Why do we hate admissions?

Nurses General Nursing

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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??

I prefer admissions over discharges any day, simply because during admission process, it is an opportunity to learn a ton about your patient. Discharges are a pain mostly because of how unnecessarily time consuming they are and they usually happen during a new admission and med passes; especially when you have patients who have been ready to go and your once pleasant patient is now suddenly turning into one of your worst patients.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Discharges are a pain mostly because of how unnecessarily time consuming they are and they usually happen during a new admission and med passes; especially when you have patients who have been ready to go and your once pleasant patient is now suddenly turning into one of your worst patients.
For me, a nice aspect about working night shift is the fact that I rarely discharge patients. I probably discharge one to three patients per year since our discharge planners and case management team schedules the lion's share of them during the day.

On the other hand, night shift is admissions mania.

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Specializes in MICU, SICU, CICU.

The two most labor intensive things a nurse has to do are discharges and admissions. I don't know how other departments do admissions and discharges back to back every day all day long.

I made my self a little cheat sheet of essential things to ask when I hook a pt up to the monitor. Allergies, advance directives, family spokesperson, last hospitalization, height, LBM, falling at home, cane or walker, dentures or hearing aides, metal implants, alcohol or drug use, flu shot, pneumonia vax, shingles vax.

Then I can zip through that tedious admission assessment once I get them settled.

I have not done a discharge in years because I work nightshift in MICU.

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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.

You have a big "AMEN" from me. I can see you work on a specialty unit. Obtaining the history on this type of patient is much more time consuming tha your average "Joe".

This admission requires AT LEAST an hour of your undivided attention.Who is caring for your other patients at this time?

That is why we "hate admissions". We just don't have the time to address all of the issues... presented with a complicated admission.

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Specializes in NICU.

Usually when I get an admit it's in the middle of the day or right at the end of the shift so it throws off my entire day. Also it's usually a post op who requires more monitoring and care, even though my other patients may require a lot of care as well. And our admission questionaire is like 22 pages long....and no PACU/ER never does this so its left to me.

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I remember when an admission consisted of a head to toe assessment, medication review, and it all was on 1 page!!! That seems like forever ago!!

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When I worked on the Acute floor, if I had a pending d/c, then I would be getting the next admit. That was hard, all the paperwork, education, etc for the d/c then to turn around and the first admit was stressful--meanwhile having other patients taking a back seat.

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I remember when an admission consisted of a head to toe assessment, medication review, and it all was on 1 page!!! That seems like forever ago!!

:yes: Those were the days , my friend.

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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.

^This^

Sums it up PERFECTLY! And made me laugh out loud. The cats! Ha, ha, ha! Love it!!!!

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Specializes in Oncology.
You have a big "AMEN" from me. I can see you work on a specialty unit. Obtaining the history on this type of patient is much more time consuming tha your average "Joe".

This admission requires AT LEAST an hour of your undivided attention.Who is caring for your other patients at this time?

That is why we "hate admissions". We just don't have the time to address all of the issues... presented with a complicated admission.

Yep. One of my last admissions I got report from the clinic: "He's being admitted with acute renal failure and pneumonia. Just needs IV fluids and antibiotics." Came to unit: disoriented, rhonchi heard across unit, RR of 50. He was tubed within the hour. So yeah, definitely the unexpected. And this was someone's third patient So those other two patients got no attention for the rest of the shift.

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