Anyone fax report?

ERNurse678 · Dec 22, 2004

Look. I'm not about to get into a pi&&ing contest with you about whose job is harder--all nurses have it tough, or there wouldn't be a shortage. I respect you ER nurses because you have to think and move so fast, and also because of the crazy people you have to put up with. I'm sure I wouldn't last a shift.
So I want you to understand that it is with the utmost respect that I remind you that patients really don't give a good ta-hoot about whose department they're in before they have a cardiac arrest, or major hemorrhagic stroke, or respiratory failure. We have to deal with that stuff too.
But--and this is my big point--we on the regular units simply do not have the resources (i.e. docs, transporters, Respiratory Therapists, Radiology) handy enough to help quickly in an emergent situation, and that's why we get nervous and complain. We know that seconds count. Where the ER is situated and designed for efficiency, we're not. Heck, I can't even pull a Nitro gtt or a stat Rocephin from the Pyxis! Can you imagine how much more time we waste dinking around trying to get stuff done that you guys don't have to wait nearly as long for?
This was brought home to me in a very eye-opening way when I floated to a Med-Surg unit and discovered that the first patient I assessed was in the process of having an AMI. There was no EKG monitor on the unit, no one came to help me with the patient, I had to page Respiratory and the doctor myself, I had to leave the patient to go all the way up the hall to get the patient medications, and then the patient was c/o needing to use the bathroom and actually tried to get OOB, attached to the EKG, to go, while the Lab tech was c/o the water that I knocked over in my haste to get the patient back in bed.
Well, at least she wasn't unconscious.
Anyhow, I think it took about 2 hours start to finish, to get this patient transferred to CCU. On my home unit, it would've taken 20 minutes--most of it waiting for the doc to call back.
And I still had plenty more patients to assess and care for, any or all of whom could've been found in the same situation or worse.
Hope that helps you understand where we're coming from, too.

I am sorry if you took my comment offensively. As I said earlier, I completely understand that the telemetry and med surge nurses have a hard job, one that I wouldn't want. The only point I was making was that when you said how would we feel if we had to walk out on to the floor to that, we do walk on to the floor to that everyday. I agree that we have more of the resources available to deal with those emergencies and that does make it somewhat easier, if that is possible, to deal with. I respect all nurses, no matter what area they work in because nursing itself is a hard job. I love my job, and I am sure you love ours and that is why nursing is such a great job because there is so many areas one can work in if they don't like the other. Again, sorry if you took it offensively.

UM Review RN, ASN, RN · Dec 22, 2004

Yep, you've totally nailed the problems that we have with ER admissions. I don't blame the faxed reports, per se, because I realize that the ED can only do so much for a patient.
Even though our staffing is OK, my particular problem is with coming in at 11 and having an LPN with a full assignment to cover, 6 patients of my own, most of them wanting pain/sleepers. Completing the rest of my assignment, I get a transfer and an ER admit, all at the same time when I first come on duty. Happens a lot. Freaks me out. Is there a solution to that?
I mean, how would you ED nurses feel if you had all that to deal with as soon as you walked in the door?
I realize that's a bit OT, and I don't want you to read it as a complaint, it's not. But it's a problem, and I'm sure there is a solution somewhere, if we just had the time to have a discussion about it without pointing fingers.

In the interest of clarity, I've posted my first post. The problem that we have on our unit is that we get the bulk of ER admits at change of shift. That was what I was trying to get resolved, and as I said, not turn it all into some kinda contest to see who's got it harder. It's like comparing apples and oranges.

I did get a bit miffed at Rena's and RNin92's comments, to be honest, and they were what prompted my second post. The last thing we nurses need--no matter which unit we work--is to be disrespectful to one another. I may not have a clue about the ER, but by the same token, please don't presume that you know all about Progressive Care. Ours is the busiest unit in the hospital besides the ER. We don't get people who pop in for an antibiotic, we get people who've already been Dx'd as having a condition warranting an overnight stay--COPDers, CVAs, R/O MIs, GIBs, whacked-out Lytes and stuff. All of which--especially the Stroke orders and the Lytes replacement--can get kinda hairy because they always get sent to our unit before the ICU, if at all possible.

Our unit takes admits at all times too, yet the bulk of our arrivals from the ER occur at change of shift. I have a problem with that. It's much safer for the patient--all of the patients, actually--to take them later on in the shift. That might not be the way it happens for you, but we would still prefer it, if it's at all possible.

After all, what's safer for the patient is usually safer--and saner--for all of us.

I hope I didn't offend anyone, either. That was not my intent.

newfloridaRN · Dec 22, 2004

I'm an ER RN.... We tend to send alot of admits up around change of shift because that's when the supervisors assign us beds. We've fought w/the sups to give us beds EARLIER so ya'll do n't have to deal w/new admits at shift change. However, when this happens-- I try to have everything done so that the floor nurse doesn't have much to do for that pt except a full assessment. I have all the meds given, labs drawn..., etc. I try to do that so we avoid conflict!!

UM Review RN, ASN, RN · Dec 22, 2004

I'm an ER RN.... We tend to send alot of admits up around change of shift because that's when the supervisors assign us beds. We've fought w/the sups to give us beds EARLIER so ya'll do n't have to deal w/new admits at shift change.

Finally, a straight answer! I always wondered why that was so. And we SO appreciate your efforts to get the bed assignments earlier. I see now where the process might be worked on to make it more efficient.

However, when this happens-- I try to have everything done so that the floor nurse doesn't have much to do for that pt except a full assessment. I have all the meds given, labs drawn..., etc. I try to do that so we avoid conflict!!

God Bless you for that!! When I get a patient and I find out that a stat med has been given, it's such a relief. I understand that you get busy and things happen so this can't always be done, but when it is done, we can move along to the next step for the patient. I also have a deep appreciation for the nurses who come up with the patient who's on a Heparin, Nitro, Cardizem, Potassium or other type of gtt instead of just sending the patient with a transporter.

And thank you, those of you who get wet reads ordered and sent with the patient, knowing that we won't have them available on the computer for another 12 hours. You understand that we don't have a clue what the CT scan or CXR says.

And here's a tip some of you might be able to use:

Even though we have a fairly complete report faxed, as soon as I get a name and a bed on a patient, I can get into the computer and pull up that patient's orders, labs and other diagnostics from the computer. When I can see what was ordered, it helps me to figure out which direction we're going in for the patient. I can even see if the patient has been a recent admit and take a quick peek at the old H&P, which helps a lot too.

ERNurse678 · Dec 22, 2004

Our hospital has a rule that requires nurses to transport if they are on one of those critical drips. Also our hospital requires that if an order is written "Stat" or "Now" then the ER has to get it done before transporting the pt. to the floor. That seems to help the floor out. At one point there were nurses that were allowing pt's to be transported to CT, X-ray or the floor while on critical drips and they then developed the policy with a list of drips where a nurse must escort. Makes sense to me. I would think that all nurses would realize the potential complications of these medicines, but unfortunately they don't all think like that..:)

ednursedee · Dec 22, 2004

we get orders marked as "stat" or "now" started as well. we also always get the heparin drip started, usually get the foleys in, usually drop the ng tubes...and we're really working hard now to get the first dose of antibiotics given within four hours of presentation on patients diagnosed with community acquired pneumonia. when i have time and i'll be sitting on the patient for a couple hours i also try to get a mar written and give any meds that need to be given. i worked for 3 years on a med-surg floor when i first got out of nursing school, so i know how helpful this is. at that hospital, sometimes we'd get patients who didn't even have iv's. when i tried to say something about that i was told, "our job is to stabilize and then send elsewhere." i'm glad that i don't feel that way, because the last thing a nurse who already has a full load of patients needs is to have to start a line on someone.

veetach · Dec 22, 2004

Well I am sure nurses on the floor are busy, however in reference to the qoute of "How would you ER nurses feel if you had all that to deal with as soon as you walked in the door?" Well let me ask a return question. How would you feel if you walked in to work and had to take report on 4 pt's of which one is on the ventilator after a cardiac arrest, one is a CVA who continues to be unresponsive, one is in respiratory arrest and is about to be intubated and a traumatic arrest is 2 minutes out? That is what we walk in the door to.

Go, ERNurse, Go!!

newfloridaRN · Dec 24, 2004

Angie O Plasty--

No problem. I am a newer ER nurse (2 years) and I don't understand the constant 'struggle' between ER nurses and Floor nurses. Sometimes we don't understand where each other are coming from, but we're doing the same job. Our Managers tell us that when the supervisor assigns us a bed upstairs, we should have the patient up within 1 hour. So if the ER brings a patient upstairs around shift change, it's usually only because that's when we got the bed assigned to us. It's a constant arguement b/w our charge nurses and the house supervisor. If they would just give us beds earlier in the day, it would make everyone's lives a little bit easier! Hope this helps.

UM Review RN, ASN, RN · Dec 24, 2004

Angie O Plasty--
No problem. I am a newer ER nurse (2 years) and I don't understand the constant 'struggle' between ER nurses and Floor nurses. Sometimes we don't understand where each other are coming from, but we're doing the same job. Our Managers tell us that when the supervisor assigns us a bed upstairs, we should have the patient up within 1 hour. So if the ER brings a patient upstairs around shift change, it's usually only because that's when we got the bed assigned to us. It's a constant arguement b/w our charge nurses and the house supervisor. If they would just give us beds earlier in the day, it would make everyone's lives a little bit easier! Hope this helps.

Thanks, newfloridaRN. I'm in FL too. I'll make sure I suggest that at our next meeting. Happily, our management is usually very responsive to our suggestions, and because of that, we've implemented many changes that improve patient safety.

There simply has to be a way to improve the process so that everyone can benefit, and I appreciate your efforts in the spirit of cooperation and patient safety.

Have a very Merry Christmas!

RNin92 · Dec 25, 2004

[quote=

I did get a bit miffed at Rena's and RNin92's comments, to be honest, and they were what prompted my second post. The last thing we nurses need--no matter which unit we work--is to be disrespectful to one another.

I hope I didn't offend anyone, either. That was not my intent.

I agree...nursing MUST stick together to do what is best for the patient. That is what prompted my starting this thread in the first place.

However, when you ask a question that clearly shows disrespect of the workload of another, you shouldn't be surprised if someone is offended.

And asking "how would you ER nurses feel..." was offensive. But I appreciate that it was not your intent.

I also totally agree that a pi$$ing contest is an excercise in futility.We all agree that we all work hard. But it is really not about us...

It is about the patient.

I worked Tele for 10 years. My unit was incredibly busy. We usually had four patients...sometimes 5...just many of the days they were not the same 4 or 5 I started with! I would drag my weary body home at the end of the shift and try to figure out which Mack truck hit me!

I DO understand the busy pace of inpatient nursing.

I also now understand the insanity of the ER.

That's why I asked the question in the first place.

But the fact remains, that it is NOT about us!!!

It IS about taking care of a patient...

The in-patient will receive optimal care from the nurses who are trained in their specialty area over the care they recveive in the ER. When it comes to ACUTE disease processes...get out of the way of the ER nurses.

But when it comes to managing the disease process...hands down it is the nurses on the units.

I was only trying to get to the best practice in getting the patient to definitive care.

If the patient requires ICU...they need the ICU NURSES...not just the real estate.

If the patient requires chemo...they need the NURSES who are trained in chemo.

Etc...

CEN35 · Jan 2, 2005

Yes we eventually started doing it. We had mentioned many things that we as "ER Staff" saw as delays and/or blockades to moving patients to prevent us from getting jammed up. One of those things was always, the nurse getting the pt is at lunch, there is only one nurse here (with 28 pt's I doubt it), there's a code on another floor, the rooms not clean, it's shift change, etc etc.

The hospital hired a company known as "H-Works" to come in and evaluate the ER and current pt flow. They allegedly do research in this area and have the "Proven best practices". they paid this company their initial fee of $100,000.

The company came in and told us the same things we told them.

The biggest help was faxing report, and then just sending the pt in 20 minutes. Instaed of trying to talk to the nurse and give report.

casper1 · Jan 2, 2005

We started doing this over a year ago. At first it wasn't working, Faxed reports were missing vital information. Information on the reports was hours old. Patients were being brought up to the floor unstable or when the recieving nurse was in the middle of transfering a patient to the unit or worst a code. Now we get a phone call prior to the patient arriving on the floor. If the recieving nurse has questions the secretary who is facilitating the transfer weill locate the nursew in ED caring for the patient

and the recieving nurse will be able to ask questions.

Having that communication between the units and ED is essential to a safe patient transfer. The other day I recieved a report about a patient that was being transfered to my floor. The patient had been in ED since 9 in the morning, it was ten at night.

The labs indicated the patient has a k+ level of 6, there was no indication that it has been addressed. The patient was uncovered. Which meant I would have had to call the attending at home. So I asked the ED Nurse to please have this problem looked into before transfering the patient to the floor. An order for a Whole blood K was ordered in ED and I drew it when the patient arrived on the floor. We were quickly able to address the problem benefiting the patient