Admits after 6:00 pm? Does your hospital do this?

Laurel RN · Mar 24, 2007

I posted this in another thread, but at my hospital nurses work 12s and 8s. So shift change is at 7am, 11am, 3pm, 7pm... and on and on. I work in PACU and the floor generally does not want to accept report an hour before or an hour after shift change, so from 6-8am, 10-12am, 2-4pm etc.. As you can see, this is next to impossible.

Sometimes it is impossible to hold a patient until after shift change. We have no control over when patients hit the unit (as is also true in ER) and we may need the bed for another patient. In units like PACU and ER it is important to get patients turned over fast... there is always another patient waiting to be seen/ coming out of the OR.

Sometimes as a new nurse it takes a while to increase your time management skills so that you can get out on time. There are unusual circumstances that can cause you to be late (like a code). But sometimes it takes a while to be able to plan your day so that if something hits at 6:15 you can manage it .

Do you enjoy nursing? Do you like patient care? If so, give it some time to see if it gets better. If it is really hard on your schedule, and impossible with your family life, but you really enjoy it, maybe you could find some other aspect of nursing that you do like.

(BTW, we can't "hold" a patient until shift change to get out of getting a new one. The patients come in and we take them, no matter what else is going on.)

Lacie, BSN, RN · Mar 24, 2007

Well, from an ER point of view, we often have admitting docs telling us to hold the pt in ER until they come in to write orders, and they don't show up until after office hours. We are not doing this on purpose, we want the pt out of the ER as soon as possible but it's not always possible.

Not only this but they cant readily admit before someone else notifies the ER of where to send them. Many times it happens due to just finding the bed and waiting on housekeeping. Also consider if that ER is full and possible a nurse short that day. Consider a code may have just come through the door when they were ready to give thier report and go home. I have never held a patient knowingly till shift change just to pee off the next shift. Also if busy that ER needs to move those pts out for the others that most likely have been sitting in the waiting room for 6 hours.

oldiebutgoodie, RN · Mar 26, 2007

I think the solution is to either have an admit nurse who does admits, especially in the 3 to 9PM window, or have strict rules on the unit as to what is expected when an admit comes late in the shift.

I would be happy to stay and finish the admit, but our manager gets on us if we leave late. Yet the oncoming nurse gets cranky if the admit is not done. So somebody (a manager with some common sense, hopefully with input from staff) should just come up with a rule.

Oldiebutgoodie

mamason · Mar 26, 2007

To answer the origional poster's question, I used to work at a facility that was notorius with this issue. The ER nurses were told by their manager to hold the pts as long as possible so they won't have to take anothe pt. By doing this, it caused contant chaos at shift change. Needless to say, the nursing supervisor and the ER manager went round after round about this. Guess who won? That's right. The ER manager was replaced. If this is what your facility is doing, then, it's not fair to the other units. It creates a chaotic atmosphere for the floor nurses who are already busy with what's going on. Now, there are certain times when the timing just can not be helped. And that is completely understandable. But, if it is happening ALL the time, then someone needs to address this issue, like your manager.

blueheaven · Mar 26, 2007

You may have the same problem that we have in the facility I work, ER or the nursing unit keeps em ALL day and then decides later in the day that the pt needs to be admitted/transferred to the MICU. On the other hand, pts don't decide when they want to go from bad to worse and in my experience it is ALWAYS at the end of a shift!!! Sounds like as a new nurse you are allowing yourself to be used. Nursing is a 24 hour a day job, and if someone comes in late on your shift, next shift should pick up the slack so that you don't have to stay over.

Momason is right! Good advice there!

BrnEyedGirl, BSN, MSN, RN, APRN · Mar 28, 2007

"the er nurses were told by their manager to hold the pts as long as possible so they won't have to take anothe pt."

as a new nurse to the er after spending 8 yrs on a stepdown/tele floor, i have to say i can not imagine any manager anywhere, actually doing this, let alone saying it out loud!!! we are nurses folks,.we take care of sick people,.in the morning, at night, while we're trying to eat lunch, the begining of the shift, the end of the shift, christmas day, easter, and even on our birthdays!!!!! it's a 24/7 job,...holding a pt to try to keep from taking another one??? please!!!!,.i work in a 25 bed trauma center, plus a fast track,.we also have 8 "hall beds",..there is always another pt waiting to be seen!!! our focus is to stabilize pts and move them on,.be it home, or,cath lab,nicu,ccu, wherever. there is even someone in an office, somewhere (w/a window i'm sure) that keeps track of how long our pt's are there, how long from door to ekg, or to ct scanner or to floor,.many of our accreditations are based on these times,..holding pt's doesn't benefit anyone,.er staff, floor staff, the hospital or the pt! i understand that the hospital is often full and short staffed,..i understand sometimes pt's need to be moved around to make room for the er admit,.it isn't uncommon for us to wait 3-4 hrs for a bed assignment from admitting,.then by the time we get the room clean, and actually get the pt to the room another hour has gone by,.at that time i really don't know what time it is!!!!! then if you throw in a code, or a couple of traumas durring this process,..well you can see what might happen!!! (those pt's don't make appoinments btw)

why are we, as nurses, so quick to place "blame" and complain of "unfairness",. when we are all just trying to do our jobs!! i see this from both sides now, and i agree some er nurses are rude and very unprofessional to floor staff when trying to move pt's out,.as are many floor nurses just as bad to the er staff. it seems there are many people who feel they are the only person in the hospital working their tail off, missing lunch,.not getting everything done,.trying to make everyone happy (and failing miserably),.and working under less than desirable circumstances!!! we are all in this together folks!! can't we just all get along??!!!!

okay,..off my soap box,....i really do love my job,..but honestly,.sometimes i feel like i'm in the 8th grade again!!!

TinyNurse, RN · Mar 28, 2007

have you ever worked in the ER??? The ER often has wait times of over 8 hours, and are holding admitted patients up to 3 days......................not to mention ambulances arriving left and right.................

That is why 6pm no longer matters.............. if the patient can go upstairs to a more comfortable area then they can ............gand this is in the patient's best interest.............

it's all about the patient,remember................

BBFRN, BSN, PhD · Mar 28, 2007

"the er nurses were told by their manager to hold the pts as long as possible so they won't have to take anothe pt."
as a new nurse to the er after spending 8 yrs on a stepdown/tele floor, i have to say i can not imagine any manager anywhere, actually doing this, let alone saying it out loud!!! we are nurses folks,.we take care of sick people,.in the morning, at night, while we're trying to eat lunch, the begining of the shift, the end of the shift, christmas day, easter, and even on our birthdays!!!!! it's a 24/7 job,...holding a pt to try to keep from taking another one??? please!!!!,.i work in a 25 bed trauma center, plus a fast track,.we also have 8 "hall beds",..there is always another pt waiting to be seen!!! our focus is to stabilize pts and move them on,.be it home, or,cath lab,nicu,ccu, wherever. there is even someone in an office, somewhere (w/a window i'm sure) that keeps track of how long our pt's are there, how long from door to ekg, or to ct scanner or to floor,.many of our accreditations are based on these times,..holding pt's doesn't benefit anyone,.er staff, floor staff, the hospital or the pt! i understand that the hospital is often full and short staffed,..i understand sometimes pt's need to be moved around to make room for the er admit,.it isn't uncommon for us to wait 3-4 hrs for a bed assignment from admitting,.then by the time we get the room clean, and actually get the pt to the room another hour has gone by,.at that time i really don't know what time it is!!!!! then if you throw in a code, or a couple of traumas durring this process,..well you can see what might happen!!! (those pt's don't make appoinments btw)

this was the reality when i worked in the er. i have never known a manager anywhere to approve of sand-bagging beds. nurses who were known to do so where reprimanded and then fired, if they didn't comply with through-put. i have only known a couple er nurses who would even want to hang on to a patient any longer than they had to, and they never got away with it. if something wasn't said by the other nurses or the er docs, it would be shown in the numbers- which were posted monthly.

Tweety, BSN, RN · Mar 28, 2007

"the er nurses were told by their manager to hold the pts as long as possible so they won't have to take anothe pt."
as a new nurse to the er after spending 8 yrs on a stepdown/tele floor, i have to say i can not imagine any manager anywhere, actually doing this, let alone saying it out loud!!! we are nurses folks,.we take care of sick people,.in the morning, at night, while we're trying to eat lunch, the begining of the shift, the end of the shift, christmas day, easter, and even on our birthdays!!!!! it's a 24/7 job,...holding a pt to try to keep from taking another one??? please!!!!,.i work in a 25 bed trauma center, plus a fast track,.we also have 8 "hall beds",..there is always another pt waiting to be seen!!! our focus is to stabilize pts and move them on,.be it home, or,cath lab,nicu,ccu, wherever. there is even someone in an office, somewhere (w/a window i'm sure) that keeps track of how long our pt's are there, how long from door to ekg, or to ct scanner or to floor,.many of our accreditations are based on these times,..holding pt's doesn't benefit anyone,.er staff, floor staff, the hospital or the pt! i understand that the hospital is often full and short staffed,..i understand sometimes pt's need to be moved around to make room for the er admit,.it isn't uncommon for us to wait 3-4 hrs for a bed assignment from admitting,.then by the time we get the room clean, and actually get the pt to the room another hour has gone by,.at that time i really don't know what time it is!!!!! then if you throw in a code, or a couple of traumas durring this process,..well you can see what might happen!!! (those pt's don't make appoinments btw)
why are we, as nurses, so quick to place "blame" and complain of "unfairness",. when we are all just trying to do our jobs!! i see this from both sides now, and i agree some er nurses are rude and very unprofessional to floor staff when trying to move pt's out,.as are many floor nurses just as bad to the er staff. it seems there are many people who feel they are the only person in the hospital working their tail off, missing lunch,.not getting everything done,.trying to make everyone happy (and failing miserably),.and working under less than desirable circumstances!!! we are all in this together folks!! can't we just all get along??!!!!
okay,..off my soap box,....i really do love my job,..but honestly,.sometimes i feel like i'm in the 8th grade again!!!

we don't sandbag beds. but our manager knows how many patients each nurse can safely handle and there comes a time when we have to put our foot down and say "enough is enough". yes, i do know that the er does not have this option when there's an ambulance at the door, but our manager's concern has to be the safety of the patients on her unit, the rention and satisfaction of the floor nurses who get burned out with the constant bombardment of unsafe ratios, and keeping "customer service" scores up. i'm sorry that the er gets busy and they get gridlocked when the floor is busy and they don't have the luxery of saying "i'm maxed out and can't handle another patient", but fortunately i do and don't hate because of that. :)

however, there is also a time when it's unsafe in the er and our directors have a "never divert" policy and they admit patients to the floors and we are not allowed to refuse.

we are also not allowed to object an admission, no matter what the time.

it's tough to get along, but we have to maintain a spirit of cooperation, while looking after our own interests.

99% it works where i work. every now and then be bump heads, but for the most part it works.

mamason · Mar 28, 2007

Ok....let me just say, " Not all ER's hold pts." I was only talking about the armpit that I use to work at. As I said, the manager was fired for this. I really don't know why I'm even trying to explain myself. I believe that people are just taking this personally instead of trying see the whole picture.

queenjean · Mar 28, 2007

I don't mind finishing an admit left over from day shift usually. The exception to this is that they don't tell their charge nurse or the night shift charge that there is an unfinished admit, so sometimes I get stuck with two at once. My other beef is that the patient has been there for over an hour, but the day shift admission nurse had several admits and couldn't get to it--hello, even though you have an admit nurse on days, you still are capable of doing an admit! Do the stinking admit (this especially smarts if you are brushing off the crumbs of the birthday cake you just ate in the back room prior to shift change--ya got time to eat cake, ya got time to do the frickin admission!). If an IV goes bad, a patient is waiting for a PCA, and you know that IV therapy can't get there for over an hour, you start the freakin IV yourself, of course. This is no different.

That's what irritates me. Shift change admits from ER? Nahh, I don't care anymore. If I get an admit at shift change, it just means I'm not up for an admit for a while. In my most humble opinion, it's never a good time to get an admit!

flashpoint · Mar 28, 2007

I've noticed that things get crazy at chift change no matter where you work. I work in an LTC and from 1700-1800, we have supper, supper meds, pharmacy comes in, and doctors who put us off all day finally call back with orders. From 0500-0600, we have a HUGE med pass, rounds, and we have three residents who have to get up for dialysis. The dialysis patients need weighed, dressed, and fed...and we have to cook their breakfast. It's just a really busy time.

I don't mind having something from the previous shift passed on to me unless the charge nurse is outside smoking when I pull into the parking lot and she sits eating a sandwich before calling her husband to see what he wants before supper and finally gives me report. If they are calmly smoking, eating, and talking on the phone ten minutes before shift change, they can calmly put the order they just received on the MAR. I don't think they should be running like crazy to get my help, but they shouldn't be taking an extra break either.

Off my soap box...back to our regularly scheduled topic...