Evening shift - Managing Admissions

Sour Lemon · Jan 29, 2018

Hi!! I'm a new grad nurse currently in orientation and will soon work evenings in a busy med-surg unit. I hear it can be chaotic when slammed with several new admissions which frequently occur during this shift, while managing anything from 6-8 patients. As a new nurse this makes a little nervous, and so I'm writing to ask if you guys have any experiences to share or reccomendations on how I can be time efficient and manage this challenging task. Thanks so much!

Whoever you are hearing this from should also be able to give you good tips. For me, it's all about organizing and anticipating. I have a little list of admission key words to remind me about what I might not remember in the moment ...things like height, preferred pharmacy, vaccine status, etc. I start gathering information before they're even off the stretcher and in their bed and I assess right away. I might not chart it for several hours, but I have it all written down or in my head.

I also have things set up as soon as I know someone's coming ...MRSA swab, camera for wound pictures, IV pump and tubing, etc.

Giving the CNA a mini report as soon as I get it helps us knock things out quickly as a team. My co-workers frequently jump in and help me, too. And of course, I help them when it's their turn.

Buckeye.nurse · Jan 29, 2018

I'll second everything that Sour Lemon said. Also, remember that getting your admission settled and assessed for stability is a priority...getting every little thing done on the admission checklist is not. Some things obviously must be done right away--height/weight, vital signs, admission labs, IV access, stat meds, etc. However, at most hospitals there is 24 hours to complete the nursing database for a reason :) I work the questions into my shift as I can, but I prioritize them in with the needs of my other patients.

guest52816 · Jan 29, 2018

As Sour Lemon stated, gather as much information about the patient as you can before they arrive on the floor. I would go into their ER notes and pull things to fill out my brain sheet. You should also be able to see which fluids they have infusing, so you can set that up ahead of time.

And remember, the only things you need to do immediately are a physical assessment, skin assessment and DNR questionnaire (the latter at least at my old facility). The rest can be done later. Once you get comfortable with your job, you will develop your own system. Within a few months, it got to where I could complete an admission in about 35 minutes.

Delegate as much as you can of the process to the CNA (height/weight and vital signs).

You'll get the hang of it!

guest52816 · Jan 29, 2018

I feel like I should add that none of my night time admissions required STAT labs or medications.

In some ways, they were my easiest patients, as the MDs didn't reorder home medications until the next day.

Also, at my old facility, nurses would split admissions with each other. So, the primary nurse did all the stuff that HAD to be done ASAP, while the second nurse would take the back end of the admission, such as medication reconciliation.

But all that depends on how cooperative your co-workers are.

cosmicnurse · Jan 30, 2018

Wow this is all great information, thank you so much! I agree and will make sure to gather as much info as I can from the onset. Like you guys mentioned charting and completing the assessment questions etc seem like such a hurried and overly prioritized part of admissions, but I must not lose sight of the most crucial actions which are the skin and physical assessment, dnr/dni. I guess it's a skill I will perfect with time and experience. Thanks again for taking time to reply!