Receiving admissions at shift change is probably one of my biggest pet peeves in nursing. The reasons for this could fill pages upon pages, but I will try to be relatively brief:
- Responsibility for the Patient is unclear
- Paging physicians to notify of arrival to floor can become a fiasco especially when you are busy trying to complete admission assessments and get the chart ready for them.
- Patients almost never have an accurate medication list or their bottles.
- There is often 100 family members in the room which makes asking personal and confidential health related questions impossible.
- The patient may be in pain, nauseated, annoyed, tired, and just plain frustrated and is tired of answering the questions they have already been asked at least twice before.
- It does not matter how much you have or haven’t done of the patients admission, the nurse receiving the new admission is always annoyed with you. I have actually stayed over an hour after my shift trying my best to get a patient admitted only to have the receiving nurse make a smart-assed comment about 1 medication that needed clarification!
- I always feel like I am in a rush and will forget to do something.
- If the physicians happens to arrive while you are assessing the patient, all bets are off, and you’ll be there for a while. Firstly because you’ll have to stop doing your assessment so he can do his. Secondly because he’ll often tell you verbal orders, elect not to write them as well, as since you received them you are responsible for completing them.
- The secretaries do not take responsibility for properly transferring phone calls and communications about patients during the shift change time, which can greatly delay the departure of the nurse whose shift is ending. For example: at 7:10, when you shift is done, and you are charting at the nurses station, if the secretary blindly yells out “32 needs to go to radiology” is a demanding and callous tone, and the receiving nurse completely ignores it, then what is the right thing to do? Should you be considerate and take the patient down, to be helpful to the receiving nurse? Would she do the same for you? Is it even a matter of courtesy/responsibility? These issues would not even come into play if it wasn’t for non-direct yelling secretaries.
- An order for an NG tube at shift change is never a good thing.
How do you feel about admissions at shift change? How about admissions or shift change in general?
Our shifts are 6-6, and since there was so much complaining, there is no transfers/admissions during shift change (0545-0630). Although the intent is good…I really think it should be extended from 5-7, because otherwise there is too much confusion & proper care cannot be guarenteed (in my humble opinion). A proper admission cannot be completed in 15 min and most night shifts are blessed with a unit secretary at nights to put orders in or put the chart together.
And honestly, if you are working night shift and leave a medication clarification for day shift, THERE IS NOTHING WRONG WITH THAT, as long as it isn't something immediately needed. I do both days and nights, and to wake up a physician during night shift to clarify anything not dealing with cardiac, breathing, pain/nausea, is not neccesary.
I hate admissions at shift change too! There's already enough chaos! I work nights and the best time for an admission is after midnight. By that time things have calmed down, meds are done, and I can sit with the patient, properly assess them, and give them the time they deserve. My main thing with admissions at shift change is making sure they are comfortable. I'll give them pain meds, Zofran, etc whatever they need to be comfortable because it's probably going to be a couple hours until I can get to them.
Mary-
The funny thing is ER make out like they have no idea its shift change. I mean seriously, whats waiting another 15 minutes to bring them up when they've been waiting hours already. I personally would much rather get an admission right when my shift started, verses any time withing the last hour or two of my shift. At least when they get there early, I have time to catch up.
I agree, it is not something that require a physician be bothered by in the middle of the night, but I believe the gems I often exchange report and patients with are just looking for something to be annoyed by. It sure feels that way.
Sarah-
Agreed! I suppose we cant designate a time frame, but if folks would be considerate on all ends of the spectrum, it would surely be a help.
I really hate feeling like I cant give a patient the full attention they deserve, especially when they first arrive, and likely are exhausted.
At the beginning of my career the guilt and so-called dedication to my patients would keep me there past my shift to 'finish what I started'.
Now..
I believe that nursing is a 24 hour job, and I can start an admission and hand off the remaining tasks to the oncoming shift without reservation.
I'm not 'dumping' on them in anyway, I do as much as I can with what time I have, but in the end we all have to work through the continuum of care.
imho
I became a nurse practitioner mainly because of the stress involved with staff nursing. This is just one example of the stress involved with being a staff nurse. There is so much less physical stress as a nurse practitioner.
The best time for an admission is when the patient is ready to be admitted – it IS after all, about them, not you. All the reasons you listed are about nursing culture and are things that can, and it sounds like, should, change. Everything you list suggests a break down of communication at shift change that places patients in danger. What actions can you take to improve this risk to patients and yourself?
Twitter: thenerdynurse
says:
I agree, the best time to receive a patient is when the patient needs to be admitted. But this isn’t what always happens. Often time they will hang on to them until the end of their shift so they do not have to take a new patient….