Your Gettin a Patient - The Doors Open and In Rolls Your Pt. - page 4

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   scattycarrot
    Ok, I am a bit confused here. In the uk we transport our own patients from ED to wherever it is they are going and then give report to the nurse on the new unit. Do you not do that in the US? Or am I reading this wrong!
  2. by   UM Review RN
    Quote from scattycarrot
    Ok, I am a bit confused here. In the uk we transport our own patients from ED to wherever it is they are going and then give report to the nurse on the new unit. Do you not do that in the US? Or am I reading this wrong!
    It's done differently here. On our floor, the ER will fax up a report on the patient, verify it with a telephone call (usually to the unit secretary) who is then supposed to notify us that report has arrived.

    Our Charge nurse is supposed to have told us that we are getting a patient before that happens so that we can have the room ready.

    Sometimes both the Charge nurse and the unit secretary fail to inform the receiving nurse of the pending admission. Therein is the problem and the floor nurse may have just discharged three or four patients and might be in the process of admitting a Direct Admit when a patient suddenly appears out of nowhere and someone says, "Oh, by the way Angie, that's your patient."

    Normally I don't care, I can pick up the ball and run with it. But when I've just come on shift and it's chaos, with patients coming and going on stretchers to various tests, and others being discharged and admitted, and I don't know who's who, and suddenly a crashing patient appears on the scene....

    well, you get the picture.

    Instead of arguing about who has the faster reflexes, we should be helping one another resolve these problems, is all I'm trying to say.
  3. by   nuangel1
    Quote from Angie O'Plasty, RN
    It's done differently here. On our floor, the ER will fax up a report on the patient, verify it with a telephone call (usually to the unit secretary) who is then supposed to notify us that report has arrived.

    Our Charge nurse is supposed to have told us that we are getting a patient before that happens so that we can have the room ready.

    Sometimes both the Charge nurse and the unit secretary fail to inform the receiving nurse of the pending admission. Therein is the problem and the floor nurse may have just discharged three or four patients and might be in the process of admitting a Direct Admit when a patient suddenly appears out of nowhere and someone says, "Oh, by the way Angie, that's your patient."

    Normally I don't care, I can pick up the ball and run with it. But when I've just come on shift and it's chaos, with patients coming and going on stretchers to various tests, and others being discharged and admitted, and I don't know who's who, and suddenly a crashing patient appears on the scene....

    well, you get the picture.

    Instead of arguing about who has the faster reflexes, we should be helping one another resolve these problems, is all I'm trying to say.
    well in the case as you describe above that is the charge nurse and or unit secretaries fault for not telling you about the pt sooner.it is certainly NOT the ers fault.
  4. by   scattycarrot
    Thanks for clearing that up. I can understand the frustration of the floor nurses at not recieving report on a newly arrived patient or turning up unannounced. In the ER we are used to patients rocking up sick as dogs with no notice but its different. The ED is set up for exactly that sort of thing and we are used to working with limited information, whereas on the floors, its an intrusion into an already busy scene (and I don't mean that disrespectivily towards the patient) and floor nurses expect a report and expect time to prepare,as its the way it is supposed to be done. However, this understanding goes both ways and I myself have dropped onto a unit 'unexpectantly' 5/10 minutes early because it was a case of getting the patient out of the ER as quickly as possible because of pressures on the department at that time. Now, I appreciate that each unit has its own pressures but transferring a stable patient to make room for a trauma or a code, makes sense to us in the ED. Unfortantly, that means other units get the shortend of the stick sometimes.
    What I still don't get is who transfers the patients to the floor? Is it orderlys? What if the patient goes off on the way?Just curious!
  5. by   EmmaG
    Quote from scattycarrot
    What I still don't get is who transfers the patients to the floor? Is it orderlys? What if the patient goes off on the way?Just curious!
    In my hospital, we had phone report instead of faxes. The patient wasn't transported until the report was done. They were brought by the ER techs. When transported to ICU/PCU, they were accompanied by an RN.
  6. by   Altra
    Quote from SarasotaRN2b
    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...
    Because it's not very courteous to keep a bed occupied when there are 25 people in the waiting room who are waiting for it, not to mention that 55 year old male coming through the door with active chest pain & a crappy heart rhythm right about now ...
  7. by   EmmaG
    Quote from MLOS
    Because it's not very courteous to keep a bed occupied when there are 25 people in the waiting room who are waiting for it, not to mention that 55 year old male coming through the door with active chest pain & a crappy heart rhythm right about now ...
    I agree. Which is why I wonder why I have to wait hours after being told I'm getting an ER admit... only to have them show up at shift change. (I certainly can't speak for anyone else, but one of my co-workers transferred to our ER and confirmed that many of the nurses there wait til the end of their shift to send patients out to the floor...)
  8. by   Miss Mab
    Quote from Emmanuel Goldstein
    I agree. Which is why I wonder why I have to wait hours after being told I'm getting an ER admit... only to have them show up at shift change. (I certainly can't speak for anyone else, but one of my co-workers transferred to our ER and confirmed that many of the nurses there wait til the end of their shift to send patients out to the floor...)

    I think this issue has been discussed ad nauseum.

    You are waiting forever and a day for the admitting/holding doc to actually write the orders---otherwise they will go with no orders and I've learned here that floors really don't like that.

    Some pt.'s come in, everybody and their mother knows they will be admitted---pt. placement is aware of it early(like syncope w/injury,etc.)but they still need to wait on CT/maybe repeat enzymes, who knows? I was under the mistaken impression that was a courtesy to the floor because that way you're not getting an additional pt. while you wait. It does suck at shift change, though. Talk to the one writing orders.

    Finally, a very few lazy nurses DO try to sit on their pt.'s. It's generally not tolerated and I can assure you that ISNT the big problem.

    Sorry if some were offended by my tone. I was just making light of an age old issue and yeah, people were making it an 'us against them' thing before I walked in. I have offered suggestions. It is being set up for us to be at odds each other when all we each really care about is the pt.'s safety. Look to the admin. and process changes and quit taking it. They don't care that this issue drives both sides nuts. It's not a 9-5 problem is it?
    Last edit by Miss Mab on Oct 16, '07
  9. by   EmmaG
    Quote from Miss Mab

    Finally, a very few lazy nurses DO try to sit on their pt.'s. It's generally not tolerated and I can assure you that ISNT the big problem.
    Like I said, I can only vouch for what my friend told me of her experience in one ER, however after working in a number of hospitals since I started traveling, I suspect it isn't as rare an occurrence as some would think.
  10. by   scattycarrot
    Quote from Emmanuel Goldstein
    I agree. Which is why I wonder why I have to wait hours after being told I'm getting an ER admit... only to have them show up at shift change. (I certainly can't speak for anyone else, but one of my co-workers transferred to our ER and confirmed that many of the nurses there wait til the end of their shift to send patients out to the floor...)

    Unfortantly, there are bad apples in every department. That doesn't mean that every ER nurse is the same or that every floor nurse is the same. I have worked with good and bad(e.g, lazy, unmotivated, unsafe) floor nurses who swing through ER sometimes but I wouldn't want to label them on someone elses experience of one hospital ( I appreciate that you were talking from your own experience, which is valid, its just unfortunate that this is turning into an ER nurse vs floor nurse discussion).
  11. by   Altra
    Quote from Emmanuel Goldstein
    Like I said, I can only vouch for what my friend told me of her experience in one ER, however after working in a number of hospitals since I started traveling, I suspect it isn't as rare an occurrence as some would think.
    I know you're speaking from your experience and your friend's ... but to me you may as well as be describing life on Mars ... I have absolutely no frame of reference to imagine what you're describing. I guess somewhere in the universe there are hospitals that don't look at ER wait/throughput times and where charge nurses are not "charged" with moving the mass of humanity that flows through the ER everyday as quickly as possible just to keep everyone's head above water and prevent occurrences such as waiting room deaths.

    Today I took a patient to the unit while a tech took another of my patients admitted to telemetry to the floor. By the time I came back to the ER we didn't even have to put the stretchers back in the rooms -- I had 2 new patients in their place. This is the rule, not the exception.
  12. by   caroladybelle
    Quote from scattycarrot
    Ok, I am a bit confused here. In the uk we transport our own patients from ED to wherever it is they are going and then give report to the nurse on the new unit. Do you not do that in the US? Or am I reading this wrong!
    In the USA, things are a bit different......

    On the floors, the nursing supervisor has low censused several nurses or floated nurses to the point that each floor has the minimum number of possible nurses to handle the maximum number of patients apiece. That do this by assessing the census sheets, and the patients' admitting diagnosis.

    (the admitting diagnosis often has little to do with actual extent of work that the patient actual requires nor the actual treatment the patient needs. For example, an 80 year old violent dementia patient, in renal failure requiring peritoneal dialysis every 6 hours, and positive for weeping shingles and TB....the MD admits the patient as "Prostate Cancer" to a two person room, despite the fact that he is not being treated for it, it is not the cause of the current issues, nor is the Oncology unit this place to actual treat this pt, as no one there can do peritoneal dialysis, infectious patients do not belong there unless absolutely essential, and you shouldn't place a pt a semiprivate room with TB.)

    The admission clerk will see that they need to admit the "prostate ca" patient and place them in an oncology semi-private.....despite the fact that there is only one empty bed, and 4 scheduled admissions for chemo in the AM. And no possible DCs. This means that the main person placing patients is often ignorant of the "whole picture", and even if they did, have little medical knowledge with which to make proper placements.

    The Admit clerk notifies the nursing supervisor who alerts the charge who alerts the nurse.

    Meantime the ER nurse faxes the report/calls report, often before the floor nurse is not even notified. And then gets annoyed, when they ask the patient's name, etc. or if the nurse is not IMMEDIATELY available.

    Often the the staff nurse does get report and notes that this as problem. If s/he is lucky they catch any problems before the pt arrives. Sometimes, s/he is not lucky. Examples: The "lung cancer" pt that was sent up, had severe dementia, 8 stage 3/4 decubes, and a shortened, externally rotated rt leg and no pulse in it. Of course, the hip/leg had been xrayed and consulted on, none of which was on the written report. And as the report the patient as up "ad lib" to the BR, well, so much for assessment. I can also cite a cancer patient (and hospital employee) sent up to floor on 3 separate occasions, soiled and soaked, the final insult - the ER "accessed" the pass port by sticking a regular needle in it to draw blood.....leaving a lovely 18 gauge open hole in the port, that patient was bleeding out of.....they dressed the site with a pressure dressing and kept reinforcing it. I received the patient at shift change, completely soiled and with 4 bloody ABDs wrapped on her arm. She promptly to get FFP because of bleeding out of the passport.

    There are numerous cases of ER error.....just as there are numerous floor errors and numerous ICU errors.

    On another wellknown thread here, where ER nurses were vented, I defended their right to vent, against those that felt that should not be allowed to, that they were "not very nice/good nurses".

    Floor nurses deserve the right to vent, also.

    Anyway, since ER nurses rarely deliver patients to the floor, and often don't even have to talk to us.....this issues foster animosity on both sides at each other, instead of the real enemies...the supervisors/budget crunchers that deliberately leave us short, management that has a nonmedical person making placement decisions instead of someone qualified, MDs that do not put the real admission data down, because they want to turf a pt and wait to the end of their shifts to do so (much of the problem with shift change admits is the ER MDs "clearing the Board".
  13. by   CarVsTree
    Obviously, we can all site instances in both the ER and the floors of nurses that just don't care or are incompetent.

    ER nurses I empathize with you the best I can (never having worked ER) to the pressures that you have to move patients. My original post has to do with patients arriving on the floor with little or no notice.

    In my hospital phone report is not required with the exception of trauma alerts. All the ER RN has to do is chart on their patient and a report is automatically generated that I can access. It is however the responsibility of the ER RN to give a courtesy call that the patient is on the way. My problem was that I was never told I was getting a patient and the courtesy call came as the patient was rolling in. In this case, what was the point of the courtesy call? Why was I not called at the same time transport was called? Or as the transporter that was standing around waiting for my patient (not likely!) in the ER walked off with the litter.

    Not the ER's fault that I was never told I was getting a patient. Perhaps the ER nurse told someone at the desk to call the floor re: my patient being transported. My point isn't the ER is tyring to ruin my night and the point isn't well we get patient's in a moment's notice and we do just fine. Different areas, different staffing, different roles.

    Point is, our patients deserve to have a floor nurse that is aware and prepared for their arrival. Point of post was that it's not great for the patient, not great for the RN receiving, but it is dealt with. I'm sure there are ways to make it better.

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