Question for those working on med-surg with post op patients

geekgolightly, BSN, RN · Aug 31, 2003

I've worked the Neuro floor for about a year as a student nurse and have noticed that it is very common for the PACU, ER and NeuroICU to send us patients at the end of shift. They order the bed at the beginning of the day and hold onto the patient until half hour before change of shift, which is how they avoid having to take on another patient themselves. Really frustrating.

When I become an RN, I am going to suggest that a policy be implementedregulating how many hours a unit has from ordering the bed to sending the patient so as to avoid this in the future. Does anyone else with more experience have suggestions as to how to thwart this selfish behavior?

SharonH, RN · Aug 31, 2003

Originally posted by peaceful2100
For those who work on med-surg floors with post op patients is it very common for you to receive fresh post op patients at change of shift time.

The reason why I asked is because the nurse I was working with the other night received 2 back to back post-ops less than 40 minutes apart and that was on top of the 7 patients she was ALREADY assigned to. The made her really, really upset. She does not normally work on that floor. Although she does work on another med-surg floor.

How do you handle the stress of getting back to back post-op patients on top of the patients you are already assigned too especially around change of shift?

That is the main reason why that floor can't attract/keep nurses is because of that and the nurse/patient ratio.

Once I re-take boards in October I am suppose to be working as a RN there but I am not sure I want to any more given the things that occur and the high ratio.

That poor nurse did not finish giving all her 2100 meds for all her patients until after 0100.

Yes that is common for 3-11 shift. Those first 3 hours are usually the worst. I don't handle any advice for you, I handled it by going to days and then quitting. Good luck.

Paige Turner RN · Aug 31, 2003

It is getting more common every day where I work. We are also receiving direct admit patients often at shift change. Our nurse team leaders are very good about assigning them and often will take them themselves if everyone has a heavy load ..........I see us getting stretched thinner and thinner with no relief to come in the near future.

mdfog10 · Aug 31, 2003

Hi,

I work on a gen surg unit and this happens to us also. I think it is partially due to different shift hours in the PACU, but I also feel that sometimes if they get rid of their pt then they can go home. At my hospital we have a big problem of not having enough critical care beds, so there also seems to be a big push to get pts out of recovery and ICU, so they dump on us. Recently ,in charge, I told recovery that we were swamped and the last two post ops had to wait till night shift (we work 12hrs). sometimes it works and sometimes it doesn't. If it isn't a symptom of a bigger house wide problem , then I would try to get it changed.

:eek: :eek:

RN-PA, RN · Aug 31, 2003

Originally posted by SharonMH31
Yes that is common for 3-11 shift. Those first 3 hours are usually the worst. I don't handle any advice for you, I handled it by going to days and then quitting. Good luck.

I work Med/Surg 3-11 also and will say the first FOUR hours are usually the worst. I've often been getting ready to listen to report from 7-3 shift at 2:45 when the unit clerk or the 7-3 nurse will hand me the phone and ask me to take report from PACU, saying, "You might as well get report since it'll be your patient." There are times I've refused to take it, depending on how crazy the unit seems or how angry I might feel if it's recently happened a lot. I will then either ask the day shift nurse to take report or will tell the nurse calling report to call me back in a half hour. If they have a problem with that, I call and ask the nursing supervisor to hold them off for a while, if possible. If they're really backed up and busy, I'll take report, but it's tough to start off the shift that way. We also get transfers from ICU or PCU at change of shift as well as ED or direct admits. I recently got a transfer patient from ICU and on the report sheet they sent there's a place for vital signs to be written just prior to transfer. The time written next to the VS was "12:00" and I received the patient around 3:05. I should've said something to somebody at the time, but I was just too dang busy to follow-through on it.

I think change of shift admissions are unfair (to nurse AND patient) and potentially unsafe if it's a fresh post-op or unstable ED admission, especially when you've already got 5 to 6 patients you haven't received report on and have never laid eyes on. I mentioned in another thread about retention issues that I've been asked to represent our unit on a newly formed hospital-wide retention committee, and this is an area (among others) which I plan to complain loud and long about.

Long Term Care Columnist / Guide · Aug 31, 2003

I too work 3-11 on a med/surg floor, and this is an almost daily occurrence for me. However, I'm lucky enough to work with some awesome nurses who make sure the afternoon assessments are done before I come on, thereby freeing me to take the admission or the new post-op. I'll stick my head in my patients' rooms, check their ABCs and IVs, introduce myself and ask if there are any immediate needs, then go deal with the new patient. It works well most of the time; the only times it doesn't are when day shift has been crazy and they haven't had time to pee, let alone do second assessments, or the nurse is one of those few truly lazy ones who do as little as they can get by with and leave everything they possibly can for the next shift to pick up.

bellehill, RN · Aug 31, 2003

I work 12 hours on a neuro/med-surg floor and we always get pts at shift change. If we do not take phone report the PACU will just send the patient up. I don't understand how this happens and get so frustrated at PACU. They know what time our shift change is, can't they wait 20 minutes? A lot of times we come on shift and have 3-4 post-ops coming within 90 minutes, it is ridiculous. Our charge nurses are also famous for accepting ER admits for placement after 1930, makes me so mad. I don't handle it well, just suck it up and keep going.

QUEENIERN · Aug 31, 2003

One of the ways to help facilitate the new admission process, I feel is to walk in "their" shoes, so to speak. Because I used to work on a med-surge floor I know full well what it is like at shift change, or at any other time you are getting slammed with admits and or discharges. There are a few things I try to do to help with this process. Granted not everyone does this or would even attempt. (of course they have not walked in your med-surge shoes either!) (I work in surgery now). Anyway...Most all of our surgery pts. come from ER, Day Surgery, or are already a in-patient. If they are to be admitted to the med-surge unit (or anywhere else) we call for a room as soon as possible. The pt. may not even be on the table yet but we call for the room early and this seems to help our nurses, because @ that time we don't give a full report but the unit at least knows if the patient is male or female and if they have any special needs they can set up for as soon as they are able. (like over-bed trapeze). So at this point the nurse knows ahead of time they will be getting a new admit and hopefully an aproximate time. After the procedure & while the pt is in recovery, the PACU nurse (sometimes myself) looks over the orders and at that time calls 1st report giving a few details about the patient & type of procedure etc. plus any special orders (like oxygen setup) and an aproximate time of discharge from PACU to Med-surge. At that time if there is going to be some type of problem this is their time to say so. We have at times taken a pt. to their room, but stayed with them continuing recovery until "a" nurse. (house sup, whoever) can fully accept the pt. This does not happen often but if things are going crazy (code, etc.) We (surgical team) do what we can to help. Also if the pt. was admitted thru day surgery we have already filled out the assessment and admit papers. This saves a lot of time for the nurse. This also gives our department surgery/PACU the ability to know our pt. better and therfore give a more complete report to the admitting nurse. It' helps for all departments to know the policys and flow of other departments to give a better understanding and enable each department to know they are not a lone department. We ALL rely on each other to give quality care. Our med-surge nurses always take report, because @ 1 point they WILL have the pt, and if they or someone else (charge nurse, mgr, house super) can not accept the pt. @ time of transfer we do what we can to help. Take 1st set of vitals etc. until someone is available. Just knowing we are "having" to stay with the pt. makes them make great effort to get there as soon as possible & not take advantage. So it is not just a unit working as a team but the facility as a whole working as a TEAM.

ratchit · Sep 1, 2003

I don't want to start a war, here- I've done floor nursing and it's a rough job. But I work in PACU and see the exact opposite happening. We don't keep patients until shift change- we can't get the floors or units to take them. I have never kept a patient until after shift change for my own benefit- it's because the floor won't take them. We keep a log in my PACU of what time the patient could have left, what time they did leave, and why there was a delay. "Would not accept report" is the most frequent item listed.

I know it's not always the nurse's fault. Patients no longer leave the hospital by 11AM on discharge day. Their orders are written late, their rides come later, no one has had time for discharge instructions, whatever- the patient is still sitting in a bed. After they leave, someone has to remember to call houskeeping and make sure they show up. Often by this point, 3pm is coming close and day nurses are tired. So they tell PACU they won't take report- "hold the patient." Which means evenings or nights walks into admits. Which stinks, but PACU didn't cause it.

This is worse when the ICU is moving a patient to the floor and we're taking the ICU bed. Two sets of reports and chasing housekeeping to clean the bed. All while the patient is sitting in PACU.

Now PACU is all backed up and patients/families are upset at the delay. Sometimes surgeries start late because PACU can't take the patients until some leave for the floors. Not good for patients who are NPO or PACU nurses who need to go home or off shift nurses who now get the admits.

It's worse at 7pm- those folks who have been there for 12 hours are exhausted. So they say wait until nights. The only problem is that I've been at work for 12 hours too and i want to go home. But I can't because there are still patients in PACU.

I'm supposed to go home at 6pm. I usually leave around 9. And then I am on call. Believe me, the delay doesn't start in PACU. Talk to your day shifters and your housekeepers about why patients come out on eves or nights.

geekgolightly, BSN, RN · Sep 1, 2003

ratchit, if only i could receive my patient when they call for report or within the hour of report; that would be delightful. instead, i am informed of a patient coming early in the morning (i work 7a to 7p. and btw, i am still a graduate nurse and have dealt with this as a student nurse even as the nurses whom i work under like to give me the admits.) and the patient does not arrive until one half hour before shift change. this happens repeatedly. we promise a bed to someone and then must keep that bed open until the patient arrives, which can be ten hours away. when shift changes. this is decidedly unfair.

if you can think of a way around this delima, i would greatly appreciate it.

live4today, RN · Sep 1, 2003

This situation in nursing is nothing new to me. I've seen this occur everywhere I have ever worked EXCEPT in military hospitals. I have always wondered why ER, ICU, and PACU send patients at the change of shift. Seems to me like this is just another means of "nursing eating nurses".

Change has got to start with the way nurses treat each other on the job from one department to the other. If change does NOT begin here, don't expect it to begin anywhere else. We can be our own worst enemy. THAT much is true!