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!
I've noticed that if you really hustle and run yourself into the ground trying to get an admit finished, the on-coming shift will STILL be a pain if there is ANYTHING left to do, so why even bother? I just try to prioritize in terms of what needs to be done carewise and paperwork wise and leave the rest WITHOUT making any excuses. At my hospital they will give attitude if the patient walked onto the unit 5 minutes before change. During report just say, "I've done this, this and this. As far as I can tell, this, this and this is left to be done." And then refuse to entertain any complaints or take responsibility for not doing something if you honestly didn't have the time. Tell them to talk to the charge nurse. Believe me, they won't.
I work as a taveler, and one advantage to that is, you get to see how different facilities handle the same situation. Almost every place I've worked at had a "one hour rule" for admissions. If it arrived within an hour of the end of your shift, you were responsible for setting up initial orders (ie....NG tube to low int. suction, oxygen, a tray if a diet is ordered etc) and do an assessment.
That rule seems to work well. The nurse coming on doesnt complain as long as the pt. is comfortable.
I did work at one place where the admission paperwork was yours, regarless of when they came. That didnt work so well. Its no secret a lot of units/nurses hold pt's who are supposed to transport until the very end of the shift. So, when that new admit was phoned to the charge nurse, it was hell decideing who got it. As the travel nurse, that was usually me.
I've noticed that if you really hustle and run yourself into the ground trying to get an admit finished, the on-coming shift will STILL be a pain if there is ANYTHING left to do, so why even bother? I just try to prioritize in terms of what needs to be done carewise and paperwork wise and leave the rest WITHOUT making any excuses. At my hospital they will give attitude if the patient walked onto the unit 5 minutes before change. During report just say, "I've done this, this and this. As far as I can tell, this, this and this is left to be done." And then refuse to entertain any complaints or take responsibility for not doing something if you honestly didn't have the time. Tell them to talk to the charge nurse. Believe me, they won't.
Some people complain if there is anything at all left to do where I worked. Others don't say a word and are very understanding if you don't get to touch anything. I think it really depends on who is relieving you.
As a nightshifter, I'd want you to do the initial interview, VS, telemetry strip, and at least take a peek at the orders for anything that's a stat or now order. If it's that close to shift change, catch me when I come in so I can do the initial physical assessment, since I'm going to have the person all night. Of course, if it's like our ER likes to do, they drop them off in life threatening respiratory distress, or in the middle of HAVING an MI, (or in one memorable case, the pt was DEAD, while the ER nurse insisted they had been talking to the person in the hallway, rigor not withstanding....). If that happens, go ahead and send them to ICU, and skip the "fluff." I always tell new nurses, "concentrate on what will kill you first." If they're in with acute distress, get HELP. Don't let your shift dump a critical on you alone.
This happens to me all the time. I am a niteshifter and have been a RN for less than 6 months. We usually do get some notice from 10min to 30min notice. I try to make sure all my other pts are OK and all my AM meds are done and my documention is done. Then I do my admission database (list of questions including vitals and pain status), put chart together. If there were orders sent up then I scan them to pharmacy and try to enter stat stuff. Then depending what time it is then I pass on what I did not get to. We have to start giving report before 0700.
We try to do the "CYA"-type stuff plus a quick check to see if anything is urgent, like getting a heparin drip going. Typically I'll do a quick head-to-toe assessment, grab a set of vitals and run a tele strip (Frankly the kind of stuff that would potentially get you in trouble if you did not catch, deal with and document before reporting off like high BP, respiratory distress, etc...)
I do what I can. Whatever I can't get to, I pass on.
Same here when I worked med-surg. Do what you can and remind the next shift it's a 24 hour facility. I never liked to pass on stuff but sometimes you have to. Do the best you can and that's it.
This thread reminds me of a friend from nursing school. He started off in the ICU and, his words not mine, "Cracked under the pressure".
I always thought it was nursing as a whole that gave him problems, not the ICU. The things he didnt like were common to all areas of nursing. This, last minute admissions, was the biggest one for him. He just couldnt get over how often pt's were transfered from ED right at shift change.
I had a, 82yo pt come to the ED today c/o dizziness. They arrived around 1130am. I put orders in (EKG, PCXR, CBC, CMP, PT/INR, CKMB, TROPONIN, BNP), had lab draw blood, made sure the EKG was done. I gave meds, kept the pt on continuous cardiac monitoring, tried orthos but the pt wouldn't stand up because he felt "weak". Wife was insisting that the pt should be admitted. The pt told the doc that he wanted to get up and try walking again and wanted to go home, despite the fact that we called for an admit doc and put in a bed request. Needless to say, the pt wasn't able to get up without "feeling dizzy" (very unsteady). The bed request was put in at 1330.
Its now 1500 and I've fed both the pt and his wife, reassured them that I would call report as soon as their bed is ready. I give report to the next shift in the ED at 1515, and low and behold at 1520 an admit bed is finally assigned. I have 4 pts at this point - 2 chest pain, one altered mental status (probably hepatic encephalopathy and just arrived by ambulance), and my dizzy admit. I try to call report on my dizzy pt, but the nurse asks "can you call back in 15 minutes?" I tell her "it won't be me calling report in 15 minutes, it will have to be another nurse; I leave at 1530"; she states "I leave at 1530 too".
Normally, I'd stay and try to call report again - but I'm sick of staying late all the time. I'm sick of not having a lunch break and barely having time to use the bathroom. After running around crazy all day, all I want to do is give report for continuity of care - I fed the pt, toileted him, did his med rec, revitaled him, medicated him, etc. This was not a "dump" pt and he had been waiting over 90 minutes to get a bed assigned. This isn't fair to the pt, nor is it fair to the nurse that takes my pts at change of shift.
Why is it so hard to take report? I could see if the pt was critical, but come on; he's old, from home, dizzy since 9am and has had similar episodes in the past. I gave his home BP meds and finished his med rec, I gave meclizine 25mg; no allergies, hx of HTN, PE, and DVT and is on coumadin; CT head neg, neg PCXR, labs WNL aside from a subtherapeutic INR. He's A/0x3 and is yelling at me because we are "making him wait" in the ED. Despite the fact that I efficiently cared for this pt and had everything going prior to an MD walking in the room, I get dinged due to the fact that the nurses on the floor won't take report.
His admit bed was ready, so deal with it; don't make the pt wait. Don't make me stay longer than I have to because I've put in my time for the day. I can't always stay late, and there's always something to do for our pts; that's why there are nurses there 24/7. Its change of shift in the ED, pts are in the hallway because we have no open beds, I can't call report and so now my relief who knows nothing about the pt will have to call. The pt probably wouldn't have gotten to his room until 1545 anyways, so why can't you take my report?!?! For the love of it, we called for an admit bed 90 minutes ago!
Sorry, just had to vent from the other side of the fence...we all need to pitch in and get the job done and do what is best for the patient, not what is easiest for ourselves. And as I said, I usually would stay but I also need to adhere to the time clock, as it doesn't look good if I am clocking out late all the time...
I had a, 82yo pt come to the ED today c/o dizziness. They arrived around 1130am. I put orders in (EKG, PCXR, CBC, CMP, PT/INR, CKMB, TROPONIN, BNP), had lab draw blood, made sure the EKG was done. I gave meds, kept the pt on continuous cardiac monitoring, tried orthos but the pt wouldn't stand up because he felt "weak". Wife was insisting that the pt should be admitted. The pt told the doc that he wanted to get up and try walking again and wanted to go home, despite the fact that we called for an admit doc and put in a bed request. Needless to say, the pt wasn't able to get up without "feeling dizzy" (very unsteady). The bed request was put in at 1330.
Its now 1500 and I've fed both the pt and his wife, reassured them that I would call report as soon as their bed is ready. I give report to the next shift in the ED at 1515, and low and behold at 1520 an admit bed is finally assigned. I have 4 pts at this point - 2 chest pain, one altered mental status (probably hepatic encephalopathy and just arrived by ambulance), and my dizzy admit. I try to call report on my dizzy pt, but the nurse asks "can you call back in 15 minutes?" I tell her "it won't be me calling report in 15 minutes, it will have to be another nurse; I leave at 1530"; she states "I leave at 1530 too".
Normally, I'd stay and try to call report again - but I'm sick of staying late all the time. I'm sick of not having a lunch break and barely having time to use the bathroom. After running around crazy all day, all I want to do is give report for continuity of care - I fed the pt, toileted him, did his med rec, revitaled him, medicated him, etc. This was not a "dump" pt and he had been waiting over 90 minutes to get a bed assigned. This isn't fair to the pt, nor is it fair to the nurse that takes my pts at change of shift.
Why is it so hard to take report? I could see if the pt was critical, but come on; he's old, from home, dizzy since 9am and has had similar episodes in the past. I gave his home BP meds and finished his med rec, I gave meclizine 25mg; no allergies, hx of HTN, PE, and DVT and is on coumadin; CT head neg, neg PCXR, labs WNL aside from a subtherapeutic INR. He's A/0x3 and is yelling at me because we are "making him wait" in the ED. Despite the fact that I efficiently cared for this pt and had everything going prior to an MD walking in the room, I get dinged due to the fact that the nurses on the floor won't take report.
His admit bed was ready, so deal with it; don't make the pt wait. Don't make me stay longer than I have to because I've put in my time for the day. I can't always stay late, and there's always something to do for our pts; that's why there are nurses there 24/7. Its change of shift in the ED, pts are in the hallway because we have no open beds, I can't call report and so now my relief who knows nothing about the pt will have to call. The pt probably wouldn't have gotten to his room until 1545 anyways, so why can't you take my report?!?! For the love of it, we called for an admit bed 90 minutes ago!
Sorry, just had to vent from the other side of the fence...we all need to pitch in and get the job done and do what is best for the patient, not what is easiest for ourselves. And as I said, I usually would stay but I also need to adhere to the time clock, as it doesn't look good if I am clocking out late all the time...
Oh my. You must have been writting this while I was posting a thread about this issue. I always wondered why everyone gets transfered at shift change.
I guess, nurses holding onto pt's is only one side of the story. There are those who wont take report either.
What do you say though about the instances where........out of nowhere, the ED/CC/whatever floor is calling saying the pt. needs transfered "Its an emergency, we have to clear out beds".........about 1 1/2 hours before change of shift. They give report, and the pt doesnt transfer until over an hour later, right at shift change.
firstyearstudent
853 Posts
I've noticed that if you really hustle and run yourself into the ground trying to get an admit finished, the on-coming shift will STILL be a pain if there is ANYTHING left to do, so why even bother? I just try to prioritize in terms of what needs to be done carewise and paperwork wise and leave the rest WITHOUT making any excuses. At my hospital they will give attitude if the patient walked onto the unit 5 minutes before change. During report just say, "I've done this, this and this. As far as I can tell, this, this and this is left to be done." And then refuse to entertain any complaints or take responsibility for not doing something if you honestly didn't have the time. Tell them to talk to the charge nurse. Believe me, they won't.