Safe to take new admit at shift change

That Guy, BSN, RN, EMT-B · Dec 5, 2015

Im not going to send a crumping bad pt at shift change. Your avg pt that has stable vs, no immediate needs, you bet they can go up.

VANurse2010 · Dec 5, 2015

Of course the patients in the ER aren't the only ones in the hospital, but the ones in the lobby are the only ones who don't have a bed, a monitor, and an assigned caregiver (unless you count the triage nurse, who in many a busy ER at 1900 is theoretically responsible for "reassessing" dozens of triaged patients who at that point may have been waiting for hours), and moving them past triage to begin an actual workup is a much larger net gain to patient safety than ensuring that patients who are already monitored, assessed, medicated, and assigned to a caregiver don't have to share their nurses's attention with an admit at an inconvenient time.

I think the point is that the patients are not assessed when admissions roll up at shift change.

VANurse2010 · Dec 5, 2015

Im not going to send a crumping bad pt at shift change. Your avg pt that has stable vs, no immediate needs, you bet they can go up.

Not all of your ED colleagues have common sense or intelligence.

Wrench Party · Dec 5, 2015

My facility is changing their policy so that we have to stop everything we're doing, accept the patient, and take report from the ED nurse. This would be great if the ED wasn't notorious for keeping patients all day, and sending at 1830, 1845 when they should be sent up by 1700.

The former policy was: report had to be confirmed by the floor nurse and discussed, then the patient could come up. Gave us time to get everything ready and prep the oncoming nurse if near shift change. If too near shift change, the admit was delayed to PM.

Nonyvole, BSN, RN · Dec 5, 2015

And no, the ED patients aren't the only sick ones in the hospital. However, they're being cared for by emergency nurses. Can I take a critically ill patient and manage them for a shift? Yes. Is it ideal? No, because odds are I have at least three other patients. Is it safe? No. Again, look at the number of other patients I have, and my current knowledge base. I don't have the finely-tuned assessment skills that the floor nurses have for that particular diagnosis and patient needs, because my assessments are focused on finding out what is immediately wrong with said pt and correcting it.

Same from the physician side. They are EM physicians, not whatever specialty the patient needs.

Sorry if this sounds harsh. I've had to manage ratios that would not be accepted in any ICU, and all I could do was suck it up and go to my unit manager after the fact, because of a wide range of reasons. It's never fun.

emmy27 · Dec 5, 2015

Not all of your ED colleagues have common sense or intelligence.

So your argument is that your ED's nurses lack common sense and intelligence, and therefore it's best to leave admitted patients with them as long as possible, regardless of how this overloads the capacity of the ED or delays initiation of care for other patients.

Got it.

Anna Flaxis, BSN, RN · Dec 5, 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 don't understand. What is unsafe about this? Getting report on your assignment shouldn't take more than a few minutes per patient, and it only takes a few minutes to look up your new admit. The room should be readied for the new admit in advance, and the CNA should be present to tuck the patient in when they arrive- orient them to the room, gather VS, address any immediate toileting or ADLs.

Although I am an ER nurse now, my first few years as a nurse were on the floor, so I understand the challenges you face. This sounds more like a time management issue to me, which, since you're a new grad, is to be expected. I suggest you identify your resources. Look around and notice which nurses are really good at certain things. Some are good time managers. Some are skilled at IV starts. Some have great people skills. When you have a situation requiring a particular skill set, ask the person who is strong in that area for their advice. This is collaboration, which is an essential survival tool for all nurses, not just new nurses. We don't practice in a vacuum, and shouldn't behave as if we do.

I see the term "unsafe" thrown around a lot. But just because it makes you feel uncomfortable does not mean it is unsafe. Identify your work processes that are interfering with your ability to take the admit smoothly and efficiently, and alter those work processes.

I know this is easier said than done, because as a new grad, you probably feel like you don't even have your feet on the ground most of the time, and like you're just hanging on by the skin of your teeth. I get it. But this, too, shall pass. Pull up those hip waders, brace yourself, and wade in. Know who your support is if you get into trouble, and don't be afraid to ask for help. One day, you will be the experienced nurse, and will be able to be that lifeline for the new grads.

That Guy, BSN, RN, EMT-B · Dec 5, 2015

My facility is changing their policy so that we have to stop everything we're doing, accept the patient, and take report from the ED nurse. This would be great if the ED wasn't notorious for keeping patients all day, and sending at 1830, 1845 when they should be sent up by 1700.
The former policy was: report had to be confirmed by the floor nurse and discussed, then the patient could come up. Gave us time to get everything ready and prep the oncoming nurse if near shift change. If too near shift change, the admit was delayed to PM.

There are NEVER any delays with the accepting docs, consults, procedures etc that cause a delay in admitting people.....

Im ducking out before this turns into a floor VS ER thread.

allnurses Guide · Dec 5, 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.

Bravo - I work 8 hour shifts in an LTC which means that I can carry as many as 22 patients. Last night 3-11 I was designated charge with two LVNS and 2 CNA for 40 patients so for once I felt adequately staffed. I was informed at the beginning of the shift that we would be getting an admit so after talking with the staff and agreeing how we would break-up the workload. I would do the chart check, manage all IV's and incoming orders, assist team members as needed and take the admit. The shift was going reasonably well but the admit did not arrive until 10:30pm which was ok as I could start it off with the initial assessments and endorse off to the next shift and maybe get out in time. Well right at 11:00 while we were starting report one of my resident coded - remember this is LTC - our crash cart is a joke and we don't even have an automated defibrillator - Myself and one other nurse ran to the room and I called back over my shoulder to call 911 - the nurse at the desk yelled - I can't do overtime! I yelled back "F*&K overtime call 911!" Which she did because it took paramedics 15 minutes to get there but our efforts were in vain. I did not get out of facility until 2am and have to go back today at 3 pm. What does this have to do with admits at shift change? As charge I usually walk the unit and check on each resident as I prepare for the shift change. While constructing the time line for the code It was noted that the resident was A&O at 10:15 by the CNA (who's a pretty good CNA) but I am left wondering if I had been able to do my normal routine I might have seen something. Likely not but I still wonder.

Hppy

chacha82, ADN, BSN · Dec 5, 2015

I don't know that it is safe but it does go on. It is definitely a disruption in getting things going for the rest of the night. I would put eyes on my admission, get them on telemetry if that applies, and see their vitals. On our floor we also do EKGs on all of our admissions. After that I shoo the EMTs out of there and go back and see what has to get done. If they're stable and someone else isn't, I go get that other person taken care of first. Now if you admit needs a heparin drip or something like that you need to prioritize that. All of the admission questions (in my opinion) can wait for later. I also end up delegating tasks to my techs during this time. Do that if your floor has them. They can keep eyes on your other people and report instability to you.

tyla1997 · Dec 5, 2015

Unfortunately we can not always control the ebb and flow of patients. It is important to remember that they are with us for our care and compassion. As new nurses we get caught up in the "tasks" of nursing. Healthcare has become a service industry, so that being said, 90% of nursing is customer service. It is alright to introduce yourself, get them comfortable, get baseline set of vital signs, ask them if they need anything, and then let them know when you will be back. This will start you off on the right foot and help to develop a patient-clinician relationship based on trust and understanding. It will also make you feel empowered to control your time and schedule. Win-win for everyone. It is easy to say it will get better, but as you grow as a nurse, you will also find other areas of your practice that need to be changed/revised/improved. So, accept the challenge now, learn to grow, learn to accept change as a positive aspect of your career and you will appreciate what you have to offer to your patients.

SororAKS, ADN, RN · Dec 6, 2015

I concur about the ER not giving report. I and any nurse I ever worked with in ED always gave report. That's a huge concern.