How does your tele and ER work together?

[Hrtnurse14]

I have been a tele nurse for almost four years. I am getting ready to start a new job as staff in the ER. Tonite being my last nite on tele I was vividly reminded by my coworkers of the very poor relationship our tele has with our ER. The tele nurses always seem to think the ER should have done more for the patient prior to receiving them and the admission always seems to come up at shift change. On the other hand our ER is very busy and short-staffed. They are using alot of ancillary staffing ie agency and registry that are not completely familiar with our docs and procedures. There is new management who used to work in the ER and they are trying to make amends but say it is going to take time. The er always complains that they are too busy and need to get the pts up to the floor asap. Are any of you facing this at your workplace? Needless to say I didn't get many kudos on my transfer! :chair:

[wildcherry]

Rest assured to all who post on this thread......it happens EVERYWHERE! Neither department is aware of what's happening in the other and everyone is stressed.

Our hospital recently started using an "admission team" to help. Well it's actually only 2 nurses strong right now....but it helps out with the whole admission process. They meet the pt in ER and do the nursing admission paperwork (12 or so pages long at my hospital) and it helps ALOT! We all know that admissions take time....and this "team" frees us up to take our admission, as well as continue with the pts we already have on the floor.

Does anyone else use something similar?

[ark-two]

We have a lot of the same problems on our floor between er and tcu. I would like to add on our floor a lot of the time it depends on the nurse who is going to take report. One of our charge nurses gives everyone else er's and will not take one. She loaded everyone up, I personally received 2 and one who needed blood hung, now! She gave herself less patients. Er called for report, she had to take the pt and it was 1 hr before shift change. She all the sudden became Busy. After she blew er off for 1/2 hour, I went above her and took the er and had more patients then I was supposed to, but I was also working the next shift and needed to pick another one up. I already knew my patients. I try to give the 12 hr nurse any er @ 2300 shift channge and the 3-11 nurse the 1900 shift change er. Works out better! Some of the charge nurses enjoy giving the new nurse coming on the er. That is really aggrevating because of report and we do the admission on the floor and it usually takes 1/2 hr just for the admission. Then there's the care plans and consults, and orders and so on.

[laura.lynn_rn]

Well, that shouldn't be the norm, but more than once I've had to give report on a patient I didn't even know.

I think this is absolutely, definately, the most annoying thing about getting report on a pt from the ER. If you have not set your eyeballs on the pt, don't even bother calling me. Just my opinion

[neneRN, BSN, RN]

I think this is absolutely, definately, the most annoying thing about getting report on a pt from the ER. If you have not set your eyeballs on the pt, don't even bother calling me. Just my opinion

See, this is exactly what some of the other posters are trying to get across, if you don't work ER, you don't know what its like/why we do some of the things we do.

When I'm charge in the ER, and I know that one of my nurses has just rec'd a bed to call report on, but I also know that I'm giving her an ambulance pt that's actively coding...let's see, should I help her out and call report on the pt, or should I let the pt sit in the ER for another hour until she gets freed up and can call report herself?

And it doesn't even have to be that extreme of a scenerio; if I know one of the nurses is swamped, there is no reason to delay getting pts out of the ER if I can help by calling report. The way our ER is set up, the most critical rooms are assigned to RNs and they do not have the luxury of help , i.e., no LPN or tech; it is primary nursing for our most critical pts. No, I may not have assessed the pt myself, but I am able to read the chart and I hope I can assume that you are going to assess the pt when you get them.

[McGyverRN]

I can understand your point of view, but sometimes the report is so inaccurate that we floor nurses wonder if the pt in the bed is the one we got report on. We need an accurate ER assessment so that we can compare ours with the yours. It has happened where the ER assessment is dramaticaly different from our initial assessment. Those pts can end up in ICU or worse, coding. I have millions of stories, just like everyone else. Floor nurses have no idea what's happening in the ER and ER nurses have no idea what is happening on the floor. So each area thinks the other is at fault. One thing that is for sure, though....the ER gets rid of the patients and we have to deal with them for 5 or 6 days...or more.

[ERERER]

i am not even going to get started on this subject. just let me tell you that i have worked both sides.......

so, what is the solution? what can we do to make this work? there has to be a way to make this safe for the patient. we all have stressors in our job so let's put our problems aside for the moment and come up with something that would work. wouldn't it be great to go into work with suggestions for improving this situation that is happening in every hospital in America????

[laura.lynn_rn]

i am not even going to get started on this subject. just let me tell you that i have worked both sides.......

so, what is the solution? what can we do to make this work? there has to be a way to make this safe for the patient. we all have stressors in our job so let's put our problems aside for the moment and come up with something that would work. wouldn't it be great to go into work with suggestions for improving this situation that is happening in every hospital in America????

yes, that sounds great, but until hospitals and administrators begin to not only value nurse's input, but use it to change practices, we will probably be stuck where we are. as I said before, that's just my opinion.