Handling New Admits in a Fair Way

[monicanurse]

Hi all,

I was at work the other day ( and I havent been working there for very long) and I had gotten one new admit . 20 minutes later , I get a call from the charge nurse saying "you are getting another admit." I asked her if any of the other nurses had gotten admits and her answers was "you have all the empty rooms." In my opinion , this is a crazy way of doing admissions. One of the other nurses only had 4 patients. She could have taken the admit so I spoke up and finally she gave it to her. I find this a little ridiculous that one person gets stuck with all the admits. What are some ways your hospital unit does "fair" admits? Is there such a thing anymore?

[guest2210]

I was at a facility that had an RN scheduled as the admissions nurse. She had her mobile computer and went from room to room and only did the new admits/transfers. Once she completed it, she'd give report to the nurses that the admits affected. It worked really well.

[BluegrassRN]

We do not make staffing based on geographic area (ie, you have rooms 210-205, etc). We make assignments based on acuity and on continuity (who had the patient the night before). Your assignment may not be rooms close together, but you won't have all the heavy patients, while someone else has all the walky-talkies. That's ridiculous. High acuity patients are divided as equally as possible among the nurses. Admits on night shift rotate, with each nurse taking one, then if we get enough, we'll go back around.

I can't comment to how things work on days, because I don't know how they balance admits with dismissals. 5 days a week, they have an admit nurse, and I know that makes a difference.

[Patchouli]

i agree. #1 you need an acuity paper to be filled out by the nurses on that prior shift so that the charge can fill assignments out fairly based on poss admissions, d/cs and acuity. #2 if everyone that could help out when your admission comes did a small part of the admission, imagine how much smoother the admission would go. sounds like you need to get a staff meeting together over this.

[diane227, LPN, RN]

As the charge nurse on a 34 bed unit I take several things into consideration when making an assignment. First of all, nurses are assigned specific patients at the beginning of the shift and any patients that we know are coming. We do not assign rooms unless we have a patient in that room or we know we have a patient coming into that room. No one ever gets two admits in a row if I can help it. We try to give the same patients to the same nurse each day they work when we can. The next thing I do is determine who will be having discharges to determine when they will be available to take an admit or a transfer. I then determine the number of patients each nurse already has. The max is 5 each. Never, ever more than 5 no matter what. Plus acuity. Then I have to consider who has isolation and who does not because I cannot give a surgery patient to a nurse who has an isolation patient. I also do not assign any pregnant staff to isolation patients and I have a nurse currently getting chemo and she gets no isolation patients. I also try to assign their rooms as close together as possible because our floor is huge and I hate to make people walk from one end to the other, although sometimes this cannot be avoided. I am lucky that I have a very flexible staff and they will help me make adjustments if needed to accomodate what we need to do to get the patients into the unit. It sounds confusing but it really works out very smoothly usually.