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

mattsmom81 · Nov 12, 2003

The reason I may push medsurg to take two patients at 7 pm may be because the house super has canceled the extra nurse who would take them if they were to stay. Which means I probably have 2 critical patients plus two who are no longer ICU status but still in my unit pending transfer.

Another reason I must move fast is if ER is holding several critical patients waiting for my ICU beds to free up. I do try to communicate this to the frazzled medsurg staff...we're all pushing because we ourselves are being pushed...its not anything preplanned on our part.

I hate shift change transfers too but sometimes its unavoidable.

healingtouchRN · Nov 12, 2003

no way, settle them in, make sure they are stable & then assign them to some one fresh, that is why there are shifts!!! I had rather get some one I have assessed & started the paper work than some one sleepy trying to do & staying over....

StrongRN · Nov 15, 2003

Perhaps your director should initiate a "cooling Period" like we have at my hospital. It goes like this - we do not take admissions 15 minutes before the end of a shift and not for the 15 minutes after change of shift. We have people trying to go home too. Now keep in mind that if we have someone who has worked 3p -11p , 7p - 7a, then if it is a crunch type situation and the patient need to come out now because they need that bed - then my 3-11 staffer can if possible for her/us take an admission at 6:59p to help our sister unit out. And for the most part this works fairly well. At least from the aspect that we are doing what L&D want. I would like to see L&D extend a helping and understanding hand our way a little more frequently.

Does anyone have an idea what L&D has the impression that they are the "chosen" ones and Womens Surgical Nurses are only here to do as they are told.?

We each are valuable in our own right. And I dare to say most could not run the hall with 8-9 patients (gyn, antepartums, postpartums, renal, gi. etc.) What do you think?

RN92 · Jul 16, 2004

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?!
traumamama, we must work at the same hospital..i am in er. i dont know why everyone thinks we would want to "hold onto" a pt until shift change!! i hate having admitted pts. they usually have a lot of new orders (admission orders) that i just dont have time for. where i work - as soon as we get orders, we start trying to get the pt to their room. calling report to the floor is like trying to pull teeth....the best excuse ive ever heard for not taking report - is when the unit secretary said "that nurse is in the bathroom and she might be in there a long time." also, these pts have been lying on hard stretchers for hours in a busy, noisy emergency room. they shouldnt have to wait any longer. i agree that we need to avoid shift change by 30min either way - but if the floor nurse has been avoiding report for several hours - then its just tough.

mscsrjhm · Jul 18, 2004

The reason I may push medsurg to take two patients at 7 pm may be because the house super has canceled the extra nurse who would take them if they were to stay. Which means I probably have 2 critical patients plus two who are no longer ICU status but still in my unit pending transfer.
Another reason I must move fast is if ER is holding several critical patients waiting for my ICU beds to free up. I do try to communicate this to the frazzled medsurg staff...we're all pushing because we ourselves are being pushed...its not anything preplanned on our part.
I hate shift change transfers too but sometimes its unavoidable.

Agreed...

The shift mess is usually because of cancelled nurses.. "Census says... ship 'em out now....cancel brand x agency first (they are more expensive)...No extra ICU RNs available...."

flashpoint · Jul 24, 2004

I work ICU when there is a patient and ER when there is not. From the ICU standpoint, we often get orders to transfer our patients to Medical if their 0600 labs are WNL...change of shift is at 0700...average lab turn around time on routine orders is 30 minutes. Since we are a small hospital and the ICU nurse is often on call only, it makes no sense to call someone in for 30 minutes jsut to avoid a change of shift admit to Medical. In ER, it seems like we get a lot of patients at 0500 and 1700...Grandma wakes up with SOB and comes in at 0500...Man in a Suit gets chest pain on his commute home at 1700 and comes in...average door to floor time in our ER is 2 hours.

Neither ICU or ER intentionally goes out of their way to make the floor nurses lives hell...and since we run at a different pace and different routine, the half hour from one shift to another is no different from any other time of day or night. Also...you can't take a lunch when every bed is full and the waiting room is overflowing from the minute you walk in to the minute you walk out...someone has to be there to take care of the patients and when there is no one to cover you during lunch, you shove a sandwich in your face while you pee! :-)

rollingstone · Jul 25, 2004

When I get an admit around shift change I'll document the assessment and VS. I'll have the patient start the admission history paperwork and let the next shift follow up on it.

blue280 · Jul 25, 2004

In our hospital we have a report line that the ER uses. When the ED RN finishes her report, she call the floor and lets the unit secretary knoe the report is on the line. The floor RN has 20-30 minutes to listen to report and get the room ready. ED is usually good about waiting until shift change is over but when a patien t does come up at shift change, the outgoing RN settles the patient, makes sure the patient is stable then leaves he rest for the next RN.

Pediatric Critical Care Columnist · Aug 18, 2004

We often have the same issues. The patient is determined to be ready for transfer to the ward during AM rounds, let's say by 0930. The charge nurse contacts the ward and is told they have to get their discharges out before they can take the patient. So a couple of hours pass. At 1130 the charge nurse calls again, and this time the story is that the receiving nurse is gone for lunch and will call when she's back to get report. Another 90 minutes tick by. Now it's 1300 and there's been no call from the receiving nurse, so the ICU nurse calls up and is told that now they can't take the patient until after 1500 when the 15-23 nurse comes on because they got two unexpected admits. At 1515 the ICU nurse calls up to give report and is told the 15-23 nurse is still in report, she'll call when she's out. So here we are at 1700 taking the patient up, nearly 8 hours after their transfer orders were written. Happens everyday!

On the other side of the coin, should a kid on the ward go sour, we take over care of that patient the instant the code is called, or the decision to transfer to the unit is made. That is the expectation. Whether we have to transfer someone out to be able to take the kid, whether any of us has had a pee break, whether there's even a nurse to take the kid, it's on its way within 15-30 minutes.

Admits from the OR come when they're ready, often without a heads-up... the doors open and there they are. This is not supposed to happen; our attending is supposed to accompany the patient up. Sometimes two will roll through the door one right behind the other.

ER takes the cake though. They'll call the unit asking when they can send up little Joey who fell down the steps. No matter what they're told the kid comes up when they decide to bring 'em. Last ER admit I got, I told them I needed 10 minutes to set up. That was at 0030. I waited and waited and called down to find out hwat was taking so long, and finally at 0130 the kiddie came in. He had orders on the chart from ER (C-spines AP and Lat, bloodwork) that should have been done down there and weren't. They brought him up so I could take him back down for his x-rays. It was the middle of the night and he was their only patient... needed ICU because the ER nurse gave him a 1 for verbal because he only nodded his head in response to questions, giving him a GCS of 9-10. On my initial assessment he was a 12, ward material.

One time, not long after I started working in this unit, I sent a patient who was in septic shock to the OR at 1630 for debridement of an intracranial mastoid abcess. The OR called at 1845 to say they were on their way up, and they arrived at 1855. I stayed to help get her readmitted because they were short on nights and the night nurse would have no help, finishing up at 1940. When I asked for OT, I was told in no uncertain terms that I should have left at 1915, regardless of what kind of mess I was leaving for the night nurse, and my OT was denied. I will never make that mistake again. The only time I'm ever out of there at 1915 is if I don't have a patient, but I won't do a change-of-shift admit ever. Not ever.

RN92 · Aug 18, 2004

er nurse gave him a 1 for verbal because he only nodded his head in response to questions, giving him a gcs of 9-10. on my initial assessment he was a 12, ward material.

i dont understand this. our icu beds are as precious as gold. the er nurse has very little input on deciding which dept the pt goes to. we're a teaching hospital and the residents pretty much camp out at the bedside (in the er) assessing the pt.

RNKPCE · Aug 18, 2004

I think it is common problem everywhere. Post ops always seem to come at change of shift too. Well nursing is a 24 hr job and things can't always be wrapped up with a bow. When we get admits at change of shift we try to help each other out to get as much done as possible, but no way will I stay over to enter admission records in the computer. If the writing is legible anyone can do this. Would my manager want to be paying overtime to do this? The most important thing where I work is to put the patient on the monitor, get initial vitals, and give them the call light, unless of course they are in distress.

We also have a check list of all the things that need to be done on an admission such as the nsg h/p, allergy band patient, care plan, teaching assessment, stat or now meds, belonging list, acuties retroactive and proactive. We check what we have done and hand over the list with what remains to be done. This helps things not fall through the cracks.

Katnip, RN · Aug 18, 2004

Batmik, you're right. Nursing is a 24/7/365 job. We can't always transfer patients at the most convenient times.

When I worked on IMC we got patients at change of shift. We got them at lunch time. The point is, PACU, ED have more patients rolling in right behind and no place to put them. Every treat someone with an active MI in the hallway because the nurse upstairs wants to pass all her meds first?

In our ED we're supposed to have their patient up to their room within half an hour of a bed assignment. Some days it's taken me that long just to find someone to take report.

Yes, I KNOW you're in the middle of a dressing change when I call. I've been there too. But as soon as the dressing change is done, you should go to the phone and call the ER/PACU and get the report, not go on break, not go do 5 more dressing changes. I've seen people do that, and it steamed me to no end. People in PACU and ED would be shocked when I'd call back withing a few minutes to take report or tell them housekeeping was done cleaning the room. It's a matter of simple courtesy.

Yes, there have been nurses who will hold a patient until change of shift, but the way bed administrators are cracking down, it's getting less common. If a patient gets a bed assignment at 1830, sorry, that patient is going up.