Calling report to the floor.

There is one particular nurse in our PCU who is just miserable all the time when you call her report from the ICU complaining about every little thing that might not have been done or needs clarification. When I just got report on the patient and haven't even seen them yet and am told to call report STAT, I have little to no time to iron out any minor problems for a patient I haven't even seen because a crashing patient is coming from the ER. I just tell her that I'll give her the phone number of the nurse that just left and had the patient all day and didn't follow through with the minor details. I still get a boat load of attitude though. I know the PCU nurse is stressed but I had zero to do with the "perceived" problems she feels aren't her responsibility. I don't have a choice. I have a crashing patient coming and it really doesn't matter if the dulcolax hasn't been reordered or no diet orders have been entered. All minor things the PCU nurse will just have to take care of. Then I get attitude along the lines of,..why does this patient have to be transfered,...you only have 3 patients in the ICU??? She's unaware, of course, that a vented, septic patient on pressors needing a STAT central line, Aline and a temporary dialysis Cath is already on the way to the ICU. Oh and their blood sugar is 1200 and they need an insulin drip and q 1 hour blood sugars and q 2 hour blood work,...and in addition, I have another vented patient, who I haven seen yet. Grrrrrr!!! Oh, and would I be a dear, the on coming nurse is going to be late,...can wait until she gets there and just give her report??? NO,..No I cannot!!! Happens all the time.

I have 2 beefs with taking report from ER, but even so I try not to be surly about it . These are: 1) at change of shift. I'm busy handing off my other patients to the oncoming shift or receiving report from a nurse who wants to finish up and go home. If you have held that patient until shift change to avoid getting a new patient, shame on you. If it just happened to work out this way, I appreciate the sentiment behind wanting to go ahead with report so that a nurse who doesn't really know the patient won't be giving report in a few minutes, but this is really inconvenient.

2) the room isn't clean. I don't know when the room will be cleaned. You promise you won't send the patient until it is, but guess what? I've been burned too many times to trust you.

Unfortunately, I've had the experience of calling a code on a "stable" patient within an hour of arrival on the floor from ER. So if I'm not going to be able to get in the room and lay eyes on that patient pretty quickly, I'm stressed out.

Like I said, I try hard not to let my stress level affect my attitude on the phone. I know we are all stressed.

There is one particular nurse in our PCU who is just miserable all the time when you call her report from the ICU complaining about every little thing that might not have been done or needs clarification. When I just got report on the patient and haven't even seen them yet and am told to call report STAT, I have little to no time to iron out any minor problems for a patient I haven't even seen because a crashing patient is coming from the ER. I just tell her that I'll give her the phone number of the nurse that just left and had the patient all day and didn't follow through with the minor details. I still get a boat load of attitude though. I know the PCU nurse is stressed but I had zero to do with the "perceived" problems she feels aren't her responsibility. I don't have a choice. I have a crashing patient coming and it really doesn't matter if the dulcolax hasn't been reordered or no diet orders have been entered. All minor things the PCU nurse will just have to take care of. Then I get attitude along the lines of,..why does this patient have to be transfered,...you only have 3 patients in the ICU??? She's unaware, of course, that a vented, septic patient on pressors needing a STAT central line, Aline and a temporary dialysis Cath is already on the way to the ICU. Oh and their blood sugar is 1200 and they need an insulin drip and q 1 hour blood sugars and q 2 hour blood work,...and in addition, I have another vented patient, who I haven seen yet. Grrrrrr!!! Oh, and would I be a dear, the on coming nurse is going to be late,...can wait until she gets there and just give her report??? NO,..No I cannot!!! Happens all the time.

We hear a lot of complaints on this site...but your's are completely valid. I'm guessing she simply has no clue ....Sounds like she needs to walk in your shoes for a day.

AAAMEN.

I'm sure I sometimes sound cranky about getting admits from EOD staff without intending to. A big problem with transfers between units in our hospital is that the EOD staff work a different shift than the rest of the floors, except ICU. While they are trying to transfer patients out before the next shift comes on at 4 PM, we are just getting report on our patients at 3 PM so more often than not our admits occur right at our shift change before we even have a chance to meet our patients and get our feet under us. Again this comes down to administration. If we were all working the same shifts, or at least not having shifts change so close to each other, it would not be such a big issue.

It doesn't happen often that we have insulin drips, mostly because we are primarily an oncology floor, but I have had a patient with an insulin drip with 3-4 other patients who also might be getting blood or on a heparin drip.

I won't do the sandwich but I will administer PRN meds if I have them because I know that it may be awhile before the floor nurses get to it.

I'm not sure what you mean by we "also get to triage."

Yes, we have an MD but once the patient becomes an admit, I have no more access to an MD than do you because the ED doc is no longer the patient's attending physician.

By "get to triage", I just mean that the guy with the toe infection can be kept waiting when the ambulance with the MI rolls in. Once they get to the floor, they're on more of a schedule.

Luckily, our ER docs will give a few "courtesy" orders here and there even after a patient has been admitted ...sometimes even after they get to the floor.

Please reconsider the sandwich ....but I'll take the ativan by itself if that's all I can get.

By "get to triage", I just mean that the guy with the toe infection can be kept waiting when the ambulance with the MI rolls in. Once they get to the floor, they're on more of a schedule.

The triage nurse is also in the unenviable position of having to sit out in the lobby and bear the brunt of the angry patients who aren't being seen quickly enough for their liking.

When it's going off, we're rolling our patients out as fast as we can and aren't all that concerned about detailed reports and tying up all the loose ends. It's just not too high on the prioritization list.

Admittedly, some ED nurses are famous for dumping on the floors just as some of the floor nurses are infamous for always being hard to reach and nasty. Both are wrong.

Luckily, our ER docs will give a few "courtesy" orders here and there even after a patient has been admitted ...sometimes even after they get to the floor.

Please reconsider the sandwich

....but I'll take the ativan by itself if that's all I can get.

I used to absolutely hate when the ER nurse calling report would tell me "this isn't my patient, I'm just helping out" and proceed to read from the SBAR. I can do that myself!

But after working at a hospital in which the ER does not call report, I appreciate any type of person to person handoff.

I've called for clarification and gotten a snotty attitude.

At the places I work that call report, I'm usually stressed but manage to get the stressed ER nurse to grumble along with me and we sort of blow off some steam together. Once they realized I'm not out to give them a hard time, they usually give a pretty good report. Every now and then, you get somebody difficult that you have to force to give you an acceptable report, asking them questions when you know they're trying to rush you off the phone but they're the exception.

I had one nurse who was all bent out of shape because I couldn't tell her where was the functional IV. I finally quipped, "start at the bag of maintenance fluids and follow the tubing... at the end you will find the IV site." Not my proudest moment, to be sure, but at some point it gets tiring trying to rehash needless details which are documented in the chart.

Emergent opening of the chest

and emergent opening of the abdomen

Yep they were too unstable to travel.

yep and tamponade too. We have to "crack" the chest back open and the surgeon digs out all of the clots around the heart while I'm prepping them for emergency surgery. Beating heart exposed and all.

Sometimes you just have to deal with it.

Yup, one time I had a fresh trauma patient. Just arrived from OR. No BP, Tachy. Trauma surgeon at bedside. Double concentrated Levo AND double concentrated Neo and fluids running 999 on the pumps. Had to open the abdomen in the room to try and stop the bleeding. Rapid infuser with so many units of blood I had to count the empty bags to keep track. Not a good night. And no,....I wasn't able to have this as a 1:1 patient. Ugh!!!

Yup, one time I had a fresh trauma patient. Just arrived from OR. No BP, Tachy. Trauma surgeon at bedside. Double concentrated Levo AND double concentrated Neo and fluids running 999 on the pumps. Had to open the abdomen in the room to try and stop the bleeding. Rapid infuser with so many units of blood I had to count the empty bags to keep track. Not a good night. And no,....I wasn't able to have this as a 1:1 patient. Ugh!!!

I needed to breathe in to a brown paper bag for a few minutes after reading the last line.

*twitch*