Admission, Transfer, Discharges

This is about nursing admissions, transfers, & Discharges.   Information comes from Davis Advantage for Fundamental Nursing Care by Marti Burton and David Smith

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Hello, and welcome back to Nursing Together. I am Michele Hogan, your host, and today we are going to be talking about three events that happen all the time in healthcare. That's your admission, your transfer, and your discharge. Now, at first glance, these might sound like administrative processes. A patient comes in, we get them settled, maybe they move to another unit or even go home. Simple, right? It's not actually really that simple. For a nurse, these may feel like routine processes, but for a patient, they can be some of the most stressful moments in their healthcare experience. And this is what I want you to think about throughout today's podcast. What feels routine to you may feel anything but routine for the patient we want to remind you that hospitalization can be traumatic. Patients may be frightened, anxious, overwhelmed, or feeling as though they have lost control in their lives. So let's walk through these transitions together and see how our patient sees us. Admissions. Your first impression matters. Think about the moment the patient arrives to your room. Maybe they have never been hospitalized before. They don't know you. They don't know the hospital. They don't know what's happening. They might not even know exactly what is wrong with them. Then you walk through the door. At that moment, you're not simply just the nurse. You may be the first person who makes an unfamiliar environment feel a little safer Your first impression can influence the patient's entire experience. So when you enter a room, think about your body language. Are you smiling? Are you making eye contact? Are you speaking calmly or are you sighing, looking at your watch, frowning, or appearing rude? You may be thinking, "I'm short-staffed. I've got six patients. I'm behind, and I haven't even eaten lunch yet." And maybe all of these things are true, but your patient doesn't need to carry your stress. The patient is already carrying their own. So make a conscious decision, "When I walk into the patient's room, I am going to be present for that patient." Introduce yourself. Tell the patient your credentials. For example, "Hello, Mr. Stevens, my name is Michelle. I am your LPN today, and I'm going to be taking care of you." That simple introduction establishes professionalism and begins to build trust. And notice something else, you've used the patient's appropriate title and last name. Unless the patient specifically asks you to use their first name, please use their last name. Avoid terms like honey, sweetie, dear. You may mean them affectionately, but professional communication means respecting the patients as an adult. So what is the patient feeling? Now let's put ourselves in those patients' shoes. Imagine you wake up tomorrow morning and someone tells you need to go to the hospital. Suddenly, everything's changing. You may have questions. What is wrong with me? What kind of tests will they be doing? Will it hurt? How long will I be there? Who are all these people? What is going to happen to my family? And what is this going to cost me? Those questions represent something nurses need to recognize: fear of the unknown There are several reactions to a hospitalization that a patient can feel, including fear, anxiety, loss of control, and loss of identity. So let's go ahead and break some of these down. Fear of the unknown. Fear is extremely common. The patient may not understand their diagnosis. They may not understand the tests. They may be afraid of the pain. They may be afraid of surgery. They simply may be afraid of what they don't know is coming up next. And the easiest thing that you can do as the nurse is to explain exactly what you're about to do and try to allow them to know what is going to be happening throughout their stay. Instead of saying, "I'm going to auscultate your lungs," try, "I'm going to listen to your lungs with my stethoscope." Same nursing action, completely different patient experience. Remember, medical terminology may be completely normal to you and completely foreign to your patient, so communicate in language that they can understand. Don't assume that because something is routine for you, it is routine for that patient. Anxiety is more than just being nervous. Anxiety can come from many different sources. Maybe the patient is worried about their diagnosis. Maybe they have children at home. Maybe they take care of an elderly patient. Maybe they own their own business. Maybe they don't have insurance. Maybe they are worried about all of the things and how are they going to afford not only the hospitalization, but their medicines after discharge. These concerns are real, and sometimes the nurse may be the first person to recognize them. You don't have to solve the problem yourself, but you do need to recognize when the problem exists and connect them with the appropriate resources. For example, social workers are a great resource to help patients after they get discharged, or possibly with concerns such as financial problems or other social needs. So remember, you don't have to have every answer. You do need to recognize when your patient does need an answer and try to help them find it. Loss of control. So now let's talk about something that can be easily overlooked, the loss of control. Think about how much control you normally have in your own life. You can decide when you wanna wake up, when you wanna go to sleep, what to wear, what to eat, when to shower, when to use the bathroom, when to come home. Now someone is telling you exactly when breakfast is coming, wakes you up at 5:00 AM for vital signs, tells you need to wear a gown. Someone comes in to get a blood draw. Another person comes in for X-rays. Another person asks the exact same question that three other people just asked. The patient may begin to feel like, "I don't have control over my life." And that is why sometimes it is simple as offering choices that can make the difference. Would you like ice in your cup or tap water? Would you like your socks on? Would you prefer to sit in the chair or remain in the bed? When clinically appropriate, small choices give the patient back some control, protecting their privacy and modesty. Now, let's talk about something that every nursing student needs to take seriously. It's modesty. To you, seeing a patient's body may be just your everyday work. To the patient, this can be extremely embarrassing, so protect the patient's dignity. Close the door. Pull the curtain. Cover the patient. Expose only the areas that are necessary to provide the care that you are doing at that time. Knock before entering. Close the curtains or ask permission to enter. Don't forget the patient's clothing, and if the patient can dress independently, allow them to do the goal is not simply to complete a task. The goal is to provide care while preserving dignity and independence. And here is something worth remembering. Just because you have become comfortable with the human body does not mean your patient has become comfortable. Don't turn your patient into a room number. Another common experience during hospitalization is the loss of identity. Suddenly, the patient has become a room number, a hospital identification number, a diagnosis, a wristband, a call light. Learn their name. Use their name. Call them Mister, Misses, Ms., or another appropriate title, unless they request something different. Never refer to someone as the CHF in room 402. That person is not CHF. They are a person who has heart failure. That distinction matters. Remember also that the patient isn't just their room number. We now need to look at another layer, and that is cultural awareness. Your patient may have beliefs, traditions, religious practices, dietary preferences, family structure, or communication styles that are different from yours. Your job isn't to decide whether or not their beliefs are right or wrong. Your job is to provide respectful nursing care. If there is a language barrier, use an interpreter according to the facility policies. Don't assume simply speaking louder will solve the communication problem, and don't pretend to understand when you don't. Instead, clarify, ask questions, listen, pay attention to facial expressions and non-verbal communication because sometimes a patient is telling you, "I don't understand," without actually saying those words. Let's go ahead and start with the actual admission process. So we're moving from the emotional side to the actual nursing admission. During admission, information is collected and documented. This includes demographic information, insurance information, emergency contacts, physician information, reason for admission, and advance directive information. The patient needs proper identification. The identification band is important for patient safety. Before medicines, treatments, procedures patient identification must be verified according to the facility's policies. And remember, the patient is not the only thing being admitted. You're also establishing a baseline. You're collecting subjective and objective data. Subjective data is what the patient is telling you. "My pain is a seven. I'm feeling nauseous. I haven't slept." Objective data is the data that you have observed or measured. Blood pressure, temperature, pulse, respiratory rate, breathing sounds, bowel sounds, level of consciousness, strength, and other assessment findings. The baseline becomes incredibly important because later you need something to compare it with. You can't recognize a change in a condition unless you know where that patient started. This is where I want you to connect admission to your nursing process. You collect the data, then you analyze the data. You identify the actual problems and the potential problems, and then you use the information to help develop the plan of care. But there's another important concept here. Discharge planning starts at admission. Yes. You've heard me correctly. Discharge planning begins when the patient is admitted. Why? Because you need to know where the patient is going back to. Do they live alone? Are there stairs? Can they bathe themselves? Can they prepare their own meals? Do they have someone that is available to help? Do they need assistive devices? These questions can completely change your discharge planning Now let's go ahead and start talking about the actual discharge. Eventually, the patient is going to leave, And this is where we sometimes make a mistake. We think, "They're discharged. We're done." No, the patient is only leaving the hospital. Their care actually continues. The goal is a safe transition. The discharge process includes verifying the discharge orders, reconciling medicines, providing instructions and prescriptions, gathering their belongings, documenting the patient's condition and vital signs, documenting the time and the method of transportation, and preparing the room for the next patient. But one of the most important pieces is patient teaching So let's think about it like this. Imagine you're discharged from the hospital with three new medications, a new diet, a new dressing change, a follow-up appointment, activity restrictions, and instructions about symptoms that require medical attention. Someone hands you six pages of paperwork and says, "Have a great day." Would you feel prepared? Probably not. That is why discharge teaching needs to be intentional. Teaching includes the patient's illness, dietary changes, medical administration, treatment they need to perform, adaption for daily living, follow-up care, community resources, home health, hospice, support groups, and other services needed. And don't just ask, "Did you understand?" Patients will automatically say yes. I personally one time had my fourth child, and my nurse was going through my discharge information. It had been six years, but I'm like, "This is my fourth child. I know exactly what I'm doing." I rushed them through my discharge process so I could get home to my other three children. But by the time I got home, there were things I didn't remember, not only for myself, but for my child. I had to actually go back and read the information myself. But if I didn't know medical terms or if I didn't medically know what was going on, I could have been in trouble and could have had some adverse reactions to that Ask your questions. Have the patient explain the information back to you. Look for verbal and non-verbal signs that they understand Now let's talk about one of the biggest safety responsibilities during discharge, and that is medicine reconciliation. The patient may have medicines from home, then the hospital might add more medicines. Sometimes a specialist adds another medicine. A medicine gets discontinued. Another medicine can change dose, and suddenly the patient has a list of medicines that become very confusing. Your responsibility is to carefully compare what the patient was taking before with what the patient should be taking after discharge. Look for duplications, look for omissions, look for dosing changes. Make sure discontinued medicines are clearly identified, and make sure a patient receives a current medication list with all the correct doses. Think about it this way: Medicine reconciliation Isn't just paperwork. It can prevent a medical error. Now let's talk about an encounter that may or may not happen, and that is a patient leaving against medical advice, or AMA. A patients decides, "I'm leaving," even though the provider has not authorized this discharge. Your responsibility is to attempt to explain why leaving may not be in the patient's best interest. But here's something important. You cannot simply force an adult patient to stay because you disagree with their decision. The patient continues to leave, follow the facility policies.. Many hospitals ask the patient to sign an AMA form. If the patient refuses to sign it, make sure you document that the form was offered and refused, and notify the appropriate provider according to the policy. And remember, your role as a nurse is to educate, advocate, communicate, and document. Sometimes a patient's condition improves, but they need to move to a lower level of care, and sometimes the patients deteriorate, and they need to go to a higher level of care. A patient may move from one unit to another or may be transferred from one facility to another. Regardless of what they are doing, the most important question is: what does the receiving nurse need to know to safely care for this patient? For internal transfers, you need the appropriate order. Explain the reason for the transfer, reconcile the medicines, gather their belongings and their necessary supplies. Complete the transfer documentation, give report to the receiving nurse, document the time and the transfer, and make sure the patients have their belongings and have arrived safely. Imagine your patient suddenly develops an increased shortness of breath, cyanosis, an oxygen saturation dropping from ninety-two to eighty-five, a heart rate of one twenty-six, respiratory rates of thirty-eight, blood pressure of one ninety-eight over one hundred and ten, and the temperature rised to one hundred and three point six. The provider orders an immediate transfer to the ICU for intubation And ventilator support. You're the LPN caring for the patient, and the RN charge nurse is assisting. What matters most? This is where you have to prioritize. The patient's immediate safety and psychological needs come first. You don't want to become focused on completing paperwork, packing up belongings, and other routine transfer tasks that you lose sight of the patient who is rapidly deteriorating. Ask yourself, "What happens now?" and, "Can that wait until the patient stabilizes?" That is critical judgment, not simply knowing the checklist, knowing what matters the most right now. Transferring a patient to another facility requires additional coordination. You need appropriate transfer orders. Transportation must be arranged. A transfer summary may need to accommodate the patient. The receiving facility needs information about the patient's conditions, vital signs, medicines, diet, activity restrictions, teaching, follow-up appointments, and other relevant information. And don't forget confidentiality. Patient's information must be protected. The medical records being transferred must be handled according to the policy's requirements and facility policies. The receiving facility should know that the records are being transmitted and reach the appropriate personnel. So let's take a step back. Admission, transfer, discharge. These may look like three separate tasks, but they are actually all connected. Admission is about establishing safety, trust, baseline information, and understanding the patient's need. Transfer is about maintaining continuity and safety while the patient moves from one location or one level of care to another. Discharge is about preparing that patient to safely continue care outside of the hospital. Throughout all three, communication matters, documentation matters, patient identification matters, patient reconciliation matters, education, privacy, and most importantly, the patient matters I wanna leave you with my final thought. A patient may forget your name, they may forget exactly what you said, but they will remember how you made them feel when they were frightened. Admission, transfers, discharges, these aren't simple movements from one location to another. They are a transition in a person's life, and your role as an LPN is to make sure those transitions are safe, clear, and less frightening. So next time you're assigned an admission, don't think, "Oh my God, I gotta do an admission." Think, "I have a patient who may be scared. I have an opportunity to make an experience better." When you're preparing a patient for discharge, don't think, "I need to hurry up and get this paperwork done." Instead, think, "I need to make sure this patient is prepared to safely manage what happens next." And when transferring a patient, don't think, "I'm just moving a patient to another unit." Think, "I'm responsible for helping ensure that the next nurse has what they need to safely continue this patient's care." That is the difference between simply completing the task and thinking like a nurse. I'm glad you joined me today for another episode of Nursing Together. Until next time, remember, every transition is a nursing opportunity to protect safety, preserve dignity, reduce anxiety, and advocate for your patients