Change of Shift Admissions

Repat · Apr 8, 2004

Makes sense!! And I always take report if the admitting nurse is not available, but I do let the reporting nurse know that I am not the admitting nurse, and ask them to please wait until after lunch or whatever to bring the patient up so I have time to review the report with her. We used to fax report, which was great because there was a time lag between them faxing report (1/2 hour) and the patient being brought up. Gave us time to gather necessary equipment (hard as it may be to believe, there are not oximeters and IV pumps sitting at every bedside waiting for patients!). Howver, ER complained about it, and now it often happens that as I am taking report, the patient is rolling up to the nurses' station desk. Again, unsafe and inappropriate.

I always try to just give report before I leave at 7p and I always thank the nurse that is recieving the report and tell them that they can come and get the patient after shift change if they need to. As someone said, it is a team effort and I try to help all members of the team as much as possible from the nurse that is relieving me to the nurse I am giving a patient to.
Pam :)

RNPATL, DNP, RN · Apr 8, 2004

Pam .... it is good to get the persepctive of others and I think that is why this BB is so great. I totally respect your post and certainlly your position and have to say that I agree. I know the ED is busy and direct admits are a hassle for you all too. But it just seems like it makes better sense for the patient instead of bringing them to the unit where they are not going to be seen for a while.

I am certainly not expecting the OR, ED or any other department to hold a patient because it is not convienent for me. It is really not about me, rather about the safety of the patient. Why on earth would I want a patient being transferred from PACU right at change of shift. There is far to much to do with a new post-operative patient. Taking him/her at change of shift is not a safe time to transfer in my opinion. But we must remember ... it is not for my convenience, rather it is for the patient's safety.

During report, we have a nurse generally covering the floor. But it is a stressful time ... especially as we transition from days to evenings (yes, we are an 8 hour shift hospital). It just seems like continuity of care is not considered many times when patients are brought to the floor.

Not sure what the solution is, but it is good to talk about it and thank you Randy for startig this thread. :)

bellehill, RN · Apr 8, 2004

We have a problem with PACU sending patients during report or calling to give report while we are changing shifts. It aggrevates me to no end, should I listen to the nurse leaving or stop report to take a patient from PACU nurse? I realize part of this is managements problem with not giving bed assignments quick enough.

Once I have taken shift change report I am fine with getting patients, but please don't interrupt my shift change report...it already takes too long.

The other thing that aggrevates me is to come in for my shift a see that I have admissions coming and the ED was told they couldn't come before 7:30pm. Why? Because I am not as busy when I come in as the nurse who is leaving? Again...a management issue not discussing a certain department.

Tweety, BSN, RN · Apr 8, 2004

In the case of waiting to give report because the floor nurse is in report, do you not have someone covering your patients while you are off the floor taping your report? Or not having any admits during a certain time period?! get real! Do you think we are allowed to tell patients "oh I'm sorry, you can't check in during certain time periods?" :angryfire

No you don't have the option of telling the ambulance you're in shift change report. Apples and oranges here. Patients are covered by ourselves (we don't have an extra nurse wandering around covering patients during report), when the profressionals are in report and if they absolutely have needs then report is interrupted. We get interrupted in report all the time.

But to insist two people get interrupted in the middle of report, when it's not really necessary , when report might have been called 15 minutes earlier, or perhaps 15 minutes later is just plain rude and selfish. So the ER nurse gets to leave on time and two people are inconveniced on the floor. Guess it's a matter of who is more important.

It does get irritating the when kind ER nurse agrees to wait, then 30 minutes later the floor nurses are STILL in report, then 30 minutes later they are still in report. Then the floor nurse wants to wait "until I've seen all my patients", then wants to wait "until I medicate all my patients", then "opps....the rooms not ready yet, hehehehe......." Passive agreesive nonsense is done on both sides. Again, teamwork is the key. As a charge nurse, I don't allow "my" staff to play those games, but try to let them get through report before putting the ER through. Again, it's our hospital policy not to obstruct the ER, if they insist, we are required to take report, because getting patients out of the ER is the priority here, not the convience of the floor. :)

Hope this doesn't deteriorate this thread.

Stitchie · Apr 8, 2004

I have worked "both sides now" and can honestly say that I avoid trying to transfer patients at 1430 or later, because I know what a pain it is. That said, sometimes it really is unavoidable to bring up the patient for reasons not apparent to the units: the attending/PCP was slow in getting back to us, beds aren't available, or Triage is full and it's getting ugly. I don't know of any ER nurse (but I'm new there, so be gentle pls) who would deliberately send up a patient at 1445 but I could be wrong. Aside from that, when there is no way we can go on bypass because Cook County is closed to Trauma and Northwestern is on bypass, we have to function to pick up those patients who are diverted -- and that means trauma patients in our Level II hospital. It's scary, stressful and not the optimum solution for a small hospital in a large city (Chicago, to be exact, outskirts of).

So I think we need to remain flexible and above all kind to each other. It is really the patients who come first, and who truly are deserving of the best care available to them.

askater11 · Apr 9, 2004

Do R.N.'s in E.R. all work 7 A.M. to 7 P.M.? The hospital I work at is like that. Prior two hospitals had some very odd working times--we didn't seem to have such problems as at my current job.

We do get a lot of E.R. admissions between 5-7 P.M. At times we can each have one admit each R.N.--plus one nurse 2 admissions between 5 and 7 P.M. We'd all be running chaotically--it was crazy!!! (there would be 8-9 admission in two hours.)

Now they have a rule no E.R. admits between 6:30 and 7:30 P.M. We also changed from phone to fax report. That seems to work well. I'd like to get report via fax before my shift from E.R. to 7:30--I don't mind. And totally understand it's easier for the R.N. going off shift from E.R.

Stitchie · Apr 9, 2004

Do R.N.'s in E.R. all work 7 A.M. to 7 P.M.? The hospital I work at is like that. Prior two hospitals had some very odd working times--we didn't seem to have such problems as at my current job.
We do get a lot of E.R. admissions between 5-7 P.M. At times we can each have one admit each R.N.--plus one nurse 2 admissions between 5 and 7 P.M. We'd all be running chaotically--it was crazy!!! (there would be 8-9 admission in two hours.)
Now they have a rule no E.R. admits between 6:30 and 7:30 P.M. We also changed from phone to fax report. That seems to work well. I'd like to get report via fax before my shift from E.R. to 7:30--I don't mind. And totally understand it's easier for the R.N. going off shift from E.R.

No -- we have staggered shifts, coming on every two hours. We work 8, 10, or 12's. That may be some of the odd working times! RN's can come on at 0500, 0700, 1100, 1300, 1500, 1700, 1900, 2300 and leave at 1100, 1300, 1500, 1700, 1900, 2300 or 0100 (or whatever). These are definitely crazy hours!

The reason you may have so many admissions then is because it's usually busiest between 1500 - 2100. Absolutely insane where I work. Today Cook County / Stroger Hospital and Northwestern Hospital were both closed to Trauma (metro Chicago) and it was ugly.

meownsmile, BSN, RN · Apr 9, 2004

No criteria where i work. I wish we could get them to hold shift change admissions. We can always count on them. Same with surgicals, never fails they snow us with new surgicals just as lunch time comes up, or change of shift.

MrsWampthang, BSN, RN · Apr 9, 2004

Seems like it is apples and oranges here. I don't know what the solution is, except to realize that we are all in the health care business and as such none of us can expect to go our entire day without something unexpected coming up.

Someone asked why a patient can't be held in ER just a little longer? Well, imagine if you were that patient that has been down in the ER for 5-8 hours (including a 2-3 hour wait in an uncomfortable waiting room), do you really think you would care whether that floor nurse got to have lunch or not? Actually in some venues that would be considered a short wait, am I right?

Patient's sure don't care whether ER nurses have gotten to pee once, let alone get any type of break. Never fails that right at lunch time they will roll, or walk in the door, and build up to ugly numbers by afternoon. Sometimes it doesn't even take that long for it to get ugly, sometimes it starts first thing in the morning and never slows down. And we don't have the luxury of waiting until the room is cleaned by housekeeping before we take our next patient. Sometimes all we have time to do is throw a clean sheet on the bed ourselves before the next patient walks in the room.

We don't admit patients close to shift change to be mean, at least I don't, but sometimes we truly do need the bed because there are umpteen people lined up in the waiting room waiting to come back. I try to at least call report before I leave at 7p. I don't expect them to take the patient but I sure do appreciate it when the floor takes my report so I can leave one less thing for my relief to do; more often than not the shift coming in at 7p hits the ground running so it is nice for them to have that one less thing to worry about.

As frustrated as we all get with each other, I don't think most of us would trade our jobs for a nine-to-five, weekends and holidays off job for any amount of money. We all need to try and be more understanding of each other and this is a great forum to learn the "other side of the coin." What say ye? :chuckle

JMHO,

Pam

Ahhphoey · Apr 9, 2004

I work on a small, but busy post surgical unit and it never fails, everyday, we get a postop patient either 5 minutes before shift change or during shift change from the day to evening shift. It truly aggravates me. When I have time, I will tape my report and am more than happy to get the patient settled while the oncoming shift listens to the tape, then I can answer any questions when the patient is comfortable. However, hardly ever am I far enough ahead to tape report for the next shift. I understand that each department needs to keep things moving, but, it is extremely unsafe to bring a fresh post-op patient to a floor where all the nurses are in report and only UAPs are available to receive the patient onto the unit. Believe me, if I have time, I always take the report and the patient as soon as possible, but I too have other patients to tend to.

telenurse04 · Apr 9, 2004

How many of you have a change of shift admission for M/S patients from the ER and what criteria is there, if any? Ex. no admisions 15 minutes prior to end of shift nor during report.

I am a telemetry RN. What we do is try to get an admission or float nurse to come to the floor to admit the patient. Sometimes, the float/admission nurse admits the patient while they are in the ER.

What terks me off is when the day shift nurses leave, there arn't any admission nurses, I am in the middle of something and I get a direct admit. Also, the other night our poor eve shift recieved 7 admissions. That's like an admission an hour! Luckily, we are designed to have 12 hour shift nurses to come in at 7 PM so that alleviates some work when they arrive. I did not realize this, but I think I heard that hospitals are allowed to not accept more admissions if it is going to be unsafe practice to admit more patients.

I know what you mean when you wish that there should be a waiting time or criteria before a patient hits the floor at these busy times. In fact, sometimes the ER will send up a patient before report is even called up to the recieving nurse. Sometimes you will barely hang up the phone and you see the patient. What I think is bad customer relations is when a direct admit comes to the floor. They are dressed in civilian clothing. They come to the desk. It is crazy..and you are like "can i help you?" And, then you realize that they are the admission you didn't even know you were getting. "let me see who your nurse is...oh, I am your nurse!" I think if I were that patient, I would feel under-valued.

sharann, BSN, RN · Apr 9, 2004

Well, I work PACU and we do NOT work shifts like normal people on units, we work until all the surgeries are over. Today I was "scheduled" to work 9-5:30 and I left work at 0030 (15 hours). At 7 pm I had four patients and 2 nurses and 2 more were coming out so I apologise but I can not hold for any floor shift change or not, since we are only allowed 2 pts each (keeping 2 would give us 3 each). So, we don't hold for any reason except for a lack of nurses or beds. We DO if we are able to though. We love our floor nurses and don't want to overwhelm them! These are my friends too. So people often don't see the other side until they have actually worked there.

Forget all I said what do I know after 15 hours of work Im a maniac, going to bed now:)