ER Nurse (Me) calls Report to Ortho/Neuro floor

[libran1984, ASN, RN]

*Disclaimer* : No identifying names will be used in this. All dates, room #'s, etc have been changed and any resemblance to any person(s) with said ailments is by pure coincidence

That being said....

I, an ER nurse, call report to the ortho/neuro floor. "Hi! This is A. Doe from the ED. I'm trying to call report to the nurse who will be taking room # 1234."

The floor nurse picks up the line. "Hi. This is Jane Doe, RN. How can I help you?"

I enthusiastically begin telling the nurse how she is going to seriously love this patient. "Hi! I've got great, ambulatory, low maintenance guy for you. Name is John Doe born on 1/2/3333. No allergies. Diagnosis is a compression fracture of T11 found today in an MRI here in the ED. The admitting Doctor is Jonny Doe. Soooooo here's his story. The guy, being so young, has had a rather long battle with degenerative disc disease since his mid 20's and multiple spine problems coming and going. He says he noticed some pain in his back earlier this AM that quickly worsened within the hour- hence he came here. He had a titanium rod placed in his back on 4/5/6666, so it wasn't very long ago and he describes the pain as if the rod is poking him. We've been trying to control the pain with dilaudid. We've given 1mg at 1300, 1mg at 1400, 1mg at 1440 and 2mg at 1623. We've gotten the pain from a 9/10 to to a 5/10. Dr. Jonny Doe is having him admitted for pain control over night and then fromm the sounds of it John Doe will have a vertebroplasty, where they inject a cement like mixture into the vertebrae. As our ER doctor is describing it, its supposed to solve John Doe's problems and offer immediate relief. Until then just keep giving him his PRN dilaudid and he'll be a happy camper with little to no complaints."

I'm so proud. I covered all my bases.

"Is there anything else I can tell you?"

The Ortho/Neuro nurse asks me, "What labs have you done?"

I think to myself for a moment. "You know what, we didnt really do any labs in the ER. I don't think I drew even one vial from him. Like it was pretty easy going. If AM labs are needed on the floor the IV should work well and if not his veins can be used for dart practice across the room they're so huge."

"That's unusual." says the O/N nurse. "What's his history?"

"Being such a young guy he doesnt have any known medical conditions other than the degenerative disc disease and the rod in his back placed on 4/5/6666. "

"What meds is he on?"

"He's not taking any medications" I reply.

"I find that hard to believe" the O/N nurse argues. "You gave him 5 mg of dilaudid and he's still walking you say?"

"Well, yah. I mean, I thought the same thing but dilaudid just doesn't seem to work well on bone pain" I'm feeling kind of uneasy now.

"And you don't think he's taking anything else?" she pushes onward.

"Well, if he is taking anything else neither the ER doctor or myself have reason to argue with the diagnosis or MRI results." I think to myself that a broken back is still a broken back. It has to be fixed one way or another.

The O/N nurse changes course. "How did the fracture occur?"

I feel relief that we're changing topics but hesitant that she hasn't just accepted the patient yet. "The doctor said these types of fractures can occur spontaneously. The pt denies any form of known trauma."

I hear a sigh on the other end of the phone. I can actually hear her eyes rolling around in her head. "Does he have a diet order?"

"Yes, he's on a regular diet."

"Has he eaten yet?"

"Yes. His wife brought in Pizza Hut. He'd prefer Papa John's though, but I think it did his tummy well."

"Has the admitting doctor seen him yet?"

"I dont know. There are a lot of admitting doctors down here and I've never met this admitting doctor before. However, our ER physician went over in extensive detail what to expect from now until he leaves tomorrow afternoon or evening. Apparently this shot he's going to get is pretty quick and doesn't require a lot of acute care. He's gonna be an easy in an out."

"Are you the patient's nurse?" she inquires.

My mouth drops a bit. I'm shocked. I'm actually stuttering over my words because apparently i'm doing something wrong. "Yes. I'm the patient's nurse. i've been with him since he arrived and carried out all orders." I'm flabbergasted.

"Why don't you know if the admitting doctor has seen him?"

"I'm very busy and the doctors only stick around usually to write admitting orders and say hi to the patient."

"Well, what are my admitting orders then."

I begin to speak firmly now. "You are to give the patient a regular diet and administer 1-2mg dilaudid IVP q2-3 hours PRN."

"Is that what the order sheet says?"

"I dont have an order sheet. This is a very straightforward case of pain control until the procedure can be done tomorrow. I'm reading you the admit sheet."

"Did the admitting doctor write that order? I need to have an order sheet".

"I'm under the impression the admitting doctor tells our ER physician what to write on the admit sheet and they do so. I am now looking at that sheet and that is what I would presume to be your orders."

Sounding exasperated the O/N nurse expresses her frustration with one questions: "So what am I supposed to do with him?"

"I presume you are to manage his pain throughout the night until which point the admitting physician whisks him away for whatever this procedure he's having occurs. Do you have any other questions or may I send him up now?"

"And What is you full name?"

"My name is A. Doe"

"Alright you can send him up."

"Thank you." I hang up the phone.

OMG.... way to turn an easy easy patient into a nightmarish report. I mean what else can you ask for.

You have a patient who:

1. needs pain control

2. is ambulatory

3. is a/ox3

4. is cool as heck.

If you want to clarify your orders, then call the doctor, lady. But this all seems extremely straightforward to me. Simply manage his pain over night and then after the vertebroplasty send him home!

Did I do something wrong?

[VANurse2010]

I don't think you did anything wrong. It sounds like she was being a [rhymes with hitch] and didn't want to do *any* research of her own or do her own assessment.

[tothepointeLVN, LVN]

Sometimes I find when I'm too chatty during report I open myself up to lines of questioning like that. Sometimes people equate friendly with stupid. I guess maybe the theory is if your smart you'll know there's nothing to be happy about.

[Aurora77]

From the ortho/med surg nurse side, I wonder if all the questions come from not getting pertinent info in previous reports. One of my coworkers got report the other night about a pt in with chest pain. Completely failed to mention the guy was drunk as a skunk (apparently that wasn't important). That only came when the ER charge called to complain about my coworker for asking what said pt's troponin was.

Or she was just being picky and odd.

[Meriwhen, ASN, BSN, MSN, RN]

With all due respect to the ED side...not all nurses give as good of a report as you do. Lord knows the number of psych patients that I've gotten from ED nurses whose telephone reports are either minimal because they want the patient out of there ASAP, (Them: "The patient is drunk, when can I send him over?" Me: "What have you given him?" Them: "Some Ativan. When can I send him over?") and/or gloss over medical issues completely (because they are convinced that somehow I do not need to know that the patient has got a implanted access port, can only ambulate with a walker or has an INR of 5). And sometimes I feel like I'm pulling teeth trying to get information out of ED nurses...especially the ones that call me with report from the bedside and basically tell me nothing about the patient because they're afraid to speak in front of the patient. With some EDs that are known for doing this, the first words out of my mouth are, "Leave the room, then call me back."

Keep in mind that the patient's destination is going to have somewhat different concerns than yours, and so they're going to ask questions. I don't think this necessarily means that you gave a poor report or that the ED didn't do their job. Just that the info that the destination feels is important to them may not be all the same things that you and the ED think are important. Also, as the poster above me stated, perhaps that floor nurse had a bad experience with previous reports where they weren't given all the information, and so tend to interrogate thoroughly.

IMO, don't let it get to you. Personally I thought your report was pretty darn good.

In all fairness, I've been on the other side of the interrogation when I'm calling from the Psych ED to place a patient on the units and dealing with 10,000 questions, 9,000 of which I feel are inane. So I do feel your pain and frustration.

[jadelpn, LPN, EMT-B]

Sometimes it really is a matter of not getting all of the information. Sounds like you gave a through report. However, a person with chronic pain sometimes medicates with something they have on hand at home, even if it is "I took 6 Advil and 4 Tylenol and a couple Benedryl to sleep". And with a number of patients, the medical history and meds changes once they hit the floor. However, "I find that hard to believe" statements are putting the person (you) somewhat on the defensive. So whether you think the patient is pretty cool or not, I would just stick to the medical facts, orders, etc. and not that the person will be "easy" or an "in and out". And admitting doctors are important, as when the patient states in an admission assessment they take valium, and perhaps a BP med, and are diabetic, (that for more people than you can imagine severe pain clouds what an ER nurse is asking about medical history and meds) it is up to the floor nurse to track down the admitting MD for further orders.

And a regular diet is pretty straightforward, but if the patient is having a procedure, do they need to be NPO after midnight? Do they need labs (CBC) before the procedure is done? Is there an order for the procedure in the a.m.? If not, is the admitting MD doing the procedure and will be up to write orders? (which then opens up for some further paperwork for the OR). I am sure as an ED nurse, this patient was a godsend easy-peasy from your otherwise crazed day. But for floor nurses, as much information regarding this patient as far as medically as opposed to just that he is "pretty cool and easy" doesn't leave us to track down admitting MD's for more orders, when orders are being written in the ED.

[wooh, BSN, RN]

I guess maybe the theory is if your smart you'll know there's nothing to be happy about.

Bahaha! Love.

[Esme12, ASN, BSN, RN]

i can actually hear the tone of voice........like the annoyed waitress at the all night diner at 3am, eye rolling, snapping their gum with a nasal twang and smelling of smoke.......

"jeeze pal.....you want fries with that?" as she rolls her eyes.

as a side note.....mid twenties, long standing spine/pain issues, recent surgery, tons of dilaudid for pain still awake, but on no home meds.....spells suspicion. they would almost have to have something for pain.......i hate that the ed nurse in me has suspicions but experience has taught me to doubt.

[Orange Tree]

Everyone is so different when it comes to report. Your initial report would have been too much information for me and driven me crazy. When I'm getting an ER patient, I want to know the diagnosis, whether they have a med rec and about any meds that have ben given and are NOT in the ER charting (that should be none, but things happen). If the patient is disoriented, some history is helpful, but otherwise I'll just ask the patient myself.

[wooh, BSN, RN]

Everyone is so different when it comes to report. Your initial report would have been too much information for me and driven me crazy.

Hehe, me too. Just tell me what I can't read in the computer and let's get on with admitting the patient.

[MyUserName,RN]

I don't think you deserved that kind of questioning. Honestly, the report you gave her is better than I ever get from the ER for admissions. The best we get is a sloppy SBAR faxed that you usually can barely read, that almost never has the pertinant information on it, then you many times get the patient to the floor and don't have an any orders for meds, etc. I feel like this nurse probably has had some bad experiences from other nurses from your ER and that's why she was responding this way. That doesn't make it right though.

[cardiacrocks, BSN, RN]

Did anyone ever think for a minute that you might have been dealing with a fairly new nurse on the other end of the phone, they tend to ask far more questions. At least as far as I can tell, just wondering if you ever thought of who you are giving report to? Just throwing this out there...