Faxed Report

ernurse728, LPN · Dec 2, 2002

Well Caroline...I am sorry if you have incompetent ER nurses at your facilty. I am however very competent and do know how to write out a fax report. Maybe your facility needs to come up with a better system. As in my ER I am the one that cares for my patient, I decide what needs to be done before the MD even sees them, I do the IV & Labs, the ekg, the Vs and the meds. And on most days I could probably give report without looking at the patients chart. I always no what is going on with my team! I am not the type of nurse that sits on her a%& all day long and delegates everything out.

Look I am not trying to turn this into a pi%&ing match. I know that the floors are busy...unfortunately most of the floor nurses don't have a clue how the ER works, they have never been ER nurses. And I think that you will find a majority of you ER nurses have been on the floors in the past. So there are some excuses that I cannot and will not tolerate. Not to mention that we haven't talked about how horrible it is for the patient. They have usually been in the ER for hours, wait for lab results, deciding that they need to be admitted, then awaiting admission orders and a bed assignment. They are usually tired and uncomfortable. and they want to go up to there room, where it is a little more quiet so they can get a little rest.

caroladybelle, BSN, RN · Dec 2, 2002

No p@#$ing match intended. And I don't think that we have "incompetent" ER nurses... It is just that expectations of floor nurses and ER nurses vary from place to place. In my facility, Onco is expected to do hard sticks and access ports, not ER, as well as handle other things. But because of afformentioned problems, faxed report did not fly.

Everyone in nursing gets dumped on in various ways and at different times. We all need to accept that and fight the real enemies of nursing - inadequate staffing, poor pay, poorly trained ancillary staff, lousy management - instead of whining about each other. We have to try to accept that nurses are doing the best that they can with what they have.

In response to the initial query, byY2KRN, the floor rarily has control over when housekeeping cleans the room. I could page til I am blue in the face to get a bed cleaned, but until a supervisor puts a stat on it, it could wait til doomsday. The supervisor is the one that calls for a bed (& we tell them that it is not clean). Unfortunately, faxed report will do nothing to speed that up.

CMERN · Dec 2, 2002

Hey ...where I work we call X 2 to try and give report..we notify the E.R. charge R.N. if floor says bed not in room or room dirty,..E.R.Charge R.N. puts stat on room... we call to verify if room is in deed "ready" and we roll 'em up. with the written report in hand .1st page of chart and if we get to floor with no one insight we walk and find floor charge nurse and hand over chart....we get aback up and we have HOLDS in E.R. but gee things have greatly improoved since we implemented our 1, 2, 3 your goin up rule. :)

CMERN · Dec 2, 2002

I would not trust a FAX report as the primary way to send up a report to floor ...it might be good to send once room assignment recieved..to floor..but i think it might cause more confusion if not routed correctly and unfair if the floor is unaware that the report is coming

**canoehead, BSN, RN** · Dec 2, 2002

If the room hasn't been cleaned and the Er nurse is getting frustrated they generally let the floor nurse they are going to page housekeeping themselves, taking it off the floor nurses' list of things to do. Housekeeping takes a page from ER more seriously- I don't know why...the bed gets cleaned, and the pt gets moved, everyone is happy.

So there's a solution for everyone. Maybe the ER nurses have more of an edge of "I'm gonna kill someone if I don't get rid of this pt" and it scares the housekeepers. Heck, if it works...

CMERN · Dec 2, 2002

:rotfl: :rotfl:..sorry it just hit me funny.....:chair:

ernurse728, LPN · Dec 3, 2002

Unfortunately we have a big problem in our facility with the floors saying that the bed isn't clean when it really is. That in itself has nothing to do with the fax report.

Y2KRN · Dec 3, 2002

Well we went with our new policy for faxing report! It started Yesterday. Last night I get to work at 1900 of course there is a change of shift admission. The nurse signing off to me takes care of getting the patient admitted and faxes report. I go on about taking care of my four other patients. My medic and tech transport patient for the off going nurse.

At 19:47 I get a call from the floor, saying that there is a patient in bed so and so, and I have no idea why he is here. I explain that the off going nurse faxed report and had the patient taken to the floor. She said well I have many questions, I told her that I would try to answer some of them but, that I never laid eyes on the patient. She was soo furious. The first question she comes out with is what is the diagnosis?? I say very nice that there is an admitting sheet with the admitting diagnosis. She said yes here it is. Then she said does he have any allergies?? I realized at that point she was not reading the fax or chart at all. I kindly said please read the chart and if she had any more questions to call me and I gave her my extension. She said what kind of nurse are you, when you can't answer simple questions about a patient you sent to me, and hung up.

I was flabbergasted! I told my charge nurse and she said well it is the first day we are doing this. I said yes that is true, and I understand it is stressful when things change. I do understand that. However to be disrespectful to other professionals is just infuriating.

She did call me back about 20 min later after she had read the chart and started yelling that the patient should have gone to the Rapid admissions unit. I gave her right to my charge nurse, because I thought if I was going to have to spend one more minute on the line with her I was going to be the one who was unprofessional!!!! I hope things get better and we can make this work. I like being able to move patients.

Carolina thank you for your input as well. I have been on the other side of the tracks and remember what it was like getting admission upon admission with no end in sight! I'll admit it was not my cup of tea! It is very stressful to have long lists of meds to give, charting to do, rounds to do, Docs to call, and patient families to deal with. We do appreciate you and know that you also have emergencies to deal with. I know it is not easy up there, no speciality in nursing is!!!!!! I guess we just have to keep moving forward and try to change what we can and improve systems. Take the things that work with old systems and chuck what doesn't work.

I guess it all breaks down to good communication. It is the ER nurses job to ensure all infromation is there for the floor, and to try and accomadate and complete as much information and orders as we possibly can for the floor nurse. In turn respectful communication would be nice from the floors sometimes. I used to hate when the ER called too, but I always tried to be nice because I was not in there shoes and they were not in mine or the cause of most of the floor problems. As the floor is not the only cause of not moving patients in the ER. There are many factors that go in to it, as we have seen from the above posts. Let's just try and respect eachother.

Thanks to all who responded!! I will let you know if the faxing of report flys, or sinks.

P.S. It is frustrating when you get no help transferring patient, getting them on tele, changing pumps, etc.

Happy Holiday's

Y2KRN

ernurse728, LPN · Dec 3, 2002

Y2K - I am curious as to what kind of system you have for your fax report, guidelines etc? For instance does there have to be a return call to the nurse receiving the pt prior to the pt's being moved?

Y2KRN · Dec 5, 2002

Hello ernurse728,

I think that they are still working out the details of this new system. We got a memo stating that we call the floor and alert the unit clerk that we are going to be faxing report on the patient going into 420. Then we fax report, ( we have a totally computerized charting system specific to the ED) all of our ER nursing notes go to the floor, from triage information to in er treatments and medications given. After that the floor has twenty minutes till the patient arrives. We carry phones with us, so we give our name and portable phone extension so if the floor nurse has any questions they can contact us. I don't know how to fix the dilemma that came up with me on the first night. I didn't see patient that the floor nurse had questions about. However, the questions she was asking were things that she just needed to look for, however if it was a question about baseline or medication administration or something then I probably would not have been able to help her anyway. Which can happen even when a report is called. However, no we do not at this time need to confirm with the receiving nurse that the patient is being moved.

We do not fax report to any of our ICU's or our Rapid Admissions Unit. We still call report to them. We are supposed to be expanding our rapid admissions unit soon. We do not send a cover sheet though and I think maybe we should. Our management thinks labs can be looked up by the floor nurse, as well as x-rays. If the house Doctor has seen the patient then we fax their orders as well. We try to initiate any orders the house Doc has given. If I was the nurse receiving report I would like to know if the patient has a high k+ or something without having to look it all up. I send the lab results anyway. I think a cover sheet would be good to, just to give a little baseline nursing observation. "The patient has been comforatable, or is anxious, may be a little stoic you may want to ask him about his pain etc.

There has been many changes since I started working at this Ed. We went from a 30 bed Er seeing 80,000 patients a year, to a brand new 50 bed er not including fast track. On top of this major move, we went live with an all computerized charting and tracking system specifically designed for an emergency department however the catch is "we are this new company's beta site." So, they are working out their kinks with our ED. I was completely overwhelmed at first, but it is getting better. Our computer system in the ED is separate from the rest of hospital and there were major issues to deal with. We are now interfaced with the lab so that is a great improvement, but we are still not interfaced with radioloy which is our weakest link right now.

During the early summer we had so much hate mail via editorials from the community, morale became very low. Complaints were mostly about wait times which could be up to 6-8hrs. Plus we had many staffing issues. They have improved on staffing issues and are now hiring paramedics (god bless our medics, and techs) which has also helped greatly.

Holding patients is another issue. Our beds fill up fast and the hospital is currently building an addition which will house two more ICU units and I think more monitored beds. We have three ICU units now. CICU, MICU, and SICU.

I think the worst part is not moving patients though because the family wants you feed them, do all their meds, etc. and really doesn't understand that we just can't do all that when the code or trauma is in the next room. Some families understand but, most don't you tell them we have a critical patient and their retort is well you should have enough people to help because our family member is critical too. What can you say to that?? Our patient ratio is 5 to one and most assignments include a trauma room. This is a big improvement however to the not so long ago past when we would have to cover for lunch and have 10 or a little more patients to look after. When we would have a trauma then the rest of our patient's were fending for themselves however that was more of a staffing issue.

Whew, I went off on a tangent, but it feels good to get all out. It is getting better and the floors are still not happy with the faxed report but, I think it will take time to adjust. I know that one good measure I think from being a floor nurse is that, they will not have to come to the phone to get a report from the Er and can continue that med pass or endo-tracheal suction they were doing. I remember that I hated to be called to the phone, when I was trying to push multiple crushed meds through a g-tube or suctioning a vent patient.

Thanks for listening,

Denise

asweeneyrn · Mar 3, 2011

I have worked as both an ED nurse and a floor nurse and I think that if everyone would work both areas for a spell they would be more understanding of each other. Patient flow is a very difficult thing. You have patients stacked up in the ED waiting to be seen or moved up to the floor, so it is frustrating for the ED nurse. On the other hand, the nurse on the floor is trying to manage 5 patients' medications, discharge the sixth patient, close the chart out and get ready for the new patient coming up fromt the ED. Another thing is that discharges are not always just a simple "here's your paperwork, you can go now" sort of thing. Often times you are having to wait for equipment set up, home health set up, the ambulance to come get the patient, etc. I know it is very frustrating on both sides of this situation. I think that nursing in general can be a very frustrating, high stress career. I just think that we need to be A LOT more understanding of one another and do the best we can to accomodate the other departments.

I know that faxed report caused a huge barrier between the departments in my hospital. We lost that small time that we had the talk to the other nurses and we compromised that personal touch that telephone report offered.

Editorial Team / Moderator · Mar 3, 2011

Just a note: this majority of this thread is nearly 10 years old.