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.
I would and have refused to take patients in this situation, if you take a patient and cannot maintain the patients safety then you are liable for anything that happens to the patient. Its my license and no one elses and i feel that as long as nurses like the one you described are willing to take unsafe assingments, the conditions we work under will continue. FYI the ceo of the last hospital i worked for made close to 1.5 million a year. Let him come and tell me to take an unsafe assingment.
I also work med-surg 3-11 and often a patient is ready to come to the floor at change of shift- we have a policy that PACU waits until we are done getting/giving report before we accept the patient.No patiet is ever brought to the floor and dropped off until the floor nurse has taken/given report or is ready to except the patient. Same is true for ER admits,they have to wait until we are done taking or giving report before we take a new patient. Unless it is truely an emergency ( trauma coming in to the ER) and then the patient is brought out to the floor sooner.
Yes I've been there. We were the first floor to go to the twelve hour shifts. We began to notice we were getting a LOT of patients between three and four PM. Hmmmm.
As the rest of the facility went to 12 hours, particularly ER and
OR/PACU, the 3Pm transfers slacked off and more 7 pms started.
HOWEVER, I have to say in that interval a huge same day surgery unit opened, 8 new ORs opened and managed care hit us hard. So coincidence probably played a bigger part. All we can do is our best. Having an LPN partner on each team helped immensely, as we could handle the onslaught together.
One thing we had that really helped was a phone number that we had to call to report a patient had left a room. That sent a page to housekeeping, dietary and billing......and we no longer got call after call asking if a room were clean yet.
Several times PACU has wanted to send a pt at shift change even thought they KNOW they are not to until one hour after shift change. The charge nurse takes the call and say "now you know we're up here trying to give report, and you know that you're not to send someone up at shift change." That works. PACU"S never been that crowded to have to get someone out because they are running out of room. PACU'S shift hours run different so they aren't trying to get people out so they can go home.
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?
I am a PACU RN and believe me, we do not "hold" patients until the end of YOUR shift. This is not some sort of conspiricy. We are a 24/7 department like you but we do not have 8 or 12 hour set shifts at 7-3,3-11 or 11-7. We come in around the clock to supply needed staffing for or's requirements. We recover the patients until discharge requirements from PACU have been met and the pt has been seen by anesthesia. We then call report because it essential to keep pacu slots open , so that OR's are not put on HOLD. We can not hold patients in PACU just because it is your shift change. We have a constant flow of 80-100 pts. plus add-ons Q day. If it could be done differently to make everyone happy that would be great, but in the mean time maybe you ought to walk in a PACU RN's shoes before placing blame. And yes-- I have worked the floors before. Been there done that! That's why I transferred! Best of Luck!
I am a PACU RN and believe me, we do not "hold" patients until the end of YOUR shift. This is not some sort of conspiricy. We are a 24/7 department like you but we do not have 8 or 12 hour set shifts at 7-3,3-11 or 11-7. We come in around the clock to supply needed staffing for or's requirements. We recover the patients until discharge requirements from PACU have been met and the pt has been seen by anesthesia. We then call report because it essential to keep pacu slots open , so that OR's are not put on HOLD. We can not hold patients in PACU just because it is your shift change. We have a constant flow of 80-100 pts. plus add-ons Q day. If it could be done differently to make everyone happy that would be great, but in the mean time maybe you ought to walk in a PACU RN's shoes before placing blame. And yes-- I have worked the floors before. Been there done that! That's why I transferred! Best of Luck!
I too have worked PACU and storey is absolutely right. Unfortunately it works out that those first four hours of 3-11 shift are when we are getting creamed because that is when the morning surgeries are finishing up. It's very frustrating and it would be nice if mgmt. could come up with something innovative in regards to staffing those hours in order to lessen frustration for the floor nurse and ensure safe care for the patient.
However, ER and ICU will hold patients until the end of the shift(not always is that the case), the units are a little worse at that than the ER but it happens.
Keep a couple things in mind, though. When admitting calls to say the patient will be coming, that doesn't mean the patient is ready to come. It means that the patient has been assigned. They may not even be out of surgery yet.
When they get out of surgery, there is tons to be done before the patient can leave PACU- they have to be warmed up, pain controlled, vitals need to be stable, PCAs received from pharmacy and started, IV fluids changed, etc etc. Then there are the Q5 min and Q15 min vitals to be done, and often labs to be drawn, results received, and meds or blood started before leaving PACU. Not to even get into the charting and taking calls from docs and family. It can be anywhere from 1-4 hours between arrival in PACU and readiness (clinically and on paper) to leave. A patient who gets out of the OR at 10AM might be good to go at 11AM, or maybe not until 2 pm if they are complicated. So you knew this pt was coming at 8AM, but for them to arrive at 2:30 pm may very well be the earliest they could get there.
We had huge problems with this just today. The floor had an open bed but thought the roommates would be inappropriate due to age. They would not accept the patient before 7pm because another patient was going home. So we had to wait until that one's senior services van arrived, housekeeping changed shifts then cleaned the room, then and ONLY then would the floor take report. Coincidentally, that happened at 8pm, when we started trying to call report on this very easy patient at 4:30.
2 nurses had to stay 2 hours late, on involuntary overtime, because the floor refused to take report before 7. We even heard the charge nurse saying "we've had enough today, they will have to wait." Totally inappropriate, the supervisor would do nothing.
I know our floors had a rough day. But so did we, and that patient who had been sitting in PACU for almost 6 hours deserved better.
It sounds like your hospital has better teamwork and maybe isn't as full as the ones some other people here work at. Maybe you could do a shadow experience in the PACU to see it from the other side, though. Not being critical, just pointing out that there's a whole side to this that you haven't seen yet.
Originally posted by geekgolightly
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.
I also work med-surg 3-11 and often a patient is ready to come to the floor at change of shift- we have a policy that PACU waits until we are done getting/giving report before we accept the patient.No patiet is ever brought to the floor and dropped off until the floor nurse has taken/given report or is ready to except the patient. Same is true for ER admits,they have to wait until we are done taking or giving report before we take a new patient. Unless it is truely an emergency ( trauma coming in to the ER) and then the patient is brought out to the floor sooner.
I didn't mean to imply that I would dump the patient on the floor. But I'm sure you've seen nurses say that PACU has to hold patients until after shift change when there was plenty of time to accept them. And please keep in mind that you're saying no until 3 or 7pm- the next shift won't accept the patient for at least an hour after that.
It's fine for PACU to wait if the patient wasn't ready until just before shift change and there is space in PACU to hold the patient for a while. We all used to work the floors- we don't even call during those hours if we haven't been waiting for a while already.
If I am told it's too busy to take a patient, I do one of three things. If I know the nurse and know she tells it like it is, I say ok, call me when you're settled. If I don't know the nurse, I'll call back in 30 minutes to see what's going on. If the nurse has fibbed about how busy the floor is before, I might wait a bit or send the sup up to see what's really going on. You'd be surprised how often the sup goes up and finds the room ready and the floor calm- no reason to refuse the admit except that shift change is in an hour or two.
If the floor won't take report but the supervisor tells me to bring the patient, up they go, report at the bedside or the nurses station. That's not dumping, that's appropriate patient care in spite of an inappropriate refusal to take report.
I think everyone should have the chance to observe a different unit of care in their hospital-then you would understand what the "other" nurses do!
I work in surgery, but have worked on the floor also.
The first thing floor nurses need to realize is that patients are charged for time in the operating room and PACU on a 15 or 30 minute increment Most patients are kept in the PACU for an hour-
that has changed relatively little since I started nursing!
Nurses in PACU work the same hours, if not longer than floor nurses. They also cover call on a regular basis. I don't think any of them try to push their patients through to get home early.Patient in times and out times are logged daily and checked daily by management. Patients must also meet certain criteria to be discharged from PACU. Any discrepancies must be accounted for to management. This is much the same as when floor nurses run overtime because they are not done with their charting.
Also remember, suurgeons often dictate what cases and how many cases are scheduled at what time. Nurses have no control over length of actual surgery time-and often we do not know a patient is going to be admitted until we see how the surgery progresses, what we find, what has to be done, and how that patient responds to anesthesia and surgery itself. It really is about the patient and what is best for them--not the nurse-in PACU or on the floor.
I am a PACU RN and believe me, we do not "hold" patients until the end of YOUR shift. This is not some sort of conspiricy. We are a 24/7 department like you but we do not have 8 or 12 hour set shifts at 7-3,3-11 or 11-7. We come in around the clock to supply needed staffing for or's requirements. We recover the patients until discharge requirements from PACU have been met and the pt has been seen by anesthesia. We then call report because it essential to keep pacu slots open , so that OR's are not put on HOLD. We can not hold patients in PACU just because it is your shift change. We have a constant flow of 80-100 pts. plus add-ons Q day. If it could be done differently to make everyone happy that would be great, but in the mean time maybe you ought to walk in a PACU RN's shoes before placing blame. And yes-- I have worked the floors before. Been there done that! That's why I transferred! Best of Luck!
Mol
7 Posts
I would and have refused to take patients in this situation, if you take a patient and cannot maintain the patients safety then you are liable for anything that happens to the patient. Its my license and no one elses and i feel that as long as nurses like the one you described are willing to take unsafe assingments, the conditions we work under will continue. FYI the ceo of the last hospital i worked for made close to 1.5 million a year. Let him come and tell me to take an unsafe assingment.