Flamed during report.

natsfanrn · Feb 26, 2007

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....

Tweety, BSN, RN · Feb 26, 2007

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.

kyti · Feb 27, 2007

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).

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:confused:

natsfanrn · Feb 27, 2007

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...

EmerNurse, BSN, RN · Feb 28, 2007

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.

PANurseRN1 · Feb 28, 2007

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....

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.

tazski12 · Mar 4, 2007

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.

Laurel RN · Mar 17, 2007

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).

ali anesthesia · Mar 17, 2007

Another perspective--I have problems with PACU nurses not wanting to take the patients from the OR. They are always understaffed and busy or want the patient street ready when they get them. If you don't like to work in the PACU, find another place to work.

Anesthesia a stressful enough in a busy hospital where short turnovers are expected. Then having to deal with delays because of PACU issues just does not make sense. Our chief CRNA solved this problem with PACU supervisor, when she said the PACU budget would be charged for the extra OR time.

I understand your issues, I used to work in PACU, but having been in anesthesia gives me a whole new perspective. The patients deserve the best care--I give it to them in the OR, so it is not unreasonable to expect it in PACU.

Ali CRNA

BBFRN, BSN, PhD · Mar 17, 2007

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).

Not true for everybody. I always want to know if/when Fentanyl, MSO4, Versed, etc. was given.

Laurel RN · Mar 17, 2007

Another perspective--I have problems with PACU nurses not wanting to take the patients from the OR. They are always understaffed and busy or want the patient street ready when they get them. If you don't like to work in the PACU, find another place to work.
Anesthesia a stressful enough in a busy hospital where short turnovers are expected. Then having to deal with delays because of PACU issues just does not make sense. Our chief CRNA solved this problem with PACU supervisor, when she said the PACU budget would be charged for the extra OR time.
I understand your issues, I used to work in PACU, but having been in anesthesia gives me a whole new perspective. The patients deserve the best care--I give it to them in the OR, so it is not unreasonable to expect it in PACU.
Ali CRNA

It is absolutely amazing to me that PACU would refuse to take a patient! That is unheard of where I work. They call, we take the patient... no matter what we are dealing with. Even if we have patients backed up from the floor, if we are short staffed, have a patient going bad, and we are dying. Wow. It never occurred to me to even attempt to refuse a patient.

But we are all accountable for on-time starts so we would not want to delay the next case ... plus, then we'll just be there later when that next patient comes out. Sorry to hear that that happens. I don't think it's a common occurrence at most hospitals, at least not the 3 hospitals I've worked at.

amnesia · Mar 25, 2007

Our PACU was having the same difficulties with calling report. Our nurse manager did a 3 month survey in an attempt to determine just how many delays were caused by the floor turfing patients because of staffing issues, no beds, dirty rooms etc. Our PACU is a very busy one ranging from 60-100avg. cases per day. Her survey provided specific information and data that she presented to the "floors". As a result of this study, a new policy was instituted whereby floor RNs have to take report on the first call or we redirect our calls directly to their supervisor who takes report for them. Things were a little rough at the beginning, but are starting to flow better now. I know this is very frustrating to the "floor" staff, but unfortunately we are getting slammed just as quickly as they are!