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

[PickMePlze]

I'm a new grad and I've been working where I am for almost a year. I work 7-7 days. One of my main reasons I'm throwing in the towel on this job is be because of the 6:00 admits, ER, or some other department wanting to call report and transfer patients in the same hour that we have to give report to the night nurse. The floor I work on is already a zoo, and by the end of the day I AM DOG TIRED AND READY TO GO HOME. I get sooo pissed off, this is driving me insane. Im spending my days off looking for another job. Many a nights I don't get home till 9 pm because of this crap.

I can't understand why they wait till after 6:00 pm. Am I missing something here?

[caroladybelle, BSN, RN]

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!).

Honey, the other day, I spent every stinkin' minute (for 14 hours, after having assignments redone every 20 minutes for 3 separate times because of staff that got pulled/reassigned/didn't show up, and having to redo report) running ragged...on a floor that I was floated to.

I did not get a bite to it, or more than a sip of water from the fountain, from 0615 to 1900. But I did get some cake at 1900, while waiting for the assignment to be rearranged AGAIN. It was the only thing that I had to eat since.....2000 the night before.

If somebody had shot their mouth off about some crumbs, I would have probably gone postal on them.

Don't gripe about cake crumbs...that may have been the ONLY thing that day nurse has had all shift.

[Quickbeam, BSN, RN]

This thread has given me waking nightmares of my years in pediatrics....8 hour night shifts in a central city hospital. 75 % of our floor admits were midnight to 7 AM. No... we, weren't staffed for it (10:1 per RN, no aide, no RT). I'd get 2-3 admits a night, sometimes 4 or 5. My philosophy was safety, comfort and as much paperwork as I could possibly get done. I left on time. I never got much guff because I worked as hard as I could.

For the original poster, you have my sympathy and understanding. Admit overload was one of the reasons I left hospital nursing for community health. Many times, frustration with admits masks a serious staffing shortage or schedule problems.

[burn out]

Learn what the rules are at your facility and play by them. First they can not send any patient that report has not previously been called on...If it is at the end of the shift and I am tied up and I am the one to take the patient then they may have to wait until I get back to the phone to call for report...sometimes that is not until 7p.m. By that time night shift is there and can take report and the patient. If I end up having to take the admission the assessment is the only thing that has to be done in 20 minutes after arrival (in ICU) so I hook the patient up to monitors with help of my coworkers and write a short admit note and fill out the assessment form, the next shift can fill out the rest of the admission stuff and do all the lab , meds etc. Do only what has a time factor and the patient needs and make sure your other work is done before you take the admit that late.

[BrnEyedGirl, BSN, MSN, RN, APRN]

AARRRGGGGHHHH,......trying to be nice,.really do understand we are all very busy,...called the floor at 0610 gave report,..night shift Rn (very nice) says "if you can hold this pt 20 min or so, so I can give report to ongoing shift it would sure make things smoother up here",..great,.have a few empty rooms, pt is stable, meds given,.all tucked in,.my dayshift relpacement shows up,.give her a quick report,."report is called, chart is copied,.ready for a tech to take her upstairs",..0725 get a phone call, on my cell phone, in my car on the way home,.it's the dayshift charge nurse on the floor,..'it isn't acceptable to leave a pt "in limbo" dayshift RN on floor had questions,.ER dayshift Rn "hadn't really seen the pt",.....what do you do??

[queenjean]

If somebody had shot their mouth off about some crumbs, I would have probably gone postal on them.

Don't gripe about cake crumbs...that may have been the ONLY thing that day nurse has had all shift.

It's fairly easy to tell whether someone (or the entire floor in genera) has had an easy or a difficult shift. No one is going to be grumpy to anyone who works hard and has had a long and difficult day.

If you are *always* passing off tasks to do, though, when every other nurse was able to get everything done; if you are always taking smoke breaks; if you are always sitting on your a$$ eating cake or cookies when I get there, then, yeah, I'm going to give you a hard time about taking time to eat goodies instead of getting the admit done that's been here for an hour. If you ran your a$$ off and were shoving cake in your hole to keep yourself conscious while you typed at the computer trying to finish up your task list and charting, heck no am I going to be ungrateful.

We have hard nights on nightshift, too, we really do understand.

[blueheaven]

Shift change admits are not cool. I had the misfortune to go into labor and present to the OB dept at shift change. They just put me in a room, did a brief assessment and didn't give me a call light (too big a hurry to get the hell out of there) went from 5-10 in record time. Door was closed, hubby stepped out to get a cup of coffee. I almost had my daughter by myself! A little too close for me, this momma don't do her own midwifery!

On the other hand, all of us in the MICU get used as the hospital float pool more than the other 2 ICUs. We get pulled all over the hospital and unfortunately have to go to the ER. If we are working with certain irregular ER staff, we know it's not going to be a good day. The irregular staff will hold their patients as long as they can and those of us who are pulled or work agency are working our butts off. Do the irregular staff help when we are in a bind?? NOO! They have a new charge nurse there and I hope she can light a fire under some of them. NM got fed up with trying to deal and she resigned.

[PANurseRN1]

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!

We do not sit around in the ED "La di da, la di da, oh well, I have nothing better to do, I guess I'll ruin the floor nurse's day by holding my pt until it's the most inconvenient time for her to take him, then I'll call with report."

[PANurseRN1]

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.

I found that claim extremely hard to believe as well. We are constantly told about wait times. Oh yeah, and what with all of the "no fly zones" the floors have about when you can't call report and with ED holding pts, you had better believe the second we can get a pt upstairs, they go. An ED is no place for a pt to be held waiting for a bed.

[PANurseRN1]

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!).

Wow. Really, sometimes the things I see here just amaze me.

[Daywalker]

The most frequent time my unit receives admissions and transfers: SHIFT CHANGE. OH and Admitting assign beds just before shift change (that way Staffing can understaff the unit). We're lucky if we even receive report on patients from RR or ER.

You must work at my hospital! The pt's usually arrive on the floor with labs and ECG's pending, too (my biggest beef, since ER is supposed to do those things, and I'm busy enough as it is). Our place does admits even in the middle of the night, but that doesn't mean you should regularly put in an hour or more of OT on this. That's why there's another shift.

[Roy Fokker, BSN, RN]

I like how we on nights are expected to deal with admits - but they won't even send us a unit secretary (or let us have a charge nurse!) for our night shift.

And it really chaps my hide how we keep getting medical patients (I work on a surgical floor) - and when we check the board, we see that medical has one or two beds free. :stone I won't bother griping about how medical gets better staffing than we do.

I need to really push my Director about this - oh wait! I forgot! The director for both floors is the same person

[jw62]

PICKME, I hate to hear how frustrated you are, but know the feeling. I have been a nurse for almost 22 years and theproblems stay the same.

Sometimes the later admits can be because the Dr offices are closed and therefore the patient comes to ER...

I can't speak for other hospitals, but I know at ours the admits just happen when they happen...last night they had 5 admits on the night shift...

Please try to hang in there...it IS frustrating, but this can maybe be a way to help make an improvment...grab the bull by the horns and go to yoru leaders with a fiscally responsible plan that might help you all...maybe having someone stagger shifts? or someone who is just dedicated to admits and procedures (that type of thing)....

We need good nurses, and I can understand your frustration but it really is 'that way all over' or so we all hear that...