Transfer at change of shift?

[BeachBayNurse]

Just a question from a clueless med/surg nurse, not trying to blame or make assumptions!

Why is it that all my admissions from the ER get sent to me at change of shift? I understand that it may be due to that the ER nurse did not get a chance to earlier and wants to call report so he/she can leave. However, it then results in that the nurse I am relieving cannot give me report because suddenly the admission is rolling through the doors and needs pain medicine, the family wants to know what's going on, etc. This seems to happen all the time and the result is the previous shift has to stay over.

I know it is not due to anyone being thoughtless, just wanted to hear from some ER nurses what is going on from their side of the trenches :typing

[Penelope_Pitstop, BSN, RN]

since i have never worked er, i can't answer your question. but, as a former floor nurse, i know that all patients seem to arrive at 1500, 1900, or 2200 (and occasionally 0600...which is darn near close to shift change also!), whether from er, pacu, or a transfer from icu. i have worked pacu (i was a tech there before i had any floor experience) and i know that sometimes the nurses see it as a favor if they keep the patient there for longer than necessary, plus they leave at 1930, and this way they won't be bored.

jess

[Dixielee, BSN, RN]

I don't know what the process is at your hospital, but I can assure you the ER staff are not sitting around waiting for ways to make your life miserable. I think if you actually tracked the times you got patients, you would see they come at random times, it is just the ones that come at shift change are the ones you remember, because it upsets your routine.

In our hospital...50+ bed ER, 900+ hospital beds, countless admissions from ER and outside hospitals, this is the usual process.

Pt presents to ER, treatment begins, the wait for labs, x-rays, CT results, etc.

If pt is deemed sick enough for admission (not cath lab, surgery, etc), then admitting physician, resident or hospitalist is notified. Pt is put on their long list of patients to see...so more waiting.

When the doc finally gets around to seeing the patient, they pick up the chart, do a quick look and sometimes request a bed at that time, even though they have not seen the patient. Many times they wait until they have completed the process then request the bed.

If they have requested the bed prior to seeing the patient, sometimes the bed shows up as ready, while the resident is writing now, stat, etc orders to be done in ER, which further prolongs the wait, and makes the floors look like we are holding the patient for some reason.

If the room is requested at the end of the admission process, then there is usually a lengthy wait (recently up to 36 hours) before a bed is available. In the mean time, we start the now or stat orders. If it looks like a lengthy wait, then we do the routine meds, serial labs, and any other procedures that may come up.

Meanwhile, while the ER is full, patients in the halls, etc. and we are holding patients who already have orders for the floor, we have a waiting room full of people, ambulances coming in every few minutes and there is a constant juggle to place the sickest patients in a bed, while many others sit in the hall or the waiting room.

We can never say we are full, or a bed is not clean. I can't tell you how many times we have tried to get a patient upstairs and have heard, the bed is dirty, housekeeping is on break, or there is still a patient in the bed waiting for a ride home, or that all the beds are full. The ER has a revolving door policy, we can never close and can never refuse a patient.

I do know that it it does seem like a lot of beds that have been requested for hours, suddenly become available 30 minutes before shift change, and when we try to call report, we are asked to wait until the next shift comes in to give report, then they need to make rounds, start meds, etc. The excuses are endless.

So that is what it looks like from our side of the stretcher.

[Miami NightNurse]

I've felt the same way about ER. But after being a patient down there and watching them I have to agree with the above post. All different departments, different shifts want to assume the other doesn't do enough. Well guess what it's not true. All shifts work hard, all departments work hard. As a patient I have seen this. As a nurse I never did.

[gonzo1, ASN, RN]

a lot of times the ER docs don't make up their minds what to do with a pt until near the end of their shift. Then they hurry up and finish all their patients so they can go home. This means the pt isn't ready to go to the floor till shift change. We don't like it either because we have to stay late to call report or take pt to the floor.

ER nurses have charge nurses who, among other things, track how long we have had the pt and continually tell us to get the pt to the floor so we can't sit on patients even if we want to.

[TexasPediRN]

We have a process that if the pt comes up at 6:15 (am or pm), then that shift is just responsible for settling them, getting vitals. The next shift will do the admit paperwork, etc.

I think it works out really well, since most of the times when shift change admits do occur, its around 6:30/6:45. I do as much as I can for the new admit, and then its up to the next shift to finish.

Completely off topic:

Miami - love the husky!!!!

[running_nurse]

on the same note, i noticed that was what the floor always complained to us about when we were sending up PACU patients.

what the floors failed to realize is that while they worked 7-3/7-7/3-11 and so on, we in the PACU did not work "normal" hospital hours.

some RNs worked 8-2130, 9-2230, 10-2330, well, you get the point.

so even if it felt like we always seemed to send our patients at shift change (which happened at 3/7/11), we never seemed to notice that. if my patient was ready to go upstairs at 230 then by all means we got them up there. it was a HUGE well-known hospital that basically operated at 100% capacity everyday. (or 103% since we ended up boarding far too many patients in PACU) so if you dawdled, chances are you LOST YOUR BED. this makes for very angry patients and frustrated nurses.

i can appreciate the fact that it's difficult to accept admits during shift change. but it was a hard concept for me to change my behavior for "waiting after shift change" because in the PICU it didn't matter if a level 1 trauma rolled through the door at 705AM when i was trying to give charge report. we never told Life Flight "sorry guys, its shift change! can you wait to send the patient until 735? or maybe even 8 so i can asses my other patients? thanks!"

just my opinion, but i understand the frustrations on both sides :nuke:

[9309]

Where I work, a doc needs to come in to admit the pt. Frequently, they are tied up untill after normal office hours. They show up after 5:00, then sometimes don't give up the paperwork till they are done dictating- sometime after 6:00.

I try to speed things up, but there isn't much I can do sometimes.

I get what it's like on the floor, and try, when possible, to not send a pt close to shift change. I work till 11p, so if we aren't bust, I will hold a pt till after shift change, and try to get the more immediate stuff started.

9309

[Miami NightNurse]

We have a process that if the pt comes up at 6:15 (am or pm), then that shift is just responsible for settling them, getting vitals. The next shift will do the admit paperwork, etc.

I think it works out really well, since most of the times when shift change admits do occur, its around 6:30/6:45. I do as much as I can for the new admit, and then its up to the next shift to finish.

Completely off topic:

Miami - love the husky!!!!

Totally off the subject again

Thanks. That was my Baby. He died several years ago but I had him for 14 years. Is that a pic of your husky? He's cute!!

[Altra, BSN, RN]

I don't know what the process is at your hospital, but I can assure you the ER staff are not sitting around waiting for ways to make your life miserable. I think if you actually tracked the times you got patients, you would see they come at random times, it is just the ones that come at shift change are the ones you remember, because it upsets your routine.

Thanks, Dixielee.

The patient goes ASAP when the bed is ready.

[crb613, BSN, RN]

All I know is in ER we cannot tell a pt....can you wait until shift change to have that MI/stroke/mva/od etc. We`take them as they come. I know I don't try to put any admit off until shift change, but if that is when they are ready to be admitted....Thats when I call report.

[NURSEOK5]

What I have experienced and being on both recieving and sending pt's I can say this.

If we have an admit I call the charge nurse let her know that I need a room, if it is close to shift change I hold the pt and do all pre op labs, ekg's and any other necessaries to help the process run smoothly. There have been times when I got the room number and the nurse to call report to but they are unavailable due to pt issues on the floor. I have taken pt's myself to the floor because of ER overflow.........since I have been on the recieving end of ER pt's also I know that keeping the flow going keeps the shift running smoothly. It is hard to handle at shift change but that is why there is care 24/7................