Getting new patient at shift change

[Double Dunker]

I work med surg at two different hospitals. Both hospitals have shift report from 0700/1900. At hospital A, if you get a new patient after 0600/1800, we get vitals and complete the admission paper work. If you get anything else done, it's a bonus. Staff is very generous about not expecting you to get everything done for a new admit whenever you are trying to finish up your shift. And in general, most attempt to go beyond the bare minimum whenever possible. At hospital B, the expectation is that the off going nurse will get everything done before leaving, even if that means you stay 90 minutes past the end of your shift. It was all I could do to not snark, "Hey, this is a 24 hour operation. Give me a break" before leaving today. My patient arrived at 1820. The patient was a direct admit, so I didn't have any orders when the patient arrived. I got vitals, did the admission paperwork, started an IV, charted an initial assessment, and spoke with RT to understand the plan so I could pass it on in report. I was slammed because I didn't hang the IV fluids, and I didn't get the glucose stabilizer program set up on the patient's computer terminal. Is hospital A really unique? What's the expectation where you are?

[crazin01]

I no longer work in an acute hospital setting, but spent about 8 years in such an environment. That said, it was always a battle with the ED to not bring admissions to the unit for 30 minutes before & after shift change. Certain ED nurses would flip & on a few occasions, they've brought patient up (with 3-4 familiy members), inform the receiving nurse of patients' arrival & give the ED papers to the unit clerk.

I personally prefer to receive a decent ED report, so would return phone calls during change of shift to take verbal report from the nurse who was providing care to the patient for 8+ hours. Versus the next shift nurse report with little to no info. For the most part, the majority of ED nurses always seemed to be agreeable to giving report over phone and promise to 'hold' patient until 1945, or something.

I've seen quite a few different facilities with a similar 'common courtesy'.

But on occasion, when a float nurse/admissions nurse was present throughout entire facility, he/she would handle all of the admissions (hospital-wide ). It was always nice to have a nurse solely for admits, depending on the level of crazy-busy in the ED.

I might be wrong, but I would hope oncoming staff would say "thanks!" and appreciate the assistance by the staff finishing their shift.

I'm sort of interested to see what others say...

[Sour Lemon]

I've finished admissions that rolled in at 06:45, but they were simple admits and I usually had the help of my co-workers. I've also had admits passed on to me that arrived at 16:30 (or even earlier). That's somewhat frustrating, but I know our regular day shift nurses are not slackers and that they have a good reason if they're leaving a "train wreck". I don't mind catching up and cleaning up, because they do the same for me when necessary.

At a previous job, I recall one day-shift admission who didn't get fluids started until night shift arrived. Her diagnosis was hypoglycemia, and she was actively seizing and bottomed out when she was initially rounded on by night shift. In that case, maybe the fluids should have been a priority. In most cases, it's not that serious.

The martyr-type nurses seem to expect the same behavior from every other nurse. I encourage them to go home - they're often already clocked out. I also remind them that if I were in their situation, I would leave the admit for them to do without a second thought. Sometimes that helps them get over their guilt, and sometimes it just lets them know what to expect from me when the table is turned.

[nursej22, MSN, RN]

At my last acute care position, overtime was greatly frowned upon and staff was expected to leave on time. This was supported by the union, because mandatory overtime (excepting extraordinary circumstances) is against state law. So your admit came, you did vitals and a focused assessment, gave them the call light and reported off.

Sure, nobody thinks recieving admit at shift change is ideal, but unless management supports anything else, it will never go away. In fact, at my former employment, multiple admits and transfers at shift change became routine. Coming on at 3 pm, it was not unusual to have an assignment of 3 admits, and a discharge to do. The manager was well aware, because she had to navigate around all the stretchers in the hall on her way out for the day.

[ladedah1, BSN, RN]

I don't think "hospital A" is necessarily unique... at the hospital I work at, it's kind of a "I do what I can for the next shift"... as in, whatever you can get done for them is acceptable, whatever you cannot, they understand. The hour before shift change, regardless of day or night, tends to be crunch-time for everyone. I like to get as much as I can get done for the oncoming nurse, so, typically, they understand when there are things which are not accomplished. Likewise, if a nurse leaves me in the same position (which is quite often), I understand that I am taking over much of the admission at start of shift.

There is kind of a 0630/0645 - 1830/1845 rule... if a patient shows up during this time (especially in the 45 range) off-going shift orients them to the room and gets them comfortable, takes some vitals, ensures stability... and oncoming shift finishes up the full assessment, meds, etc. We're MAGNET and recognized in many categories, so I'd like to think we're at the forefront of most processes. Hospital B sounds pretty unfair about this process... and to be honest, somewhat bully-esque. If you are getting out super late due to unrealistic expectations and have to be back the next shift, then what? Its easy to raise your nose at sleep deprivation when it is not your own.

[Double Dunker]

Sadly, hospital B is Magnet.

[ladedah1, BSN, RN]

Sadly, hospital B is Magnet.

Hmmm.... so much for that theory, lol! Well, maybe it just has to do with the unit and / or environment? I have in fact heard that people love the environment and interaction between coworkers on my unit... and that other units... well... arent quite as teamwork oriented. We have a pretty tough population to handle, but we're all about helping each other and making it a positive experience. Guess its just hit or miss... but i still say i would find the attitude at hospial B quite unfavorable!