Why don't you just read the chart?

MunoRN, RN · Jul 1, 2015

Even when floor nurses have access to the EMR used in the ED, charting on a patient they are receiving often isn't available to them while the patient is still in the ED, and when it is available I don't think many ED nurses realize how useless their charting becomes after the ED EMR has it's way with it. Just in general though, I don't see giving report as being a nuisance, it's a core part of my job and my responsibility to the patient. If I'm going to spend my time and energy working on a patient I'm certainly going to make sure the next nurse has a good understanding of what's been done, otherwise it makes most of what I do pointless.

Patient history, labs, etc usually are available to the receiving nurse, so when they ask "what were all their labs" I explain to them where that can be found in their charting system. Anything notable I'll point out in report (their K was 7 on arrival, now 5.3), but no, I'm not going to look up and tell you what exactly their H&H was, "normal range" is all that matters in report.

One of my biggest pet peaves is "where is there peripheral IV in their arm"? I have serious concerns about a nurse's basic thinking process when they consider that to be a relevant question on report. It's the brightly colored thing taped to their arm.

psu_213, BSN, RN · Jul 1, 2015

"he won't be coming on your time but can I give report now?"

This is a tricky one. Shift change in the ED is the same time as on a floor/ICU. Beds seem to magically appear at change of shift, which is frustrating for both sides. So at 1835 a bed is assigned. Either (a) you have the ED nurse who took care of the patient for 2 hours, and (hopefully) knows that patient fairly well--not to the level a nurse who has the pt. for 12 hours would know that patient, but "well" by ED standard--gives report to a floor/ICU nurse who is leaving at 1930, likely before the pt. will arrive. Or (b), the new ED nurse who started at 1900, who knows very little about the patient will give report to the fresh floor/ICU nurse who will have the pt. for 12 hours. Obviously, both options have their ups and downs.

The ideal would be for the off going ED nurse stays a bit late to give report, however, that is not always feasible, is not really fair to that nurse, and will definitely not be allowed by those who watch the budget.

OneDuckyRN · Jul 1, 2015

It's probably been said more than once, but I wanted to get my thoughts out while I still know what I want to say on this topic.

Sure, I've read the chart if you give me more than 5 seconds between the admit being paged, and you calling to see if I've looked at the chart.

I've also read what precious little has been charted there. Half the time, the ER has put in a Foley and not charted it. I've seen more IV's started and not charted. So...is that a field start I need to take out and re-start? Or did you start that in the ER? Also, I can't get a good picture of what's going on with this patient if the physician/practitioner hasn't actually written a note. 3/4 of the time at my facility, that hasn't happened yet. And yes, I see that you put in 7 nursing notes about this chart. "Pt transported to CT." "Pt returned from CT." "Up to commode." Those are not as helpful as you might think. I need an idea of WHY this pt is here. It's also helpful to know WHY meds were given. You gave 80 of Lasix? Great! Why? If there aren't any notes for me to read, I can only make an educated guess.

So yeah, when the charting is not great, I'm probably going to ask you a few questions. Please don't bite my head off. I really want to do the best I can for this patient, but if I don't know anything about them ahead of time, it's hard for me to know what to have at the bedside, and what other things I might expect over the course of a shift. See, that's the difference between ER nursing and inpatient nursing. We're pretty much stuck with our patients for the whole shift. You get them for a little while and either send them home, or send them to me.

I realize the tone of this might not come across very well, and that's not the way I intend it. ER nurses work very hard at what they do, and they're very busy. I get that. I'm busy too. But what really cheeses me off is when I'm expected to read minds. Or non-existent charting.

psu_213, BSN, RN · Jul 1, 2015

I would like to extend your proposal to the report that happens on the "front end" of the ER patient transfer - the one that happens between EMS and the ER. Why should EMS be wasting everyone's time calling ahead?

I would love to get a fax (rather than a sketchy voice "report" from EMS detailing what meds/interventions have been given/done. Most of our reports on arrests are called in by local EMS command, not the actual medics on the scene. Anymore report is "medics are bringing in an arrest. They don't have a pulse back yet. That is all they told me." (If they do pass on what meds were given, what airway is in place, etc. it is often quite inaccurate)

applewhitern, BSN, RN · Jul 1, 2015

We would have to go into the patient's room and log on to a computer, which takes forever. All of our computers are at bedside; we have none at the nurse's desk.

vanilla bean · Jul 1, 2015

I would love to get a fax (rather than a sketchy voice "report" from EMS detailing what meds/interventions have been given/done. Most of our reports on arrests are called in by local EMS command, not the actual medics on the scene. Anymore report is "medics are bringing in an arrest. They don't have a pulse back yet. That is all they told me." (If they do pass on what meds were given, what airway is in place, etc. it is often quite inaccurate)

You don't need to know what's coming. You can just read the trip sheet/paperwork when EMS rolls through the doors with your new patient. OP didn't say what, if any, info should be provided prior to the actual patient transfer. So, you're already ahead of the game knowing it's an arrest that is still pulseless before they arrive! :up:

ArmaniX, MSN, APRN · Jul 2, 2015

I will say when getting report from ED or the floors I've made it a great habit of mine to simply let them have their speech and not interrupt them. Half the time I get told useless information. I don't ask the nurse 500 questions. If something I feel is missing sure I will ask. Otherwise it has always been easier in my opinion to just give me the patient and let me figure the details as I go.

I once overheard another nurse getting report from the ED ask them how the patients bottom looked. That to me is pointless. I imagine as an ED nurse you don't give two cents what the bottom looks like unless their reasoning for coming to the hospital is sepsis r/t the wounds.

I truly try not to give other nurses a hard time. Tell me the best of what you know and I'll piece it together later. It only adds frustration to you and myself to try and get the tiny details or "educate" you. Egos should be left in the parking lot.

psu_213, BSN, RN · Jul 2, 2015

I once overheard another nurse getting report from the ED ask them how the patients bottom looked. That to me is pointless. I imagine as an ED nurse you don't give two cents what the bottom looks like unless their reasoning for coming to the hospital is sepsis r/t the wounds.

That's another one that gets me. Me: "Patient is A&Ox3." Other nurse: "Is she a walkie talkie?" Me: "Yes." Other nurse: "Do they have any breakdown on their bottom?" I want to say "well, when they get up to walk to the bathroom you can look for yourself."

psu_213, BSN, RN · Jul 2, 2015

You don't need to know what's coming. You can just read the trip sheet/paperwork when EMS rolls through the doors with your new patient. OP didn't say what, if any, info should be provided prior to the actual patient transfer. So, you're already ahead of the game knowing it's an arrest that is still pulseless before they arrive!

I realize I can't speak for every facility, but in my hospital, the floor gets paged, well in advance of the pt going up stairs, of the pt name, MRN and admitting dx. Anyone on the floor (RN, charge nurse, secretary, PCT, etc) can go to the EHR and print out nurses notes, eMAR, labs, rad reports, etc. So even though the assigned nurse may not have the time to look at the ED charting (which I totally understand), someone can still print the pertinent areas of the chart. Again, I know this is not how it works everywhere, but in my facility there is way more available to any floor than what is available to ED on an EMS arrival. (Plus the nurse still calls report to floor.)

When you get report from EMS command and they tell you, pt intubated with a pulse, and they arrive with neither an ET tube or a pulse, yes, we are ready for anything, but plan goes down the toilet.

canigraduate · Jul 2, 2015

I am currently working in OBS and I get crappy ED report. It's so bad, I don't even bother half the time. It does save time to look stuff up because the ER nurse is reporting on stuff that isn't relevant to my unit and is not reporting the stuff I actually need to know.

I often get the notification that I have a new patient coming and a call from the ER at the same time. "Have you had the chance to look them up? Do you have any questions?" No. Yes, but it is pointless for me to ask them because you don't know the answers.

I always ask about the IV, because a lot of the time the ER nurse will reinforce/replace the dressing and I don't know it's a field stick, which has to be replaced. Not as big a deal on OBS, since they usually leave before 24 hours are up, but it was a big deal on the Med Surg and critical care units. Also, some of the chest pain tests require an 18 gauge or larger, so I can stock the room and get that sucker started before they are wheeled out to CT or to a stress test if I know ahead of time.

Quite a few of the places I worked had ER EMRs that didn't communicate with the floor EMR, so verbal report was a must in those situations.

FlyingScot, RN · Jul 2, 2015

I need report from you because at my hospital, about 90% of the time we get patients when the ED nurses are about to leave their shift. They like to hold onto the patients so they don't get more.

This is a total myth. Ask any ED nurse anywhere and you will find that we are pushed to get the patient out ASAP. We don't control when beds get assigned and for some reason it always seems like we get them at the end of the shift then we have 15 minutes to move the patient or we have some explaining to do. Holding patients just means we get hall patients added to our assignment and nobody likes hall patients.

How would you like it if I said that floor nurses don't call housekeeping to clean their rooms after discharge so they don't have to get new admits and that's why 90% of the time when I call report I get told the room is dirty?

FlyingScot, RN · Jul 2, 2015

In a sad way, aren't the ED nurses time "more valuable" to TPTB than a floor nurse (like me) since it generates $$ for the hospital in a different way than the floors do?.

Nope. EDs are money losers for the hospitals that's why many are closing theirs. The money maker is surgery.