Opinion re: getting a new patient at the end of your shift

RNonsense · Nov 1, 2003

You're only human. You do what you can and go home. This was not an emergency, it was not a crashing patient. It's too bad you have to admit so close to shift change anyway!

ShimmaShimma0304 · Nov 1, 2003

It's CLASSIC for E.R., ICU, OTHER floors to send patients at shift change... so THEY don't get anymore patients put on them on the shift they are already on. Classic, classic, classic... I've worked in lots of different places as a travel nurse and just with my work history experience... and... Classic. It is a shame, yes. Occasionally you will meet a nice individual who will hold the patient until the other shift comes out of report, but since the patient was, indeed, stable and I didn't think it would be that big of a deal... I let him come. I got report on him at about 10:35pm and he didn't arrive until 11pm. Perhaps I would have done more than just do vitals, draw another Troponin level, and settle him in as I did if he had arrived sooner... but sheesh! I'm not real excited to float to that unit again... Seemed everyone ganged up and was smirking (not wanting to object to what they're co-worker said because they always work with her-- and you can kind of understand that) and one of the other girls agreed with her stating, "That's how we do it here... if you get a patient ANYtime on your shift, you have to do the admission assessment." I said, "So you want me to stay here for another hour when I've already been here for 8 hours?" I just left... like I said. Whatever. (the patient was sitting in bed smiling when I left, by the way-- he was FINE)

ERNurse752, RN · Nov 1, 2003

Originally posted by Marie030473
It's CLASSIC for E.R., ICU, OTHER floors to send patients at shift change... so THEY don't get anymore patients put on them on the shift they are already on. Classic, classic, classic... I've worked in lots of different places as a travel nurse and just with my work history experience... and... Classic. It is a shame, yes.

I'd like to hope it's not classic everywhere. Speaking only for myself, if a patient has been waiting several hours for a bed, why not send them up when a bed is ready, even at shift change? It's not about just trying to get rid of them.

If they're stable and the stat and now orders have already been completed in the ER, it's ok if they wait on the admission paperwork for a little while. The patients and families are just happy to be out of the ER and up in their room...they've made it to their final destination.

Pretzlgl · Nov 1, 2003

As an ICU nurse I have transferred patients at the end of a shift - but it's because the ER is sending one to us and we have to make room.

Anyway, if I receive a patient at the end of the shift I settle them in, get a set of vitals, do a quick note and hand em over. This is the reason we have "shifts". It seems many nurses forget this. If the patient is crashing, then that's another story - but everyone on the unit better have their butts helping out.

RN-PA, RN · Nov 1, 2003

Originally posted by ERNurse752
I'd like to hope it's not classic everywhere. Speaking only for myself, if a patient has been waiting several hours for a bed, why not send them up when a bed is ready, even at shift change? It's not about just trying to get rid of them.

I don't know if it's classic everywhere-- I can only speak from my own experience which is WAY too often, we're getting patients from the ED, from PACU, or transfers from ICU or PCU (telemetry) at the beginning of our 3-11 shift, (even during shift change which happened to me yesterday) not so much at the end of the shift.

To answer the original question, I used to stay and try to help 11-7 by doing the admission paperwork-- including the assessment-- taking off orders, starting the careplan, etc., when our 11-7 shift was staffed poorly with one nurse to 10-12 patients some nights. But now, they have as many patients (6-7) as we do on 7-3 and 3-11 shifts, so I don't do much if an admission comes at the end of my shift-- just get them settled, take vitals, etc. Night shift generally has more time now to handle the paperwork and orders, so I don't feel guilty about passing it on.

ruca30 · Nov 1, 2003

Hey, everyone knows that nursing is a 24 hour job. You're not so very important that another co-worker can't competently handle the same situations....and so....when ER sent up patients to us at 11pm, it was always my practice to settle the patient in, do a quick assessment (just to make sure nothing major was going on), document and put that bit in my report...and get the hell out of Dodge! And there were MANY times I came in at 7am or 3pm and had brand spanking new patients waiting for me to admit them. That's how it goes.

ShimmaShimma0304 · Nov 1, 2003

THANK YOU! I wanted to put some BOOTS ON when that lady tried to tell me that I needed to do the admission assessment paperwork! (because I was being fed a bunch of BULL!) I got a patient at 3pm who had been on the floor since around TWO that afternoon who I had to admit. NOTHING HAD BEEN DONE... Well, she had vital signs taken and all, but her orders weren't noted, she was hungry and her diet hadn't even been keyed in. She was ticked off and hungry. Oh, by the way... I did 4 discharges on that 3-11 shift last night and we didn't even have a unit clerk to help out. While we're pushing papers and "playing on the computer", the patients are hanging out in their rooms waiting for a NURSE TO TAKE CARE OF THEM!!! It's so frustrating!!! I was gonna be damned last night if that silly 11-7 nurse was gonna make me feel bad about leaving her a smidgen of paperwork. I had to come here and vent though. No guilt... just a little venting. Thanks for validating what I already suspected... nursing is 24 hours and they are indeed called SHIFTS. And if I were a lazy individual I might have something to FEEL GUILTY ABOUT.

Burnt Out, ASN, RN · Nov 1, 2003

I work 7a-7p...and I HATE it when we get admits at 6 pm or after. :rolleyes: It takes a while to do admits...I have had few admits where you just breeze right on through, and the rest... :stone

Usually if they come to our unit at 6 pm or after-we try to ask some of the admission questions, do any stat orders, get their diet ordered and just write a quick admission note in..as long as they are not showing s/s distress.

This is why we have shifts...I am NOT doing overtime just because they sit in admitting for 2 hours while the clerks do nothing but gossip:nono:

mattsmom81 · Nov 4, 2003

Where I work it takes almost 2 hrs to complete an admission history and asessment with all that is required. We made it a policy that an admit less than 1/2 hr before next shift arrives is left for next shift. Stops all the bytching and arguing.

As agency one needs supervisor's approval to stay over anyway and they would likely be reluctant to pay you extra so you did what you needed to do. Sometimes if next shift is short I will stay over if asked, IF the OT will not be an issue. BUT if I have other committments and must leave, I generally will do so.

Town & Country · Nov 5, 2003

Glad to hear you stood your ground.

When I worked med/surg, the policy was: any admits who get to the floor fifteen minutes BEFORE 7am belonged to the person leaving, fifteen minutes AFTER 7am belonged to day shift.

If I got someone up at 7am, we would get vitals, get them settled, and their orders faxed to pharmacy; they usually already had an IV started in the ER.

I did the major things and then left.

That's ridiculous.

ShimmaShimma0304 · Nov 6, 2003

I spoke with the nurse manager on that unit a couple of days ago about the tension and aggravation I received from the 11-7 nurse and she said that I was absolutely in the "right" about leaving the patient for HER to admit being that he arrived on the unit at 11 on the nose. She also arranged a meeting with her staff because she says it's been a constant problem on both of the units she manages that the other shifts don't understand that admits can be passed along if the patient arrives close to shift change. So... AHA! I have their nurse manager's permission to leave when I'm done with "my" part of settling the patient, etc. I ran into a NICE nurse from that unit and she said they had the meeting yesterday about the above topic I originally posted. Thanks for everyone's input/comments. :) Marie