Now Ive heard it all!!!

Specialties Emergency

Published

Specializes in ER, PACU.

In my ER, I think one of the worst problems we have is getting the patients up to the floor. I totally understand if there are no beds, there is nothing that anyone can do about that. However, I am sick of hearing the excuses "I cant take report the bed isnt washed", "the nurse is on break". The nurse is on break all night long when I call (I would like a transfer to that floor please), and you know damn well when you take report that the patient isnt going up right away, so by the time we get them up the bed is done.

Last night I couldnt believe my ears.

First I had the written/faxed report HAND DELIVERED to the floor because they claim thier fax is broken, and then 3 hours later when I finally got the patient rep to find out what was going on they told us "the room smells so I cant take report or the patient". Finally we got the patient rep up to the room along with 3 other people to find out if the room really did stink. It didnt. Its now approaching 6 am, and they wont take report after that. I understand not wanting to take report at 6, but if you put it off all night long, and its now 6 than tough $hit in my book. You could have done this much earlier.

I am sick of every night having to spend hours of time trying to get this patient up to the room. Faxing, calling, ect. Its ridiculous. Nurses blame the housekeeping staff, (which sometimes it is, but more often than not it isnt) and it seems that nobody is held accountable. I am sure if they did something like made the housekeeping staff supervisor notify the nurse supervisor whenever the bed is ready that this would put pressure on the nurses and call them out when they try to make excuses. in most other hospital the floors must take report even if the nurse is on break, she/he has someone covering for them, its not like there is no-one there.

Sorry about my rant!

Whew - sounds like you had a bad night! We FAX report, too. Our form includes a space to enter the time the bed was requested (in other words, the time it was decided that the patient needed to be admitted), the time the bed was reported as ready by bed control, and the time report was FAXed. Easy to see any problems, and where they are. If the bed is requested at 1700, and it isn't ready until 2300, there needs to be follow up. The the decision isn't the floor's, it's bed control. If housekeeping has the bed done, the bed is reported as ready, and the patient can be transferred. Also, the FAXed report negates the need for telephone report - the patient is brought up within a certain time of the FAX being sent (enough time to get required equipment in, for the nurse to return from break, etc). Doesn't stop the problem of a bed being requested and ready at 2000, and the patient not showing up until 0630, though!

hi ,

I worked in the ED as a tech all through nursing school . I presently work on a Tele floor and since I know what it is like in the ER I take report as soon as they call . This makes for happier ER nurses. Floor nurses in general don't get what it is like in an ER. I'm fortunate to have had that experience because i know know both sides of the coin. Where do they work I never get a break on the floor with 7 patients a night. It should be required that floor nurses spend a night in the ed just for kicks. they will never stall on taking report again .

I work CCU and we sometimes have the exact oposite problem. We will be told by bed assignments that they need the bed, in our unit the Charge Nurse decides which bed in order to match with the nurses. IE if a nurse has a transfer that has room then they will get the next admit or if they already transferred one out etc. N E Way we will them a bed and ER/ED will hold the Pt. right up to shift change and bring the Pt like at 2:30 or 6:30 with like 15/mini left before we are to start report for the next shift leaving us little or know time to recieve the Pt and acheive any part of the admission. We don't use a fax system though that does sound a little intriguiing.

You make a great point monkey....most floor/tele nurses aren't aware of what it is like in the ED. I think that you will find that a majority of nurses that work in the ED have worked on the floors in the past and know what both areas are like. I know that the floors get busy and there are times when they have a patient not doing well and that is where their attention needs to be. I have actually had floor nurses say things like "why do you always want to send them at change of shift". As if you had control over when they got admitted, when the orders were finally written and when the bed was assigned! I to am soooooo tired of the excuses. " I didn't get the fax", "our fax was out of paper". "the room isn't ready", " I am at dinner and there isn't anyone covering me".....excuse me...you work on a tele floor and nobody is covering your rooms while you are at dinner??!!?? I think not! And then when they finally do look at the fax report they ask you 50 questions that are clearly answered on the paper you so carefully filled out! It is very frsutrating when the ED is busting at the seams...ambos are rolling in 7 at time and everyone needs something yesterday! And them to top it off they nit-pick at everything...they want to patients wrapped in nice pretty bows....I am so sorry but I am obligated to do stat/now orders...not all 4 pages of orders that the doc wrote. I am a firm believer that every nurse should come to the ED just for one day to see what is like...to see how chaotic it is and why we cannot sit on these patients until the floors are good and ready!

Specializes in Corrections, Psych, Med-Surg.

"nobody is held accountable:"

That is the long and the short of it. And why should the system change, since only certain nurses are inconvenienced? The CEO, for example, is not called at 3am when this happens. Neither is the DON or anyone else who could put in a realistic "fix."

Perhaps it is time to start calling these people right away when this happens and letting THEM straighten things out. Otherwise, they will NOT get the message (and again, why should they?).

If we pick up the slack, there is "no problem" for anyone else. Remember:

Specializes in ED staff.

It all goes back to what I was taught in nursing school for me.... try to think of every patient as a loved family member. I would hate to think of my mom lying on a gurney in the ED for 5-6 hrs just because the person who was going to take care of her on the floor didn't think that way. Floor/Unit nurses have one up on the ED nurses, they can say I can't take report right now, I'm too busy etc. The ED never shuts it's doors, only in rare circumstances are we closed to ambulance traffic and we're never closed to foot traffic. I know many floor nurses are overworked, but heck so am I. All I can do is buck up and do the best I can to help those who need my help. I don't work on the floor and never have so I don't know if they actually think that the patient would be better off staying in the ED as opposed to coming to a bed where the assigned nurse is already overstressed. I firmly believe that an admission nurse would help tremendously. A nurse would get the bed assignment, meet the patient in the room and do all the admission paperwork and give any stat meds. I dunno, what do you guys think and has anyone ever seen this set-up?

Specializes in LTC, assisted living, med-surg, psych.

On my floor, we often have a PRN nurse who does admissions and any STAT work, like restarting IVs, running specimens down or picking blood up from the lab, and so on. I wish we had one for EVERY shift......they can be invaluable, especially when we're overtaxed and the admissions keep coming. (Not to brag or anything, but I do a lot of PRN'ing myself, and I'm damned good at it.) You have to be really flexible to function in this role, and most nurses where I work don't like it much--which is why I take the responsibility most of the time when the shift changes at 7--but they do appreciate the help. I know I do, when I'm the one with a team of 6 or 7 patients and everything's in utter chaos and there's another admit coming up!

an admission nurse sounds like a great idea. i would defintely apply for it. right up my ally.

I worked ICU as a nurse extern for a while, and because we were an "overflow" unit, we had a lot of floats that came from regular floors.

Some of these nurses had it down to a science..... Dickey do around until about 30 minutes before shift change, THEN transfer the patient out or take report on the admit, so that the next shift got stuck with the new patient.

I cannot imagine that this would not catch up with them. No matter how big the hospital is.

(I'm always surprised at the creativity of lazy people!)

Specializes in Neuro Critical Care.

In defense of floor nurses, we do have to wait for beds to be cleaned, we don't always get faxes and sometimes we simply can't take report. I am not defending all floor nurses, but sometimes these things do happen. I have had many situations where the bed is truly not ready and they are sent up from the ED anyway, now the pt is sitting in the hall and we have to explain to them why they are there instead of in bed.

Maybe you could keep a log of how long it takes to place a pt, is it one unit in particular that is giving you problems? Maybe your manager needs to have a sit down meeting with their manager. Generally faxing report is enough, a call to make sure it got there is nice, but you have done your part by faxing. If the floor has questions they know where to find you.

Hope things get better for you, just remember all floor nurses aren't bad! ;)

Specializes in Nephrology, Cardiology, ER, ICU.

I work as the charge RN in a level one trauma center with 650 beds. We tried faxed reporting but went back to telephone reporting for numerous reasons. However, if one of the nurses is having trouble getting a patient to the floor - I call the other charge nurse and we discuss it. If that doesn't resolve the issue (it usually does), I call the nursing supervisor. As a last resort, I have our nurse write out report and off the patient goes. We do this for a mass casualty issue only.

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