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!
Another reason our admissions take so long is that about half of them bypass the ER, and come directly to the floor or unit from either home or the doctor's office. Therefore, nothing has been done for them at all. When we do get them from the ER, there are usually stat orders for something (IV Lasix, solu-medrol, etc.) that has not been given by the ER personnel. They rarely even give the chest pain patients an aspirin, so we have to stop what we are doing and start working on their orders. Our ER docs do not put in their own orders, so we have the age-old problem of trying to figure out their handwriting, figure out what has already been done, etc. Admissions are dreaded simply because they take so long, and it gets you behind on everything else.
Personally I will put calls out to the hospitalist if for example, a patient has been in pain and is running out of pain meds with no new orders. I also try to be patient with being told "Can you call back and give report in 10 minutes?" Apparently my hospital asks their ER staff to complete more admit tasks than any other ER in the area. The complaints I've read in this thread, like sending up a chest pain without giving ASA, would not fly where I work. We really try our best to give our nurses a good admit!
I have worked both the floor and the ED. When I was on the floor, I decided that it was much more simple to just take the admits when they called, even at the change of the shift. I had to assess all my patients anyway, I might as well have the new admission right there while I'm doing it. I have plenty of time to do the paperwork. When I was in charge, I always encouraged the ED to bring the patients right up.
Now that I am working in the ED, it is extremely frustrating to me when the floors keep making me wait to get patients upstairs. I think alot of the nurses on the floors have no clue how the ER works. When the patient comes in, the ER doc sees that patient and we do a full work up prior to the decision to admit the patient. If after all the results are back, the ER doc contacts the hospitalist to come admit the patient. At this point, admitting is contacted and they start putting in for a bed assignment. Sometimes the patient has to wait a couple of hours before the hospitalist gets there to write the admission orders. Once the admission orders go through and a bed assignment is made, we will call the floor to bring the patient upstairs. We have no control over what time this happens, and yes, many times it happens at the change of shift. We will do all the stat admission orders, but not routine meds. I am truly sorry that you folks may be working short, but so are we. We have limited amount of room, but we are not allowed to refuse patients because of unsafe staffing. We literally don't know what is coming through the door next.
I certainly understand being swamped on the floor, and I will cut you a break if you say you just need a 15 minutes to get ready. When you give me the hour run around, I will get upset. Just remember, we are just as swamped as you are.
No one really loves an admit when you already have a slew of complicated patients, although we all have to accept that they are a part of life. A huge benefit to my floor in the past year or so was the addition of an Admission/Discharge nurse! A nurse who is on the unit solely to admit and discharge patients. It takes that mess of paperwork/orientation/etc out of the equation and allows the bedside nurse to simply provide patient care.
OP, I'll gladly work with you!!!!!!!!!!!!!!! You're more than generous, not sure why there's any moaning at all. Not sure how said nurse would do without you.
I just don't think it is safe to bring a patient up at change of shift. I know it can't be helped but it is still not safe. When the M-F assistant charge nurse is on she always gives me first admission. In her mind she thinks she is helping me by having all shift to do the admission. The poor patient is being rolled on to the floor at 3 pm and we are all in the middle of report. Even the aides are in report. It can take up to an hour to get report if you have to get report from multiple nurses and your other patients also needing attention at this time also. Then not to mention that some nurses leave you in a disaster area from the previous shift. Some times there are discharges that need to be done at change of shift also and these patients get upset if their paperwork is not done in a timely manner. I know nothing will ever be done about bringing patients up at change of shift but is just not safe for the new admit or your other patients. The ideal situation would be to have an admissions nurse/discharge nurse but my hospital will not do this. Just my 2 cents and my vent. And I wonder why is there such a high burnout of medical surgical nurses....
they are making us take more pts so they are looking in to having mobile nurses do our admissions. they already do that a lot anyway. we shall see............while its helpful i don't want others doing my discharges. i know the pt. I know whats gone on with their care. it only makes sense that i do the d/c and make sure everything is in order.
Admissions. The bane of the charge nurses existence. Everyone loves their charge nurse until there's an admit on the way. I frequently hear the "I don't want an admit" line as well. My response is always "and I don't want to work for a living, but I haven't picked those 6 lucky numbers yet, so here we are." It drives me crazy. Whining, griping, and then of course when that doesn't work the conspiracy theories come out. You always give me the admit because you don't like me or you're jealous of me or whatever other crazy excuse they can think of.
I hate being the charge nurse. It was thankless on the med-surg floor I came from and it is even worse now in the ICU. Now we have to re-arrange assignments and stat transfer people out in order to make room for crumping ER patients. Not only do I have to listen to my coworkers complain about the admit, but I have to listen to the floor nurse I am trying to give report to give me 5,000 excuses why they should not have to take that patient while the ER is blowing up my phone wondering when they can bring the patient. Then both the ER RN and floor RN use our internal risk management form to report me. The floor nurse for putting them over ratio or because it was shift change or med pass time and the ER RN for holding up the admission. Joy. So not worth that extra dollar an hour!
You sound like a dream charge nurse!! Our night charge nurse has a full patient load so we do most of the admission tasks ourselves, caught up or not. But we are tight knit so we help each other when we can.
And how about the fact that the management eliminated the day charge nurse?? No one wants to work days, they are on their own with one tech per 14 patients!
Having worked in both inpatient Med/Surg. and now in the ED I can understand both sides to this argument.
When I was on the floor I found it easier to try to take admissions as soon as they called for report so that I could just get it over with and move on to see my other patients. I didn't like having an admission but you understand that its part of the job and you need to just suck it up and get over it. If I was in an isolation room or doing a dressing change or something that really took a lot of time at the time the ED called I would tell them that I would call them back or they could give report to the Charge RN (most nurses on my unit didn't agree with this practice) but most of the time I took call right away (and because I very rarely delayed them they knew I was really busy when I did.) I know that there were some of the ED nurses who threw a fit if you didn't take report immediately but most were pretty understanding. I also know that a few of my fellow floor nurses who could have taken report always choose to delay by saying that they are "in a room passing meds." or "not available at the moment" for whatever reason and I find that it only caused more delays for the patient and is really counter productive. But I should note that for the most part in each category (pushy ED nurses and lazy floor nurses) there are only a few problem individuals at my hospital and you always know who they are.
Now that I'm in in ED I understand the pressure to move admitted patients up faster and I understand how it can be frustrating to call and try to give report only to have someone tell you that the same nurse is always "doing a dressing change", "in the middle of pushing morphine" or "in an isolation room" when you try to call and give report. Or even worse, when you tell whoever answered the phone to have the nurse call you back as soon as they can for report and over 30 mins. later they still don't call you back and when you talk to the nurse they say "Oh sorry, no one told me that you called."
This is always going to be an issue but I think that better collaboration between the ED and inpatient units can help to improve this process and provide a better experience for our patients.
they can change the course of your whole day and keep the unit running smoothly!
applewhitern, BSN, RN
1,871 Posts
Another reason our admissions take so long is that about half of them bypass the ER, and come directly to the floor or unit from either home or the doctor's office. Therefore, nothing has been done for them at all. When we do get them from the ER, there are usually stat orders for something (IV Lasix, solu-medrol, etc.) that has not been given by the ER personnel. They rarely even give the chest pain patients an aspirin, so we have to stop what we are doing and start working on their orders. Our ER docs do not put in their own orders, so we have the age-old problem of trying to figure out their handwriting, figure out what has already been done, etc. Admissions are dreaded simply because they take so long, and it gets you behind on everything else.