How to handle back to back admissions within 1 hours of each other while having 4 other pt

momof3lv · Feb 21, 2016

Consider yourself lucky. Usually our admits come within 10 mins of each other. You didn't say when in the shift the patients came though. Shift change or later in the night? Shooting chest pain I probably would have got a stat ekg and called a rapid. Usually when admits come the cna gets vitals and I will go in and look at them if I'm not in the middle of something. I always try to get in and check out my new patient get them set up. Charting can always usually wait till later.

new.grad.rn · Feb 21, 2016

Chatting can always usually wait till later.

Like the ton of paperwork follow with questions we have to ask them like advanced directives?

momof3lv · Feb 21, 2016

What paperwork do you have to do? Sorry everything is on computers at my job, no paperwork. Advance directive, do you have one, no? Would you like one? All I do is mark yes or no. Im not responsible for setting up their advance directive. It doesn't take that long to ask a few questions.

NursingInChaos · Feb 21, 2016

The hospital I work at is all paper charting- about 20 pages to fill out on a new admission, have to manually put a patient sticker on every page- mostly tedious busy work - we have to fill out teaching paperwork, iv paperwork- it is a pain in the rear! But yes, it can be done after you get the patient settled and Any stat orders started - ekg, blood work, etc

Twinmom06, ASN, APN · Feb 21, 2016

The hospital I work at is all paper charting- about 20 pages to fill out on a new admission, have to manually put a patient sticker on every page- mostly tedious busy work - we have to fill out teaching paperwork, iv paperwork- it is a pain in the rear! But yes, it can be done after you get the patient settled and Any stat orders started - ekg, blood work, etc

I thought everything had to be EMR by now? Or do you work subacute?

dream'n, BSN, RN · Feb 21, 2016

Prioritize and keep your cool. Handle the new onset chest pain first, but I would set quick eyeballs on the new admits as I ran by their room to quickly make sure they are breathing, alive, and ok to wait a few minutes.

dishes, BSN, RN · Feb 21, 2016

If I was a nurse on your team and I did not have any new admissions, I would swap one of my patients for one of your new admissions, if I didn't know you were drowning and you asked me to help, I would have no problem agreeing to swap.

dream'n, BSN, RN · Feb 21, 2016

My best advice for a new grad is that nursing has moments that will be overwhelming. Don't be nervous to ask for help, prioritize your care as a nurse (I don't care if your employer wants XYZ charted by 9pm, do your emergent nursing priorities FIRST), and remember that you are one person. Work the hardest you can and think about your decisions, make sure you have a nursing rationale in your mind about why you did this instead of that. This will be your protection. When I make a decision I think about defending it to the state BON, not my replaceable employer.

NursingInChaos · Feb 21, 2016

I thought everything had to be EMR by now? Or do you work subacute?

It is acute care, they are just pushing the limit- we finally have computer MARS and labs on the computer, as well as Mostly CPOE for Doctor orders, some still write though

Karou · Feb 21, 2016

First of all, this is a really normal occurrence for med surg. Two hours apart isn't bad. I've literally had two patients coming down the hallway at the same time. Multiple times.

Remember that nursing is 24/7. You do not have to complete the entire admission for all three patients. Do the highest priority first- I usually try to do skin/wounds, home medications, advance directive/MPOA, emergency contact at a minimum. Anything not done can be completed by the next shift. An average admission doesn't need to take any longer than 30 minutes. Of course, a complicated patient can take longer.

Your charge nurse can (hopefully) help also, but isn't always available. Remember that you need to ask for help! Often no one will know if you're drowning unless you speak up. Ask another nurse who isn't busy (if possible) to help.

You have to prioritize. Chest pain would be your #1.

Is the CP new? Was it already evaluated and ruled out as not cardiac? Maybe pleuritic or epigastric/GI? Are they already on telemetry monitoring and have had cardiac enzymes drawn? EKG? Notify the doctor and see if nitro/morphine is indicated.

Your time management gets better with practice. Eventually you don't even have to wonder what should be prioritized- you already know. Ask for help when needed, remember nursing is 24/7 and certain things can wait.

canigraduate · Feb 22, 2016

You have 24 hours to do the admission paperwork in most places. Get your patient stable first. If they're coming in with chest pain, you need to look at the H&P and see if it's cardiac, GERD, muscular, or pulmonary, then deal with the pain. If it's cardiac, they usually don't go to Med/Surg.

So, if I had been you, I would have seen the chest pain patient first and assessed them. If it was cardiac, I would have put oxygen on them, called the doc and gotten orders for nitro, morphine, aspirin, Troponin draw, and transfer to Tele. They could do the admission paperwork there. If it was pleuritic or GERD, you could give/ask for some pain meds or a GI cocktail.

Check on your other four patients and make sure they're breathing. Then, assess your second admission.

Paperwork comes last.

As far as how I do an admission, here are the general steps and guidelines:

It should only take about 5-10 min to assess the patient, then 10-15 min to do paperwork. Hopefully pharmacy will have finished verifying meds and you can medicate them quickly.

Most places have the same basic requirements for paperwork. Get a medical and surgical history, find out if they have advance directives or a guardianship, get immunization status during flu season, find out what current outpatient therapy they are on and if they are on dialysis, check for spiritual requirements, verify allergies, do a fall risk assessment, catalog the possessions, find out their pharmacy, get their emergency contact and PCP, and get a current med list. If you're lucky, most of that will be done in the ER intake and you can copy (but VERIFY) the information.

I generally do three or four admissions a night. Just get your process down and you can blow through it in a few minutes. The problem comes with the health illiterate people who don't know anything about themselves or their medications and you have to investigate to figure out what's going on with them.

A lot of the units I have worked on have a cheat sheet for the admission with a checklist so you don't miss any required information. If your unit doesn't have one, you could score major brownie points and make one, while saving yourself tons of time.