might have been just as busy or busier than you? I think that was pretty rude of you. I'm glad your charge nurse didn't allow it. :angryfire
Second, as I said, ER has shift change too, and sometimes the patient has been in the ER for hours waiting for tests, waiting for the admit doc to see them while they're still in the ER, waiting to be seen by the ER doc because we're swamped and that patient wasn't necessarily a priority see for the ER doc, so they waited to be seen, waiting for someone to make the decision to admit them, waiting for the supervisor to call with a bed, etc. etc. So, rather than dump that patient on the oncoming shift who hasn't spent the last few hours with this patient, report gets called before the offgoing shift leaves; that way a report gets called by someone who knows the patient and can give a more personal report instead of someone simply reading what is written. :angryfire
In the case of waiting to give report because the floor nurse is in report, do you not have someone covering your patients while you are off the floor taping your report? Or not having any admits during a certain time period?! get real! Do you think we are allowed to tell patients "oh I'm sorry, you can't check in during certain time periods?" :angryfire
I understand your frustration, but don't expect ER, OR, or any other floor to hold a patient until it's "more convenient" for you; that's inappropriate to say the least. The solution I have heard here is to have a dedicated admit nurse whose job it is to go to the floors and do the admit while the nurse who is taking the patient does whatever they need to do.
As for everyone knowing when shift change is? Not necessarily. We have shift change at 7a, 3p, 7p, 11p or various other times when we have staff coming and going so how are we supposed to know when floor change shifts? And as I said, patients don't always come at times when it is "convenient"; remember, they aren't an interruption of our work, they are the reason for it!
Sorry this is so long, but as you might have guessed, you hit a nerve with this. I don't know about other floors transferring patients to M/S but I know the frustration of ER getting patients to the floor and we have our issues from that side of it.
P.S. this isn't intended as a flame, just a response.
I have come on shift as charge nurse and found FOUR (yes, FOUR) stretchers in the hallway of our unit, waiting for someone to situate them. We, also, do not get to say wait a minute. Safety? Huh?! I know we have had other posts about this subject, and I have said it before, why do patients who have been in the ER for hours all of a sudden need their beds RIGHT THEN at shift change? And why do the confused, agitated, abusive patients seem to make it from ER to the unit in record time? This is a management issue that will not be changed until something awful happens - and I just hope it's not on my shift.
I always try to just give report before I leave at 7p and I always thank the nurse that is recieving the report and tell them that they can come and get the patient after shift change if they need to. As someone said, it is a team effort and I try to help all members of the team as much as possible from the nurse that is relieving me to the nurse I am giving a patient to.
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