Flamed during report.

P.S.
One thing that has seemed to help, is our NM met w/the floor NMs & supervisors about expediting transfers, and now the supervisors are to be called if the floor nurse is not able to accept a patient- this has made a HUGE difference & cut way down on our "hold" times in PACU; and amazingly the supervisors hardly ever have to get involved.

I work in an OB unit which has its own OR and Pacu. We always had to hold our pts until postpartum was ready whether it was vag deliveries or postops. I was once reported by the postpartum unit when I brought them a post op at 0100, who had been discharged from PACU at 2230. The bed was clean but they had to give shift report and then the night shift needed to finish rounds.. The pt was uncomfortable on the stretcher, she was large and edematous and actually had deep grooves in her arms and legs from the stretcher rails. I was reprimanded despite the fact that another labor nurse and I completely settled the pt in to her bed before even getting the postpartum nurses..and we had given them one of our staff nurses to assist them for the entire shift!! So I know where you're coming from. Also, I would work 12 hour days without a meal or break, have a pt deliver at 1700, then the charge nurse would tell me I needed to get her transferred before leaving, I would transfer at 1830..then be made to start a new admission or cover someone else for a meal! And the postpartum nurse would give me grief.
On our high risk unit we sometimes get med-surg overflow. One problem with this is that the admissions office will not always have all the facts so they will assign us pts which are not appropriate for us, or that we need to change rooms around to accomadate. (We don't do telemetry or have experience in chemo or triple lumen caths or stuff like that...just like med surg doesn't know how to do fetal monitoring) Its not appropriate to double a room with a postpartum patient who has a newborn in the room and someone with a contagious disease. Putting a pt who just had a VIP in with a preterm labor pt doesn't work. Sometimes it takes more than 10 minutes to figure stuff out..so please be patient. And when we tell you that this pt is not something that can be sent to our unit, we're not just trying to get out of work. The patient needs to be somewhere else..for their own good! I admit I haven't done med surg in 15 years...and they didn't give us any refreshers when they decided to start dumping this stuff on us.
And also, please don't send us pts who are screaming in pain, and who the transport person confirms was doing this when she was picked up in PACU. I realize that sometimes this happens because of the transport movement or because the last med wore off..but I'm not stupid. And now, I have a pt in pain who is PO'd along with her family member and only has oral pain meds ordered for me, while the PACU had IV stuff on their orders but hadn't given anything.

As a surg floor nurse, I truly try to understand the pressures the PACU nurses are under and be ready for PACU admits. but please, a few thoughts from our side...

1. If you call and say you're bringing a patient up in 10 minutes, please bring that patient up in 10 minutes. If something has delayed you, please let me know so that I can grab a quick lunch, do a procedure with one of my other patients, or do one of the many other low-priority things that I've put on hold while awaiting a PACU pt. Can't tell you how many times 10 minutes has turned into 45 minutes or an hour or more.

2. When you give report, we really don't need to know how many mics of fentanyl the pt rec'd and when he rec'd it. If it's something we can't give on the floor, we honestly don't care...and it takes forever to wade through that to get to the part that we DO need to know (we tape report here, so prob not as applicable for face-to-face reports).

3. Please premedicate the pt as much as possible for pain/nausea; even if the pt hasn't had much of either in the PACU. More often than not, the transport will make even the most comfy pt hurt/nauseous, and when they get to the floor, we have to wait 15-20 minutes or more for pharmacy to get the floor orders and get them into the system.

4. Do understand that it's difficult to provide a safe transfer of care at shift change and/or when we get multiple admits at once. We want (and are required) to be in the room when a post-op arrives, and we can't if we're still getting report on our other 5-6 patients. Even the most stable patients can take a bad turn after transport, and we need to be able to give them our full attention when they arrive.

As someone else said, we're all on the same team. Now let us floor nurses know what else we can do to help make your lives easier....

You just have to have tough skin and realize that every nurse doesn't hate you, but you're still going to have to insist they take report and take the patient, end of discussion.

I'm a busy med-surg nurse and there isn't a convenient time for a post op patient, but I know it's not their fault and I try not to take out my frustrations on the PACU.

I am very interested to know why you do not feel it is important to know how much or when we last administered a very potent narcotic pain medication

Because to be honest it doesn't matter much once he gets to the floor, especially when time is of the essence. When you call and say you're bringing a patient up and I have less than a minute b/w my other patients' demands to listen to report so that I can be in the room to greet you (as required by our dept), I become selective in what I need to know. It's a given that the pt has rec'd some potent narcs in the OR/PACU, and my assessment will tell me if he's rec'd too much. If he starts zoning out, I'm going to give narcan and take away the PCA button no matter when/how much fentanyl he's received (especially since some can receive enough to knock out a horse and still be A&O while others may have rec'd a tiny dose hours ago and still be barely coherent -- it's how they're recovering that I'm concerned about, not how much med put them in that position). I'd much rather know when the pt's preop antibiotic was given so I can make sure pharmacy times the next dose appropriately; when the pt last rec'd antiemetics or pain meds that I can give on the floor so I know when I can give him another dose; whether his VS are stable; whether he has any drains or such; if he's coming up in a bed or stretcher and whether he has a need for any suction equipment, etc, so I can get the room ready; and so on. This is all stuff, BTW, that has been left out of some reports I've received in lieu of a blow-by-blow rundown of all the anesthesia meds given intraop...

I hope this makes sense...it's not that I don't think it's important, it's just that there are certain assumptions I can make in any post-op patient, and in the interest of time, I just need an edited report...

ER has the same problem with transferring patients. I was med-surg before ER so I seriously sympathize with the floor nurses, but when I'm up to my neck in patients and an empty stretcher hasn't had time to cool off before the next patient hits it, moving a patient upstairs is paramount.

That said, I can't STAND calling report on a patient at 0625. So many of the floor nurses are simply awesome about it. I had one nurse, who's always simply GREAT, who was really frazzled one morning, but my charge was cracking the whip for me to call report. I called at 0620 and she asked if she could call me back in a few minutes. Sure, I said. I know this nurse, she's always great, so I knew she'd call back. When my charge asked if I'd called report, I had to tell the truth, she'll call me back. What did I get? "Sure, you think so don't you? She HAS to take report!" One the phone she went, hollaring to the floor charge about how her nurse "wouldnt' take report". It got rather hot. So of COURSE, my charge just HAD to call the supervisor to "make" that nurse take report. So then I get a call from said nurse, to get report, and I felt SO BAD, I apologized. This charge of mine isn't an official charge, just a fill in charge, and she really really got in the way of the decent relationship I have with this other nurse. For pete's sake, I KNEW she'd call back and the patient wasn't gonna go up until after shift change anyway. I started my report with "there is NOTHING immediately pending on this patient", just so she'd breathe a little easier. To the charges like this out there - your nurses know the nurses they have to give report to. If I tell you she'll call me back, it's cause I KNOW she will. Give it a rest.

Btw- does anyone else have a problem with calling report very close to shift change, knowing that the patient isn't going up until AFTER shift change, so that the nurse you gave report to is going to have to pass it on to the next nurse, and the nurse replacing you, who will be sending the patient, knows next to nothing about the patient?

Bless the floor nurses - that's all I can say.

I don't work PACU (I work in day surgery and ED) but I do work closely with PACU nurses. That said:

1. If a pt in PACU goes sour and that holds up the PACU nurse getting another pt to you, don't expect the PACU to take the time to call you to let you know there will be a delay. When a pt is going sour, the last thing on PACU's mind is whether the floor nurse will be inconvenienced by the delay.

2. You had better care about what meds were given in PACU, since they could directly affect your pt's recovery. This boggles my mind that someone would not care what meds were given. What would you say if the pt coded and the doc asked you what the pt had in PACU? "I don't know" isn't exactly a response that's going to make you look that great, let alone help your pt.

3. If the pt is pain free/not nauseated, it's pretty difficult to justify giving strong IV meds. How do you explain that: "The pt had a 0/10 pain rating, but I gave him 25mcg of fentanyl because the floor nurse wanted me to"? I've gotten plenty of post-op pts who didn't require meds in PACU. It never even crossed my mind to demand the pt be medicated prior to transfer. I trust the judgement of my PACU colleagues; if in their best assessment they feel the pt doesn't require medication, then I trust their decision. If worst comes to worst and the pt is in pain or nauseated, it doesn't take me that long to get the med out of the Accu-Dose.

4. PACU pts are constantly coming in and leaving the dept. It is unrealistic to expect PACU to hold pts. til it is convenient for the floor. PACU can't ask the OR to delay the pt coming out of the OR to them; they have to be ready to take the pt right away. If PACU is holding pts for the floor's convenience, that means that nurse isn't available for the post-op pt.

I can guarantee you that PACU nurses are not just sitting down there filing their nails and reading magazines all day long. Yes, we all need to work together and try accommodate one another, but some of these requests are unrealistic and flat out unsafe.

It's totally acceptable for you to vent your frustration about floor nurses complaining about you slamming them with patients. The way I see it, we're all in the same boat. We'll all have our chance to be in their shoes, where we'd be slammed with work and we'd probably complain about being slammed with work and we'd probably complain to the wrong person, too.
So, I hear you my dear. I hear you.

Sometimes I think you just have to have thick skin. Face it, no one wants report on a new patient... EVER. They truly are always swamped. It's not your fault, it's just a fact of life, try not to take it personally.

On the whole shift change thing... floor nurses are trying to wrap up their day or start their day at shift time. But, it seems like shift time is not just the 1/2 half of report, it is the hour before shift change, when the previous shift is wrapping up, and the hour after report, when the new shift is seeing their patients. At my hospital, floors do 12s and 8s. Which means shift time is at 7am, 11am, 3pm, 7pm, 11pm, etc. If you included the hour before and the hour after you'd never get a patient up to the floor. There is nothing worse than hearing at 6:25 "can you hold him till the next shift?" - b/c there is no way the next shift will take report until AT LEAST 7:30 at the earliest.

We give the floors a heads-up when the patients hit PACU and they still complain when we call. It seems like that should be plenty of time to prioritize and get ready, but it never seems like it is. When I worked CV-ICU we got a 3 minute warning. And if I wasn't in the room when the patient came up I would have been written up.

Most importantly...
It's not just about our next patients coming and being swamped, it's about what's best for the patient. It's important for them to be able to see their families, get in a more comfortable bed and off of the stretcher, and there is a significant cost associated with holding patients in recovery. When people try delaying tactics, just put the needs of the patients first. Most floor nurses will come around when you put it in that light, instead of just how busy you are in PACU (they don't care, they're swamped too).