Why do we hate admissions?

RNperdiem, RN · Sep 23, 2014

The required med section is always the worst. The ER was supposed to ask the questions, but in reality, all the paperwork for admission fell to us in med-surg.

Many people do not know what they take or what dose. Yet we are under a lot of pressure to have a complete list of everything the patient takes. No excuses. I once had an elderly patient who was looked after at home by her even more elderly uncle. I called him up to get a list of meds. Uncle was illiterate and had to spell out every word on the prescription bottles so I could get the med list.

Pediatric Critical Care Columnist · Sep 23, 2014

I haven't taken an admission for quite a long time. Not since we switched our EMR software for sure. BUT... as I'm quite often the resource nurse on my unit one of my responsibilities is to assist with admissions. Depending on which service I'm assigned to, the admissions will usually arrive right at lunch time, right at supper time or just before change of shift. One of my other responsibilities is to cover breaks... Who then misses the break? Why, I do!

Our new EMR is a ton more work than the old one. And that one was bad. So much time is spent on documentation at admission it's insane. The SOP that accompanies admission - chest x-ray, ECG, labs, line placement and so on... SO time consuming and all has to be documented in about 6 different places. Our family-centred care advisory group wants the benchmark for family allowed at the bedside to be within 20 minutes of admission. Yeah. Right. Let me just get right on that. Why don't I get you all a chair so you can watch the attending put a central line into your kid's groin...

Psychological/Social>Family Present>Mother, Father, neighbour's brother-in-law's aunt>Involvement in Care>offered to hold the central line while Dr Jones searched for the femoral vein>Time on Unit>40 minutes>Miscellaneous>Requested meal tickets, a parent sleeping room and a parking pass. I'm so tempted sometimes! It's not like anybody actually reads what we chart anyway.

proud nurse, BSN, RN · Sep 23, 2014

I don't mind an admission if it comes before 0200. After that, I'd almost rather wait until morning to get MD orders instead of waking the doctor up. The patient comes up tired and cranky, in pain, hungry, doesn't want to answer the health history questions, have to call security to lock up the meds they brought with them. They are way too time consuming, sets me back about 2 hours honestly, and I know chances are that I won't get out on time.

Long Term Care Columnist / Guide · Sep 24, 2014

I used to work in an LTC whose admission packet was 16 pages. This included a complete head-to-toe physical and psychosocial assessment, side rail assessment and consent to use them, psychotropic med assessment and consent, flu and pneumonia vaccine consents, advanced directive paperwork, initial care plan and in-room care plan. It took at least 2 and usually closer to 3 hours to complete a single admission, and Heaven help the nurse who got two or more around the same time.

The only upside was that the charge nurse didn't have to do admissions on top of her/his other duties. I was one of the admissions nurses, and those were all I did. It was a rather neat job---I didn't have to worry about taking care of other patients (unless of course I got more than one at the same time), and I got to play hostess, settle them in, get them pain meds, and answer questions during the process before handing them off to the real nurse. :yes:

Karou · Sep 24, 2014

I think it's the idea of getting an unknown patient and not really knowing what to expect (even with a good report it's still all up in the air until you see the patient). As the admitting nurse you have to provide a lot of education to the patient and family members on what to expect-- when will the doctor be here? Why can't I eat? Am I having surgery? Ect... It's time consuming to get a new patient all set up and answer all of their questions to relieve their anxiety. Sometimes until the admitting physician sees the patient we don't even have a great idea about the plan of care, which can be difficult. Usually am admission involves at least one phone call to the MD.

Our ED is bad about sending admissions at shift change, which in general is very inconvenient and stressful. Timing means everything for an admission to me. Start of shift is tough because I also have meds and assessments to do on my other patients.

That being said, I generally like getting admissions. I don't find the documentation for admissions to be too much. It takes less than 30 minutes for me to ask the questions in our admission flow sheet. I am fast at getting them set up in the room and explaining everything as I go. I feel good about being extra thorough and after admitting a patient I feel like I have assessed them well and have a good therapeutic relationship with them.

KelRN215, BSN, RN · Sep 24, 2014

When I worked in the hospital the best shifts, by far, were night shifts with a full census at start of shift. It was quite unlikely that you'd get an admission in the middle of the night starting with a full census. Of course, if something unfortunate happened- like a patient crashed and went to the ICU or your comfort care patient died, of course the beeper was beeping 10 minutes after the room was cleaned.

Admissions on nights were the worst. Either someone who just found out in the ER that their kid has a devastating diagnosis is coming up into a double room at 2AM and you have to be the one to tell them that Auntie and Grandma and Cousin Joe who are there for support cannot stay and **** off the roommmate who you wake up for the admission assessment OR the one open bed on the floor is in a double room and the patient being sent up is on precautions and you have to wake up AND move another patient at 3AM. I sooo do not miss the hospital.

I don't mind admissions in home care but it is a lot of paperwork. Our admission assessment is 12 pages for children, 20 pages for adults.

anon456, BSN, RN · Sep 24, 2014

When I worked in the hospital the best shifts, by far, were night shifts with a full census at start of shift. It was quite unlikely that you'd get an admission in the middle of the night starting with a full census. Of course, if something unfortunate happened- like a patient crashed and went to the ICU or your comfort care patient died, of course the beeper was beeping 10 minutes after the room was cleaned.
Admissions on nights were the worst. Either someone who just found out in the ER that their kid has a devastating diagnosis is coming up into a double room at 2AM and you have to be the one to tell them that Auntie and Grandma and Cousin Joe who are there for support cannot stay and **** off the roommmate who you wake up for the admission assessment OR the one open bed on the floor is in a double room and the patient being sent up is on precautions and you have to wake up AND move another patient at 3AM. I sooo do not miss the hospital.
I don't mind admissions in home care but it is a lot of paperwork. Our admission assessment is 12 pages for children, 20 pages for adults.

If our unit is full but there is a patient in the ED who needs our specialized unit, we have to move a generic patient off the floor to make room for them. It's real fun to wake up a parent and a sleeping kid at 3 in the morning to move them. Or, if all the patients need to stay on the floor, the charge nurse takes them.

wanderlust99 · Sep 24, 2014

Some hospitals have an "admission nurse" for a reason. It's time consuming and takes away from your already busy assignment. Having the admission nurse come in and at least do your admission history and med rec really helps the process.

That Guy, BSN, RN, EMT-B · Sep 24, 2014

I love admits, gets another pt off my hands....just in time for the next one to come through the doors.

Tenebrae, BSN, RN · Sep 24, 2014

I work in the community. Our admissions sort of get factored into our working day. Still dont like them. If its a wound, it requires informed consent, intial assessment 3 pages, time assessent 3 pages and careplan multiple pages, if its general palliative, catheter cares or med management, then it only requires informed consent, initial assessment, care plan. Patients for med management require a signed drug chart from their GP, and if the GP is on the opposite side of the city oh gosh that makes it fun.

And if its not done in time that can make things very challenging for the next visit

TheCommuter, BSN, RN · Sep 24, 2014

why do we hate admissions?

I don't hate admissions. I simply hate when they roll in at inopportune times.

Sometimes we receive multiple new admissions during shift change when all staff members are tied up. This challenges us because each newly admitted patient usually has time-consuming needs that must be met (oxygen, food, pain medication, questions, family member concerns, toileting, blankets, room temperature adjustments, etc).

Once we meet these needs, we've fallen behind on caring for other patients. However, we must meet these needs with a smile because we only have one chance to make a good first impression that will last throughout their hospital stay.

We also receive new admissions at other inopportune times, such as 1:00am. This is a whole other long story.

~PedsRN~, BSN, RN · Sep 24, 2014

It's a little of all of the above. For me, it's the time consuming and the UNCERTAINTY of admissions. With my established patients, I know when my meds are due and when tests are due, labs, etc. With admissions, everything comes at once and like a hurricane. The docs want it all done now now now. Fluids, xrays, stat meds - on top of admitting them, getting everything signed, setting up the rooms, orienting the patient and the families... it's just more. And I have to ***** about something.