"I don't want an admit..."

[MessyMomma]

As a charge nurse on a med/surg unit during the 7p shift, I am guaranteed to hear this at least one time each shift.

Yes, it's a busy shift; yes, I know you have another 4-5 patients; yes, I know Mr. Johnson needs his dressing changed and Mrs. Conner needs her PRN Norco...but it's your turn. You're up, everyone else has had an admit.

It's a simple fact on our floor--patient come to hospital; s/he is ill or has a surgical procedure planned; s/he is needing to be admitted; each admission needs a nurse. What is so hard to understand.

I help "my" staff lots with admits. I open and set up the room (if our aides are busy). I get all the stuff ready so you don't have to hunt for it--IV pole there; O2, Flowmeter, Christmas tree ready; tele monitor and leads there; admission kit on table; wound care supplies there if needed; NG tube or oral suction ready and waiting. And I'm gonna be in the room, so if there's something missing, I'll run and get it.

I help get the patient settled in and grab the orders.

I put the chart together, enter the orders, write out the MAR's, fill out the home med sheet and immunization sheet--if I can. The only thing I HAVE to do is put the chart together and enter the orders. The rest I do to help So basically the RN/LVN gets the patient in bed, assesses him, connects any tubes/lines, then take the completed paperwork. If there's any problems, I'll call the doc. I won't leave anybody hanging.

So that admit really wasn't that bad--half your stuff (paperwork) is done, your room was set up appropriately, all your orders are in.

I can't make it easier than that--do the computer assessment and care plan and you're done. (I do the computer stuff too, about 50% of the time).

Why is it such a big deal to get an admit? Why do you have to **** and moan about it? Why are you arguing that "it's not fair" or "it's not my turn"?

Put your big girl panties on, hush your mouth, and take the patient!

Thank you for letting me VENT!!!

[Savvy20RN, BSN, RN]

If I had a charge nurse like you I wouldn't b**ch and moan, but the nurses we have give an admission right at shift change when they see that the floor nurses are running around like crazy, don't help put anything together, don't even gather admission paper work and some times disappear when the patient needs to transfer from the stretcher to the unit bed. THIS is why we complain. If I tell you I'm swamped right at this moment and to tell the ED, PACU, etc to hold the patient for at least 5 more minutes to give me time to prepare everything and you tell them that I'm ready and to bring the patient anyway I am going to b**ch and moan.

What also bothers me is when the charge nurse takes report (without asking you if it's okay to take it), tells the other department to bring the admission and right when they are rolling on the floor gives me the report sheet and tells me that I'm getting an admission. That would have been helpful ten minutes ago...

I don't mind getting an admission. Just give me time to prepare for their arrival so that they don't sit in their room for five minutes without seeing their nurse because I'm stuck in a room with another patient. That helps amazingly with patient satisfaction scores.

[SaoirseRN]

I will personally take an admission ASAP. If I can't, and I tell ER I need half an hour, because it's me they know I honestly need that.

I am part of a float/relief pool and sometimes I have an assignment and sometimes I don't. On shifts when I don't have an assignment, I will take admits for whichever nurse has that bed and do everything except for the full, detailed admission assessment that I think the most responsible nurse should do (unless it is the middle of the night, then I do that too so the patient can sleep).

I do vitals, all the paperwork, get them whatever meds might be due, and handle all the inevitable minor tasks (finding IV pumps, getting water, fresh ice packs, another blanket, etc) that take up a lot of time, document the arrival/admission, and then report off to the patient's nurse.

It is always appreciated and gets the admissions in faster. Our charge nurses have patient loads, and our on-floor clinical coordinators don't usually get this involved in helping out, so I think it's great that you do, and they ought to stop complaining! It could be a lot worse!

[sistasoul]

Someday someone's going to make a name for themselves by coming up with a more seamless way to transfer a patient from the ER to the floor.

And i agree with the others, your nurses should be grateful for all the help you give. Back when I worked in the hospital (as an aide) the charge nurse took a full load of five pts and the other nurses were on their own.

Same on my floor. Charge nurse has their own assignment also. No help because everyone else is usually swamped. I usually have to hunt for an IV pump. Last night one of our float nurses had to go to another floor to get a pump as the house supervisor was tied up. Wonder why there is nurse burnout?

[sistasoul]

I will personally take an admission ASAP. If I can't, and I tell ER I need half an hour, because it's me they know I honestly need that.

I am part of a float/relief pool and sometimes I have an assignment and sometimes I don't. On shifts when I don't have an assignment, I will take admits for whichever nurse has that bed and do everything except for the full, detailed admission assessment that I think the most responsible nurse should do (unless it is the middle of the night, then I do that too so the patient can sleep).

I do vitals, all the paperwork, get them whatever meds might be due, and handle all the inevitable minor tasks (finding IV pumps, getting water, fresh ice packs, another blanket, etc) that take up a lot of time, document the arrival/admission, and then report off to the patient's nurse.

It is always appreciated and gets the admissions in faster. Our charge nurses have patient loads, and our on-floor clinical coordinators don't usually get this involved in helping out, so I think it's great that you do, and they ought to stop complaining! It could be a lot worse!

That would be wonderful. We rarely get helping hands on our floor.

[RoseRyan]

You sound like an amazing CN. I WISH I had that kind of help. Our CN literally stays glued to the desk the whole time. If you ask her for help, she will flat out tell you "no I need to stay at the desk". If you get an admit, forget it. She will sit right there at the desk. There have been times when I have been literally drowning and she doesn't even get up to offer one iota of help.I work in ICU so I never enjoy getting an admission. Usually they are crashing, a rapid response, post code, tons of orders, ect..but when my coworkers help me its such a blessing. Even just getting them in bed and hooked up to the monitor is a big help. Because we have a lousy CN we all try to help each other as much as possible. There have been times when so many people have been in the room helping me with setting up my admit that all I had to do was assess and chart. Please keep up the good work! I know your coworkers will be grateful, even if they do whine and moan

[NurseOnAMotorcycle, ASN, RN]

Nothing is worse than coding a pt in the waiting room full of angry patients waiting 4+ hours, 4 ambulances at the door waiting for a place to treat their pt, and stabilized pts taking up those beds because someone upstairs is dragging their feet and arguing about taking their assignment.

When I worked on Med-Surg, I hated taking pts and had a whole orificenal of reasons why we shouldn't be the one to get it. Now that I work downstairs, I get frustrated at the endless games that the floors play. We get told all the time "the ICU has beds but won't take any pts until next shift so we have to take care of them until they can take them." or "You can take the pt upstairs at 1930" which we KNOW is exactly when the next shift hates getting pts the most! So we are desperate to make space and have to look forward to coworkers, pts and EMTs yelling at us for waiting because of these reindeer games.

Frustrating!! I wish all units had a charge as great as you!

[applewhitern, BSN, RN]

Well, we have to do a valuables sheet, MRSA/Tobacco use/Nutrition/CHF screening and handle those, too. A skin assessment sheet, an intensive 3-page interview, then the care plan and thorough physical assessment. We have to obtain the actual bottles of any meds they take and enter those in the computer; our pharmacy and doctors feel that is the nurse's job~ not their's. Plus we have to deal with the numerous family members who are allowed at bedside, answer a ton of questions (even though we just got the patient, who has been in the ER for hours already). Thus, our admissions take a long time, and we still get fussed at if we clock out late. We have to do a full admission on anyone who comes 15 minutes before our shift ends. Our charge nurses take a full load of patients, too, and the medical-surgical floor has to take up to 8 patients each.

[RoseRyan]

I agree with what someone else said about the anxiety of the unknown being the worst part. Sometimes you just don't know what is going to come rolling off the elevator

[Savvy20RN, BSN, RN]

Nothing is worse than coding a pt in the waiting room full of angry patients waiting 4+ hours, 4 ambulances at the door waiting for a place to treat their pt, and stabilized pts taking up those beds because someone upstairs is dragging their feet and arguing about taking their assignment.

When I worked on Med-Surg, I hated taking pts and had a whole orificenal of reasons why we shouldn't be the one to get it. Now that I work downstairs, I get frustrated at the endless games that the floors play. We get told all the time "the ICU has beds but won't take any pts until next shift so we have to take care of them until they can take them." or "You can take the pt upstairs at 1930" which we KNOW is exactly when the next shift hates getting pts the most! So we are desperate to make space and have to look forward to coworkers, pts and EMTs yelling at us for waiting because of these reindeer games.

Frustrating!! I wish all units had a charge as great as you!

I know it must be frustrating for those working in the ED. It's not your fault being the nurse. Trust me. I understand. You have to move patients. That's your job. I just wish they wouldn't come right at shift change. 8 oclock. Okay, send them up. I didn't just finish with report, I've seen all of my patients and have probably assessed at least one of them. 7: 15... I'm still getting report and now you tell me that I have an admission on the way and I haven't even seen my other patients yet. How is that safe? Admissions take a long time to get settled in. Now I have to get them settled in and my other 5 patients haven't even seen me at all. Sticking my head in the door to say 'hi, my name is' isn't enough.

We're not dragging our feet. I know it may seem like it. We'd rather get them up to the floor as soon as you're ready to send them, it would just help if who's ever calling for a bed (usually whomever is in charge of assigning beds) would actually give me five minutes to move a physical bed into the room before sending the patient up. We've had patients sent to a room that's still dirty...I've had to hunt for a bed while my admission is waiting in the hall way... Having family members watching me while I search for a bed isn't professional at all. When I say I need at least ten minutes I actually need ten minutes. I'm not saying it because I'm lazy and making excuses.

[RNsRWe, ASN, RN]

Ah, I remember the days when I had to deal with all that....frustrating didn't begin to cover it. I sometimes had a nurse who would insist on always taking "the extra patient" when the assignment was divided, so she didn't have to take an admission. Of course, sometimes someone ELSE wanted that option, and she'd throw a fit. Not like it was her due or anything, but there you have it. Came back to bite her in the butt when we got slammed with enough admissions that everyone had an admission AND she would have to take one herself. Whined like there was no tomorrow that now SHE would have 9 patients and everyone else had "only" eight. Tough, toots, you asked for it!

I used to do charge, and I tried to help everyone as much as possible. But the thing I found was that for those who never did charge we could never do enough for them. We were supposed to be able to rotate charge shifts among several of us but that never worked out--someone always refused their turn. Thing was, I found that those who wouldn't (or couldn't) do charge usually wanted the charge nurse to take a full run AND do everything for them. Sorry, not happening. I would have loved to have had no patients and do what you described, but usually the complaint was that the charge with no patients "doesn't do anything all night". Sure.

Anyway, kudos for you for putting up with all the ridiculousness of it all.....and nightshift to boot!!

[nightbreak]

Top 5 reasons our med-surg floor has to delay an admit:

1) no clean rooms

2) have to move an already admitted patient to make an appropriate assignment for the new patient (usually r/t gender or diagnosis)

3) we are maxed out on the nurse ratio and need to wait while we call someone in

4) after reading the admit report, we realize the patient was accidentally admitted to the wrong unit

5) we don't have any MD orders for the new patient: no orders = no care. the patient is safer in the ED with an MD immediately available

We love you ED! Not playing games, just doing the best we can do with ever shrinking resources...

[Caffeine_IV]

I have had some crazy nights with multiple admits coming to the floor at nearly the same time.

It isn't that we don't want an admit but more like we don't know how we are going to handle it on top of whatever is going on. When you have an admit at shift change, that is like starting out your shift behind.

I don't blame ER. I blame the way the floors are staffed. They should anticipate admits and staff accordingly meaning nurses may have a smaller load in the beginning.