How to decide who gets the first admit

casi, ASN, RN · Aug 3, 2008

Normally our charge nurse decides based on what nurse can handle it at the moment. If one nurse has a lighter load compaired to others, they gets the first admit.

not now, RN · Aug 3, 2008

I used to work nights on a med-surg floor.

If there were multiple open beds on the floor the team lead based it on acuity. If you didn't like it, tough. If you were swamped at the moment it would come into consideration but with multiple empty beds everyone is bound to get at least one admit and on med-surg every nurse is busy. Usually team lead would say something along the lines of "I'll assign this patient to another nurse but try to catch up for the next admit."

I would usually ask for the first admit and try to fill up my rooms quickly because I didn't want an admit rolling in 10 minutes before my shift ended and days giving me grief because nothing was done. Technically it was a 5:1 ratio but with seven nurses and 36 beds "someone has to take a sixth patient..." that was usually me since the majority of the time I was the one who was the most caught up. Team lead couldn't take it because on nights they always had their own patient load.

StrwbryblndRN · Aug 3, 2008

We have done it many different ways. If pt load was even we drew numbers. Last time we did that the charge nurse got it. (I work overnight and chrge gets same load of pts)

We have based it on acuity, where the assigned room is located.

It ranges. Sometimes one person gets hit harder than another but then we team up and help each other out. It evens out in the long run. Of coorifice there are those co-workers who complain no matter what.

I think it should be up to the charge to do it whatever way they feel is fair. If there are many complaints with the same charge being unfair then step it up and try to stop it before it happens again. Not sure how to do it but our day shift got it stopped with one particular charge.

RheatherN, ASN, RN, EMT-P · Aug 3, 2008

have you guys ever heard of a "surgical nurse"? we have one that works 11-11 and takes all the surgical or admits that come back. if we do not have one for whatever reason, we go by who can handle it, or who has least amt of pts. most of tihe time we dont have a prob or arguments. there are times when ppl volunteer to take another if they can. always works out in the end, no bad feelings 98% of the time.

-H-

Daytonite, BSN, RN · Aug 3, 2008

Lord! When there are that many admissions coming to the floor I always volunteered to take the first one. That way I was out of the fighting for who was getting what was coming down the pike later because I already had stepped forward and done my part. I could always help out when later admissions, but my responsibility had been met early on.

RS0302 · Aug 3, 2008

usually its just whoever the charge nurse picks or whoever has the first empty bed. My floor is so unorganized that the charge nurse usually doesnt even know whos got the heaviest load. Sometimes if we explain we are busy, they will give the admit to someone else. Other times, it doesnt matter.

frenchfroggyAPRN, MSN, LPN, RN, APRN · Aug 3, 2008

I do the assignments on our shift at our small hospital. I try to give the first admit to the nurse with the easiest patient load. I make assignments and try to make it as fair as possible, ie:same amt of total cares to each nurse. If we have 11 patients, it is split 6:5, the nurse with 5 will automatically get first admit, but if the nurse with 6 has mutltiple discharges and only has 4 patients that nurse will get the admit. It has caused lots of hurt feelings, but if I have 5 patients and the other nurse only has 4, I should not get the first admit. ( I would have 6 and they would have 4) I also do take patients, we are a 22 bed hospital, most of the time the RN's do total patient care on 3-7 patients, it is hard but we as a group will work on each admit to get the admit, now orders etc. done as quickly as possible, it seems to work better that way.

Tweety, BSN, RN · Aug 3, 2008

The charge nurse (me) decides. I base it on a lot of things: the acuity of the assignments (some assignments are too heavy to get an admit), the number of patients each nurse has, i.e. if one has 4 and one has 5 the one with 4 gets the admit (not ideal but that's how the staff I work with likes it), the experience of the nurse (sometimes I need to bypass the busy new grad and give the admit to the more relaxed experienced nurse), the location of the bed (if possible I like to keep the patients pretty close together in each nurses assignment). There are no cut and dry rules.

Usually there isn't a lot of drama with me assigning patients. I strive to be fair and consistent. Most of my coworkers understand when I give them an admission.

nerdtonurse?, BSN, RN · Aug 3, 2008

If I have walkie-talkies or people that are going to be morning discharges, I always make sure the charge knows, and will volunteer to take the first admit (I'd rather have an admit at 2000 than 0600...). Conversely, if I've got 3 peg feeders, plus a person in the DTs, plus 2 q2h turns, and one of our frequent flyers who's a handful, I also let them know that and aks that they give me admits as a last resort.

For example, last night I had a good grip on my folks -- lots of treatments/dressing changes, but not meds every hour all night long, was going to be quiet (read: BORING) after midnight. I went ahead and took 2 admits, when the floor as a whole only had 3 all night long.

medsurgrnco, BSN, RN · Aug 5, 2008

At one unit where I worked, some staff would start 7P-7A shift with 4 patients and others with 3 - with all taking on additional patients at 2300 from the 3-11 shift nurses. The nurses who started with 3 pts got the first admits.

At another hospital, it depended on who was charge. If the mean charge nurse was on, I always got the first admit. If another nurse was charge, the first admits were given to the nurses who were on their 2nd or 3rd shift of the week as they were most likely having easier shifts than those on the 1st shift of the week. Some charge nurses would ask if it was a good time for the next admit or work with staff to give them admits at the time they preferred (start of shift or after the extremely busy 1900-2300 time period).

I think charge nurses should also look at which staff have patients that were admitted late during the previous shift, as sometimes that shift doesn't complete tasks from the admit (sometimes not their fault as the doc didn't write orders).

Hope this is helpful to you.

Okami_CCRN, BSN, RN · Aug 5, 2008

On my unit we have an admission book for Day shift and night shift. All RN's log their admissions with the date, time, and whether it was the first, second, third, etc.

The charge nurse then decides who gets the first admission based on the admission book logs. It is the only way it is fair, if you have been on vacation chances are you are first admit, it's also nice when you work consecutive days because that way if you are first admit the first day you are last admit the second day.