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 get the admission assessment & data form done, if I can get through either the education or plan of care I will, usually I can get a bit more than 1/2 done, for the day nurses tho, they know if I'm the one getting their patient, to leave me the assessment, some patients get a little irritated being thoroughly assessed twice within 1 to 2hrs so it makes it a bit easier on them.
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.
No, it gets worse. but you do what you can
I understand why the ER brings up patients when they do.
I may sound as though I have the wrong attitude here but nursing is a 24/7 job, what can't be finished on one shift has to be taken up by the next shift and so on. When I worked med-surg I wouldn't have expected a nurse in this situation to finish an admission if they were busy. Patient care is an ongoing process that continues from one shift to the next. If the previous shift starts the admission, takes some vitals and starts the paperwork surely it's not that unfair for the next shift to maybe order meds, start IV's....
If I worked on the wards again and I had to admit a patient 45 minutes before shift change then I'd do as much as I could but I wouldn't neglect my other patients and run myself ragged simply to make life easier for the next nurse. I would give the next nurse the heads up on what needs to be completed during handover.
To me it's not good teamwork and work ethic to expect the previous nurse to run themselves into the ground just to make your shift go more smoothly. Yes we all want to come on and have everything all nice and easy from the beginning but in reality life isn't perfect.
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?
:smiley_abNope, no fight-picking here! I totally see where you are coming from, as it seems silly for me to be upset because I want to go home but the floor nurse won't take report, since she is going home too. However, I went out of my way to do as much as possible for the pt so the floor wouldn't have to worry about feeding the pt, toileting him, doing his med rec, medicating his pain, changing soiled linens, etc. We have a "float" nurse who even did ALL the admission paperwork for the pt too. My charting is very thorough and organized, and I make a point to highlight all the meds I give in my copy of the chart that goes to the floor (no one else does this). This pt was very stable, received only meclizine po and his BP med (norvasc, I think) po during his ED stay. We waited quite some time to get a bed. I just wanted to give report so the pt could go to a room, as the ED beds are very uncomfortable. Additionally, the nurse relieving me already had his hands tied with new pts, plus an ambu coming in (and so calling report was the least of his priorities, and thus the pt would continue to wait in the ED). The ED charge nurse was upset because the floor wouldn't take report (which has become a big problem lately and is being tracked; the floor isn't supposed to refuse report due to change of shift per hospital policy).
The pt wouldn't have gone up to a room until at least 1545 - enough time for second shift to start. There actually wasn't much report go give (labs & radiology all WNL). The pt was old and being kept overnight for observation; I was irked that I couldn't give report because there wasn't much to give! The pt would probably be the easiest pt that the floor nurse would have all night.
I was just trying to make life easier for my shift relief and make the pt more comfortable. We've been slammed in the ED lately, and I wanted to to all I could for the next shift (both in the ED and on the floor). Our ED census has been up and our staffing has been cut as well, so its a struggle to maintain flow in the ED when we're holding floor admits with assigned beds because floor won't take report; meanwhile, there's pts on stretchers in the hallway and the charge nurse is trying to figure out why it took over 90 minutes to get a bed assigned - and now that a bed is assigned, why can't report be called since this pt is tying up one of our major trauma rooms?
If the nurse can't care for the pt at that time, then I'd rather not have the house supervisor assign a bed. We had put a bed in and the house supervisor assigned a bed 90+ minutes later (which is approved by the assigned floor's charge nurse - so according to them, "we can now take the pt").
:smiley_abNope, no fight-picking here! I totally see where you are coming from, as it seems silly for me to be upset because I want to go home but the floor nurse won't take report, since she is going home too. However, I went out of my way to do as much as possible for the pt so the floor wouldn't have to worry about feeding the pt, toileting him, doing his med rec, medicating his pain, changing soiled linens, etc. We have a "float" nurse who even did ALL the admission paperwork for the pt too. My charting is very thorough and organized, and I make a point to highlight all the meds I give in my copy of the chart that goes to the floor (no one else does this). This pt was very stable, received only meclizine po and his BP med (norvasc, I think) po during his ED stay. We waited quite some time to get a bed. I just wanted to give report so the pt could go to a room, as the ED beds are very uncomfortable. Additionally, the nurse relieving me already had his hands tied with new pts, plus an ambu coming in (and so calling report was the least of his priorities, and thus the pt would continue to wait in the ED). The ED charge nurse was upset because the floor wouldn't take report (which has become a big problem lately and is being tracked; the floor isn't supposed to refuse report due to change of shift per hospital policy).
The pt wouldn't have gone up to a room until at least 1545 - enough time for second shift to start. There actually wasn't much report go give (labs & radiology all WNL). The pt was old and being kept overnight for observation; I was irked that I couldn't give report because there wasn't much to give! The pt would probably be the easiest pt that the floor nurse would have all night.
I was just trying to make life easier for my shift relief and make the pt more comfortable. We've been slammed in the ED lately, and I wanted to to all I could for the next shift (both in the ED and on the floor). Our ED census has been up and our staffing has been cut as well, so its a struggle to maintain flow in the ED when we're holding floor admits with assigned beds because floor won't take report; meanwhile, there's pts on stretchers in the hallway and the charge nurse is trying to figure out why it took over 90 minutes to get a bed assigned - and now that a bed is assigned, why can't report be called since this pt is tying up one of our major trauma rooms?
If the nurse can't care for the pt at that time, then I'd rather not have the house supervisor assign a bed. We had put a bed in and the house supervisor assigned a bed 90+ minutes later (which is approved by the assigned floor's charge nurse - so according to them, "we can now take the pt").
Sorry, just had to vent...
Our bed assignments are a little different...housekeeping reports the room is clean and the bed coordinator makes the assignment. Not much input from us.
Typically, on our floors, your report would be taken. If I were in the middle of reporting to my relief, he or she would take your report, then I would finish. If my relief was listening to my taped report, I'd take yours and pass it on. So, yeah, it isn't always really convenient, and doesn't always go as smoothly as it might, but I understand very well, and my peers understand well enough, the importance of clearing an ER bed. Plus, as you note, it's more comfortable for the patient.
Got report awhile back from a guy I didn't recognize. 80 y.o female stroke, yada, yada, yada, then he asks if I have any questions. So I ask, "Is she good looking?" And he's all, "Dude, she's 80!" Which, last I heard, is well over the age of consent.
Teach him to dump a patient on me right at lunchtime...
ZooMommyRN, ADN, RN
913 Posts
I get the admission assessment & data form done, if I can get through either the education or plan of care I will, usually I can get a bit more than 1/2 done, for the day nurses tho, they know if I'm the one getting their patient, to leave me the assessment, some patients get a little irritated being thoroughly assessed twice within 1 to 2hrs so it makes it a bit easier on them.