I have my current favorite bible verse referenced on my bathroom mirror as a daily reminder to do everything without complaint (no one wants to hear it anyway) or as I like to put it, suck it up buttercup. I try very hard to not complain about whatever goes on in my day and to just grin and bear it, however, one thing that tests me time and time again is getting an admission from our own ED at shift change.
As any nurse will tell you, most days have a certain routine. Medications need to be passed, procedures need to be done, rounds with the doctors happen, etc. If you are lucky, this will occur without incident and you are able to pass on report and be on your merry way shortly after shift change and report are over. As a day shift nurse on a psych unit, my goals for the day consist of many things, but in the end, keeping everyone safe has top priority. For many of my patients, transition is a HUGE trigger. Transitioning from the playground, from quiet time, from group time, etc. can be hard on the kids. Transitioning from staff, especially at shift change can be time for mutiny on a psych unit. Hence my frustration with admissions at change of shift.
I am proud of the team I work with and the fact that we have a plan for shift change and how we can make things easier on "our kids." We know that many of these kids cannot trust adults and will test boundaries to the limit when a new adult is present. Our team tries (very, very, very hard) to create a consistent routine, to plan ahead, and to plan with the child what will happen next, in order to maintain calm on the unit. As a day nurse, I work hard to keep the calm at shift change so I can set up the incoming night crew with a good shift since I will likely be seeing them the next morning. This is where my plea to the ED comes in. If I know that your patient is coming to me at 1729, please be prompt and send this patient to me ASAP. Please do not put in the admit order at 1749 and then send the patient at 1915. We are now in report with the night crew and trying to maintain that thin shred of calm on the unit that we have worked hard to maintain and the patient you have sent me is crying, screaming and has nine relatives in tow, who are all on their cell phones tweeting/facebooking/snap chatting, wanting to take pictures of the patient on the psych unit no less, all while demanding water and a "safe" place to put their very expensive handbag. I understand that the ED is not fond of working with "my" kids, but please do not hold "my" kids until 1915 and tell me they need to move now so night shift assignments in the ED can be made. We made assignments as well, and this admit may change how we would have staffed. My unit is different than most. Parents do not stay. Kids are not confined to bed. All are triggered by the smallest upset/noise/change in routine. Although I may grumble when this happens, I will always stay to help the next shift in whatever way I can, I just wish other areas would understand how huge and unsettling shift change is for psych patients.
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