Published Jan 10, 2002
I read an article about nurses that go to the ER or to a newly admitted patients room to admit them, initiates treatment (ex. start IV, Abx, wound care...what ever) and then turns the patient over to the floor (or ICU) nurse.
This does not include (elective) post ops because this is already done.
Is anyone familiar with this?
P_RN, ADN, RN
I did something like that back in the early 80's. It was more paperwork than the tasks you list, but when the hospital called in "efficiency experts" or whatever, it was determined not to be a RN duty and we were all removed and put in a float pool.
I imagine that there would be too much for one person to do, and like I discovered, everyone thought that I had a "pie" job.....NOT. One of the hardest I ever had. Out of their sight they assume you aren't doing anything
Sidebar here, later (15 yrs or so) this same thing was being done by Clinical Nurse Specialists.
I would imagine that this would be a very busy job, because the turn around time should be under one hour.Therefore the person (or people) would have to be self starers and not ones that would take a 30 minute break between patients. And depending on the size of the hospital more than one would be necessary.
What I have read (all current since 1998) said that for the larger hospitals, there would need to be coverage 24/7 !!!
I can understand using a Clin Spec but I also think that an experienced nurse would be appropriate too. (I was a hosptial float in a >500 bed hospital for 12 years and I LOVED it. I did ICU, ER, NICU, Med-surg, L&D recovery room, peds, neuro, recovery room. ) I think that anyone that can successfully float anywhere could do this job.
Thanks for your input.
plumrn, BSN, RN
We have an Admission-Dismissal-Transfer (ADT) nurse that just started at our hospital recently. Mon thru Fri, 1100 to 1930. She mainly just does the admission assessments. She is too busy with admissions, and too late to get to the dismissals, so we ususually do all the dismissals ourselves. I've never had her free enough to do a transfer either. This means doing shift assessments on new pts received from ICU, or writing orders,etc. on pts transferred to ICU. What a relief! She identifies home meds first, so that we can get them addressed by the physician. I haven't been late going home in some time due to having her there to do the admits. She will help out with the shift assessments when she is not busy. She also tries to update the careplans each day when she can. It's the best idea our hospital has had in a while. But, I'm sure they will find it is not cost effective or something, so I guess we'll enjoy this while we can. She works only on med-surg at this time.
How big is your hospital?
How many ADT nurses do you have?
Does the ADT murse work on your unit ONLY?
Is the unit charged for her time? (How?)
How much time is alotted per patient?
How experienced is she?
Do you think they will expand this?
I really think that this is a great idea, especially if the nurse is well rounded and a true self starter (a fast worker who is not shall we say .....lazy)
I can invision several nurses on this "team", Critical care nurses, Peds, OB, med surg & tele. and possibly working 16 hours a day, maybe even 7 days a week.
Our hospital has 750 beds and we are expanding another 150 to 200 beds and as you well know, it takes and hour to admit someone, obtain and initiate the orders, which is a bit of a pain because rarely does an admission come at a "good" time.
I'm not sure how many patients we admit in a 24 hour period, but we are ALWAYS full with several people waiting in the ER or at home until a bed is available.
I'm going to do a lit search on this so if you can think of any articles written about this topic, please let me know.
I work in a 224 bed hospital. We utilize admission/discharge nurses in the critical care units (CCU/ICU/Telemetry) and the medical/surgical units (4 units). They come in at 11 am and work until 9 pm. They work 6 days a week. Every Sunday off. We also have a "preadmission" nurse (M-F) that sees scheduled surgery patients one week in advance of their surgery that completes all the admission paperwork. When these patients report to the hospital, the receiving nurse validates all the info on their admission paperwork. When these nurses (the ones that work in the hospital directly) are not busy - when that happens???, they are helping to start IVs or transcribing physician orders. They are never assigned direct patient care or given assignments. They stay within their own area and do not overlap. Pediatrics and OB prefer to do their own admissions/discharges due to their speciality. In our hospital, the staff nurses love them and can hardly function when they are not there. In fact, if one of them call in ill, they will give up one of their nurses to fill this role. All of our admission forms and several others that are continued throughout the patients hospitalization, is on the computer, so it is easy to follow and continue these forms. These nurses are figured in the budget of their areas. One key issue with hiring these nurses are that they must have excellent people skills, clinical skills, good rapport with the physicians, and most of - self starters that will not sit around when they have down time. Good luck with anyone anticipating starting this program - it works!
Out hospital has a relatively new acu (admissions care unit) located near er. medical patients are brought to the acu where there paperwork is done, first meds given, and admitting doctor will admit them. I think they have 10 beds. It can also be a holding area for the patients when all the beds upstairs are full.
Frann, how big is your hospital? Our hospital is always full so the acu would be too. How long can they hold a patient in this unit? Do they have a specific length of time? Who staffs it? Critical care or med-surg nurses?
We have 318 beds. the ACU started maybe a couple of years ago and has grown. Its now staffed 24/7. They try to have minimal 2 nurses on and 1 aid. Pts have had to stay in there overnight maybe longer. They just moved intoa bigger space. They have there own staff. They do mostly all the medical admit patients. No icu admits. We are the only hospital for a 50 mile radius and have been having some growing pains, the population is growing to fast. and we can't keep up. The hospital was rebuilt 8 years ago and have allready had major remodeling/expansions.
The Hospital where I work is nearly 200 beds, but sounds similar to Frann's. They recently added a new 8-bed unit (I'm not sure if there are 8 or 10 beds), "EAU"-- Express Admission Unit, and it's near our E.D. and is staffed similarly to Frann's: Two RN's, a PCT (aide), and Unit Clerk. The nurses do all the admission paperwork, put care plans and patient profiles into the computer, give some of the meds, monitor them with telemetry, and they're supposed to get patients to the units within 2 hours, but with our bed crunch, patients have sometimes ended up in EAU more than 24 hours.
We also had some kind of experts come in and tell us that one of the patients' biggest gripes is long waits in the E.D. before getting a bed on the units (natch!) Well, with the ongoing bed shortages, they at least are now in a hospital bed instead of the more uncomfortable E.D. stretchers.
It's really helped us on the floor a LOT (since only RN's are permitted to do admissions), but there are still glitches as in any new system. We of course have to check over all of the orders very carefully and there may be more than 24 hours' worth since they've been in EAU, as I mentioned. Also, some of the staff are new to our hospital and aren't as thorough as we'd wish and mistakes are often made.
Among the many things I appreciate about EAU, one of the most exciting prospects, to ME anyway, is the possibility of not having to set up Buck's traction again, one of my least favorite tasks-- since it is so darn time-consuming and I never could remember how to do it correctly!
We have embraced Six Sigma, one of the projects focused on ED throughput and the Admission Nurses were born. The goal is to complete the clinical history, pull pertinent studies, obtain orders then turn the pt over to the floor staff. The staff love it, the physicans are split 70/30 with most liking the program. We are still tweaking the role and responibilites, and expanding the coverage to 24 hours.
I work a 55 bed ortho unit. We have nurses specifically work the admit/discharge role. They work only 3 days or so a week, on the really big surgery days. Being a night shift nurse myself, I don't get to see them in action. I am sure the day/evening shifts appreciate them though. Our hospital is going to open a pre-admission unit, where patients can go in times of high census or when staff is unable to take them because of staffing issues. They will admit the patient, call docs and initiate treatments and orders. Everyone is looking forward to that unit opening!
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