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

purplemania, BSN, RN · Aug 18, 2004

We consider our facility a 24 hr operation, so team work is expected. Also, we require a full assessment each shift, so the oncoming nurse would have to do one anyway. Third, we discourage overtime. However, if the report I got from ER indicates the pt needs immediate attention or labs, I will take care of those things FULLY EXPECTING the oncoming nurse to come in after report so I can turn over the patient to him/her.

healingtouchRN · Aug 18, 2004

there is noooooo reason you should have not got your overtime, no different than if the kid coded. Some bosses just have no clue. I have no problem with people staying to "smooth the rough edges" & this includes a "code brown" on rounds or nearing visiting hours. Now, padding the check routinely is a no-no but that should just go without saying. I am like you in that way. I'll stick aorund if someone rolls in as I head out to my other life, eyeball it to make sure it's a stable admit before I stroll into oblivion! Hang in there, you'll be rewarded in the end, if not by your mgr but by your ability to sleep at night!

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 20, 2004

No offense to anyone, but our "floor" nurses are notorious for stalling. Finally, it got soo bad that management finally did something about it. Now, we call the floor secretary and tell her that we are sending pt information in the tube station or by fax. We send report and call to verify they got it. (sometimes we have to fax and tube it - because it tends to "get lost" in the abyss). Anyway, after we have sent it 2 times (the secretary sends and calls) - we wait 15 min and take pt up - no questions asked. If they dont have it, then they can get report at bedside. In our profession, it is so "unprofessional" to not only dump on your fellow nurse but also cause more distress/discomfort for a SICK patient who has been lying on a hard stretcher for hours/days (sometimes).

Tweety, BSN, RN · Aug 21, 2004

No offense to anyone, but our "floor" nurses are notorious for stalling. Finally, it got soo bad that management finally did something about it. Now, we call the floor secretary and tell her that we are sending pt information in the tube station or by fax. We send report and call to verify they got it. (sometimes we have to fax and tube it - because it tends to "get lost" in the abyss). Anyway, after we have sent it 2 times (the secretary sends and calls) - we wait 15 min and take pt up - no questions asked. If they dont have it, then they can get report at bedside. In our profession, it is so "unprofessional" to not only dump on your fellow nurse but also cause more distress/discomfort for a SICK patient who has been lying on a hard stretcher for hours/days (sometimes).

Same thing here. I work the floor and have seen nurses stall for their convience and we have the same system. ER faxes report and brings the patient up. Floor nurses are under no circumstances to obstruct an ER transfer.

That said, I've been back on the floor two weeks and have done about six admissions so far. It's such a small number I remember the times (we work 12-hour shifts) two came very near the end of the shfit 6am and 6:15, three came the minute I arrived to the floor straight up 7pm. Only one came during the shift at around 4AM. I'm not one to complain, and having worked house supervision I understand fully well what the ER goes through, but it surely is a pain to get them at those times. So now that ER has the power to send patients whenever they choose, they seem to be playing games with me. :rotfl: Just kidding.

RN92 · Aug 21, 2004

Theres going to be good and bad nurses everywhere. I have often thought that they should have nurses cross train between depts. ER nurses should have to have 4-6wk orientation to the floor and vise-versa. I know nurses in the er that hold admitted pts so they dont have to start over with a new one. I personally, and others, hate keeping admitted pts. There are sooo many admit orders that have to be started. I dont have time for my other er pts. As soon as the admit orders are written and there's a bed, Im getting that pt out of the er asap.

husker-nurse, LPN, LVN · Aug 21, 2004

At least we all agree that the admits, whether in ER or ICU or med-surg or wherever, get us all off to a rocky start!

husker-nurse, LPN, LVN · Aug 21, 2004

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.

Now, THAT is the longest sentence I ever read! Thanks :chuckle for the giggle!

Jamesdotter · Aug 21, 2004

I worked on an OB/GYN floor--sometimes bed control wanted to send us a patient who was neither OB or GYN because we "had a bed" Yeah, we had a bed. Meanwhile L&D, a separate unit, had 3 laboring multips plus some other stuff.

nursebonkers · Oct 24, 2004

Change of shift occurs at 7am (6-8pm), 3pm (2-4), 7pm(6-8), and 11pm (10-12),SO change of shift occurs for 8 hours a day.Classic my butt, Pts are discharged usually midmorning and then in the afternoon whenever the doc gets in. Beds take FOREVER!!!I do mean FOREVER to get cleaned or no one calls to have bed cleaned after patient left. NUrsing Super makes rounds, usually finds beds before lunch or in late afternoon. ED ususally gets bed assignments from super around 1:30 and 5:30 pm (while the pt is eating dinner IN ED) So I bring up pts after I write report or call report and the pts finishes dinner after 6pm and your going to give me grief, I say leave damn it and let the next shift admit the patient. This is 24hour nursing care people!!Admits after 10pm usually never happen because all the house beds are full by then and the patients are holding in the ED overnight anymore. Our ED is NOw the new pcu, tele and m/s unit( ALL IN ONE)

flea_flicker · Jan 13, 2005

That's why we have more than one shift: to pick up where the other leaves off!! On our unit, we sign the patient in, get vitals, settle them in with whatever they need.. but no, we do not stay over and admit patients. Now occasionally, if it's been an ok day and we have time to jump in and one or two of us do it, we will. But we have an understanding that we do not have to. It is a courtesy. Not expected.

JEMRN · Feb 16, 2005

On my unit, we have a "rule" for all patients admitted within 15 minutes of the end of a shift. Certainly it is not good customer service or comfortable for the patient to have to wait any longer in the ER for a bed than necessary. If a patient comes to the unit within 15 minutes of the end of the shift, the caregivers on the shift going off are responsible for getting the patient in bed, orienting them to the call bell, giving them the admission hand book, getting a baseline set of vital signs, and letting them know who their nurse will be for the oncoming shift. We also tell them that the nurse will be with them shortly to do an assessment on them and to complete some paperwork. If there is anything they need, they are instructed to use the call light. Any family that accompanies them, no matter what time it is, may stay with them until the nurse completes the admission data base and assessment.

flaerman · Feb 16, 2005

I have been an RN for 20 yrs, yes I've gotten my share of pt's admitted at the end of shift and I would take VS, write a note and pass them on to the next shift in report:inpatient nursing is a 24 hr cycle, what you can't get to, pass on. I have worked in the ER now since 1997 and sometimes we don't get the bed until the end of the shift and that may be why we are calling and/or bringing you a pt at the end of the shift. My ER is extremely busy and sometimes we will have 10-20 triaged pt's sitting in the waiting room needing a bed and can have anywhere from 1 to 3 or 4(or more) fire rescue ambulances holding the wall waiting for a bed that need to offload so they can back out on the street for whatever potential emergencies that crop up as well. I know the floors are busy but our busy is a whole lot different and can make an average floor nurse cringe with what we sometimes are dealing with. So whenever I get a bed I will be calling report and bringing you the pt whether it's the beginning, middle, or end of the shift.

Keep smiling, it makes people wonder what you're up to........... flaerman :)