[caroladybelle]

Ernurse728,

Yes, I have worked the ER, I have dealt with drug seekers and quite frankly have dealt with cardiac drips on the floor, starting them and titrating them. Some oncologists refuse to put induction chemo pts on in the unit unless they must !!!!!!! be vented (due to the high infection rate in ICUs). Which means that we have Bipap. If they can be extubated, we can get pericardial windows and s/p esophagastrectomies. And quite frankly, the only time in my 12 hour shift that I generally get to leave the floor is to give chemo or ganglicyclovir in the ICU (they don't give chemo or access ports), to give methatrexate/access ports in postpartum or the ER (because they don't give chemo or access ports- especially after the bleed). And I have yet to call ER to do an IV start-they are usually the ones calling us for a start. It has yet to matter to anyone whether the nurse is at lunch or not-the patient comes to the floor anyway- at my facility. I am sorry if that is the case where you work, it is not the case where I am at.

And ,yes those charming "one size fits all "forms do have spaces to put abnormal labs. But it seems that the individuals that fill them out, never would write them down. Invariable one would care for the pt, someone else calls for orders, the tech got the vitals, and the ER MD spoke to the pt/family about code status and other matters. Half the time, we never got a faxed report that matched the pt. Please accept that what is important to the ER, with what is going on at that time in the ER, is not necessarily what is important to the floor for continuity of care.

And yes, we do have pts w/sudden onset CP - that need stat EKG's, blood labs, CXR. And we get told that the nurse has to transport the pt to xray, and we have to call all the stats/put the orders in the computer/take care of the pt somehow someway. So frequently the floor gets dumped on (no sec/tech) also.

So, we all get dumped on , not just the ER.

PS. I am not Carol - I am Caroline/or Carolina, thank you. Peace be with you my brothers and sisters.

[caroladybelle]

PS. I haven't had time to write up problem sheets either.......not that it would do a bit of good where I work.......the suits would just stick them in the old circular file.

[ernurse728]

Well Caroline...I am sorry if you have incompetent ER nurses at your facilty. I am however very competent and do know how to write out a fax report. Maybe your facility needs to come up with a better system. As in my ER I am the one that cares for my patient, I decide what needs to be done before the MD even sees them, I do the IV & Labs, the ekg, the Vs and the meds. And on most days I could probably give report without looking at the patients chart. I always no what is going on with my team! I am not the type of nurse that sits on her a%& all day long and delegates everything out.
Look I am not trying to turn this into a pi%&ing match. I know that the floors are busy...unfortunately most of the floor nurses don't have a clue how the ER works, they have never been ER nurses. And I think that you will find a majority of you ER nurses have been on the floors in the past. So there are some excuses that I cannot and will not tolerate. Not to mention that we haven't talked about how horrible it is for the patient. They have usually been in the ER for hours, wait for lab results, deciding that they need to be admitted, then awaiting admission orders and a bed assignment. They are usually tired and uncomfortable. and they want to go up to there room, where it is a little more quiet so they can get a little rest.

[caroladybelle]

No p@#$ing match intended. And I don't think that we have "incompetent" ER nurses... It is just that expectations of floor nurses and ER nurses vary from place to place. In my facility, Onco is expected to do hard sticks and access ports, not ER, as well as handle other things. But because of afformentioned problems, faxed report did not fly.

Everyone in nursing gets dumped on in various ways and at different times. We all need to accept that and fight the real enemies of nursing - inadequate staffing, poor pay, poorly trained ancillary staff, lousy management - instead of whining about each other. We have to try to accept that nurses are doing the best that they can with what they have.

In response to the initial query, byY2KRN, the floor rarily has control over when housekeeping cleans the room. I could page til I am blue in the face to get a bed cleaned, but until a supervisor puts a stat on it, it could wait til doomsday. The supervisor is the one that calls for a bed (& we tell them that it is not clean). Unfortunately, faxed report will do nothing to speed that up.

[CMERN]

Hey ...where I work we call X 2 to try and give report..we notify the E.R. charge R.N. if floor says bed not in room or room dirty,..E.R.Charge R.N. puts stat on room... we call to verify if room is in deed "ready" and we roll 'em up. with the written report in hand .1st page of chart and if we get to floor with no one insight we walk and find floor charge nurse and hand over chart....we get aback up and we have HOLDS in E.R. but gee things have greatly improoved since we implemented our 1, 2, 3 your goin up rule.

[CMERN]

I would not trust a FAX report as the primary way to send up a report to floor ...it might be good to send once room assignment recieved..to floor..but i think it might cause more confusion if not routed correctly and unfair if the floor is unaware that the report is coming

[canoehead]

If the room hasn't been cleaned and the Er nurse is getting frustrated they generally let the floor nurse they are going to page housekeeping themselves, taking it off the floor nurses' list of things to do. Housekeeping takes a page from ER more seriously- I don't know why...the bed gets cleaned, and the pt gets moved, everyone is happy.

So there's a solution for everyone. Maybe the ER nurses have more of an edge of "I'm gonna kill someone if I don't get rid of this pt" and it scares the housekeepers. Heck, if it works...

[CMERN]

..sorry it just hit me funny.....

[ernurse728]

Unfortunately we have a big problem in our facility with the floors saying that the bed isn't clean when it really is. That in itself has nothing to do with the fax report.

[Y2KRN]

Well we went with our new policy for faxing report! It started Yesterday. Last night I get to work at 1900 of course there is a change of shift admission. The nurse signing off to me takes care of getting the patient admitted and faxes report. I go on about taking care of my four other patients. My medic and tech transport patient for the off going nurse.


At 19:47 I get a call from the floor, saying that there is a patient in bed so and so, and I have no idea why he is here. I explain that the off going nurse faxed report and had the patient taken to the floor. She said well I have many questions, I told her that I would try to answer some of them but, that I never laid eyes on the patient. She was soo furious. The first question she comes out with is what is the diagnosis?? I say very nice that there is an admitting sheet with the admitting diagnosis. She said yes here it is. Then she said does he have any allergies?? I realized at that point she was not reading the fax or chart at all. I kindly said please read the chart and if she had any more questions to call me and I gave her my extension. She said what kind of nurse are you, when you can't answer simple questions about a patient you sent to me, and hung up.

I was flabbergasted! I told my charge nurse and she said well it is the first day we are doing this. I said yes that is true, and I understand it is stressful when things change. I do understand that. However to be disrespectful to other professionals is just infuriating.

She did call me back about 20 min later after she had read the chart and started yelling that the patient should have gone to the Rapid admissions unit. I gave her right to my charge nurse, because I thought if I was going to have to spend one more minute on the line with her I was going to be the one who was unprofessional!!!! I hope things get better and we can make this work. I like being able to move patients.

Carolina thank you for your input as well. I have been on the other side of the tracks and remember what it was like getting admission upon admission with no end in sight! I'll admit it was not my cup of tea! It is very stressful to have long lists of meds to give, charting to do, rounds to do, Docs to call, and patient families to deal with. We do appreciate you and know that you also have emergencies to deal with. I know it is not easy up there, no speciality in nursing is!!!!!! I guess we just have to keep moving forward and try to change what we can and improve systems. Take the things that work with old systems and chuck what doesn't work.

I guess it all breaks down to good communication. It is the ER nurses job to ensure all infromation is there for the floor, and to try and accomadate and complete as much information and orders as we possibly can for the floor nurse. In turn respectful communication would be nice from the floors sometimes. I used to hate when the ER called too, but I always tried to be nice because I was not in there shoes and they were not in mine or the cause of most of the floor problems. As the floor is not the only cause of not moving patients in the ER. There are many factors that go in to it, as we have seen from the above posts. Let's just try and respect eachother.

Thanks to all who responded!! I will let you know if the faxing of report flys, or sinks.


P.S. It is frustrating when you get no help transferring patient, getting them on tele, changing pumps, etc.

Happy Holiday's

Y2KRN