Hospital requiring ER nurses to chart full admission assessment

by Halestorm21 (New) New Nurse

Specializes in ER.

 Hey ED nurses,
I work in the ED for a HUGE hospital system, and administration is stating we are required to complete inpatient charting in addition to ER documentation. (There are two separate documentation systems and we have only been trained on the EDM system.) They specifically want us to do a full admission assessment on patients holding in the ED. Has anyone had experience with this? Does any other ED require their nurses to chart on the inpatient side for holding patients? This is in Texas. Thanks for the insight! 

rentalnurse, RN

Specializes in ICU, CCU, ER, PACU, tele, PSYCH. Has 30 years experience. 61 Posts

I worked agency in a very lg hospital and was brought in to do ER holds. Our ratio was more than was allowed on the floor and a few very sick patients. We had to do the whole admission packet and this was pre computer days, endless questions and at least 30-40 min per patient. Well was off for a while and when came back suddenly we didn’t have to do the papers anymore. It seems that staff had a meltdown when thy had to manage all the holds and had to do the paperwork. Work up the chain to see what can be done, minimal amount etc. management is looking at reimbursement and if not admitted properly don’t get paid etc. 

Music in My Heart

Specializes in being a Credible Source. Has 12 years experience. 2 Articles; 4,080 Posts

Sounds ******* stupid... I barely have time to hit the high-points on the flowsheet but a full admission assessment? Not a chance. Of course, our admission assessments are ridiculously detailed.

Edited by dianah
Terms of Service re: profanity

LubbDubb77, BSN, RN

Specializes in Pediatrics, Emergency Department. 102 Posts

I work in a small hospital in a rural area in Washington state. Yep, we are supposed to be doing these assessments on patients that are boarded - IF they have been sitting in our ED for more than 2 hours after boarded status is applied. However, it is not my, sometimes I don't get to it. 



17 Posts

I work for a top ER that held patients precovid. We did an admission screen at I think 24 hours. Or were supposed to. They linked into the ER narrator so I wouldn’t whine too much about it because epic can link anything depending on if they have a good package. And it may be worse in the ED narrator. So saying it isn’t in the ER narrator is kinda pointless because they can add it in if their package allows them

It is easier to think of the narrators as shells or skins to cover the inpatient charting. 90% of what one charts in the ED narrator shows up on inpatient side. In most places, I can figure out anything to chart in the flow sheets. Sometimes I am quicker in the flow sheets by using keyboard tabs

Edited by ApplePineApple


Specializes in ER. Has 12 years experience. 3 Posts

I have seen several hospitals require a full admission assessment after a patient has officially become an inpatient. I think it is a joint commission standard but we would have to Google to double check. 



2,416 Posts

The problem here is that a good ER nurse prioritizes based on immediate patient safety, not long term outcomes, or arbitrary metrics imposed by outside agencies.  If it takes 45 minutes to do that paperwork, that means that back pain ready for dispo ties up a room for an extra 45 minutes, and maybe we miss something by letting the waiting room overflow.  That hour long drip I started 45 minutes later extended a length of stay.  Somebodies grandmother stayed in pain an extra 45 minutes.

I can triage 9 patients in 45 minutes.  And eat a snack and take a leak.

Not one of those idiots trying to enforce this can go into an ER and role model how to effectively run an ER, and do stuff on a med-surg schedule.