Safe to take new admit at shift change

APRN., DNP, RN, APRN, NP · Dec 4, 2015

I'm a new nurse. I do not exaggerate when I say every single shift I get a new admission within the first hour of my shift. I barely know my patients I've just taken, rarely do I get a chance to put eyes on them before my admission is here. I work in a hospital wher le ER does not call report. We have to look them up. Impossible to get report on your assignment and look up a new admit at the same time. I don't even feel this is safe.

I feel your pain. It is hard to hit the ground running when you've barely come up to speed with your time management skills (that will come in time - I promise!).

Do you have a mentor on the unit that you could seek out for pointers that are specific to your particular work area? Someone who you could role model for safe short-cuts while you are learning the tricks of the trade?

russianbear · Dec 4, 2015

No, and one thing I've noticed is they like to give the most difficult, time consuming patients to us new grads. They don't take the nurse's experience or ability into consideration when they make assignments.

vintagemother, BSN, CNA, LVN, RN · Dec 4, 2015

No. Unsafe. At my facility, the DON set things up so that we couldn't accept a new pt within a hour of shift change. That's not safe for pt care.

Sometimes, this meant forcefully not accepting a pt who had arrived. Transport had to stay with the pt. transport didn't like it. But this policy was beneficial.

loriangel14, RN · Dec 4, 2015

It's not unusual for this to happen to me but its not really an issue. I just get them settled and do vitals and do the admission when I have time. What would taking one an hour into the shift be any different than taking it part way through the shift?

NOADLS · Dec 4, 2015

I think the consensus is that it isn't safe. But that doesn't mean that your workplace will take measures to ensure that you aren't put in that situation. You could take action to mitigate the risks of the situation though. Inform whoever is in charge of your shift of the situation and request a remedy. Even if the situation isn't corrected, you've still taken the steps necessary to mitigate any risk to your patients.

From there, you can look for a long-term solution by speaking with management, or you can choose to continue to accept the remedy offered by the nurse in charge.

MunoRN, RN · Dec 4, 2015

I think you could argue that the ratios many facilities are not safe, but I don't think it's significantly less safe to take an admit at the beginning of your shift so long as it's not exceeding your ratio. By leaving the patient in the ED all that usually means is that they are sitting in the ED without getting your attention, it really doesn't make a difference if they're being ignored by you in their inpatient bed or in the ED.

And the longer you wait the more catch-up you'll have to play, which can often take more time in total than if you didn't put yourself behind.

RescueNinjaKy · Dec 4, 2015

As long as your other patients are stable then I feel that you can can take an admit at shift change. Is it ideal? Nope, nor does it feel good, but when they gotta come they gotta come, as long as it's within your safe ratio and the admit is stable. Now if there's something going on with my other patients when my admit comes I'll ask for the charge to settle my admit or at least to arrange for someone to settle my admit. We do have resource nurses that we can page but they don't come up right away.

mago8388 · Dec 4, 2015

I rather take an admit at the beginning of shift to be honrst. It's worst when you're going home in an hour after a 12hr shift and they give you an admit right when you were getting everything settled to go home and you're stuck extra half an hour after your shift because you don't want the nurse coming to relieve you to ***** about you.

SC_RNDude · Dec 4, 2015

It's safer then the patient hanging out in the ED. And, if the ED is full, there might be a sick patient in the waiting room who needs to be seen and can't until your patient is moved to the floor.

Horseshoe, BSN, RN · Dec 4, 2015

The main problem I have with your scenario is that the ED nurse isn't required to give report. One of the things we are always told about abandonment is that you cannot leave your patient until you have reported off to a nurse who has accepted the assignment.

I wonder how that practice would hold up in a lawsuit.

applesxoranges, BSN, RN · Dec 4, 2015

No. Unsafe. At my facility, the DON set things up so that we couldn't accept a new pt within a hour of shift change. That's not safe for pt care.
Sometimes, this meant forcefully not accepting a pt who had arrived. Transport had to stay with the pt. transport didn't like it. But this policy was beneficial.

It must be nice to work in a hospital with an ER where it is slow enough to have that rule. We usually have multiple admits and we give them 45 minutes to cover shift change. We have patients in the waiting room that need to be seen. We still get patients during shift change in the ER. If more hospitals instituted this policy, then that would be unsafe for the ER.