More paper work!!!

  1. Ok guys...Something NEW to add to the stress. I don't know how big the ED's are that you work in. Ours has three sections. 1) A Fast Track or Prompt Care with 5 beds...2) The regular ED with 2 Trauma beds, 18 regular beds, 12+ hallway slots.....and 3) a so called "Holding Area" with 12 beds. We have just recently..over the last several months, started to utilize these beds to their fullest , of course due to all the patients we are now BOARDING in the ED because of a FULL HOUSE or not enough staffing on the floors.

    Now to my problem... The "Holding Area" is mostly staffed with Tele nurses that like to float down to us and want to eventually work in the ED, sometimes it is staffed with our ED nurses, sometimes it is not staffed at all...and people BOARD in the reg ED (this is a whole other subject). Sometimes this area is used as an OVER FLOW for ED patients to stop potential diversion. We have always felt our ED nursing assessments and ED nurses notes were enough...and quite frankly we probably wouldn't have time for any more. I mean we have other forms also that are necesary in the ED...(consious sedations, restraints,COBRA)

    Well Management on the FLOORS has decided that they want the nurses in the ED to start and at times COMPLETE the admission workup that is done by the nurses on the floor...on ALL admissions HOLDING in the ED. Including medication Kardexs and Care Plans.

    Nothing is official yet....just in the disscusing phase. But our nurse manager says he is being pressured into having us start this practice.

    We feel that we are...yet again being DUMPED on. The managers on the floors stated it would make to easier for nurses to take the patients upstairs, maybe even easier for them to take more patients then they normally would....thus less HOLDS in the ED......RIGHT!!!!!!

    We see it as us STILL holding the patients PLUS doing all their paper work to!!!!
    Does anyone with "Holding Areas" do the floor nurses admitting paper work???? If so..do you find that the floor nurses appreciate this SO much that they are taking a few extra patients??
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  2. 21 Comments

  3. by   ERNurse752
    Our triage sheet is the first two pages of the admission data base. We don't even have the other pages in the ER, so we don't have to do them.
    As far as admission orders...if it says "now," "stat," or if it's abx, we are required to do it in the ER. If I have the time, I'll try and do some other things, especially NG's, foleys, IV's/IVF...in general, if it will immediately benefit the pt, I'll do it. Many times though, I don't have time.
    My opinion is that you are being dumped on...my gut feeling is that they won't take any more pts than they already do, and you'll get stuck doing everything. But maybe I'm just pessimistic today.
  4. by   massEDgirl
    As far as the admitting orders go...we do as much as we can in the ED also. On the floor though they have this whole other packet that gets done when the patient is admitted to them...this is what they want us to do.
  5. by   canoehead
    Sounds like they want you to open a new nursing unit, but in the hallway of your ED. So are you getting more equipment to handle the extra work, or more staff to help complete the forms, or more money for the extra duties and increased time needed to care for each patient? And the retention issue...how are you going to keep good ER nurses at your hospital if they are forced to do floor nursing in their own unit.

    Sounds like you are willing and able to do the treatments to get these patients through, and that should be a big help already. Add to that that the fact that your keeping them down there is a favor, not a duty. Especially if the beds exist on the floor and they just don't have time to take them. So the ER is being asked to solve another unit's problem. You have enough problems of your own, but maybe they could do something for you...is there anything yoooou would be willing to exchange for paperwork?

    I personally can't think of anything worse than extra paperwork(sorry). So demand a "unit" set aside for these patients and coverage from the floors or from floats if they want to do it, and more money and equipment for your ER if you have to do it. But otherwise I think that they are asking the ER to take on the floor's problems, and once you start acting like a regular unit it will never end (the responsibilities will increase)
  6. by   All41
    Check hospitals in your area and compare customary and usual practice. If there is nothing to stop this then see if you can change the format to charting by exception. Maybe there can be standardized care plans for patients in the ER. Is your hospital going to computers in the near future? If not, that is a format which can be adapted to hard copy and it eliminates so much writing. I don't work in the ED but maybe this is a start for a solution.
  7. by   massEDgirl
    I have worked at an ED that had a "Holding Area" but on a smaller scale (3 beds). They DID start the floor admitting paper work. That was in one of the neighboring towns. The ED nurses HATED taking their turn to work in it. Yes, it was back to doing floor nursing again. I now work in a bigger city hospital. The other two hospitals in the city, from what I know do not have "Holding Areas". Like everyone else in the country they have all had an increase on pts boarding in the ED...so if you don't have a "Holding Area" now...its a good chance you will in the future..it's the up and coming thing.

    The nursing office DID tell my nurse manager that they would help in staffing that unit as much as possible. Another words..if it was staffed with one of their float tele nurses, they would exspect the floor admitting work to be done.......The debate still lyes on whether the ED nurses would have to be a part of this practice. We also asked about delays in getting people upstairs when a bed DOES become available... We all know how crazy the ED can get...even our holding area is a war zone at times...Will the floor refuse the patient due to this PAPER WORK not being done...Thus creating even more delays.
  8. by   kaycee
    When we have holds which is daily anymore we are told to complete the adm assessment that is usually done on the floors. Some of that info is already completed on our triage sheet but this form is 4 pages long. We fought about it but to no avail. We also have regular beds brought down for all the admits being held and give all meds and most treatments ordered if we have time. They don't send any help so if there is extra ER staff(which there isn't usually) we beef up the staff. Usually we just try to do the best we can and take care of the important orders that benefit the pt.
  9. by   canoehead
    Can you arrange to keep all the observation patients in this new unit they are trying to give you, instead of the regular admits? The regulations re paperwork for 23h obs are much lighter and you would still have the relatively rapid turnover that your er staff likes.
  10. by   teeituptom
    Howdy Yalll
    from deep in the heart of texass

    We hold obs and admits in our er periodically just like everybody else. And we went through a point where there flor administrative types wanted us to complete their admission procedures for them, but in their meglomania. They overlooked one item. Er nurses do not have the same access to the computer as floor nurses and vice versa. praise the lord. And they are completely computerized on the floor and we have never even been trained in the use of computerized documentation. Heres hoping we never will

    keep it in the short grass yall
    teeituptom
  11. by   micro
    Originally posted by kaycee
    When we have holds which is daily anymore we are told to complete the adm assessment that is usually done on the floors. Some of that info is already completed on our triage sheet but this form is 4 pages long. We fought about it but to no avail. We also have regular beds brought down for all the admits being held and give all meds and most treatments ordered if we have time. They don't send any help so if there is extra ER staff(which there isn't usually) we beef up the staff. Usually we just try to do the best we can and take care of the important orders that benefit the pt.


    geez, do i ever understand the paperwork snaffu.....and computers were supposed to make it easier.........

    have to agree with above statement.......if they are only with you for a few hours....no, send them to us.........but if you have to hold them.....due to bed crunches......then for patient sake.....the whole sha-bang needs completed.........WHICH OF COURSE I KNOW YOU DO ALREADY.........

    work on speciality unit.....and busy just like the rest of them.........if we can all remember that we are all in this together.........(you know even though, I don't see you in er/you are working the same eight+++++++hours that i am and with the same or similar patients).....what one team member doesn't get completed.....the next one will.........

    last i looked hospitals were 24/7:chuckle :chuckle :imbar

    I know patients hate repeating the same information over and over and I do as well if I am the patient...........but that is a whole 'nother thread also.............

    that is not us nurses fault.........

    if it were up to us nurses, we would chart meds given, iv's started, vent settings, lf coarse, etc, output is.....................and patient exchanging CO2 and O2 last time of assessment.............

    something is snafu with the paperwork!!!!!!!!!
    there is an easier.......could walk out almost every night on time if not for the redundant paperwork.............

    micro
  12. by   massEDgirl
    Excuse me micro...did you say the same or similar patients??

    We get patients at a point when they are a lot sicker then what you see....don't go up until stable...at least where I work. And when the nurses on the floor have had enough...you can say NO MORE.....We do not have that luxury.

    When I am holding the pt because you have had enough..or you are full...or you need to get caught up.....or so on and so on.....Who from upstairs is helping ME get caught up?? Who from upstairs is helping me do my ED paper work?? Who from upstairs is stopping the patients from coming in so MY assignment doesn't get bigger and bigger??

    Now as a favor (because we are all in this together!) I'm supposed to do you paper work too?? Sorry!!...It just goes to show you that the ED is the DUMPING ground of every hospital.
  13. by   micro
    Whoa, MassEDgirl,

    don't take micro out of context..............letter not written to affront you, actually thought I was putting up for your case.........

    but as it must have been my incorrect language here,

    let me make one attempt to restate..........

    when I said same or similar patients...........then yes,...........sometimes we do get admits from the ED......hence the use of the word same.............

    or similar patients.......no we don't get our patients right off of "road kill".........but give me a break.............

    you do not know where I work.........so you don't know that we where I work have the LUXURY TO SAY NO MORE.........cause we don't.....................

    so get off your high horse.........at least when directed my direction...............

    and if ED is so bad.....then taco bell is hiring.............

    and no, I didn't say do my paperwork for me, but gee whiz for the patients sake, the unfortunate thing is that sometimes there are no beds in hospital to be had......due to high acuity/##### and patients stay overnight in ED.........

    know that doesn't make your job any easier.....gee give me a break...........I have the utmost respect for ED nurses......but for the patient sake and good care, yes I would hope that in that situation, that you would complete the admit hx and get admitting orders.....so nothing is missed.......I don't really think good patient care would be to get admitting orders and complete patient history 48 hrs. into stay.........


    just micro jumping back.........

    come at me with love, love back at you
  14. by   massEDgirl
    peace , joy, and love to you to micro.

    Admiting orders...yes...which we do get and have no choice but to be given.

    But complete pt history before going up stairs?? When??? Oh yea..I might have time inbetween those three traumas.

    I happen to like...no I happen to love ED work.....more hands on with the patients. Yea we have our own documentation....but If I wanted to be buckled down with extra paper work I would of stayed floor nursing.

    Just like my first post...none of this is meant to be attacking...just the feelings i have coming from my heart on how I feel we are treated by the rest.

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More paper work!!!