I wish they had to stay and watch the chaos

[greenerpastures]

Just once, I wish MDs had to stay and watch the chaos that ensues when you discharge 12-15 people at roughly the same time in one day. Oh yeah, all the discharges were put in about 4 hours before shift change, with most being completed by 30 minutes prior to shift change. Next shift walked into 10 "freshly cleaned" open rooms and 5 discharges waiting to leave. TOTAL chaos. Every nurse has 5-6 patients with everyone having multiple open rooms. Transfers, admissions from ED, direct admits from MDs were the name of the game for the next 5 hours. Throw in HS med passes, PRN pain meds, assessment needs, verifying ALL the new stuff that has to be done for transfers/admissions, as well as a few rapid responses while we are at it too. UGH! I WISH THEY HAD TO STAY TO WATCH TO SEE HOW WRONG IT IS TO CLEAR HALF THE FLOOR IN ONE SWOOP! Rant over.

[scottaprn]

Obviously you have the ability to bust tail harder since you managed to get this done.

[scottaprn]

sistrmoon- here is a participation medal for you for contributing absolutely nothing- including snark.

[glasgow3]

A bit of historical perspective, if I may:

In the past 20+ years or so there were a couple of periods where health care consultants swarmed the hospitals like the insects that they are. With stopwatches in hand, they timed nurse-patient interactions in order to determine appropriate staffing levels. Unfortunately, their methodology was insane if they sincerely intended to arrive at a fair result (which in my opinion was doubtful since they invariably promised huge cost savings to get the engagement in the first place.)

I remember quite clearly having an imbecile with ZERO critical care experience timing me during the recovery of a fresh CABG and refusing to include any time unless I was physically touching the patient. Similarly, little or no attention was given to discharges, admits, codes, irate family members/patients etc.; the verbiage as I recall was they didn't account for "non-recurrent episodes"---as though were we working on an assembly line or as though such events were rare.

These days the current crop of consultants and Powers That Be point to these benchmarks as if they were ever adequate in the first place.

The OP's problem really has nothing to do with how the physicians admit or discharge their patients, rather he/she is operating in a system based almost solely upon financial concerns.

[SHGR, MSN, RN, CNS]

Maybe dedicated discharge nurses who operate outside the staffing/census ratio?

That is a fabulous idea. We had dedicated admit nurses at various times in my working history. It worked out great.

I can see there are some people (long-time patients, for sure) that the staff nurse would want to discharge. But in this day and age of short stays, that would help the floor RNs with the stressload.

[RainMom]

Maybe dedicated discharge nurses who operate outside the staffing/census ratio?

We have 2 dedicated admission/dc nurses (small hosp) & it seems to work well. I'm on nights & rarely dc after 1900, but day shift is always relieved to see an ADT nurse scheduled on busy surgical days or days with lots of expected discharges. They focus on dc first (increased pt satisfaction/scores), then admits. Of course they can't do it all, but it takes a lot of pressure off the floor & charge nurses.

[been there,done it]

Search out the root cause. Many of the patients did not require a full admission in the first place.

Docs/Hospitalists do no teaching, or follow up planning.. stick that to the nurse... and the cycle continues.

Make them accountable for level of care... or nothing will change.

[been there,done it]

Wow 4 whole hours of buating tail at the end of your shift and 5 whole hours of busting tail at the beginning of a new shift.

These truly are the times that try men's souls.

Scott ..ya might want to read the op 's post again.

This is not about busting tail. We all do that .

OP is wondering WHY we have to do it..in this situation ..and how we, as nurses can work towards a solution.

[Gooselady, BSN, RN]

We also had ADT nurses. Once our charting system went to EPIC, discharging a patient lost most of it's time consuming complication, you could spend more time doing one to one discharge planning and print their DC papers, no signature necessary and *poof* out the door. Admissions, on the other hands, took a lot more time and we used ADT more frequently for that than discharge.

It's a multisystem issue. The docs are being squeezed and micromanaged as well, albeit differently than floor nurses. I've spent many shifts just taking out IVs and saying bye bye, turning around and getting admissions. A couple of shifts I had eight patients, total, and the ratio is 1:5 at most, mainly because of discharges and admissions. Oh, and deaths (oncology floor). Those weren't the norm, but happened often enough to honestly call it a characteristic of the job.

Patients who are told they're to be discharged wrongly expect to be discharged within the next five minutes. I have asked docs to just front load the patients that the DC could take some time. I've even chided one in particular for rounding on our floor LAST and discharging half of his patients at 1900 (MY dinner break! The nerve!). But I know it's not under his total control, you can't simplify things like that. Nursing is just like this. I was just as annoyed and frustrated as the next person, but it helped me to take a step back and look at the big picture, remember none of it is 'personal', and then if it is still too screwed up for words, it was time to work somewhere else.

[scottaprn]

Scott ..ya might want to read the op 's post again.

This is not about busting tail. We all do that .

OP is wondering WHY we have to do it..in this situation ..and how we, as nurses can work towards a solution.

I had no trouble reading her post. Since it seems you might be having some difficulty I will summarize it for you. She wants the doctors to stay around and see the chaos caused by discharging patients all at once. Not once in her original post did she offer any corrective solution. If you want to get the short summary just read the last line the OP put into all caps. Glad to help as always.

[~PedsRN~, BSN, RN]

We work to have discharges written and ready in the computer by noon if at all possible. In order to achieve this, nurses round with the physicians and know even before then orders are written who is going and who isn't.

[sistrmoon, BSN, RN]

That is a fabulous idea. We had dedicated admit nurses at various times in my working history. It worked out great.

I can see there are some people (long-time patients, for sure) that the staff nurse would want to discharge. But in this day and age of short stays, that would help the floor RNs with the stressload.

I've seen dedicated admit nurses too, at my previous hospital. But those positions always seem to get cut and eventually eliminated because...money. Better to work to the bone the nurses who are already doing everything else. I've suggested a dedicated team for dressing changes to reduce CLABIS and no one wants to do it, because...money. Even though all these things would save money in the long run(reduce turnover and training expenses when you have to hire new people because the other ones burned out and quit, for example.)

[Muser69]

We had 2 patients readmitted to ICU because the discharge / medication instructions are so confusing. Administration doesn't seem to care.