Floors VS ER

shasta1 · Mar 24, 2006

i have been in the er now since october, i came from med surg... i think it has been very beneficial to have experienced what both atmospheres are like. i remember being on the floor and having the er call to give report and i just could not take it at that time... now being in the er, i realize that i need to get that pt upstairs...rescues coming in, other pt's going bad, or maybe the pt has been in the er 10 hours + and deserves to go upstairs to thier room...usually you try to call report to the floor when you have a moment of free time. it is very frustrating...if i can give the floor 10-15 minutes i will, but then again you do find "chronic offenders"...they never seem to have the time to take report. now we call 2 times and if no nurse can take report, we fax it upstairs and bring the pt 10 minutes later....oh well its not like we didn't try to give report.....i agree very frustrating, i don't know what the solution is

FLoridarnl · Mar 24, 2006

I guess I feel that I shouldn't have to wait for nurses to finishing passing their scheduled meds to all their patients before they even take report. Especially when I've already been in the ER for 12 hours and I was supposed to leave 5 minutes ago. Hell, all I want to do is give report b/c I had the patient all that time. I can't see me telling an ambulance to wait while I pass out all of my medications before I take report. That's sooo rude. And then...to get a nasty attitude from the floor nurse...UGGGHH. If she were in my shoes, she would feel the exact same way. Only, she would be meaner about it.

suzanne4, RN · Mar 24, 2006

I have worked both sides as well, never have an issue taking report except when it is at shift change, and especially if the patient has been in the ER for hours. Trying to bring a patient up at 7 pm is just not a good time, especially in the ICU Or when I have a patient whose BP is in the 60s and I can't leave them to come to the phone. But otherwise, I try to be as accommodating as possible.

It is possible for all sides to work together, but it needs to be a two way street on this. Best suggestion is to have a little brain-storming meeting with two people from each of these departments. Not all have worked both sides of the fence, so it is not always easy to see how the other half has to deal with things on their end. Then you can reach a compromise where everyone is happy.

FLoridarnl · Mar 24, 2006

This was at 10p, not 7p. She was well into her shift and was doing her routine meds.

neneRN, BSN, RN · Mar 24, 2006

This is a problem every hospital has, and no, it will never change. The ER and the floors have completely different mindsets and priorities. Unless you've worked both, neither can appreciate where the other is coming from.

I've never worked anywhere but ER, and I could write a list about all the things I find frustrating about the floor. I often say I wish every floor nurse would just come work one day in the ER, so they would get it. But it goes both ways and I bet the floor nurses feel the same about us.

The only thing effective change I've seen in my facility is with the few floors who take faxed report. Once we get the bed, report is faxed, and the only telephone call we make is to the Unit secretary to tell them that report has been faxed. Once that's done, we put on for transport on the computer. This eliminates the nurse to nurse contact completely. (We use a preprinted report form that is detailed, but for the most part a checklist) ER and the floors both seem to like it.

suzanne4, RN · Mar 24, 2006

This was at 10p, not 7p. She was well into her shift and was doing her routine meds.

I was just referring to when I change shifts, and the only bad time to try to transfer a patient, especially to an ICU. 6:30 pm or 7:30 pm are much better. Or the same thing 12 hours later.

For a nurse that is passing meds, another nurse could have taken report for her, I do not accept that either.

wooh, BSN, RN · Mar 24, 2006

No, ER nurses can't refuse patients at the door. But an ER nurse's priority is to get them stable, M/S nurses have to get them well. And so things that don't seem important to the ER are very important to the floor. Sure, we can interrupt our med pass to get report. But then the meds are late, people start falling asleep and have to be woken up to get their meds (which doesn't contribute to a good night's sleep.) Sure, there's 24 hours to get an admission history on the chart, but do you really want to find out an important piece of info 12 hours after they got to the floor instead of when they get to the floor? We aren't painting our nails in the nurse's station on the floor. Just because what we're doing isn't important in the ER world doesn't mean it's unimportant. Delays on the floor can lead to extra days in the hospital, which means beds on the floor full and you having to hold patients in the ER, which I'm sure you don't want.

Have I not been available when you try to call report? Sometimes. I'm not going to leave a patient's bedside for a phone call. Have I asked for a few extra minutes before you bring the patient? Yes. But I've also called ER to say send them as fast as you want because we're ready and you're busy. As Suzanne said, it's a two way street. And acting like I'm not taking report because I'm lazy or have mixed up priorities isn't going to get me to accept the patient any faster.

sanctuary, BSN, MSN, RN · Mar 24, 2006

How about a voice mail system that the floor nurse can take as soon as she is free? The ER nurse could feel like her information was not lost in the shuffle, and the floor nurse gets to listen when she can. With todays electronic whiz-bangs, it seems possible...like having a number that doesn't ring, just goes to a voice messaging system???

perfectbluebuildings, BSN, RN · Mar 24, 2006

Sometimes I get a page that report is on the phone, I am in a room and doing something I can't just drop, and by the time I get to the phone the nurse has hung up. Usually I call them back before they re-call me, but sometimes they call back first and are annoyed that I couldn't get report right away. Which I can understand, but still that starts me getting my back up immediately, which doesn't help anything. I always try to say "hi, how's it going there??" and be friendly which seems to help- I know they are really busy, they know I am really busy, but taking that second always seems to make a difference. Of course I work in a hospital where the nurses, for the most part, seem to be really polite to each other and get along so that helps. The only thing that does get me is getting report on a new patient while I am still in the middle of report. I know the patients come into ER regardless of shift change. But still it creates annoyance on both sides: the ER nurse is upset that they have to wait to give report, and the floor nurses are upset that their shift transition etc. is interrupted. This doesn't happen very often though. And usually if a nurse is busy, someone else TRIES to get the report as quickly as possible. There are emergencies sometimes that throw everything off, but it seems like the transitions go OK at my hospital. I've not heard too many complaints (of course I've only been there about 8 months). I hope it gets better for you all at work.

jayne109, RN · Mar 24, 2006

I used to work on the floor. The one thing that I love is that we FAX report to the floor. Once we get a number (a signal that the floor is ready) we fax report and send them up 10 min later. We don't have problem. I like to call reports on traumas and we always call report to the ICU's and that can be a little frustrating but otherwise, we have no problems

candace miller · Mar 24, 2006

I have been a ER nurse for 12 years and worked dozens of hospital as a travel nurse all over the country. It is the same all over the country. The only suggestion I have is if there was a float nurse on each floor to take report and accept the patient. We understand that nurses are over worked, no matter where they work in a hospital. I now work as a charge nurse in ER and yes I am guility as ever other ER nurse that think everyone should drop everything and take my patient. We are going to try the fax report, but it still concerns me that a patient is brought up and the nurse may be busy and not realize the patient is there.