Change of Shift Admissions

[kgrivera79]

I have worked as an RN for 10 years in 2 different hospitals on 2 very busy surgical floors. When I started my career we had both 8hr (1st, 2nd, & 3rd shift) and 12hr (days & nights) RNs which I found to be helpful with maintaining the flow of the floor when pts came out of the PACU, but since most hospitals have moved to 12hr shifts the age old problem with change of shift admissions is seemingly more problematic. Our floor has started trialing a position of a swing shift RN who works 11a to 11p to help facilitate discharges and admissions so the regular floor staff can tend to their patients and she can cover the 7pm change of shift. In the few shifts since this position has started our swing shift nurse has had to take a full assignment at 7pm in order to cover a sick call or because our census has been high which makes her no longer available to cover the 7pm admissions to the floor. I was hoping to hear from other RNs about how their hospital/inpatient surgical floor handles of shift admission

[TriciaJ, RN]

The age-old problem is hiring a staff member to fill a specific need and then constantly having that staff member "fill in" the staffing holes. I strongly suspect that there is less effort made to cover sick calls because having an admissions nurse gives management an easy out.

At the last hospital I worked, our unit hired a CNA for night shift. The poor night staff never got the benefit of having her, because she was routinely pulled to the medical unit to work as a sitter. When she finally left for another job, they didn't bother to replace her. There was no point.

Any time someone creates a position to fill a specific need, someone else sabotages it for everyday staffing problems.

[MunoRN, RN]

I've never been opposed to getting a new patient at change of shift, that's actually when I get all of my new patients, that's what happens during change of shift.

[Persephone Paige, ADN]

Depends on if it's done right. If it's just an 'admit' to the floor, it's not really that big a deal. If it's a dump, it's a nightmare. I've had an easier admit during change of shift than a dump at 3pm with no report (pt. just showed up from the ER), blood that had been ordered for 2 hours but never given, or meds not administered. Now THAT makes me angry and somebody usually gets an ear full.

[Kooky Korky, BSN, RN]

We used to get called out of Report to get a phone Report from the ER about a new admit who'd be arriving soon. Our boss said we had to take the phone Reports. I guess the ER manager at that time had been pressuring her and trying to get rid of all his ER patients. And I guess Admin backed him up.

Utterly stupid. She wound up having to pay lots of OT to nurses who were trying to give us Report on the ward but couldn't.

Wisely, she instituted taped Report on the ward.

[MunoRN, RN]

19 hours ago, Kooky Korky said:

We used to get called out of Report to get a phone Report from the ER about a new admit who'd be arriving soon. Our boss said we had to take the phone Reports. I guess the ER manager at that time had been pressuring her and trying to get rid of all his ER patients. And I guess Admin backed him up.

Utterly stupid. She wound up having to pay lots of OT to nurses who were trying to give us Report on the ward but couldn't.

Wisely, she instituted taped Report on the ward.

Taped report isn't a legally acceptable way of doing report in my state for acute care patients, so that's not really an option. But in terms of OT, I don't see how it really makes a difference in the end which way it's done, either the ER nurse is waiting until after the end of their shift to give report because you got report from the floor nurse(s) first, or the floor nurses are waiting until after the end of their shift to give you report because you got report from the ED first.

[Nunya, BSN]

On 11/13/2018 at 6:20 PM, MunoRN said:

I've never been opposed to getting a new patient at change of shift, that's actually when I get all of my new patients, that's what happens during change of shift.

It's a totally different thing getting a patient at change of shift from the ER/L&D etc than getting your new assignment at change of shift because you're just coming on shift, unless you work in a hospital unlike every single hospital I've worked in (9)!