Admissions

TheNGTKingRN · Aug 18, 2015

We receive verbal report from all departments.

I feel ready once I've screened the patient myself by asking the ER RN a few question such as:

"Latest set of VS?"

"Pain controlled, what works best?"

"All STAT orders done?"

Do not let them hit you with a patient that has unstable vitals and has one thousand orders. If they ever dare try, write them up. It is the ONLY way those ET Nurses will learn.

It's not only about your licence but about the patient.

Being sent a patient with hypotension, 10/10 pain, guarding LRQ, and NO CBC or Type and Cross AND NO peripheral IV access is unacceptable... I've seen it happen... not to me but to other poor souls.

BecomingNursey · Aug 18, 2015

I work ER and we fax a report to the floor including a sheet we can fill out with any pertinent information regarding the patient. We then call the charge nurse of the floor the patient is going to and see if they have received the fax and if they have any questions.

If it is a Critical Care patient we have to call report to the Critical Care unit.

BecomingNursey · Aug 18, 2015

We receive verbal report from all departments.
I feel ready once I've screened the patient myself by asking the ER RN a few question such as:
"Latest set of VS?"
"Pain controlled, what works best?"
"All STAT orders done?"
Do not let them hit you with a patient that has unstable vitals and has one thousand orders. If they ever dare try, write them up. It is the ONLY way those ET Nurses will learn.
It's not only about your licence but about the patient.
Being sent a patient with hypotension, 10/10 pain, guarding LRQ, and NO CBC or Type and Cross AND NO peripheral IV access is unacceptable... I've seen it happen... not to me but to other poor souls.

If an ER nurse is stupid enough to send a patient to the floor with no IV access and with unstable vitals as you describe their license should be pulled. Not all ER nurses are this way and I pride myself in being one of the ER nurses that the CCU is happy to take report from, because I have my crap together and my patient is ready to go. Their vitals may not be perfect upon transfer but I've done everything I can to correct said vitals before sending the patient.

TheNGTKingRN · Aug 18, 2015

If an ER nurse is stupid enough to send a patient to the floor with no IV access and with unstable vitals as you describe their license should be pulled. Not all ER nurses are this way and I pride myself in being one of the ER nurses that the CCU is happy to take report from, because I have my crap together and my patient is ready to go. Their vitals may not be perfect upon transfer but I've done everything I can to correct said vitals before sending the patient.

Of course not all ER nurses are. It's the minority, I'm sure!

Thank you for being a team player!

BecomingNursey · Aug 18, 2015

Of course not all ER nurses are. It's the minority.

Unfortunately, it's the minority that give us the bad rap. I can't stand it when bad ER nurses are the only ones that get talked about. There are a lot of good ones out there too. Thanks!

Dogen · Aug 18, 2015

How do you get admissions from the ER? Verbal report, computer generated? Do you feel ready to take care of your patient?

We do verbal reports. A hospital I used to work at tried sending report sheets through the tubes (pneumatic, not internet), but they inevitably forgot to write down things like the BP, whether a UA that was ordered in the ED had been collected, etc. So we ended up calling them half the time anyway, which annoyed them because they thought they were giving us what we needed... eventually they requested we go back to report over the phone because it took less time than giving report twice.

ERGirl83 · Aug 18, 2015

I'm an ED nurse. We give telephone report to the nurse on the floor. In my current facility, we personally transport ICU pts to the floor so they get a short bedside handoff too. We also print off an SBAR sheet which is kind of a visual snapshot of important data.

I'm a big fan of a good verbal report. I think it fosters patient safety and ensures continuity of care. Especially if your charting system is crap. Not providing a verbal report with the chance to ask and answer questions seems dangerous to me.

That being said, what I'm NOT a fan of is getting the run around from floor nurses who sometimes act like they are my boss and many times don't really understand what we do down here either.

I try to give a thorough report, hitting everything pertinent to patient care and transfer of care. Even if it's in the chart. CC, Allergies, IV access and fluid status, pertinent lab and imaging results, meds given in the ED, any important miscellaneous info like if it's going to take three people to get them out of bed or that you may want to 1:1 this person if their family leaves, oxygen status, etc. I absolutely don't mind being asked a few questions. We are all colleagues, trying to take the best care of our patients.

But, please for the love of all that's holy don't ask me about a skin assessment. Don't know. Didn't do one. Not going to do one. The skin I saw was fine, if it wasn't I would have told you otherwise. It's focused assessments down here. Chest Pain does not equal get naked and let me inspect your skin. Pain control? Their pain is as controlled as I can get it with the orders I have. Will you have to give some meds when they get up there? Maybe. Am I going to park them down here until they are sitting at a two when I have a full house and 10 people in the lobby? Again, no.

While we are on the subject of orders, let's go over them, at my facility, at least, ED nurses are responsible for ED orders. That is, orders placed by the ED Physician. In fact, I can't even see most of the orders the hospitalist puts in from my screen, nor can I pull any meds from my Acudose once the patient has been officially admitted to the floor. Getting snotty with me that he ordered something that's not done doesn't help anyone. If a specialist consultant puts in or gives me a verbal stat order I do that. But, beyond that, ED orders are my orders and admitting orders are floor orders. I do try to anticipate common and obvious orders, though, and ask my doc for them. Femur fracture? Hey doc, I'm gonna place a foley, ok? But, sometimes we are busy, and I have two other critical patients, the patient didn't have to pee, I didn't have an order or even a second to think about it and yes, they are coming up without one. I'm sorry they aren't as nearly packaged as you would like. They are much better than when they came to me.

And the delays on taking report kill me too. Don't get me wrong. I get it, you have 4 other patients and may have stepped into a room, maybe you're doing a procedure. No biggie, call me back. Only, really, call me back. Not in 45 minutes either. Just got an admit 35 minutes ago? Sorry, that sucks. By the time I get back downstairs from dropping this guy off, and break down my chart I'll have one too, oh and two more at the exact same time since I had two dispo'd while I was upstairs. It's just life. We have to roll with it sometimes. If we are (by some miracle) slow and I have extra beds, I am more than happy to sit on a patient for a half hour or so, but if we have people stacked to the hilt? Sorry, I've got to come up. And again, because I can't access meds or orders for an admitted pt, this would not be good for any of us to happen long term. Also, shift change admissions. We all hate them. I get that it sucks for you to take report on a pt you will have for less than 30 min. It sucks for me more when I agree to wait for the new nurse who is supposed to take ED report first, but instead takes floor report first and refuses to take ED report until damn near 1945. And then gets annoyed that they are getting report from a nurse that's literally never met this patient because I've gone home.

For the most part I get along great with the nurses upstairs. I try to do my part to make the transition of care as easy on the patient and the nurse as possible. Code brown in the elevator? I'm happy to stay upstairs and help you clean it up even when I'm busy. IV blew right before we came up? Happy to help start another. Even when you have two techs and I've none. It's just the courteous thing to do. As such, I don't have too many issues. But, occasionally I get attitude from nurses during report, demanding details we simply don't delve into down here and then being downright condescending when I explain why I either don't know or haven't done something. It's frustrating, rude and doesn't help anyone.

As as far as some of the previous posts, I cannot imagine a pt being admitted without baseline labs, and IV access of some kind. What kind of work up or treatment can have been done to even determine a need for admission without it? But again, some of that is on the providers as well. We can only do procedures we have orders for. I hope though, that most of us are assertive enough to say, Hey doc, I'm going to put in a CBC and CMP on this guy. Anything else you want?

I firmly believe doing three shifts with a nurse from another floor would help the animosity that accompanies report sometimes. A facility I used to work for required ED nurses to spend three shifts upstairs and floor nurses to spend three in the ED. This way each nurse had an appreciation and a basic understanding of what the other goes through and why things might be the way they are. It helped morale and report issues A TON

TheNGTKingRN · Aug 18, 2015

But, please for the love of all that's holy don't ask me about a skin assessment. Don't know. Didn't do one. Not going to do one. Pain control? Their pain is as controlled as I can get it with the orders I have. Will you have to give some meds when they get up there? Maybe. Am I going to park them down here until they are sitting at a two when I have a full house and 10 people in the lobby? Again, no.

I would definitely not expect an ER nurse to give me a skin assessment report unless the patient came in with hives or some unusual infectious skin disease!

My rant on pain was misplaced and mostly aimed at PACU. PACU ... this IS the place to bring patients to a baseline pain level. I'm not saying a 2/10 but for Petes sake... don't bring me a 10/10. The anesthesiology residents are in the PACU... would it kill you to suggest a block or PCA? Do you have to send down a screaming patient onto the wards? I understand some patients have inconsolable pain with fairytale tolerable pain levels.

Again. Aimed at those PACU nurses that don't five a tahoot. I know most care. 99 of 100 patients I get from PACU are managed. But when I get those with unbearable pain and blood pressure of 180 SBP and 100 DBP... yeah I'll be upset.

calivianya, BSN, RN · Aug 18, 2015

We get verbal report, but I can't tell you what the rest of the hospital does. I have learned from this forum that critical care usually gets verbal report even when other floors don't - which is something I didn't know before.

I feel ready to take care of my patient when the picture the ED nurse gives me is actually what the patient looks like and the ED nurse actually does whatever he/she said is going to happen. Got report once that was something to the lines of, "Well, he just coded for the second time and we just got a pulse back, we're maxed on Levo and the pressure is 70/30, but don't worry, I'm going to run another bolus and get another pressor before I bring him up, so it's probably going to be half an hour at least" which is something I would have felt fine about.

When the same patient rolls up in ten minutes, with no additional pressor started, no bolus run, and the monitor, facing away from the ED nurse to the bottom of the bed, is reading the a-line at 20/10 while the ED RN and the RT are both just casually walking up like nothing's wrong... not so much. I made sure that patient never even hit the bed in my room - coded him on the ER stretcher to prove that I had nothing to do with the situation.

I have respect for ED nurses most of the time but I have a real problem with the ones who are not proactive about stabilizing the patients and bring me dead people.

loriangel14, RN · Aug 18, 2015

We have an electronic report that the ER nurse fills in on the computer. When they call the floor to give report to the nurse taking the admission that nurse can pull up the eletronic report on theor computer and read along and ask questions. It's great because you don't have to write down anything and if you can't remember something from the report you can just pull it up and reread it.

nightsinBoston · Aug 18, 2015

Our ER started with verbal reports, then went to faxed reports. We now get virtually no report at all. We can have as little as 10 minutes notice. The online reports we can see, consist of vital signs and meds given. We might be able to look at the doctors notes, but often no note is written until after the patient hits the floor. I am so worried that something bad is going to happen. Last night we got a patient that the floor doctors didn't even get report on. ER said, well if they need report they can come down and get it. It isn't a courtesy, it's protocol. I am so worried.