Well, once again I've been sent a patient that is just a complete mess and I have no idea what is going on with him. This seems to happen more than a lot lately.
This patient came in because his wife found him on the floor and when he came to he was confused and weak. He had chest pain in the ambulance that was relieved by nitro.
When he got to the ER they did a lumbar puncture, EKG, CT of chest, abd, and head that were all negative except the LP. They were unable to get that because of bone spurs apparently. His vitals were stable, but white count was 23.9 and he had some respiratory acidosis. The man wears oxygen at home due to copd and smoking 3 ppd. He has sleep apnea but will not wear a cpap, so they sent him up on 2L. I ended up having to get him a mask due to him breathing through his mouth and being knocked out cold from morphine he got in the ER.
So anyways, I talk to the wife and she says he has been throwing up every morning and sometimes through out the day for 9 months, also having malaise, fevers, urinary retention, and just not feeling well. Apparently he had been confused more over the last three days. Turns out he had a pretty significant cardiac history with stents and was a recovered alcoholic. There was no mention of this by the ER nurse.
I soike to the MD and she said he was over sedated from meds he takes at home and possibly had gastroenteritis. She said she was going to order a repeat LP for the am.
First of all, I was only told that he came in confused for 3 days and had an elevated white count and unsuccessful LP. The nurse said he had no other tests done, did not mention any of his history other than HTN and COPD, and didn't say anything about fevers or vomiting. Second, he had been in the ED for 12 hours and didn't even have his EMS stick replaced, had no temperatures recorded except right before coming to the floor, and hadn't been given any fluids, just 1 dose of vanc and ceftin.
Im very confused as to how they can get away with not recording vitals. I figured she had only given me his last set because he just got there. She could've given me a range if he'd been there an entire shift already!
I had to call that nurse back when I got the patient to ask why there were orders for fluid boluses and to get the results of tests that she said he had never had. She denied he ever had a fever or that there were orders for a bolus when she had him. She was very rude and acted as if I was overreacting, but the Dr told me the patient needed to be in ICU. There were just no beds. Then the nurse finally said she thought he had meningitis and to just wear a mask. Ugh!
Also, in the doctors h/p it said nothing about any of his symptoms except for chest pain and elevated white count. I'm so confused and probably too exhausted to be thinking about this right now. All I know is this patient is sick and would be better off going somewhere else if the ER doesn't even have a clue what's wrong with him after he's been there for that long.
I would absolutely love it if I could do this where I work! Matter of fact, I always attempt to look at everything before they call to give me report for that exact reason...so I can know more, know what to ask, help them out on not having to tell me every little thing, etc. For whatever reason they made it unavailable to view a patient in the ERs info unless you have worked in the ER before and been put in their system or something like that. Sometimes registration will transfer them in the computer before they call for report, but hardly ever. It's very frustrating and leaves a lot of room for confusion when I do get to view their stuff. I always have questions for the ER nurse, but hardly ever bother to call and ask because most of the time they're too busy to look up everything.
The main issue I have been having lately is they will be in a hurry to get off the phone (because they're slammed...I know) so they may forget to tell me what they've given and not given (they don't always scan the meds) and so when I see a med that was due at say 1500 and its still in red when I get them at 2300 I don't know whether they've had it or not and neither do these patients lol so I have called before to ask and can never get in touch with the nurse who had the patient. Or the nurse says she did give it but doesn't sound confident and it's just scary.
See, this? This is a system problem that needs to be addressed by people who are paid more than the floor nurses.
Are you able to see any of the charting done by the ED after the patient comes up? Hopefully yes, and hopefully they charted the meds given. If you can't, that's when you contact the doctor. "Evening, doctor. I'm calling about Mr. X, in room 3456. He had meds ordered by the ER physician at 1800, but nobody is sure if he got them. Would you like me to give him them now, or wait until tomorrow? His vitals are this, and he has these complaints." Enough of these phone calls, and the physicians will be pushing for a change...
My facility says screw it, and a hard copy of the ER chart goes with the patient to the floor. We can't scan the meds in in the ED, and yes, we can sometimes forget everything we have given, so this way the floor can simply look at our charting.
I don't know about your hospital, but mine would rather that there are ZERO incidences of med errors that are so, so preventable.
While I can sympathize to a degree with some of your thoughts about the "ER nurse dropping the ball, again".. I'm an ER RN at a large, inner city, level one trauma center and have worked Med-Surg and SICU.
Some of the issues you've mentioned sound more to be on the admitting physician and not necessarily the ER nurse. I completely agree with some of the comments for you (and others) to go down to your ER and shadow for a shift. You might come out of the ER with a completely different thought process when you receive a train wreck from the ER.
We carry 4 patients in our ER and we might have one or two intubated patients with multiple drips
running (which would be a 1:1 or 2:1 ratio in an icu) And still have to have our ratio 4:1. And God help us if another hospital is on diversion because now we have 5 or 6 patients with beds in the hallways. (Our hospital refuses/can't divert- that decision is not a nursing one) ..
I try very hard to not send train wrecks to the floor, ever, but our job in the ER is to fix what is life threatening at that moment - not necessarily do a million dollar work up on someone that's getting admitted anyway. And trust me, 98% of ER nurses do care (I know this wasn't your comment- someone else mentioned them not caring) because if they didn't care, they wouldn't be run ragged on a daily basis for fun.
Maybe, as nurses, we should be coming together to advocate for nationwide RN to patient ratios instead of attacking each other about what someone did or didn't do. We are all in this together, we need to start treating each other better
I remembered this post and was like hmm yea I agree from the ICU perspective ER drops the ball a lot, but having read multiple replies I gained perspective and shrugged it off.
But then today I am reminded how much I either really like a few ER nurses or dislike them very very much. And then remember our ER is not some super large metropolitan ER with crazy stuff happening constantly. When i call over and hear a bunch of laughter and look at the census boards and see limited amounts of patients I wonder why then as soon as the call comes to admit a patient and a room choice is needed that they are calling to give report the second i'm off the phone with another person for room choice.
Then i wonder why there is no common courtesy or common sense when we receive 3 of your patients as admits in an hour and then you are upset I have told you to wait with the the other two one of which is intubated...heaven forbid you have to manage a elderly vented patient (which will come up with no foley as usual); the other on jail clearance and is overflow like the other 3 that could wait indefinitely but this one is complaining of chest pain as a way to escape jail. Just because you see we are low census (at the time with less staff in house as a result) thinking it gives you some right to just drop it all on us because you want to go home right now. No love for the ER. .|.
I remembered this post and was like hmm yea I agree from the ICU perspective ER drops the ball a lot, but having read multiple replies I gained perspective and shrugged it off.
But then today I am reminded how much I either really like a few ER nurses or dislike them very very much. And then remember our ER is not some super large metropolitan ER with crazy stuff happening constantly. When i call over and hear a bunch of laughter and look at the census boards and see limited amounts of patients I wonder why then as soon as the call comes to admit a patient and a room choice is needed that they are calling to give report the second i'm off the phone with another person for room choice.
Then i wonder why there is no common courtesy or common sense when we receive 3 of your patients as admits in an hour and then you are upset I have told you to wait with the the other two one of which is intubated...heaven forbid you have to manage a elderly vented patient (which will come up with no foley as usual); the other on jail clearance and is overflow like the other 3 that could wait indefinitely but this one is complaining of chest pain as a way to escape jail. Just because you see we are low census (at the time with less staff in house as a result) thinking it gives you some right to just drop it all on us because you want to go home right now. No love for the ER. .|.
I am am so over this back and forth argument between the ER and the rest of the hospital! Every one of us can spew stories of how we were done wrong by another nurse but we were the only righteous ones in the situation and the only ones who truly know what we are doing in taking proper care of our patients! No one person or department holds a monopoly on this! Please just get over yourself and CHOOSE whether you are going to just continue to complain and hate on your fellow nurses or if you are going to suck it up, do your job, and try to find solutions to those things that can be fixed!
I am am so over this back and forth argument between the ER and the rest of the hospital! Every one of us can spew stories of how we were done wrong by another nurse but we were the only righteous ones in the situation and the only ones who truly know what we are doing in taking proper care of our patients! No one person or department holds a monopoly on this! Please just get over yourself and CHOOSE whether you are going to just continue to complain and hate on your fellow nurses or if you are going to suck it up, do your job, and try to find solutions to those things that can be fixed!
How exactly do I "fix" the problem when my pts are coming to the floor in urine-soaked clothing, sent up against policy before orders are in, dumped in a room and gone with no notice to the floor that the pt has arrived? How do I fix antibiotics overdue by 6 hours? Doctors breathing down my neck about late meds, incomplete charting, undone tests?
I think both floor and ER nurses need to just admit that sometimes, there are nurses in both units that suck. Sticking up for all of "your" nurses, even the stupid/lazy/mean nurses, just makes the unit look that much worse.
Some ER nurses are awesome. Some suck. Just like floor nurses. It is not "my job" to explain to an ER nurses that it is not acceptable to send a pt up in clothing stiff from dried urine. And, speaking for myself, if I'm not answering your report call, there's a good reason, like my patient is trying to not breathe now. Or I'm up to my elbows in poop and can't touch the phone. This does not mean all floor nurses are innocent.
How exactly do I "fix" the problem when my pts are coming to the floor in urine-soaked clothing, sent up against policy before orders are in, dumped in a room and gone with no notice to the floor that the pt has arrived? How do I fix antibiotics overdue by 6 hours? Doctors breathing down my neck about late meds, incomplete charting, undone tests?
I think both floor and ER nurses need to just admit that sometimes, there are nurses in both units that suck. Sticking up for all of "your" nurses, even the stupid/lazy/mean nurses, just makes the unit look that much worse.
Some ER nurses are awesome. Some suck. Just like floor nurses. It is not "my job" to explain to an ER nurses that it is not acceptable to send a pt up in clothing stiff from dried urine. And, speaking for myself, if I'm not answering your report call, there's a good reason, like my patient is trying to not breathe now. Or I'm up to my elbows in poop and can't touch the phone. This does not mean all floor nurses are innocent.
First thing you need to do is change your attitude. It feels good to you bitc_ about all of the things that you THINK someone else did wrong but NOBODY wants to hear you whine about it! Part of the attitude change needs to include getting rid of the idea that there are "your" nurses and "my" nurses. We are all in this together and the sooner you see us all of us as part of the same team, just with different roles, the better off you will be. I'm not sure where you got the idea that I was "sticking up" for "my" nurses but it didn't come from me. Neither did I say that some ER nurses don't "suck" or that it's your job to explain to an ER nurse how to do his or her job. Many of the posts on this thread have already stated that every department/floor has their share of nurses that fall short in some respect, whether intentionally or not, but that fact should be a given and for the life of me I don't understand why it constantly needs to be repeated because it should be one of those things that's just understood without question! And you need to extend some understanding and benefit of the doubt to the nurse handing off your patient, the same way you are demanding it for yourself. Just like The ER is not privy to everything that is happening on the floor, you don't have all the facts either, but are forming conclusions based on some isolated pieces of information and deciding that you are being unnecessarily screwed over. if you truly want to change anything then start with yourself--step up and be a leader for change. Instead of just complaining, find out where the process is broken and offer solutions. Exactly what those will be will obviously be different for every hospital. But even if you try and you don't see the changes you want, you CAN decide not to be miserable and make those around you miserable with you.
First thing you need to do is change your attitude. It feels good to you bitc_ about all of the things that you THINK someone else did wrong but NOBODY wants to hear you whine about it! Part of the attitude change needs to include getting rid of the idea that there are "your" nurses and "my" nurses. We are all in this together and the sooner you see us all of us as part of the same team, just with different roles, the better off you will be. I'm not sure where you got the idea that I was "sticking up" for "my" nurses but it didn't come from me. Neither did I say that some ER nurses don't "suck" or that it's your job to explain to an ER nurse how to do his or her job. Many of the posts on this thread have already stated that every department/floor has their share of nurses that fall short in some respect, whether intentionally or not, but that fact should be a given and for the life of me I don't understand why it constantly needs to be repeated because it should be one of those things that's just understood without question! And you need to extend some understanding and benefit of the doubt to the nurse handing off your patient, the same way you are demanding it for yourself. Just like The ER is not privy to everything that is happening on the floor, you don't have all the facts either, but are forming conclusions based on some isolated pieces of information and deciding that you are being unnecessarily screwed over. if you truly want to change anything then start with yourself--step up and be a leader for change. Instead of just complaining, find out where the process is broken and offer solutions. Exactly what those will be will obviously be different for every hospital. But even if you try and you don't see the changes you want, you CAN decide not to be miserable and make those around you miserable with you.
It is not my job to explain to an ER nurse why it is not appropriate to send urine soaked patients to the floor. The fact that you somehow believe this is also the fault of cold-hearted ****** floor nurses doesn't surprise me.
That is not a system failure, that is an individual failure.
It is not my job to explain to an ER nurse why it is not appropriate to send urine soaked patients to the floor. The fact that you somehow believe this is also the fault of cold-hearted ****** floor nurses doesn't surprise me.
That is not a system failure, that is an individual failure.
What?!? If you actually read what I wrote then you certainly didn't comprehend it! It's obvious that your only desire here is to complain.
How exactly do I "fix" the problem when my pts are coming to the floor in urine-soaked clothing, sent up against policy before orders are in, dumped in a room and gone with no notice to the floor that the pt has arrived? How do I fix antibiotics overdue by 6 hours? Doctors breathing down my neck about late meds, incomplete charting, undone tests?
When I worked ICU, incidents such as you've described would be written up, and the unit managers would get involved in trying to figure out how such a thing happened, and how to make sure it didn't happen again. Does your facility not have incident reports or similar procedures?
Would you like to come down and call the CNO to tell her that we need to go on divert?? Being in the ED, I'm pretty much immune to silly attacks...however, this one struck a nerve. There are times I would like to go on divert, but, well, census is our friend, or so they say. If you know how to convince the individuals who can say 'divert' to actually say 'divert,' please, let me know!
Nonyvole, BSN, RN
420 Posts
See, this? This is a system problem that needs to be addressed by people who are paid more than the floor nurses.
Are you able to see any of the charting done by the ED after the patient comes up? Hopefully yes, and hopefully they charted the meds given. If you can't, that's when you contact the doctor. "Evening, doctor. I'm calling about Mr. X, in room 3456. He had meds ordered by the ER physician at 1800, but nobody is sure if he got them. Would you like me to give him them now, or wait until tomorrow? His vitals are this, and he has these complaints." Enough of these phone calls, and the physicians will be pushing for a change...
My facility says screw it, and a hard copy of the ER chart goes with the patient to the floor. We can't scan the meds in in the ED, and yes, we can sometimes forget everything we have given, so this way the floor can simply look at our charting.
I don't know about your hospital, but mine would rather that there are ZERO incidences of med errors that are so, so preventable.