The Non-Admit Nurse

As a charge nurse one of my responsibilities is to assign beds to patients coming in from the ED.  Somedays that gets sticky:  do they need to be close to the station?  isolation?  what nurse can I overload?  Others it’s real simple:  there’s one room and one nurse.

I’m looking at the locator (which shows what’s in the ED with notes if the patient is expected to be admitted) and see the following:  admit tele, k2.8, poss. seizure.  So I mark them on my cheat sheet and wait for the call from the nursing supervisor.  And like clockwork the phone rings.

I give the room away and tell the nurse.  Eons later the ED calls up with report, but the residents don’t want tele.  I mean, really?  A potassium of 2.8 with a seizure and no tele?  As I finish pounding my head against the desk, the nursing supervisor calls back.  “So they don’t want tele.  But I have a room on neuro and a chest painer who needs a room.”

“OK, let’s swap.  Neuro can have the low K and we’ll take the chest pain.”  I say.

“Hey J” I say to the nurse who was taking that patient, “Low K is going to Neuro, but we’ve got a chest pain for you.  Same room though.”

And we wait.  The morning is slipping away and we’re starting totake bets on whether this new chest pain will show up before shift change adn the phone rings.

“Hey is the room where chest pain is going an isolation room?” ask the supervisor.

“Yeah, it’s a private.” I say.

“But is it a negative pressure room?”

“No, what are you getting at?”

“They’re ruling them out for TB.  They have a nodule on the chest film and a positive PPD in their history.”

“Sorry, it’s just a private.  You’re out of luck.” as Isay as I hang up.

“Uh, J.” I finish, “they’re ruling out chest pain for TB so their not coming either.”

2 admits, not a single on to the floor.  I say to J, “Y’know, I should try to give you patients more often.  Guess they just don’t like you!” I joke.

As frustring as that may be, I love it when that happens.  One night I tried to give 3 patients from the ED to a nurse, all three ended up going somewhere else.  I guess the patients have heard about our reputation and just don’t want to come hang out!

Call Me Admit Guy

I don’t mind getting admits.  Being on the night crew we do far more admits than discharges, so it is something I know very well.  A couple of months ago, my wife was admitted for observation overnight for atypical chest pain.  I was following along in my head the screens for the admit history form and anticipating the questions as they came.  We do it that often.  It’s always tough though when you start the night off with an admit at shift change.

I’ve barely finished getting report from the say shift when  the unit secretary pages with, “ED with report on line 1.”  So I take report, but the patinet seems very familiar.  Somethings tickling in the back of head that I know this patient.  I ask the ED nurse to give me 15 minutes to at least pop my head in to see my other people and let them know that I’ll be back.  I get about 5.

With this admit the ED cleaned up.  The patient came up with admit history and med reconciliation already complete, so I guess it made up for the quick arrival.  Got them all tucked in and settled and went on my way.  It was perhaps the easiest admit I’ve had in awhile.  And the patient?  Sure enough, I remembered them, and they remembered me.  Seems I had done a good jub the last time they were in, so they were actually happy to see me.  What a change!

To top that off, I had a patient come back from surgery who at the sight of me nearly burst into tears saying, “I’m so glad you’re here tonight!” Twice in one night.  It was almost surreal.  Then I heard it was nearly a full moon.  Guess that explains that.

As admits, later in the night I get a call from charge who says we’ve got one coming up and it would either be me or A, and she would let us duke it out to see who takes them.  As my luck would have, A had conveniently disappeared right before ED called report.  So I took it.  The ED nurse said, “Didn’t I give you report already tonight?”   “Yep, I replied, I’m just the admit guy.”  Again I asked for 30 minutes as the admit didn’t have orders yet he said, “I’ll try.”  Sure enough though, they came through.  I asked for 30 and they gave me a hour and 15.  I got caught up, charted and ready to go.  Dialed in the admit, settled them in, put ‘em to bed and finished the night.

It’s nice when it goes well, too bad it doesn’t happen all that often.  But I’ll take it when it does.