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

badphish · Feb 6, 2009

Is this as bad as it gets? I will so rock as a nurse. As a paramedic we sometimes get codes at end of shift and have to work them (gasp) after our shift is over on way to ER.

And I apologize to the ER staff for bringing in Codes and stroke alerts at shift change. Those patients should know better.

eriksoln, BSN, RN · Feb 6, 2009

Is this as bad as it gets? I will so rock as a nurse. As a paramedic we sometimes get codes at end of shift and have to work them (gasp) after our shift is over on way to ER.
And I apologize to the ER staff for bringing in Codes and stroke alerts at shift change. Those patients should know better.

LMAO. Its not working over that urks me. That gets under my DONs skin, but not mine. I am mostly concerned about the pts that come right at change of shift and I feel like I am dumping on the next shift. Guess just staying over a bit would solve that, but like some others have pointed out, administration wont appreciate paying time and a half for it. kmoonshine brings up a good point too though. I wonder how many times I've gotten a new pt. who came right at shift change simply because the nurse refused report.

Nurse_Hagatha · Feb 6, 2009

Is this as bad as it gets? I will so rock as a nurse. As a paramedic we sometimes get codes at end of shift and have to work them (gasp) after our shift is over on way to ER.
And I apologize to the ER staff for bringing in Codes and stroke alerts at shift change. Those patients should know better.

I would gladly stay over at the end of the shift as well for any emergency situation, whether it was my patient or to help another nurse out. Most nurses I work with are the same way. It is consistently being dumped on that irks me. I would not even gripe about the occasional change of shift admission, but it happens all. the. time. at my hospital. It gets old, just like it would get old if you had end of shift codes everyday you worked which maybe you do, if so I apologize.

kmoonshine, RN · Feb 9, 2009

I would gladly stay over at the end of the shift as well for any emergency situation, whether it was my patient or to help another nurse out. Most nurses I work with are the same way. It is consistently being dumped on that irks me. I would not even gripe about the occasional change of shift admission, but it happens all. the. time. at my hospital. It gets old, just like it would get old if you had end of shift codes everyday you worked which maybe you do, if so I apologize.

I'm generally happy to help out at the end of shift if there's an emergency or if we're getting slammed. However, this has been happening to me on a regular basis - so perhaps we have a staffing issue that needs to be addressed?

The last shift I worked was 9-5 (up to 5:30pm). At 4:30pm a chest pain comes in. He's tachy, hypertensive, diaphoretic, nauseated - looked like crap. Stat EKG, labs, PCXR, 2 IV's, nitro sublingual and nitro drip, aspirin, zofran IV, fentanyl IV, cardiology paged, etc all done by 5:00pm; I'm supposed to give report and go home. But, the nurse taking over for me "is too busy" to take my report. So here I am, 1:1 with this patient. I initially thought acute MI, but the ED doc was thinking angina. I get a bed assigned, call report; its now 5:50pm and I ask a tech to prepare for transport (I needed to go along since the pt was on a nitro drip). The cardiologist comes to the ED at 6:00pm and decides "lets cath him now". Ok...so the cath lab team is paged to come in. I'm titrating this nitro drip, its now 6:15pm...then its 6:30pm. Cath lab team comes down, but they decide to cath another patient who coded in our ED, so the cardiologist asks the charge nurse "can you hold the chest pain down here for now?" The charge nurse looks at me, and says "go home now while you can".

I didn't get out of there until 6:45pm. I felt guilty for leaving, but at the same time I had to go home (my birthday dinner was cold when I got home ). 15 minutes over my shift? Ok, I suck it up. 2 hrs over my shift? Ugh - I can't do this on a daily basis, especially if I don't get a break!

GooeyRN, ADN, BSN, CNA, LPN, RN · Feb 9, 2009

Same here. I dont normally mind staying over a short amount of time if I don't HAVE to be home. For some, though, kids HAVE to be picked up from the sitters house/daycare at a certain time. Not everyone has a huge support system for things like this. For me, I HAD to get home so my dh could go to work. (I did nights, he does days) I can't stay over my shift and make dh 2 hours late for work regularly. Once or twice a year? Fine. No problem. Daily? Um, no. If my shift ENDS at 7am, I should be able to leave roughly around 7am, give or take 15 minutes, short of a true emergency. Getting stuck an hour or more past your shift end isn't fair to employees, OR to employers that need to pay OT. Believe it or not, many people do have important lives and/or important committments outside of the hospital.

mamason · Feb 9, 2009

It really depends on how my day is going. If I'm caught up, I will attempt to do the entire admission and stay a little late in order to help the oncoming nurse. Mainly, because it's probably not going to be the first admission she's going to get for her shift. If I'm way behind, I try to get the pt settled in and make sure they are stable enougth to wait for the oncoming nurse to do the admission. If the new admission is a train wreck, well, it doesn't matter how much time you have. In this case, you need to just take care of the pt regardless. SO, on our floor, we basically play by ear. THere are some nurses who don't do this. Others, like myself, try to work together as a team because after all, they are ALL of our pts. :smokin:

Elvish, BSN, DNP, RN, NP · Feb 9, 2009

Where I work (mother/baby), we can get transfers from L&D no later than 0630/1830. Now, that usually translates into the pt actually getting to the room around 0640, which leaves me 5 minutes before shift change. I introduce myself, let them know how often we're going to be checking them, get a quick set of VS, check their fundus/bleeding, and make sure they know they can eat whatever they want (vag del).

If a c/s pt gets there at 0640, I do the VS/fundus/bleeding thing, make sure their pain is ok, make sure their IV is running well and has a pump, and make sure they have something to drink if they want it. That's it.

I mean really, you do what you can do. You're only one person, and as much as another nurse may want you to think otherwise, they are only one person too. When it's me on the receiving end, I appreciate having a clean, painfree, stable patient. If anything else is done, so much the better, but that's the most basic.

rgdavisRN · Feb 9, 2009

Whether I am busy or not, I always get a set of vitals and do a head to toe assessment.

If the patient is stable, and I am busy, I pass the rest on.

If the patient is not stable, I do whatever I have to and go home late. I've stayed late before when patients have extremely high/low BPs, high temps, respiratory distress, etc.

If I'm caught up with my other work, I do as much of the rest of the assessment as possible, so the night shift RN will not start the shift with a lengthy admission assessment.

nursemike, ASN, RN · Feb 9, 2009

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'm not trying to pick a fight--I think it's good to see things from the other side of the fence. In fact, since I used to do transports, I've seen first hand that very often the ER nurses are not sitting at the nurses' station, doing their nails and ordering Avon. And now, as a floor nurse, I've seen a few glorious moments when my peers actually were sitting at the nurses' station, doing their nails and ordering Avon--but those are pretty darned rare upstairs, as well.

Still, it seems like you're asking why it's so hard to take report in the middle of giving report to one's relief. And if report has already been given to the next ER shift, isn't it more logical to have them repeat your report to the oncoming floor nurse than giving report, again, to the off-going floor nurse so they can repeat it to the oncoming nurse? If you've reported off, is it even still your problem? If you and I are going to be in our cars on the way home before the pt gets to his room, is this really even an issue?

As I stated, even though I haven't worked the ER, I've spent enough time there before I was a nurse to know how crazy it can get, and how busy it usually is. But I've also seen more than enough attitude from a minority of ER (and ICU) nurses who seem to imagine that critical care is where the action is, and the nurse with 5 acute care patients should be happy to take a little break from their life of leisure and pick up one more. I'm not accusing the poster of that or even saying the attitude is all that common, but it does exist, and the question, "Why is it so hard to take report?" could be interpreted as an example of that, or as an actual question. I prefer to see it as the latter, and to admit that there may be some floor nurses who'll drag their feet to stall a new admit, but not many, and the times when it's hard to take report are the times when you've got three other pretty urgent things going on, as well. And, at least where I work, the floor nurse has very little to do with when an admit bed is available.

So, vent away. I feel your pain. But please do try to remember that it's no picnic upstairs, either, and we're all supposed to be on the same team.

Oh, yeah, and for the love of God, please don't tell people they'll get something to eat/drink when they get to their room. They'll get it when, and if, we get a diet order.

In answer to the OP, if I get a new patient and none of my others is in a code, the new one gets a full assesment. If possible, they get their admission info taken and entered into the computer (in the past, entered after report, but now we enter it as we take it) even if it means staying over a few minutes. And most of the nurses I follow show the same courtesy, if they're able. The oncoming nurse will have plenty to do once the doc starts putting in orders, and other patients to see, as well.

Virgo_RN, BSN, RN · Feb 9, 2009

Oh, yeah, and for the love of God, please don't tell people they'll get something to eat/drink when they get to their room. They'll get it when, and if, we get a diet order.

And, looking at the chart to see if there is a diet order is NOT my first priority when the patient hits the floor. The chart doesn't even come to me, it goes to the ward clerk. I don't see the chart until after I've settled the patient in, gotten a set of vitals, and have done a head to toe. Typically, they're admitted after the kitchen has closed, and all they're gonna get is a sandwich or some soup and pudding or jello, not a hot meal. Just because our hospital looks like a ski lodge does NOT mean we have room service 24/7! So, to the family member who is bugging me about food, going on and on about how Mom hasn't had anything to eat all day, sit down, shut up, stay out of the way and let me do my job! Mom will eat when it's time.

Hm. Wrong thread, I think.

gonzo1, ASN, RN · Feb 9, 2009

I'm going to try to make this easy and short. I used to do med/surg/tele, I now do ER.

In the ER I constantly have a charge nurse who is asking me why I haven't moved my pt out yet and taken a new one. Sometimes it is because one of my 6 (yes, 6) ER pts decided to crawl out of bed and fall, or decided to stop breathing, or any number of things. Or maybe I got another ambulance.

Or maybe the ER doctor decided to add one more test before pt goes to the floor, or maybe the hospitalist stopped to see the pt and write orders.

Trust me I have a charge nurse standing behind me saying move the patient, move the patient.

Another problem is our doctors hold pts so they won't have to take a new one. I can't tell you how many times I have done everything for the patient and the doctor won't finish his final paper work so I can copy the chart and send him out.

It is my job to make sure all tests have been completed on pt, all labs noted, and tell the doctor it is time to finish up with pt so he can go to the floor and the doctor won't do the paper work because he doesn't want to start a new pt before he leaves in 2 hours.

At one of the places I work they are actually starting to ding the doctors for doing this.

Also there is a phenomenon called end of shift ambulance/code. It never fails, 15 minutes before end of shift we get an ambulance and you can't tell someone who can't breath that you are going home. And the nurse relieving you is ****** because she doesn't want to start her shift with someone who can't breath and has diarrhea.

When will we nurses get the fact that nursing is a 24/7 job. That there really is no beginning/end. Just a continuum.

When will we stop beating ourselves and each other up for not being super heroes.

nursemike, ASN, RN · Feb 9, 2009

I'm going to try to make this easy and short. I used to do med/surg/tele, I now do ER.
In the ER I constantly have a charge nurse who is asking me why I haven't moved my pt out yet and taken a new one. Sometimes it is because one of my 6 (yes, 6) ER pts decided to crawl out of bed and fall, or decided to stop breathing, or any number of things. Or maybe I got another ambulance.
Or maybe the ER doctor decided to add one more test before pt goes to the floor, or maybe the hospitalist stopped to see the pt and write orders.
Trust me I have a charge nurse standing behind me saying move the patient, move the patient.
Another problem is our doctors hold pts so they won't have to take a new one. I can't tell you how many times I have done everything for the patient and the doctor won't finish his final paper work so I can copy the chart and send him out.
It is my job to make sure all tests have been completed on pt, all labs noted, and tell the doctor it is time to finish up with pt so he can go to the floor and the doctor won't do the paper work because he doesn't want to start a new pt before he leaves in 2 hours.
At one of the places I work they are actually starting to ding the doctors for doing this.
Also there is a phenomenon called end of shift ambulance/code. It never fails, 15 minutes before end of shift we get an ambulance and you can't tell someone who can't breath that you are going home. And the nurse relieving you is ****** because she doesn't want to start her shift with someone who can't breath and has diarrhea.
When will we nurses get the fact that nursing is a 24/7 job. That there really is no beginning/end. Just a continuum.
When will we stop beating ourselves and each other up for not being super heroes.

Yeah, but at least you guys get your own TV series! Well, I guess Chicago Hope was kinda med-surg, heavy on the surg.

Oh, I'm forgetting--we're all just the "extras," anyway.