How do you handle shift change admissions?

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This has been a bone of contention forever in my hospital, between the floors and the ER. It happens (quite frequently, it seems, though probably not as frequently as we floor nurses like to make it out) typically in the following manner--30 minutes or less before shift change, ER calls up an admission, and wants to get that pt to the floor before shift change (probably because their nurses dont' want to have to give report to someone else). Our nurses dont' want to take report, because an admit takes a while to do, so between giving report and taking the admit, the nurse will be there very late. Not to mention the fact that the nurse is pulled in two very important directions--the oncoming nurses can't get report if the nurse is tied up with the admission. The pt can't wait for 15-20 for assessment and treatment to start if the nurse is giving report. If we just put the ER off until next shift, they get grumpy, and the pt ends up spending waaaay more time than they need to in the ER.

Has anyone come up with a good solution in their facility?

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This has been a bone of contention forever in my hospital, between the floors and the ER. It happens (quite frequently, it seems, though probably not as frequently as we floor nurses like to make it out) typically in the following manner--30 minutes or less before shift change, ER calls up an admission, and wants to get that pt to the floor before shift change (probably because their nurses dont' want to have to give report to someone else). Our nurses dont' want to take report, because an admit takes a while to do, so between giving report and taking the admit, the nurse will be there very late. Not to mention the fact that the nurse is pulled in two very important directions--the oncoming nurses can't get report if the nurse is tied up with the admission. The pt can't wait for 15-20 for assessment and treatment to start if the nurse is giving report. If we just put the ER off until next shift, they get grumpy, and the pt ends up spending waaaay more time than they need to in the ER.

Has anyone come up with a good solution in their facility?

We must work at the same facility - happens all the time. Sooooo frustrating!! Makes the whole day run behind. I don't want to make the ER nurses stay late, and in all actuality they probably don't want to make me late either. I wonder if the shift times could be changed - have ER nurses in and out an hour earlier or later or vice versa? Probably would be a struggle to get that to happen. Anyway, I know where you're coming from - very annoying!! :madface:

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Specializes in ER, NICU, NSY and some other stuff.

Most places that I work if it is this close to shift change then the offgoing shift will tuck the patient into bed, get vs etc. THen the oncomingshift will actually do the admission paperwork. It is unfair of your oncoming shift to expect you to stay over and complete the entire admission.

I work ER and we try to avoid sending up patients at shift change unless we are getting slammed an deperately need.

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Most places that I work if it is this close to shift change then the offgoing shift will tuck the patient into bed, get vs etc. THen the oncomingshift will actually do the admission paperwork. It is unfair of your oncoming shift to expect you to stay over and complete the entire admission.

I work ER and we try to avoid sending up patients at shift change unless we are getting slammed an deperately need.

This is how we do it! In the words of my manager "This is a 24 hour facility". The next shift usually has an attitude about it, but that's just part of the job.

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Specializes in ER, NICU, NSY and some other stuff.

Exactly Tweetie.

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Specializes in Med/Surg, Ortho.

Thats called continuity of care. Our ED does the same thing. They dont want to stay either so they clean house right before shift change.

Usually what we do is current shift will get patient weight, VS, into bed and oriented to the room/bed(CNA's), then the current Rn will do as much of the paperwork (MAR,I&0,etc) as possible before she leaves. The admission assessment is usually left for the oncoming shift since they will have the patient for the full shift and they have to do an assessment anyway for the shift. Leaving the admission assessment just gets that out of the way for that patient for their shift anyway. It works ok, and most dont complain to much. Its a pretty fair and equitable way to work it out with the oncoming shift.

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Specializes in A little of this, a little of that.....
Most places that I work if it is this close to shift change then the offgoing shift will tuck the patient into bed, get vs etc. THen the oncomingshift will actually do the admission paperwork. It is unfair of your oncoming shift to expect you to stay over and complete the entire admission.

I work ER and we try to avoid sending up patients at shift change unless we are getting slammed an deperately need.

I work LTC, and we often get re-admits riiiight at shift change. Also, often get called with report during med pass. For the most part, the off-going shift is to get the paperwork together, and the on-coming shift finishes it up.

What really gets me is when we are promised faxes with Meds, etc., and we never get the paperwork. Grrrr!

"Mac"

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i always end up staying late.

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Specializes in PACU, PICU, ICU, Peds, Education.

In our facility, no transfers or admissions are allowed for one hour around change of shift to any unit. Report cannot even be called. The only exception is PACU, which can send up anytime, so that the OR doesn't get backed up. This annoys the floor nurses to no end, even though we DO try to hold them past shift change.

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I work in Long Term Care also and it doesn't matter what facility I am in or which hospital the patient is comming from it always happens at shift change. It isn't just ER patients either it is also in-patients from the floors. When I was doing admits I would try to get the patient in as early as possible but it never worked out. The doctors wouldn't come in early enough to write discharge orders, or they had to wait for lab/xray results. The discharge planners didn't have their paperwork completed. Transportation couldn't be arranged on one end or the other. There was always some reason why the transfer couldn't happen sooner. I think this is a universal problem and I wish I knew the answer.

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I too work in long term care and have the same problems! We will do basic vitals tuck them in then next shift does the paper work all 32 page admission forms!!!

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Specializes in LDRP.

Well, here, if they come from admissions unit, its not so bad. The database/paperwork/etc is done.

If they come from ED, then it really depends what time they come. If report has already started, then oncoming shift does it. If they come before report, i attempt to do as much as i can, or at least, the most difficult parts. Once, had a pt arrive to floor at 5pm. I did the admissions database, flu/pneumonia vaccine screening, dvt screening, med reconciliation sheet, verified all meds, noted all orders, gave the meds, did the assessment, charted the assessment, and so on. What did the oncoming nurse fuss at me for hte next day? For not putting patient label stickers on all the 80 zillion sheets i filled out. the least little thing......

anyhoo, we cant not have admissions right around shift change. the rule at the facility is that the holding unit (whether it be ED waiting to send to us, or us sending to a nonmonitored floor) should ideally have the patient completely transferred within 30 minutes of the time the bed is assigned. (and htey are assigned by bed placement who doesn't give a diddly)

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