Why do we hate admissions?

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After reading about the report thread I got to thinking, why do we hate admissions? Has it been since the documentation expanded to 4-6 pages on one admission? Is it because we are not prepared for them or do not get adequate notice they are coming?? Is it because they are so very time consuming? Is it because we know we will spend at least 2-4 hours to get the entire admission completed which includes notifying the MD and getting the orders verified? Is it the family that we have to deal with to make sure all of their needs are met as well as the patients?? Why??

Double-Helix, BSN, RN

1 Article; 3,377 Posts

Specializes in PICU, Sedation/Radiology, PACU. Has 12 years experience.

All of the above, perhaps? I think the biggest issue is that it is so time consuming to do the admission assessment and documentation, teaching, inventory of personal items, orientation to the room, floor and policies. So nurses know that getting an admission means taking a lot of time away from the care of their other patients when time management is already stretched pretty thin.

classicdame, MSN, EdD

2 Articles; 7,255 Posts

Specializes in Hospital Education Coordinator.

another reason could be that before the admit there was a discharge and that, too, is time consuming

nursegreene

35 Posts

Another reason , is in addition to all the time it takes to complete an admission I still have my regular patients to tend to.

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MiaLyse, APRN

855 Posts

Specializes in Psychiatry. Has 20 years experience.

I actually don't mind the work involved doing an admission. I like it and get to learn much about the admission. However, lack of time makes everything feel more rushed than it should be.

ICURN3020

392 Posts

I actually don't mind getting an admission most of the time. Of course, if I am in the middle of a crazy shift with a really unstable or busy patient, the last thing I want to hear is that I have another one on the way.

Usually though, I find it somehow easier to start fresh with a new patient versus one who's been there for three weeks with a long, complicated story. If given the choice between picking up an established patient and an admission, I usually volunteer to take the admission. Must just be how my brain operates :sarcastic:

Specializes in SICU, trauma, neuro. Has 16 years experience.

Because it adds so much time-consuming tasky stuff to a nurse's to-do list when s/he is already stretched thin.

Where I am now they're actually not too bad. We use Epic, and a colleague of mine added a "required admit documentation" tab (different from the Navigator, if you're familiar w/ Epic--much quicker than the Navigator) to my list and all I have to do for documentation is go down that list asking the questions, plus the patient education tab, add at least one problem to the care plan, and do the Braden assessment.

I've worked in a SNF and an LTACH with paper charting, and the admit documentation packet was RIDICULOUS. I'm talking detailed 2-page-long transfer and ambulation nursing assessments. Umm, why? Admin, you DO realize that they are going to be assessed by a master's degreed physical therapist, right? Detailed med reconciliation list that the RN had to fill out so that the MD could simply check "Continue" or "discontinue." Grrrrrrr.

And then there's the "Why is this BP med different? You need to call my clinic and ask them for my med list. Call the nursing home and talk to the TMA. I don't take generics--CVS is still open, you can go there and get my real prescription." (These are some actual quotes from yesterday. I had the resident come in and go over her home med list against the hospital orders...because heck no I'm not going to call your nursing home, and I CAN'T make meds appear just by talking to the TMA.) Granted she was not the typical ICU admit...but this kind of thing happened ALL the time at the SNF.

Early in my career I remember this one VSS. I was having a very busy shift and was trying to get all the admission stuff done, get her assessed so I can be thinking of a care plan for her, and tend to my other 4 sick patients, and then try to get some dinner myself. She kept interrupting me saying, "Nurse, I need a VCR." "Nurse, I need a towel," (it was a tablecloth for her bedside tray table) "Now Nurse, can you get me two pieces of toast with mixed fruit jelly?" I would have been MORE than understanding if it was "Nurse, can you bring me some Dilaudid?" She was a sickle cell pt. I would totally get needing her Dilaudid yesterday. But the constant "Nurse, I need--" waitressing requests.... And I JUST told you my name. :banghead:

NightOwl0624

536 Posts

Has 6 years experience.

I really only hate admissions when they come right at shift change. Unfortunately, they almost always do!

Ayvah, RN

722 Posts

Specializes in Med Surg, Specialty. Has 10 years experience.

The reason is simply staffing.

Admissions are just another task in our list of things to do. Were staffing adequate, even problematic admissions wouldn't be an issue.

blondy2061h, MSN, RN

1 Article; 4,094 Posts

Specializes in Oncology. Has 15 years experience.

Soooo time consuming, and it's such a guessing game. "Did you take your tacrolimus this morning? The Prograf? The one to prevent graft versus host disease that you need your blood levels tested for?"

"Oh honey, I just don't know."

Repeat x34 meds.

Then we get to the other questions where everything is a story. "Have you fallen at all in the last year?"

"Well you see I used to have this cat named Joe and he was an orange domestic short hair and used to love hanging out at the top of the stairs, but I knew old Joe and could predict that he would be there. One day Joe started having accidents outside of the liter box, which was very unlike him...."

Continue for the next 45 minutes with that story, then on to the next 25 questions. God help you when you get to blood transfusion history and HIV testing.

Then it's a scavenger hunt to see what the clinic they came from did and didn't do, because the patient swears up and down that he peed in a cup down there already.

And you still haven't gotten their IV fluid running or antibiotic up yet.

ICURN3020

392 Posts

Then we get to the other questions where everything is a story. "Have you fallen at all in the last year?"

"Well you see I used to have this cat named Joe and he was an orange domestic short hair and used to love hanging out at the top of the stairs, but I knew old Joe and could predict that he would be there. One day Joe started having accidents outside of the liter box, which was very unlike him...."

Continue for the next 45 minutes with that story, then on to the next 25 questions. God help you when you get to blood transfusion history and HIV testing.

THIS!!! And trying to tactfully redirect them to keep from going off on tangents without being called "rude" or "uncaring".

I just hate getting them at shift change. Like ER calls the SBAR in at 9:30 or 10 pm and then send them up at 11:05 so they can just leave and I'm trying to get report AND settle them in at the same time. Likewise when the pager goes off at 6 am and you know they're going to hang on to that admit till 6:35 - so they come too early for it to be a dayshift admission, and late enough to screw up last rounds, pain meds and potty.