New Admission Documentation

[LatteRN]

Hello fellow nurses,

I currently work RN Supervisor for 3-11pm shift, and I need some advice regarding admissions. If my shift gets new admissions, I am responsible for the entire admission - orders, consents, assessments etc. However, if I get multiple admissions or late admissions, I find it impossible to get everything done by 11pm, especially when I am also dealing with staffing, IVs, phone calls etc.

Back in the day, my 11pm RN Supervisor would pick up right where I left off, admissions would get done timely, and all was good. We have had a lot of staff turnover however, and now the night shift does not finish up admissions. I feel like since these admissions came on "my" shift, even if they came at 2200, that they are my responsibility and I stay very late to get as much as I can done.

I understand that night shift may get hectic and there is no time; or they do not feel comfortable finishing up assessments for a patient that they may only see sleeping. However, I can't keep staying until 0215 to get admissions done. It is a ton of work, on an already busy, short-staffed 3-11pm shift.

Any advice? Do I just do my best, give my report and leave more or less on time? Is there a process that has worked well at your facility?

Thanks everyone!

[lukesbaby]

Legally if you get an admission you must call the MD and verify all of the orders and diagnoses. You must enter the diagnoses and orders into the computer and notify the pharmacy, kitchen of diet and the family member of the residents arrival. You must also implement and priority care measures such as starting Oxygen, wound vacs, IV's, feeding pumps, etc. if it is ordered, and start a care plan with priority problems. This is stuff that can't be endorsed. You must also take note of the fact in regard to what the facility policy is on admissions and follow it. This is not something you can endorse to the next shift.

[ACRosas, BSN]

To lukesbaby: I absolutely do not agree with your comment; where in your law is this stated, which state are you working in, and are you a supervisor or floor nurse? If it's in your clinical policy, that is a different matter, and if that's the case, you need a new group of people writing the policy because I can tell they haven't been at the bedside for awhile.

When I get an admission at the change of shift or near the end of my very busy shift, I endorse the admission to the next shift. I DO make sure that an assessment is done and documented, if the patient appears stable, then I feel 100% okay leaving the admission resume for the next shift, if they are unstable, I am more present to give medications and get this patient the treatment they need. I am a floor nurse though, not a supervisor, and floor nurses are expected to do the admission, the supervisor is not involved with patient care directly except to settle disputes, manage crises, or risk abatement. Why are the floor nurses not taking part in the admission of the patient? What're your patient/nurse ratios? I'm sorry you're having to shoulder so much burden.

[caliotter3]

When I worked in LTC, floor nurses did the admissions. If I were you I would not be staying until after 2 am. And for that matter, our facilities had a cutoff time for admissions. As I recall, it was around the end of normal business hours, 5 or 5:30 pm. Our DON fiercely defended that practice. She did not allow the swing shift to get slammed with admissions just because the discharging facility wanted rid of the patient/resident.

[Anne36, LPN]

Yes, I have seen second shift stay till 2 a.m. Doing an admit. They are supposed to complete their admits even tho their shift ends at1030 and we take admissions 24/7. Management nor corporate cares. I just hope they are not clocking out even while being told no overtime.

[kbrn2002, ADN, RN]

Well if they expect the admitting nurse to stay and complete the entire admission that's a lousy policy. Hopefully they aren't also complaining about the inevitable overtime that will generate.

A more reasonable policy ensures that the essentials are complete: Order check, skin check and POLST within 8 hours, initial care plan within 24 hours and everything else within 24-72 hours depending on the assessment.

Though if the new admit isn't responsible for themselves and their responsible party is there when when the new resident is admitted it's a good idea to have all needed consents and other paperwork signed while that person is in the facility. Trust me, it's not always so easy to get that responsible party to sign everything in a timely manner otherwise.

If there isn't some kind of new admit checklist for your facility you need one. Then requirements can be checked off and initialed as done and when completed the admission checklist goes to the DON.