new admission 45 minutes before your shift is over..what do you do?

[glamgalRN]

I'm a new nurse on a med/surg unit and have been off orientation for 2 weeks. I've noticed that it's common for us to get new admissions around 1830-1845ish from the ER and the admissions unit. It really bugs me because I'm never sure how much of the admission stuff I should do for the next shift. I feel bad leaving work for the next shift, esp with me being new. It's a horrible feeling knowing that if a more experienced nurse was working they would have everything done but no matter what I'm running around trying to keep up. Some of the nurses have told me if the patient arrives after 1830, to get a set of vitals and greet the patient and tell them the nurse will be in shortly. Is that typically what you do? Is that rude?

I worry so much that when the night shift realizes they're getting my patients they think "great, nothing will be done and we're going to have to go back and fix all of her dumb mistakes!" Ugh..I hate being new!

Thanks and I look forward to your answers!

[Nurse_Hagatha]

If you have time and you are caught up with the rest of your work, then do as much as you can. If you are running behind, then get the patient settled in. You cannot do it all, and neither can the nurse coming behind you. They may try to make you feel like they can by making you feel bad in report.

I am still a fairly new nurse, but have learned over time that those nurses who complain the most in report, and throw the biggest fits and try to make me feel like an incompetent nurse, are often the ones who when I come back to work and get report from them have left the biggest messes.

You are new and learning, and you are only one person. Keep that in mind, because there are nurses who will try to eat you alive in report. Whatever you do, DO NOT let them make you feel like you are less of a nurse.

[*ac*]

With 45 minutes, I think you need to assess and document that assessment. I do the minimal amount of computer documenation required. Let the doc know they're there. Usually there are no orders yet, so that's about all I can do, anyway.

I don't think a set of vitals is enough. I do enough to feel that the patient is safe. As you get experience, you'll be able to do a ton in 45 minutes.

Also, I try to be really caught up on my other work before 1800 in case this happens. Ask the charge nurse if you have something coming. Get everything ready if you can. Some people will drage their feet, hoping the admission will come after change, but I disagree; if you find out earlier that something's coming, call and get report as soon as possible. If you can, encourage them to come on up and get rolling.

Just some ideas. They don't always work. Sometimes you just have to go in to report and say, this patient just got here and I did.... (emphasizing what I did, not what I couldn't get to).

[GooeyRN, ADN, BSN, CNA, LPN, RN]

I did a few years of med/surg. I did vitals/pulse ox, started the IV, set up 02 if ordered. I would do a QUICK eyeball assessment to see if they were in imminent danger, if they had severe pain (to see if it could wait- I hate leaving people in severe pain!) , and determine if they were oriented or not. Get a bed alarm if ordered. Show them the call bell. I would let them know we were on the shift change and their nurse would be in shortly to do the paperwork and get them their meds. I would write a quick note- the time, Patient is/not oriented to xyz , VS/pulse ox, what they complained of/reason of admit, anything that seems really off, and that is it. I leave the admission paperwork, flow chart, care plans, putting in of orders, and writing up a kardex for the oncoming nurse. I like to get out on time, so I don't stay to make sure everythingis done, but I do make sure the patient has their IMMEDIATE needs met. I hate walking into a shift and you need to get your assignment, report, etc. you get out on the floor (usually after about 1/2 hr to get report and such, and that is if they are the first patient you see) and you find that the patient is very angry b/c no one addressed their severe pain. They have been on the floor for an hour and no one brought them pain meds. You go to check orders, they were not entered. You enter them, and go to give them their IV pain med, and they do not have an IV started. :angryfire Do what you can, don't feel bad about leaving work not completed, but make sure any immediate needs are met, or let your replacement know of unmet needs if you can't get to it before you leave, so no one is in pain or turns blue while waiting.

[jjensen]

I will try to do a full assessment and start the admission. One of the most important things is to start the IV for the next RN... I will guarantee that they will appreciate that.

I always think that what goes around comes around, meaning that you will be the RN coming on in the same boat sometime, so try to be as nice and get as much done as possible so the favor will be returned...

[JustMe]

OMG!!! This must be a requirement for being a hospital super!! Our admissions also come at change of shift--then we hear that the patient has been in the ER all day?!:angryfire In our ICU we put them in the bed, put them on the monitor, get their weight and VS, do a quick assessment and write an admit note. The Date Base can wait. Any nurse who complains doesn't realize yet that a hospital is 24/7 and the workload must be shared. No one nurse can do everything.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

Our admissions usually came at shift change, too. Hmmmmm...... Now you have me thinking... WHY?

[Virgo_RN, BSN, RN]

I do what I can. Whatever I can't get to, I pass on.

[Whispera, MSN, RN]

Admissions come at shift change because the people sending them to you are in shift change too! They feel the need to transfer before they leave.

[wooh, BSN, RN]

We start report at 645, and have a rule that anything coming after 530 we just HAVE to do a set of vitals, let MD know the patient is there (if no orders) and settle them in the room. I do as much as I can get done, just because that's what I'd want done for me. Usually I get everything done except for meds that haven't come from pharmacy yet.

As for what the next shift thinks, if you're TRYING, they know. I don't mind getting report and fixing stuff from a new nurse that's trying. Getting report from a lazy experienced nurse that just didn't want to do things, that's a different matter.:)

[Whispera, MSN, RN]

Two hospitals I've worked in have had policies that no patient could be transferred any later than an hour before shift change....

[rn undisclosed name]

We have a policy that if they come at 6 or later all we have to do is greet them and get a set of vitals. I try to do more if possible but they give us 24 hours to do an admission. I entered the meds in the computer but wasn't able to address anything else other than why the pt was there and if there were any pain issues. The pt had a clinic appt and was admitted directly from clinic. During the time I received this pt I also had to transfer another pt to a different unit. I can only do so much. I left the room and came back and the APN was already in there so I couldn't do anymore of the admission. I just gave report to the oncoming nurse with what I knew.

ETA: I used to do more but we get in trouble if we stay past our shift so I just pass it on.