Safe to take new admit at shift change

[russianbear]

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.

[toERortonot]

Is it possible that you are perceiving that the new grads get the "most difficult, time-consuming patients" because you are still working on prioritization and time management?

this can be true... however;

when you give your entire assignment to a veteran nurse, she goes straight to the charge and has a hissy-fit about her patient load. demands an exchange.

and i know when i have gotten a "gem" when i give report to the oncoming shift. they're furious when receiving this handoff. um... --- ask the doctor why this pt has q2 pain medication scheduled... oh wait you're too busy cleaning diarrhea every other hour off another patient w/c-diff. where's my aide? my director needs another 100k car so we're running without a CNA, today, tomorrow, and the next. i have to cover (2) patients when an LVN is on the floor. 1:7 patients in CA? just my typical day.

time management/prioritization? i am rarely on overtime. this is the reason i receive these patients. i am almost at my 1 year mark.

[VANurse2010]

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.

nice try, but that's not what was said at all and you know it.

[thenightnurse456]

It is unsafe, but it's the unfortunate reality of nursing. It's like this everywhere.

[sjalv]

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.

While I would prefer to get an admit at start of shift too, I do not stay past my shift just because I got an admit right near shift change. Nursing is a 24/hour job. I focus on doing a) what's most important for the patient and b) what I would want done if it were me coming on. That includes, starting IV's, getting drips going, getting labs drawn, getting the admission history done, etc. But hey, if something doesn't get done, or if barely anything gets done, the next nurse can do it. It is not your fault if you get an admit right at 0640. The best the next nurse can hope for in that case is that you got the patient a warm blanket and tucked in.

[ColoradoRocky]

zIn EMR systems, all that information should be accessible to the receiving nurse as soon as they're informed they're getting a patient.

Its that way at your hospital perhaps, but I have seen a incomplete data with ED patients that come up (high acuity) rather than go thru the admitting unit then up - because in a very busy ED, that's the most likely place for data to get "dropped" etc. Also, the real admit history and admit assessment are done on our unit upon transfer, compared to the focused and often cursory one done in the ED. But the biggest issue is there can be important things that the electronic systems don't capture, especially with regards to family and other hard to quantify/capture things we assess. And I can use the e-systems and find those holes, but who am I supposed to talk to if there is no interactive handoff? That's why I want and need that verbal part of the handoff - more than once the reporting nurse and I have caught something that that the electronic systems dont capture but that are important (or something not documented properly yet, etc). So your point about "just look at the computer" doesn't really hold well in the face of patient safety -- don't trust automated systems exclusively (that will eventually kill a patient IMHO), do trust continuity of care and use the e-systems plus a verbal report to be sure. Im in a Level 1 trauma center and its evidence based part of our P&P if I recall correctly.

[nurseypants123]

As a new nurse, I really felt unsafe getting patients in the first hour of shift. After some time, I prefer getting them at 2000 rather than right before 2200 med pass. The only time I really get peeved now is if they insist on bringing them up in the middle of shift change when I haven't gotten report.