Something funny

itsnowornever, BSN, RN · May 19, 2013

I was a floor nurse for nearly two years before transferring to the ER. I worked on a very busy tele/step down unit. Reading this post just makes me chuckle...I never purposely tried to "hide" when the ER nurse would call the floor to give me report on an admission...but there were times when they would call and I would tell them to call back in 5-10 minutes because I was in the middle of administering medications to one of my patients (I know you mentioned that, but it happens!) I do know of other nurses that I worked with who would purposely try to "hide," do some procedure, "forget their phone" (we had phones that we carried during our shift) or something....anything, just to delay their admission so they can get something done.
I admit, I hated when the ER called right at shift change and would bring up the patient shortly afterwards (or right before my shift would end).
But it's true. As a former floor nurse, I had NO IDEA what the ER nurses were going through.
Now from an ER RN perspective, all I can do is laugh because I truly understand that when the ER RN calls to give report, it needs to be done NOW and the patient needs to be brought up promptly because we need the beds in the ER. Or if it is at shift change, that off going nurse who has taken care of that patient for the past few hours needs to call report because they KNOW the patient. It just makes more sense. Sure, I've had ER nurses call report on a patient that they haven't even laid their eyeballs on. I understand both sides, but I do get annoyed when I try to call report and the floor nurses are like "can you call me back? thanks." Dang it, it's like chaos down here and who knows if I'll be able to call you in the next 5-10 minutes. Makes me want to repent for all of the times I told the ER nurses that when I was working on the floor!
With that said, I am now calling report to some of my former coworkers. There was one patient I had for several hours...doc finally decided he was going to admit them and admitting doc finally accepted them. It was 0600. I called report. The patient was to be admitted to the floor I used to work on. The nurse begged me to keep the patient down there, saying, "you're my friend, please..." um, NO. They need to go upstairs.
I called report on another patient at around 2040 (again, being admitted to my old stomping ground lol) and the nurse gladly took report when I called, but then said to me, "if you can wait until after I am done with my 2100 med pass that would be great." I told them that definitely wasn't happening, but i was nice about it.

I HAVE held some patients for 20 min or so if we weren't slammed, and the ICU nurse was very nice about it, told her I didn't know how long I could hold, but I'd try. She's probably the only one ill do it for. When I have sent many upstairs and all but that ONE nurse has "hidden" we have a problem! I get that they are busy and shift change we DO try to hold off on transfers, sometimes paying over time to the ER RN who is waiting an hour after change to do the transfer. We try to accommodate, but I think they just try to take a mile if we give an inch sometimes.

Posting from my phone, ease forgive my fat thumbs! :)

dandk1997RN, MSN, RN · May 19, 2013

I don't appreciate the 'games' they play. They know they are getting an admit, they know I'm calling. They hide, they won't answer the phone, they won't take report. They figure when I'm calling is a good time to perform a procedure, draw blood, pass meds.
I would just love, in the perfect world, that there was a mutual understanding that both our jobs are hectic and chaos in their own way.

You say at the end of the quote that you understand both jobs are hectic and chaotic. Right after you say we floor nurses are playing games. Have you considered that maybe we actually ARE busy? I work intermediate tele and carry a pt load of 6-7. Odds are good that when you call me, I'm going to be working, and often times it won't be something I can drop at the ER nurse's beck and call to take report. If I ask for 5 minutes to finish an IVP med, give me 5 minutes. If the secretary tells you I'm in an isolation room changing a dressing, give me 15. I could be pushing iv cardizem for all you know, and the patient I already have in my care deserves just as much attention as the one I'm going to pick up. I would never stop in the middle of what I was doing with one patient to go do something with another except in an emergency- the same holds true for taking report. As soon as I'm done with the task at hand, I'll happily call back to get report. The sooner I get the pt in my clutches, the sooner I get them safe and settled with a completed admission, so believe me, I want to take report.

And for pity's sake, please don't get mad when I won't take report from you when I'm already getting report from someone else. I was once getting report from one ED nurse when another called the floor and insisted I put her own colleague on hold and take report from her first. This also happens at shift change- just because you call on the phone doesn't mean you go first. People wouldn't shove ahead of someone like that in person, but have no problem trying to do so over the phone.

It's sad. I like to take my own report and the sooner the better so I can get everyone under control an have a full assignment rather than empties looming over my head, just waiting for the other shoe to drop/. Why would you assume we're playing games? We could just as easily assume ED nurses are holding on to pts so they don't get another when they show up ten minutes before shift change with a pt whose orders are 3 hours old.

Sorry- stepping down off my soap box now- nothing personal to you, Sassy5d, so please don't take offense- none is meant. We have this problem where I work and it really bothers me.

And to all the patient nurses who ask if I am able to take report instead of assuming I'm sitting around (I'm not- I've only taken two breaks since October) thank you! We're all a team in our individual hospitals and we need to be considerate and work together.

emtb2rn, BSN, RN, EMT-B · May 19, 2013

Ya know, kimberlina does bring up simething i do see with a couple of my er co-workers - holding on to stable admitted pts so they don't get a new one. Not fair to anyone.

SweetMelissaRN · May 19, 2013

Ya know kimberlina does bring up simething i do see with a couple of my er co-workers - holding on to stable admitted pts so they don't get a new one. Not fair to anyone.[/quote']
I'll be honest, I've done that before once when I was about to get a psych (after taking over the stable pt, that would have given me all psych patients!) I was really dreading that... Nothing against psych pts, but there's a reason I became an ER nurse not a psych nurse!

itsnowornever, BSN, RN · May 19, 2013

Kimberlina- if you are truly busy then you are one of the precious few, but so far, I am pretty sure I can tell you who is truly busy and who is not (they may have a lot of pts but they aren't doing much) because I hear a lot of "she's on break" or "she's in the bathroom" and it's not ONE time it's repeatedly. Ok, you're going pee, I'll call back in 10; she's still in there? Ok maybe poop, call back in 10; holy cow? Perhaps she needs to go home if she's STILL in the bathroom!!!!! And then I'll have my charge call, cause that's just monkey business!

Posting from my phone, ease forgive my fat thumbs! :)

psu_213, BSN, RN · May 19, 2013

It's sad. I like to take my own report and the sooner the better so I can get everyone under control an have a full assignment rather than empties looming over my head, just waiting for the other shoe to drop/. Why would you assume we're playing games? We could just as easily assume ED nurses are holding on to pts so they don't get another when they show up ten minutes before shift change with a pt whose orders are 3 hours old.

I certainly don't assume that the floor is playing games, but please don't assume that the ED nurse is either. When I was working on the floor, it really frustrated me when an pt from the ED was assigned at 4 am, yet they were not brought up until 6:55am (or 7:10, etc.). Now, working in the ED, I realize this happens for several reasons:

1. The patient cannot be transferred to the floor until they are stable and the ED doc approves them to leave the ED. How it works in our hospital--the ED doc writes the admission order (i.e. admit to Dr. Smith to a regular bed, dx: dyspnea). As this point, the bed can be assigned by the nursing supervisor. So this might happen at 4 am. Well, the doc has not actually approved the pt to leave the ED yet. Suppose they also have chest pain on inspiration. So they need to be tested for a PE, but because of renal insufficiency, they can't get a CTA, so they have to wait for a VQ scan. By the time this test is done and the doc approves them to go to the floor, it is not 7:15. It is highly inconvenient for everyone involved, but this is one explanation for it.

2. The patient's attending physician could be at bedside. They could be there for who knows how long and the physician wants to complete his/her full eval before the patient leaves the ED. Another situation where the untimely arrival of a pt on the floor might have nothing to do with the ED nurse.

I could go on with further examples, but I think these illustrate the point. While I'm sure there are instances where the ED nurse does hold on to a pt unnecessarily; however, both sides (both the ED and the floor) should not assume the worst for why there is a delay on the other end of the floor.

NO50FRANNY · May 19, 2013

There are definately some downsides. We are seeing the same number of patients only faster, so we are all pretty tired and I have noticed a small increase in the number of failed discharges which was bound to happen. The system officially started earlier this year so information regarding pt. outcomes will be studied down the track. We are still tweaking the system and gathering feedback from the wards and specialties as we go. Nothing much has changed overnight, in my particular facility if the ER physician thinks the patient needs review from a specialist they will come in to see the patient regardless of time which was true prior to the new system. The only thing that has changed here is that the emergency doctor can deem the patient "safe" to go to the ward and be reviewed there later rather than wait in emergency overnight. Obviously when this happens, the ER doctor will write up medications etc. to see the pt. through until they are reviewed. Hope this helps :)

NO50FRANNY · May 19, 2013

I have to say without a word of a lie, the problem of wards not being ready for patients, delaying tactics, obstructions essentially no longer exists. The important thing to remember is that the wards lose money from their budget if the patient breaches the 4 hours, not us, so the incentive is on the other side. The only time we can't move a patient on is when we have complete access block in the hospital and no beds are physically available. They have trialled similar systems in the UK but it didn't work very well, ours is a fine tuned version put together by exceptionally clever nursing and medical driving forces. Results will be published down the track I would imagine because it's working. If you check out "National Emergency Access Target" or NEAT on a search engine you'll find out the particulars. Hope this helps :)

NO50FRANNY · May 19, 2013

This is brilliant! Are there any down sides? Is there any feedback from the floors and specialists regarding overnight shifts?

Hi there, I buggered up my reply to this- it's comment 18 / 19.

itsnowornever, BSN, RN · May 19, 2013

I have to say without a word of a lie the problem of wards not being ready for patients, delaying tactics, obstructions essentially no longer exists. The important thing to remember is that the wards lose money from their budget if the patient breaches the 4 hours, not us, so the incentive is on the other side. The only time we can't move a patient on is when we have complete access block in the hospital and no beds are physically available. They have trialled similar systems in the UK but it didn't work very well, ours is a fine tuned version put together by exceptionally clever nursing and medical driving forces. Results will be published down the track I would imagine because it's working. If you check out "National Emergency Access Target" or NEAT on a search engine you'll find out the particulars. Hope this helps :)[/quote']
I will search it! Thank you!
Posting from my phone, ease forgive my fat thumbs! :)

Altra, BSN, RN · May 20, 2013

Ya know, kimberlina does bring up simething i do see with a couple of my er co-workers - holding on to stable admitted pts so they don't get a new one. Not fair to anyone.

I have never worked in an ER where this would be possible. Your admitted patient has a bed and there is not a compelling reason why they are still in the ER? You haven't called report yet? Fine - someone else will - and the patient will be out the door in 5-10 minutes. IF ... the floor will take report. :sneaky:

PengiRN · May 20, 2013

I have never worked in an ER where this would be possible. Your admitted patient has a bed and there is not a compelling reason why they are still in the ER? You haven't called report yet? Fine - someone else will - and the patient will be out the door in 5-10 minutes. IF ... the floor will take report.

I agree. My charge nurses would be on those nurses' rears to get their patients up and get those beds open! Or if I see a patient has been sitting, I'll see what I can do for my co-worker to get that pt moving. I (& pretty much all of my co-workers) hate seeing the waiting room fill up and beds not opening up quick enough. I don't think you could get away with that for long..