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

PMHNP10 · Nov 6, 2003

I'll be the first to admit that I don't like to finish something I feel should have been done already. And at the same time, I don't like to leave things for the oncoming shift. The more I can take care of, the better day they will have. Of course part of my hope is that such above and beyond efforts are recognized in the future by my coworkers...I must say they have been. Please don't get me wrong. In no way am I saying you are wrong for not completing an assessment when you get a pt right before the end of your shift. I'm just saying that I would do everything I could to complete the task at hand, but if the favor is not returned, and there is no good reason, I make that mistake only once.

ShimmaShimma0304 · Nov 6, 2003

Yes, I agree. And I *did* do what was absolutely necessary to be done before I left. I just wasn't going to stay for an additional hour (or whatever amount of time it took) to complete the admission history. Nursing is 24 hours and that nurse was UGLY to me about finishing the paperwork. I got the guy settled. I took his vital signs and I drew his blood and sent it to the lab. Done... finito! I worked my a** off that shift and I wasn't about to stay another minute... especially since the patient was stable and she could handle the rest. Her attitude stunk about the whole deal and she was being unreasonable acting as though I was sloughing something off on her that I shouldn't be. That's B.S. I could easily stay at the hospital 24/7 but I'm not gonna kill myself when my RELIEF is supposed to pick up. I don't push off things on other shifts and that's not what this was about. I'm done talking about this. (this was about a week ago that it happened and the nurse manager said I did the right thing-- and that's good enough for me, especially since this is what I suspected all along)

Town & Country · Nov 6, 2003

yes, i agree. and i *did* do what was absolutely necessary to be done before i left. i just wasn't going to stay for an additional hour (or whatever amount of time it took) to complete the admission history. nursing is 24 hours and that nurse was ugly to me about finishing the paperwork. i got the guy settled. i took his vital signs and i drew his blood and sent it to the lab. done... finito! i worked my a** off that shift and i wasn't about to stay another minute... especially since the patient was stable and she could handle the rest. her attitude stunk about the whole deal and she was being unreasonable acting as though i was sloughing something off on her that i shouldn't be. that's b.s. i could easily stay at the hospital 24/7 but i'm not gonna kill myself when my relief is supposed to pick up. i don't push off things on other shifts and that's not what this was about. i'm done talking about this. (this was about a week ago that it happened and the nurse manager said i did the right thing-- and that's good enough for me, especially since this is what i suspected all along)

i don't blame you. you did your job. you have nothing to justify.

if anything, you should be thanked that you did what you did....that was that much less the next shift had to do. but please don't hold your breath waiting.

Fgr8Out · Nov 6, 2003

I'm in total agreement with you, Marie.

Get a set of vital signs, ensure the patient is settled and preliminary questions answered, check the orders to see if any are stat and get those ordered. Attend to the immediate needs first, assessments/admitting paperwork are not the priority.

MrsWampthang, BSN, RN · Nov 6, 2003

As an ER nurse I have to admit that I like to get my patients upstairs before I leave. (I work 12 hours) The reason I do this is that usually when I admit a patient, I have been taking care of them for several hours, know everything that is going on and I don't like to have to dump an admit onto the oncoming shift, who would have to call report on a patient that they don't know anything about.

I like to at least call report to the floor, even if they can't take the patient until after shift change. Usually our 7pm shift comes in and literally hits the ground running so calling report on a patient that is going upstairs is one less thing for them to have to do.

On the other side of the coin: I have called to floors before and been told "that nurse is at lunch, can she call you back?" First:it must be nice to get to take a lunch break; we're lucky if we get to eat period, forget about getting to take a lunch break. Second: if a floor nurse goes to lunch isn't someone covering her rooms and why can't that nurse take report on the patient? This is what happens at my facility sometimes so please don't think that I am saying this is classic to all facilities! I just wonder sometimes about that. I admit I don't am clueless as to what happens after the patient reaches the floor so I can't speak to one floor shift dumping on the other floor shift.

I once called to give report to the ICU at around 6:30am and was asked if I could call back in about 15 minutes when the next shift got there?! With an ICU patient we have to take them up ourselves and I had already been there for 12 hours, had been taking care of this high acuity patient for several hours and now was asked to wait to bring him up?! I told her no, I wanted to give report to her and get him up there and settled. I don't think the receiving nurse was happy, but she took report, I took the patient up and then I went home.

Please don't think I am critizing floor nurses at all! Just airing my frustrations.

Pam

Fgr8Out · Nov 6, 2003

Pamela,

As a med-surg nurse on the floor, I have to agree with you. ER is not the place to be once a patient has had an initial assessment and is no longer in need of emergency care. It's important to get them on the floor as soon as possible and free up the ER for the next wave of patients.

Repat · Nov 6, 2003

Please explain, ER and ICU nurses, WHY patients who have been in the ER (for example) for hours all of a sudden need to come to the floor at shift change? Why, if they have been "taken care of for hours" in the ER, can they not be brought up one hour BEFORE shift change? I have asked to shadow ER/ICU nurses in order to answer this question, but it hasn't been "convenient". Is it because if census is down, you don't want to be DWOPPED (a perception on the floors), or is there a more reasonable explanation? I certainly understand why the one poster wants to give report on the patient she has been caring for, rather than leave it to the next shift. Makes perfect sense. But I really feel, in the total chaos of shift change there is too much room for error if a patient is dumped at shift change (another perception). And, as one famous poster claims, you get only as much s*** as you are willing to take, so if you don't get a lunch, whose fault is that (not the floor nurse!).

MandyInMS · Nov 6, 2003

Got an admit @ 6:30 this am..we work 7-7..settled the pt..took vs..did as much as we could on the admit until 7a ..then reported what was left to the next shift..we all jump in and work on the admits, so most everything was done.Only reason I'd stay over was if the pt was unstable.

MrsWampthang, BSN, RN · Nov 7, 2003

Please explain, ER and ICU nurses, WHY patients who have been in the ER (for example) for hours all of a sudden need to come to the floor at shift change? Why, if they have been "taken care of for hours" in the ER, can they not be brought up one hour BEFORE shift change? I have asked to shadow ER/ICU nurses in order to answer this question, but it hasn't been "convenient". Is it because if census is down, you don't want to be DWOPPED (a perception on the floors), or is there a more reasonable explanation? I certainly understand why the one poster wants to give report on the patient she has been caring for, rather than leave it to the next shift. Makes perfect sense. But I really feel, in the total chaos of shift change there is too much room for error if a patient is dumped at shift change (another perception). And, as one famous poster claims, you get only as much s*** as you are willing to take, so if you don't get a lunch, whose fault is that (not the floor nurse!).

EEEEEEEEIIIIIIIIIIIIIIIIIIIIIOOOOOOOOOOOOOOO Look out! here comes the fire truck!!!!!!!

Sometimes the doctor won't decide to admit them until the last minute. You have no idea how often I sit there watching the clock waiting on the doctor to say it is ok to get a bed, knowing that the clock is creeping closer and closer to quitting time.

Sometimes we have a bed and the admitting doctor decides they have to see the patient in the ER before they go to the floor so there's another delay.

Sometimes we don't get a bed for the patient until less than an hour before quitting time; if it's less than a half hour before shift change, that's when I will call the floor and beg to just give report and not send the patient until after shift change. This is so I don't have to dump report calling on someone who will probably hit the ground running when they come in. I try to be considerate of both the floor staff and my relief. I know it sucks to come in and have to admit the patient. So from a floor nurse perspective, does it help to not have your admit come to the floor until shift change? In our hospital, we have care partners that do the vitals, weights, and the preliminary stuff.

Sometimes we have a bed for one patient and we get tied up with another patient and can't get back to the admit right away.

As far as 3-11 goes, I work 7a-7p so when I get a bed for my patient, I call report and send them up. How am I supposed to know who works 3-11 and who works 7a-7p?

Sometimes we have a waiting room full of patients that are waiting to come back and we need the bed space so we will try to call report and get the patient to the floor as quickly as possible.

I have tried to call report to a floor only to be told that the nurse can't take report because housekeeping hasn't cleaned the room yet!? I have had them call down and tell me that they couldn't take a patient yet, because they changed the patient's room from one that was cleaned to one that now has to be cleaned. (unknown reason for changing rooms).

My pet peeve is when I am giving report and the nurse who is getting report starts whining to me about why is her floor getting this patient? I want to scream "I DON'T KNOW!" The doctor is the one who decides what kind of floor they go to not me.

I don't know how it is in other hospitals, but in our ER, we always try to take care of the admitting orders before we send them upstairs, like starting ATBS and starting cardiac profiles.

You think there's too much chaos at shift change on the floor, I'm sure there is, but the nurses in ER aren't sitting around doing nothing, and sometimes it just isn't possible to get someone to a floor "one hour before shift change."

I had to turn an admit over to my relief tonight because the ER doc and the family doc didn't decide to admit the lady until like 1850! The secretary gave me the bed as I was giving report to my relief right about 1858. I didn't even think about calling report but I felt really bad that I left her with a report to call. Fortunately I tend to chart almost every little burp the patient makes so it probably wasn't that hard for her to look at the paperwork and call report.

I can't speak for ICU, but this is the story from my ER. We all have tough jobs, and we all have our own stresses to deal with, and unless you have experienced those stresses you have no idea what they're like, from either side of the coin.

Oh, and I never said I blamed the floor nurse for my not getting a meal break. It is the nature of the beast and one that I am very used to after 15 years of working either EMS or ER. It just gets frustrating when I have a patient I need to admit because there are ambulances rolling in the door and a line of people waiting out front to come back and I am told that the nurse is at lunch and will call me back.

I get frustrated because I need to get the patient upstairs now, not 30 minutes from now, because I need the bed in the ER now for one of umpteen patients that are waiting for the room, or the ambulance crew that is standing in the hall with thier patient on a stretcher waiting for the bed to be empty.

As with my last post, this isn't meant to flame floor nurses; it is a response to the poster that asked why and I just tried to answer in a reasonable manner. I hope it didn't sound mean or hateful because I didn't mean it to. BTW what is DWOPPED?

As someone once said "can't we all just get along?!":rolleyes:

So that's my story and I'm sticking to it!

Pam

Repat · Nov 7, 2003

Thanks for the answer!! I know it's complicated, but I have to say that we often (more than often) have a bed booked at 10 or 11 AM, and I can set my watch by the patient rolling in at 1845 (yes, we work 7a-7p, too). We NEVER get a patient with orders, although basic labs are often done but that's about it. That's why I would really like to shadow an ER nurse some day. We can't know what it's like down there, just as you all can't know what it's like where we are. And no, we don't have PCA's to do the basics - all new admits must be assessed by an RN, which means that often we only have 2 RNs to 35 patients (the rest LPNs), and when we have 10 admits, all within the shift change hour, you can see why we balk. And, often, this is all done without a secretary. Nuts..... Thanks again for the answer (I was really curious).

jadednurse · Nov 7, 2003

Originally posted by Pamela_g_c
My pet peeve is when I am giving report and the nurse who is getting report starts whining to me about why is her floor getting this patient? I want to scream "I DON'T KNOW!" The doctor is the one who decides what kind of floor they go to not me.

As an ICU nurse, I just wanted to comment on this. Getting a patient in the ICU that really doesn't NEED an ICU bed is frustrating. Especially when it's one of our last beds. Especially if it's a trauma hospital...you never know when the next trauma patient will roll in and REALLY need the bed we just admitted the "inappropriate" patient to. It's a matter of using our resources appropriately. I certainly understand your frustration over getting asked the question and not knowing the answer though. It would certainly be helpful if the admitting doc clued the ER nurse into why that particular pt needs an ICU bed if it's not already apparent.

Good thread here. Nice to see all the different perspectives (ER, med-surg, ICU, etc.). Helps to understand the "big picture".

berry · Nov 7, 2003

fact is all departments have problems and issues. Everybody wants the hospital to run around a schedule most suitable for them (only gonna happen for surgery cause thats were the money comes from) I know i call report almost everyday between 630-7p i hate to do it but thats life the reason why, i try to finish up my pts i work 7a-7p the er docs are the same way but they work 6-6 this magical force happens about 500 everday they stop picking up new pts and try to finish admit/dc the rest of them which means er nurses get ready rooms around 6-615 and just like you dont want to start a new admit we dont want to give report on a pt we should have upstairs.