Late admissions/close to shift change

Morguein · Jan 14, 2016

I feel like you should do what you can in the hour that you have left. I'd assess the patient, do any STAT labs, and any emergent STAT orders like hanging blood and starting drips. Then, I'd get the admission paperwork done. As far as the paperwork, I feel like you should just do the part where only you can do that part like the initial assessment part. Make sense? As far as any history info or patient family info, etc..the next nurse can get all of that. It's ridiculous to have to stay for hours to complete the admission process. As they say, nursing is 24 hours. The next shift can pickup from where you left off. Just because the patient happens to come on your shift, does not mean that you must do EVERYTHING including ALL THE ORDERS, and ALL THE RIDICULOUS AMOUNTS OF PAPERWORK, etc... Sorry, I'm not screaming. haha! I'm just emphasizing key words. I think it's terrible that anyone would get upset with you for not doing 12 hours of work in 1 hour. That's ridiculous. They need to tell you "thank you, and I've got it from here" and let you go home.

MYSTICOOKIEBEAR · Jan 16, 2016

Prioritize. Do the really important things that you would want the previous shift to do for you. Make sure the patient is stable, has access, has critical medications infusing or at the ready, and has all crucial supplies (suction, O2, trach etc). You should NOT be staying that late unless there is a particularly horrendous code or extremely unstable patient on the unit. Otherwise endorse it to the next RN. There is only so much you can do in one hour.

Larry3373 · Jan 18, 2016

It sounds like you work in an ICU where there is limited staff to assist with admissions. In one ICU I work for, the admission is basically done for you by the other nurses while you're getting report. We received a code from the floor the other day on the vent. We started diprivan, the lab drew blood, we took vitals, put in an assessment. The primary nurse basically just gave report to the dayshift nurse. That is standard practice in our unit, but we are a large unit an may have more staff than you have on the unit at any given time. The other ICU I work for is smaller and sounds similar to what you describe, but we still try to help each other. At the smaller ICU, we hook the patient up to the monitor, clean them up a bit, make sure our pumps are set correctly, try to draw labs, start IVs, etc. we are not responsible for admission documentation after 6 am, except vitals, and maybe the assessment part at most. In the end you can only do what you can do.

Here.I.Stand, BSN, RN · Jan 28, 2016

Prioritize the most important stuff -- stat labs, critical drips, adequate suction (say they have an ETT, OGT, and a chest tube, but only one suction head in the room). Don't worry about getting it all done; as they say, nursing is 24/7/365. If the oncoming nurse is mad at you, he/she is the one with the problem, not you.

sjalv · Jan 28, 2016

I'm here to echo everyone else's thoughts: do the important stuff. That is, important for the patient. Admission history, med rec, etc can wait. STAT labs/orders (such as blood transfusions) should be done ASAP. As a nurse, I would far rather come onto a shift with an admission history to do rather than 10 different labs, 2 drips to start, blood consent to get, blahblah.

OBwonKnewbie · Jan 28, 2016

Same. When I am admitting a new patient (in L & D) I get them on the efm monitor and then initial vitals. I start asking admission questions while I start their IV (I practically have the admission questions memorized because our admission form hasn't changed in years). While I start the IV, I draw off any labs I need and send them off. Then start any medications (fluids, antibiotics, pit, w/e). When the next shift comes in, I give them report and then go quickly finish my charting and verify the orders. The next shift can take over anything else that I didn't get to, but I leave knowing I did the main things. If the patient comes up so late the next shift is coming in (and they are clocked in), then its next nurse who needs to admit them. I may help them out by starting the IV and getting labs for them while they start the admission charting, depending on the time. I don't worry about the next shift being mad at me because I didn't ensure they have a task free shift. I'm over that. I know I didn't sit on my butt all night and that everyone was well cared for. Some will never be happy.

CamillusRN, BSN · Jan 28, 2016

I'm almost 3 months into being on my own in a mixed medical/surgical ICU unit. Overall, I'm felling a lot more confident however, late admissions still really fluster me. I do not want to leave anything for the next shift and upset anyone. When you get an admission within an hour of shift change what do you focus on. Obviously making sure the patient is stable. But when they need and NGT, an extra IV, cardiac enzymes, admission charting, etc...I would be there hours after my shift, especially when the rest of my team is busy and unable to help. I still don't have a clear answer on this and want to have everything possible done. What is acceptable/the norm without making the next shift upset?

Not sure making the next shift happy should be the priority. You mentioned obviously making sure the patient is stable - stick with that. Once (if) that's done, use your ABC's to prioritize your tasks. Since you brought it up, OG/NGT has to do with airway to help prevent aspiration if the pt's intubated. If not intubated and A&O, the next shift can insert it. If they need an extra IV and it's not a matter of life or death, leave it for the next shift. Same goes for labs and treatments. Admission assessment can only be done by you, but you can leave pretty much everything else. If you wanted to offer and stay to help put in the extra IV or NG/OG, I'm sure the gesture would be appreciated but it wouldn't be necessary and you would probably just end up being taken advantage of.