Your Gettin a Patient - The Doors Open and In Rolls Your Pt. - page 3

How does this happen??? Pt. arrives is seen in ED @ 2100 as a trauma alert. Primary/secondary survey, orders entered in CAPOE, plain films, CT scans done, etc. I get a call from my AP (unit... Read More

  1. by   Miss Mab
    Unstable pt.'s in the ICU? Well I never....

    No offense taken, SADER. I was just pokin' fun 'cause you all got almost three whole pages of free ER bashing. Just wanted to share from my little perspective.

    Seriously, these are systemic problems. Floor transfer/pt. through-put are issues that need to be addressed constantly and consistently. My feeling is that patient placement/bed or house supervisor actually holds much of the responsibilty for the falling through the cracks in communication.

    My conspiracy theorist side leans toward believing this "breakdown" is indeed intentional and certainly often avoidable. Yeah, let's find even more imaginative ways to keep these little nurses fighting each other. Next we'll make ICU/ER units BSN only slots.....

    Oh, don't get me started!@ I have immense respect for all hospital RN's. Nobody has it easy. I thankfully managed to eek out a grand educational experience before I couldn't holds me tongue anymore amd finally stopped pretending that my former preceptor and other myriad crew were not, in fact, nuts!!! God bless 'em. Now I've got my wings back and couldn't be more thrilled. You kids watch your six!
    Last edit by Miss Mab on Oct 15, '07 : Reason: Z -11. Where am I??
  2. by   grace90
    Quote from Emmanuel Goldstein
    This poor guy was probably the saddest case I've ever seen. No intact skin, anywhere. Serous fluid pouring off of him. Called the primary in who transferred him to a burn unit (where he should have been in the first place) and he died soon after.
    TENS?
  3. by   elthia
    Quote from Miss Mab
    Unstable pt.'s in the ICU? Well I never....

    No offense taken, SADER. I was just pokin' fun 'cause you all got almost three whole pages of free ER bashing. Just wanted to share from my little perspective.

    Seriously, these are systemic problems. Floor transfer/pt. through-put are issues that need to be addressed constantly and consistently. My feeling is that patient placement/bed or house supervisor actually holds much of the responsibilty for the falling through the cracks in communication.

    My conspiracy theorist side leans toward believing this "breakdown" is indeed intentional and certainly often avoidable. Yeah, let's find even more imaginative ways to keep these little nurses fighting each other. Next we'll make ICU/ER units BSN only slots.....

    Oh, don't get me started!@ I have immense respect for all hospital RN's. Nobody has it easy. I thankfully managed to eek out a grand educational experience before I couldn't holds me tongue anymore amd finally stopped pretending that my former preceptor and other myriad crew were not, in fact, nuts!!! God bless 'em. Now I've got my wings back and couldn't be more thrilled. You kids watch your six!

    True, but when an acute care floor recieves an unstable pt from the ED, then those nurses have their hands tied, because many interventions and medications those unstable patients need are restricted from being given and performed on a regular med-surg floor. Been there and done that too many times too count. It was worse when I was a new RN and worked at a place that DID NOT have a rapid response team, now I have no problem on calling the RRT on a new admit and saying they arrived to the floor 5 minutes ago and I believe that they seem to be in distress.
  4. by   Miss Mab
    Quote from elthia
    True, but when an acute care floor recieves an unstable pt from the ED, then those nurses have their hands tied, because many interventions and medications those unstable patients need are restricted from being given and performed on a regular med-surg floor. Been there and done that too many times too count. It was worse when I was a new RN and worked at a place that DID NOT have a rapid response team, now I have no problem on calling the RRT on a new admit and saying they arrived to the floor 5 minutes ago and I believe that they seem to be in distress.

    Agreed.

    The only unstable pt. I've heard here was in the ICU. Maybe I missed it?

    Anyway, nobody's grass is greener....g'night
  5. by   UM Review RN
    Quote from Miss Mab
    OK, I'll play.

    Good catches on the floor, ya'all. It's crazy how we ER folk can have a doc see a patient, work them up, make a determination to where and what floor they are to be admitted after having been stabilized for hours in the ER, write orders for that floor and then thankfully you're able to see our combined foolishness and fix it. whew....

    Those Q1 hour neuros? Absolutely right only a unit could do that AND keep up with their other 4 or 5 pts. Well, except for those last six hours that they did downstairs.

    Mostly I'm grateful that so many are able to survive, night after night, the toxic gas that is released from the vents(I guess) that blinds and deafens everyone--clerk, cna's, rn's, etc. each time a 200 pound gurney with broken wheels goes aaallllllllllllllll the way from the entrance, past the desk, to the verrrrry last room--with a human being pushing it. Hear no evil--see no evil? Wish I had my invisibility superpower when I wasn't at work! My, what mishief I could do...

    Hmm..I guess I like being able to rapidly assess a pt. and know how to keep them stabilized while I work out a bedding issue and not freak out. In a hallway even! I am an ER nurse.........(job #2---I survived #1. Who knew how great nursing could actually be! ))

    I think that's your phone ringing.

    No one said anything bad about ER nurses. That was certainly not the point of the discussion. Bashing us floor nurses was rude and uncalled for.

    You might offer a solution of some kind the next time this problem is voiced.

    My solution would be to have the ER nurse fax Report and then actually verify receipt to the receiving nurse. Takes three seconds, cell phone to cell phone. If you can't get the floor nurse for some reason, verify it with the Charge nurse. Our system is that the ER admissions is supposed to verify by fax and then call anyone on the floor to verify receipt of the fax. Which doesn't cut it if no one tries to inform the receiving nurse.

    And why should we get in an uproar about knowing that we're getting a patient? Because people make mistakes. And patients crash and burn. One died in the elevator on the way to the floor. I've seen a few crash right after they got to the floor. So how are we going to Code the patient who isn't even on Tele yet and hasn't been seen?

    It's our patient. It's our license. We need to work together to solve the problem.
    Last edit by UM Review RN on Oct 16, '07
  6. by   TrudyRN
    I am troubled by the lighthearted, essentially willing-to-accept being treated in an unacceptable manner that I am sensing from these posts by those who are victims of this practice of incomplete or no report from ER's.

    Just a reminder - this will change only if you guys make it change. Also, you do NOT have a responsibility legally to a patient that you have not agreed to accept. And how can you agree to accept until you get a report?

    I know you don't want the patient, who is hearing all of this intra-personnel stuff, to be scared or feel he/she is a burden to you. But you have a license to protect.

    Make your bosses make this stuff stop. Couch it in terms of patient safety and lawsuit prevention for the employer, not in terms of your own license protection and well-being/fairness to you, as they don't care a hoot about you, only about their own $$$$$$.
  7. by   UM Review RN
    Trudy, are you suggesting that we write up occurrences (even when the patient was "safe") as incidents to Risk Management?

    (We already file an incident report when a patient needs to be transferred to a higher level of care.)
  8. by   EmmaG
    Quote from TrudyRN
    I am troubled by the lighthearted, essentially willing-to-accept being treated in an unacceptable manner that I am sensing from these posts by those who are victims of this practice of incomplete or no report from ER's.
    I can assure you we were not light-hearted and willing to accept this. We had a run of inappropriate admissions who ended up being transferred to ICU/PCU almost immediately after arriving to the floor. Where they should have been admitted in the first place. Our risk management department did get involved, and the situation did get better.

    As far as my experiences in my travel assignment, there was little I could do to effect change as I was only temporary staff. I did make it a point to call the ER once I knew I was receiving an admission, and asking to speak to the nurse caring for the patient. That made me some enemies, I'm sure. I was told off by a few, but I insisted on getting at least some semblance of a report. I didn't really care what they thought of me, or if I was viewed as 'rocking the boat'---it's my license, after all.
  9. by   CarVsTree
    Quote from Miss Mab
    OK, I'll play.

    Good catches on the floor, ya'all. It's crazy how we ER folk can have a doc see a patient, work them up, make a determination to where and what floor they are to be admitted after having been stabilized for hours in the ER, write orders for that floor and then thankfully you're able to see our combined foolishness and fix it. whew....
    What does this have to do with patients' arriving with no report/notice?

    Those Q1 hour neuros? Absolutely right only a unit could do that AND keep up with their other 4 or 5 pts. Well, except for those last six hours that they did downstairs.
    It is a policy in my hospital that patients' that require q1h VS& Neuro checks go to the unit and rightly so. I'm sure you were never late on a q1h neuro check in all your ED exp. Also, you have monitored beds which takes care of the vitals piece - we do NOT.

    Mostly I'm grateful that so many are able to survive, night after night, the toxic gas that is released from the vents(I guess) that blinds and deafens everyone--clerk, cna's, rn's, etc. each time a 200 pound gurney with broken wheels goes aaallllllllllllllll the way from the entrance, past the desk, to the verrrrry last room--with a human being pushing it. Hear no evil--see no evil? Wish I had my invisibility superpower when I wasn't at work! My, what mishief I could do...
    What are you talking about? Your sarcasm is misdirected. If you are referring to the post regarding walking into the room and finding the patient there, how do you know that the patient past the entrance, desk, and went to the very last room. Could have entered the first room. BTW, we don't have a "desk" at the entrance to our units. Many units don't have a desk. And even if it were there, who exactly would be sitting at it, the unit receptionist?

    Please, if you have nothing constructive to add, like why patients are sent up with nor report/no courtesy call, than please refrain from replying.
    Last edit by CarVsTree on Oct 16, '07
  10. by   teeituptom
    Quote from suemom2kay
    How does this happen???

    Pt. arrives is seen in ED @ 2100 as a trauma alert. Primary/secondary survey, orders entered in CAPOE, plain films, CT scans done, etc.

    I get a call from my AP (unit clerk) @ 0230, "you're getting a pt., report's in the computer." I knew there was no bed in the room, as I walk out into hall to get the bed to bring it to 17A, the doors open up and in rolls the pt. Fortunately, the pt. was A&O and could tell me his injuries. I stood there and read report in front of patient.

    We won't even begin to talk about the crazy orders the first year put in... But in his defense, he was just hired a few days before to replace a first year that quit.

    I don't mind short notice but how about 5 minutes... Hmmmm.... How 'bout 2 minutes.... 10 seconds just don't cut it.
    you get them when they have been satblizied

    we routinely get traumas with just a minutes warning and just blink an eye.

    the floor and the ER look at things diffferently.
  11. by   deeDawntee
    Quote from Miss Mab
    Unstable pt.'s in the ICU? Well I never....
    Where did I say that my patient wasn't unstable? If you would read my whole post you would see that I said "stabilized". My post referred to a pt in septic shock who was sent to me without central access or the pressors that were obviously needed. They "masked" the whole issue...
    that was my point. And I also learned what to ask when "accepting" a patient...since I don't have MD's on the floor like they do in the ED, it is much harder to get things done that Docs have to do in person (like central access). That was my point....
  12. by   SarasotaRN2b
    Quote from Tweety
    I hate when that happens. It happens to us too. Usually, I assign the patient and two seconds later the ER or admitting is one the phone...."um, can't I tell the nurse first?".
    Hi Tweety, this is definitely one of my pet peeves as a unit secretary. Another is when we are beeped that we will get a patient maybe midway during the shift...they don't call report until shift change or the patient rolls in at shift change. The ER is one of the departments that have rotating hours...i.e. not everyone starts at 7a or 7p. Why can't they just wait until 8? Just basic courtesy...

    Kris
  13. by   UM Review RN
    Quote from teeituptom

    the floor and the ER look at things diffferently.
    That is why you have different staffing levels, a doc on the unit, stat preference for all tests, proximity to Radiology, transporters, an entirely difffernt Pyxis system in which you do not have to wait for a Tylenol to be profiled before pulling it.

    The ER has EMTALA to guide your triage function. Your patient, triage nurse or EMS gives you "report." On the floors, we have something called "continuity of care" and we have no less need to know what has already been done for the patient.

    We are certainly not "less than ER" nurses because we are not ER nurses, we too have protocols to follow and a different skill set.

    One of them is that we are to get Report before each patient gets to the floor. Our complaint is that we are not getting Report or that we get insufficient Report or that the patients are coming before we even have the room cleaned.

    In some cases, the patients may have been stablized and became UNstable on the way to the floor.

    You need to stop making this about nurse vs nurse and understand that just like a person doesn't walk in off the street into a Trauma room, we should not be getting patients who have been treated by the ER without getting some form of Report.
    Last edit by UM Review RN on Oct 16, '07

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