The War with the Floors - page 7

I am writing a paper for school on the all out war that goes on between the ER and the floors. I have worked at several hospitals for the last 27 yrs-it's always the same. They do everything in their... Read More

  1. by   Jennifer, RN
    I have found that as an Ed nurse, some floor nurses are never happy with report or receiving pts. Being on the other end of the phone while trying to call report has been a real eye opener on how rude and obnoxious some (note: I said some) floor nurses can be. I am sorry the iv is in the AC. I am sorry you are taking care of XXX amt of pts, but, trust me, I feel your pain and frustration where I am working as well. I know getting new admits sucks, especially at shift change. Been there, done that. It also sucks to get a CHF'er or STEMI right at shift change by EMS. I am sorry the pt is confused and disoriented. I am sorry that you will have to call the MD for orders. I feel the same when EMS rolls in with pt c/o seizures or active chest pain with no IV site. Disappointed, frustrated, more work for me. In the end, it is all about the pt and the care that they are entitled to.
  2. by   bjb_wyo
    We recently had a new policy on this. Call to give report, try again in 20 minutes and then contact the house supervisor to have her contact the floor. Sounded good, except we went for well over an hour before we could give report. We cannot use fax reports, must be verbal with opportunity for questions.
  3. by   Marie_LPN, RN
    We cannot use fax reports, must be verbal with opportunity for questions.
    As of Sept. 1st, that is what our facility is going to, because of the unanswered questions issue.
  4. by   jonear2
    On our systemit goes like this: Existing pt d/c'd, housekeeping cleans room, housekeeper notes in computer that room clean, bed assignment assigns pt. Charge nurse approves or declines and picks another pt (example: trauma head wound declined b/c we could see there was a bed on post trauma that was empty and we took the pt that bedboard had assigned to them- chest pain. We are internal medicine/ tele) then ER calls report. If the nurse is busy then another nurse who is not busy takes report getting the name of the reporting nurse in case there are questions. No muss no fuss. There are no misconceptions about clean rooms, who will take the pt or otherwise. The only thing that I hate about getting admits is that until our clerk puts in the pt into our floor's system, we cant pre-order IV pumps or kangaroo pumps or bedside commodes ahead of time. That's very inefficient I think.
  5. by   HappyNurse2005
    OK, here's my ER report beef.

    We have a "bed board" that is a computer program, so when a pt is assigned to us, we can see it pop up on the bed board. who they are, where they are coming from, why they're coming, etc.

    Well, bed board popped up a pt that was coming to us from our partner hospital (the women's adn children's hospital-1 mile down the road) ED. Literally, 4 minutes later, I get told "your patients here!" I'm like, uh, no she's not. I never got report. Well, she was there.

    Now, when I've gotten a pt from sister hospitals ED before,t hey call report to me,a nd the hospitals ambulance brings them over.

    Turns out, the ED at sister hospital called report to this hospitals ED b/c she didnt have a bed assigned upstairs yet. (she should have stayed there til she had a bed). THey gave report to Nurse X in our ED. THey drive the 1 mile here, go to the ED and Nurse X isn't there. (on break? busy? i dont know) So, they are told, hey she has a bed upstairs, just take her up.

    SO they brought her up and never called me report. THe EMT had to tell me about her, and I couldn't ask any questions, b/c he hadn't been the one taking care of her! The disorganization and subverting of the system that already works just teed mee off.
  6. by   Jennifer, RN
    Last night, I had 5 pts, all being admitted for different reasons. I was taking care of unstable GI bleed, stable GI bleed, pneumonia, chest pain and sob. Tried to call report on stable GI bleed pt 2 times at about 1745. The floor refused report, saying they were too busy to take report. I then had a 7 month old in PEA roll in with CPR in progress. Another nurses calls report on my other pt (since I was a little busy), and a tech takes the pt upstairs. The tech gets reamed on the floor and accused of holding the pt until shift change. No one would come to the room to help him transfer the pt to the bed. This is not an isolated case. Er nurses are expected to take care of the worst of the worst, and try to appease the entire nursing staff of the hospital by keeping an eye on the clock. For 1, I could care less what time it is when I transfer a pt. I work 3-11 or 3-3, so the classic 7-7 shift change means absolutely nothing to me. 2nd, I do not get a choice on whether I get to take report or not on my pts. If you don't want a pt at shift change, take report when I call it. Or maybe you would like bedside report? Maybe I should have told the medics last night, sorry, I can't take that not breathing ped pt because I have to make sure that this other non critical pt gets to the floor before shift change so the floor nurses won't be mad at me. Yeah, right! They just arrive and I have to take care of them. Yes, I have gotten very critical pts at MY shift change and I stayed late making sure that pt was stable enough to hand over to the next nurse. That is part of my job.
    The night before, a tele charge nurse (on the same floor I used to work on) complained that they got 2 pts at the same time from the ED and accused us of doing it on purpose. Like we have time to conspire with each other to plan this intricate devious plot to piss off the floor nurses. I work in a very busy 42 bed ER and I do not know whats going on in other nurses pods unless it is a trauma or other critically ill pt, much less know when they have called report and are planning to transfer a pt.
    Maybe this sounds mean and obnoxious, but I just needed to vent. Used to be a floor nurse, hated getting ER admissions too, until I realized that without those admissions, I wouldn't have a job.
  7. by   JessicRN
    We tried to get three pt's up to the floor and was told to wait so the nurse could finish her meds. Iwas strange since all three pts had different nurses but we still can only send up one pt every 45 minutes. Onr of the pt's was confused and was climbing off the bed. We only have stretches with no alarms. As a result, a pt who should have been in a bed with an alarm jumped out of the bed and fractured her hip in many places. OH WELL the floor did not get that pt the pt went to the ICU and left 10 minutes after she was given a bed
  8. by   Furoffire
    I was always used to a phone report from the ER and like it that way. Now we receive faxes and I hate it. The ER faces about 10 pages of stuff and its just too overwhelming on a crazy unit as it is. I don't have time to sit down and make sense out of all the paperwork, which is nice like labs etc. but I have missed stuff. With a phone call I get just the "facts" and its alot easier for me and more effective.
  9. by   RN2MSNasap
    We give verbal report...by and large if there is a bed available and clean, and it is not change of shift giving report is generally not a problem where I work...The thing is that we change shifts at 6 and the floor changes at 7..We in the ER are generally mindful and respectful of that and give them a chance to settle in....I know it from both ends as I was a floor nurse for many many years and I know the feeling of having 8 to 10 patients, and having to take report and its close to the end of the shift...but there are times when there are ambulances backed up and you have to give report and get the patient up regardless of the shift change..but i think at least in my experience the communication between the er and the floor is generally good
  10. by   SteveNNP
    Hi all,

    I work in a Level I 80-bed ER, and we fax a one-page report form to the floor, then call to ask if they got it, and if they have any questions. If it's a critical pt, I'll call report. While I haven't worked ED that long, also having worked ICU/floors, I understand both sides. Once I "hear" that the pt is going to be admitted, I fill out the fax. I send it as soon as a bed is assigned. The reason my pts come up 2 hours after I send report is that I probably got 1-2 new sick pts to start IV's, give stat meds/tx, code, take to Xray/CT/MRI. I'll bring them up as soon as I have a free minute. Once I get my tail back to the ER, there's probably another critical pt in the bed, and my coworkers will be connecting monitors, charting, pushing meds, running crowd control. RN's get 4-5 pts each, with any acuity level combination. The floor nurses complain about getting 2-3 pts at a time from the er *per floor.* WE can get 4 pts at one time PER RN! I start out my shift with 4 pts and end with 4 completely new ones, having probably seen, transferred/discharged 12. If my pt's a mess, I apologize. It's only because I have 4 other critical pts to go back to, and I didn't have time to change his gown/sheets while we were coding him (the first time.) For the most part, the floors are good about taking report and opening up beds. The ED is the literal front door of the hospital. We can't make more room once our beds are full. We HAVE to get the pts to the floors so we can make room for the traumas/criticals who can't wait in triage, even if it's 7pm.

    **zipping up flameproof suit*** ;>P
  11. by   UM Review RN
    Quote from SteveRN21
    Hi all,

    I work in a Level I 80-bed ER, and we fax a one-page report form to the floor, then call to ask if they got it, and if they have any questions. If it's a critical pt, I'll call report. While I haven't worked ED that long, also having worked ICU/floors, I understand both sides. Once I "hear" that the pt is going to be admitted, I fill out the fax. I send it as soon as a bed is assigned. The reason my pts come up 2 hours after I send report is that I probably got 1-2 new sick pts to start IV's, give stat meds/tx, code, take to Xray/CT/MRI. I'll bring them up as soon as I have a free minute. Once I get my tail back to the ER, there's probably another critical pt in the bed, and my coworkers will be connecting monitors, charting, pushing meds, running crowd control. RN's get 4-5 pts each, with any acuity level combination. The floor nurses complain about getting 2-3 pts at a time from the er *per floor.* WE can get 4 pts at one time PER RN! I start out my shift with 4 pts and end with 4 completely new ones, having probably seen, transferred/discharged 12. If my pt's a mess, I apologize. It's only because I have 4 other critical pts to go back to, and I didn't have time to change his gown/sheets while we were coding him (the first time.) For the most part, the floors are good about taking report and opening up beds. The ED is the literal front door of the hospital. We can't make more room once our beds are full. We HAVE to get the pts to the floors so we can make room for the traumas/criticals who can't wait in triage, even if it's 7pm.

    **zipping up flameproof suit*** ;>P
    Steve, please.

    We all work hard. We all have patients that code or turn from great to critical in a matter of moments. We all have unbelievably impossible expectations thrust upon us from management.

    I've been over this ER vs. the Floor thing ever since I realized that the ER nurses have as little control over who goes where and when as we do--and maybe even less.

    May all your patients survive and be admitted to the Floor.

    ~Peace.
  12. by   mvsnurse2b
    Hello again, since my last posting we no longer fax report to the floor. It seems rather than getting typed information that was complete and sent at least 30 minutes in advance of the patient's arrival-some administrator or nursing supervisor/manager from the dark ages have decided that report must be verbal. So for those of us in the ER who are dealing with disasters(what else is new?), coding patients, assorted drips (that can only be done here or in ICU) etc. etc. now we must wait for our receiving nurse to take report. Of the past five days-I have done 4-13 hr shifts. On each of these days my admits have sat for the day!!! No one can tell me why. Although I give kudos to our hospital for not sending patients to an unstaffed floor-our waiting rooms have gotten ridiculous. What ever happened to your doctor directly admitting you to the hospital? Why are all of these people coming through the ER? And why does any floor nurse under these circumstances not love us? The iv access is established, all admitting paperwork and initial assessments are done, labs, dx, and initial meds as well as orders are written and established by us-in addition, to our "real job" of ER nursing. I just don't understand why we can't get along. Nursing is a second career for me-I don't get the hostility that emenates within the ranks. Get it together people-the business world is just as hard-the rules and the customers are just as tough-but employees take on challenges together. We need to do the same as nurses and make our work environment a little more supportive, so that the job gets done with less stress. If we don't help each other-who will?
  13. by   noelle4
    Quote from sjt9721
    Yes, funny...but let's turn it around...

    I work in the ED and we are never busy. We just sit around the nursing station talking with docs or hang out in the ambulance bay flirting with the firemen. We do get a lot of patients, but we don't cover them, clean them, water them, or feed them. Hell, we barely speak to them. When a patient is ready to be admitted, we watch the clock and wait until we know the receiving nurse is at lunch, out smoking, or still in report. We are so bored in our department that we have time to keep track of the individual flooor nurses' schedules. We also know that the inpatient units are the only places in the hospital that actually work hard so try not to get too upset with us.

    The shoe can fit on either foot. Can't we all just get along?
    Quote from sjt9721
    Yes, funny...but let's turn it around...

    I work in the ED and we are never busy. We just sit around the nursing station talking with docs or hang out in the ambulance bay flirting with the firemen. We do get a lot of patients, but we don't cover them, clean them, water them, or feed them. Hell, we barely speak to them. When a patient is ready to be admitted, we watch the clock and wait until we know the receiving nurse is at lunch, out smoking, or still in report. We are so bored in our department that we have time to keep track of the individual flooor nurses' schedules. We also know that the inpatient units are the only places in the hospital that actually work hard so try not to get too upset with us.

    The shoe can fit on either foot. Can't we all just get along?
    I'm just seeing this post for the first time today, but feel I have to comment. I've been on both sides too and I have to side with the floor and Donn. I LOVED the ED, and will return one day. Most of the RN's were great, hardworking people. BUT...there actually was the same small group that DID sit at the nurses station most of the time, actually READING magazines, and then changing personalities before my eyes when there were paramedics around (even some married RN's ), shamelessly flirting...It was pathetic. I was told not to accept no for an answer when calling to give report b/c "they (tele, ICU, etc) just don't want to take the pt and will stall.." I almost believed it until I transfered to a tele unit and saw for myself.
    I'd love to hear more from others who have experienced this.

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