LPN: Med Cart to Admissions Nurse

Maremma · Jul 18, 2012

Well don't panic. That is for starters! LOL Oh boy how badly I wish WE had an admissions nurse! Tonight was a nightmare for me. I am the full time 3-11 LPN down my hall. Half LTC and half rehab. I walked in to shift today to discover one of my patients had passed away an hour before I got there, one was transferred to another hall at the same time before I got there and on top of all of this extra work waiting for me I have THREE admissions, one just came in 1/2 hour before I get there two more on the way before supper! I am convinced they hate me and are trying very hard to make me quit! I have to so all my own admissions on top of running the floor.

You are not the one that has to order labs or anything else for that matter. The Dr has to do that.it is not in our scope of practice to make orders. Just to transcribe them confirm them/get facility Dr approval, create the lab slips for whatever the DOCTOR orders.

Have you ever done an admission at all before? Your facility may be different than mine but I can tell you how I do it. I have made myself an admissions checklist to be sure I do not miss anything required and so if the RN feels nice that night and decides to try do any part of it to help me out we are on the same page and neither of us does something already done and neither one of us thinks the other guy already did it and neither of us do it.

My priorities are always "food and narcs". It would be wise for you to also make it a priority. If you are lucky enough to get your paper work ahead of time it makes it easier to write up all the orders that will be coming with them from wherever they were before. You will be able to see what narcs will need the C-2 scripts and you will be able to get the diet slip ready to go to ensure food will be there for them the next meal time they will be present for.

I know tonight was really bad for FINDING the order in the mountain of crap they send so as soon as you can get your hands on the paperwork to read through it the better. I am sure they will train you how they want it done.Write down everything they tell you and then create you own personal checkoff list from there. You will do great!

amoLucia · Jul 18, 2012

To me, something seems to be amiss if there has been 3 other admissions nurses within 5 months. That they have not satisfactorily met the expectations of mgt is worrisome. Were they seasoned, experienced nurses or were they newbies to nsg (or new to LTC)?

An admission is a MAJOR time-consuming process with many pieces. The first thing that came to my attention questions if, as an LPN, are you permitted to do that 'coveted golden assessment' that seems to be the domain of RN's??? Or willl this require another nurse to do that part of the admission?

Some places already have an Assessment Checklist that gets signed off. If you've already received new admissions where you are, you know that after you get them in the bed, there's vital signs, fingersticks (if nec), a body check for skin integrity, a wound assessment (if nec, with approp. tx accdg to your facility policy & proc). A systems assessment, head to toe, is completed. Catheters, IV sites, shunts/fistulas, ostomies, casts, splints, etc get checked out. All this is documented, esp wound sheets with measurements. Does the family know the pt came to you? ID band ID band ID band!

Admission assessment includes info re daily ADL's, B&B and sleep patterns and a whole lot more history to accompany the physical findings. I smiled at the other post re 'food & narcs'. For me, it's 'food, MD notification for orders CALLED IN and pharmacy notification esp for narcs delivery'. There's safety/falls risks assessments, Braden/pressure sore assessent with implementation of any necessary interventions, esp alarms. Complete the CNA shower book and feeder list. And make sure your new admisssion has had a dinner even if arrival is after your supper time! The CNA's usually complete a personal effects inventory.

You'll check the hospital discharge orders to transcribe them as admisssions orders to an MAR and TAR. Don't forget the PPD and flu shots. Allergies? DNR? Are there any consults or MD appts needed (esp for ortho or chemo/radiation) to be followed up? What about dialysis with transportation arrangements? Lab slips will be made out for any labs ordered. Just FYI - you may have in-house standing orders or protocols for labs. And as the cherry on top, you get to start a care plan!!! Aren't you thrilled???? Several quick & easy needs are safety/falls, pain, psych meds, infection risk for IV/foley and wounds. I can go on & on.

As I said, admmissions are time-consuming because of all the pieces needed. It would be a luxury if you get the paperwork early and someone helps out as mentioned above. But the ultimate accuracy will be your responsibility. You will need to be focused, thorough and able to work independently & quickly. You should have a supervisor avail as a resource if nec.

Sorry this is so long but you asked! Good luck.

brandinalove · Jul 18, 2012

Thanks for your replies, very helpful. Up until last night I'd never done an admission start to finish because usually the admissions nurse would come in and take over at 3. It is a long process and lots of little things to remember but definitely seems doable. At our facility the admissions nurse is also responsible for labs for the building (120 beds) and writing out the new orders. This is especially tough on Mon and Thurs when we do PT/INRs. Yes, the admissions nurse is expected to do the full body assessment, this is the most important part and the part they found unsatisfactory in the previous nurses. I'm definitely up for the challenge and look forward to it. Oh, and I didn't wanna know about labs bc I'm expected to order them, I was just curious about what meds are known to affect certain labs. Thanks again!

whereisrebecca · Jul 27, 2012

Ask your DON what the others were doing wrong and take notes. After you have done a couple of admissions make your self a comprehensive check list of things to be done for admissions in order of priority. That way when things get crazy busy you can refer to your checklist instead of memory. I like to file everything in the chart before I start that way if there are 3 or 4 admits you won't be mixing papers/charts. If time permits, focus only on 1 admission at a time.

DSkelton711 · Jul 31, 2012

In our facility a RN has to do assessments as it is not in the scope of LPN in the state I live. Sounds like something a person with good prioritizing, time-management and assessments skills could do. Good luck!