When will everyone understand things are different in the ER

Guest219794 · Jul 9, 2017

By the way Clay- Looks like you are new around here. This subject comes up often. There is at least a 50/50 chance that this will actually tick some people off, and cause arguments.

AcuteCare4Life · Jul 10, 2017

Actually, I do understand. I've worked on Med/Surg and Tele for years, just finished orienting a new grad. When the new grad asked the ER RN when was the patient's last BM I nearly flipped! That is NOT important information from the ER. Get the basic information and the rest of the details get as admitting the patient or, if possible prior to patient arrival. Yes, there are times when there isn't a bed in the room, or the room isn't clean yet, then the patient needs to wait in the ER. Last week I had just hung up from receiving ER report when Code Blue was called for a patient in a room down the hall. Night shift, minimal staff,I had to respond to the code. When the patient didn't make it, remembered the ER patient on whom I received report. Rushed around the corner to the room to find the new patient and his wife without any staff around. GREAT!! Explained to the patient that I had just come from a code and apologized for not being there when he arrived to the room. The patient responded that he had heard the Code Blue called prior to leaving the ER. Too bad whomever transported the patient didn't hear the page, because leaving a patient in a room without having staff receiving the patient can be dangerous.

EDNurseT · Jul 10, 2017

Actually, I do understand. I've worked on Med/Surg and Tele for years, just finished orienting a new grad. When the new grad asked the ER RN when was the patient's last BM I nearly flipped! That is NOT important information from the ER. Get the basic information and the rest of the details get as admitting the patient or, if possible prior to patient arrival. Yes, there are times when there isn't a bed in the room, or the room isn't clean yet, then the patient needs to wait in the ER. Last week I had just hung up from receiving ER report when Code Blue was called for a patient in a room down the hall. Night shift, minimal staff,I had to respond to the code. When the patient didn't make it, remembered the ER patient on whom I received report. Rushed around the corner to the room to find the new patient and his wife without any staff around. GREAT!! Explained to the patient that I had just come from a code and apologized for not being there when he arrived to the room. The patient responded that he had heard the Code Blue called prior to leaving the ER. Too bad whomever transported the patient didn't hear the page, because leaving a patient in a room without having staff receiving the patient can be dangerous.

Agreed..that's not safe.

Kuriin, BSN, RN · Jul 10, 2017

I came from a medsurg/tele floor before I transferred to the ER. I can definitely understand both sides of the spectrum; however, because I do have knowledge of floor nursing, I try to answer all questions. HOWEVER, when they continually ask me questions that are easy to find in the chart just to delay the transfer, that pisses me off. I told one floor nurse that I would hang her Rocephin, but I needed to get off the phone to do it. Nurse continues to ask me questions. I then ask, "Do you want me to hang the Rocephin or not? If so, then I need to go."

I also came from a hospital where the ER calls for report -- meaning, the floor nurse will often not have time to look at a chart before the call. Where I work currently in the ER, the floor will call for report. LOOK UP THE DAMNED CHART BEFOREHAND!

~Mi Vida Loca~RN, ASN, RN · Jul 11, 2017

If they ask me when the last BM was, I just tell them I just gave them lactulose so I anticipate shortly.

amzyRN · Jul 12, 2017

I've worked on the floor before ER and can see both sides also, however, I also know that the medical record is easily accessed (unless your still doing paper charting) so it's much easier for the floor nurse to look things up. I've worked some of the heaviest floors with high acuity and nothing compared to the workoad of the ED. The floor nurse can have the time to sit for 5 minutes and look things up. In the ED there is much less sitting and reading charts. I don't expect other units will understand and frankly I don't care that much if they do. I give them the best report I can and will take 5 minutes to tell them everything I know after that, they can look things up. I've gotten attitude before and rudeness and I don't let it fluster me and I don't let it sink in either.

marie.rn2419, RN · Jul 12, 2017

I get it. When you need to vent, you need to vent.... I've worked tele/floor, ED/Trauma and Critical Care. Prior to working ED, I didn't understand ED. I just knew the frustration of the floor. Before I worked ICU, I didn't understand the depth of the ICU reports and lengthiness/questions, because I just knew the brevity of the ED (keepin' em alive) and the 'meat and potatoes' of the floor. Now, when I transfer a patient out of the unit, I probably annoy the crap out of the receiving nurse with my overload of info...

It's frustrating for all parties involved. I'm not sure if there is really any solution to the war of the departments... It used to drive me insane. Now, I try to just let it ride and not take it personal when I get/give report. As long as you can at least address the ABCs and basics for the patient - I.E. no lethal/unstable rhythms ongoing without being addressed, you know which critical meds were/weren't given etc, I just try and do my job.

ClayH · Jul 12, 2017

You work in a facility where you have your patient for 30 mins 27 of them stabilizing and they already have a bed and nurse to report too??

Welcome to Mayo Clinic where we'll give you the best care in the world but we'll also have to take your kidney to pay for it.

~Mi Vida Loca~RN, ASN, RN · Jul 13, 2017

Welcome to Mayo Clinic where we'll give you the best care in the world but we'll also have to take your kidney to pay for it.

So in the ER at the Mayo Clinic you're telling me that the time you are assigned your patient, to the time you have an assigned bed and are able to give report, is about 30 mins??? Which would mean you're getting work ups and labs and scans and results back in what 10 mins???

I just want to make sure I am understanding correctly, because at first I was simply being facetious, but it seems like you are now stating this is accurate.

DayDreamin ER CRNP · Jul 13, 2017

Hypothetically, put the shoe on the other foot: you've got 30 minutes left in your shift; you need to close your charts out; answer those last minute call lights (@ opposite ends of the unit); check your charts in case some [damn] doc has sneaked an order in there you missed; gather your thoughts and brain sheet for report; take Mrs. "I can't go, Nurse!" off the pan for the eighth time today; check a blood sugar on Mr. "I don't feel so good."
Night shift is drifting in; an admission takes 45 mins to an hour, minimum. How would you feel, getting a phone call for an admission? Seriously, you've just handed him or her an hour's worth of work, paperwork to follow. You also know this will put you overtime, for which admin will now question your parentage.
I'm just saying give the freshly resuscitated customer a couple of moments to be monitored and then transfer him/her.

I really do get what you are saying but the biggest difference is that all of those things you have mentioned are not life threatening or altering. Most, if not all, of those things can wait a minute or two.

I have been picking up shifts "upstairs" on another unit from my ER home. Things are very different and I think a lot of great dialogue has evolved by me being there and not being defensive of every little thing we do or don't do in the ED. I've been asked a LOT of questions and have explained our processes.

In our facility, it seems that the floor thinks we sit around and hold our patients downstairs until we want to take them to his/her room. They thought that we purposely waited until right at shift change to take patients up. (we have a no transfer policy from 1830-1915) That is not the case at all. We actually get fussed at if it takes longer than 30 minutes to transport the pt up once we get a room assigned unless the patient is not stable or is waiting to go for a test or something.

The floor also doesn't understand why we don't always get an MRI or echo or some other tests before coming up. In nutshell, we simply cannot sometimes d/t the MRI or test schedule. It just isn't always feasible. The floor also gets bent outta shape if we don't treat a 220 blood sugar on our NPO patient. They also fuss because we started an IV in the AC.

We wonder why we have to call six times to give report, or why we get asked about the patient's last BM. As I've been working upstairs, I can see a lot of things the ED could do better and I can also see why the floor gets butthurt about some things too.

I guess we really DO need to walk in each other's shoes from time to time.

elijahvegas, ASN, RN, EMT-P · Jul 13, 2017

Floor nurses annoy me to no end with their stupid questions they want on report. I mean i can see the relevance to some but a lot of them they ask just so they can bypass half their charting and assessments by just going off of what you tell them.

bgxyrnf, MSN, RN · Jul 13, 2017

In general, I think a lengthy verbal report is an out of date vestige of the pre-computer era. I think it is a dangerous game of telephone, (maybe I am dating myself by mentioning this old game.) and the practice should be banished. In what other industry is critical information electronically documented, then verbally communicated so it can be hand written?

Very well stated.

In the inevitable occurrence that the nurse's hand written notes differs from the electronic chart and orders, to which will the nurse be held accountable? And would it be exculpatory if the nurse stated, "But the ED told me...,"

The chart is the chart for a reason and it should be the primary means for information to be recorded and communicated.