*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?
With that being said I have had a few reports go as so: blah..blah... chest pain...blah blah..resolved. Me: "walkie talkie?". ER guy: "yep". Me: skin good? ER dude: "yeah, intact. Its all good". Me: "Sweet, thanks." (I pre-print out our sbar that usually has labs on it and skim through it. If I see something weird then I will ask.) That is the awesome report I get at times.
) After iv bp meds (labetolol), po labetolol and clonidine it went to 194/110(105). I am on tele. No BP iv drips here. She said this was patient's baseline and asymptomatic. Okee-dokee...I get the pateint admitted, blood pressure never goes lower than 205/110 (highest 219/115) and immediately get an order for ICU transfer with a drip to titrate blood pressure. Within 2-3 hours of getting the patient from ER he/she is in the ICU. ER nurse's argument was "he/she is asymptomatic, why give an ICU/PCU bed when someone else can use it?" I wonder if it was her dad/mom, etc if she would have felt the same way. (sorry lack of spacing/paragraphs- dumb smart phone)
She said she thought she was talking to a nursing student. Regardless, that was not appropriate. 
Needless to say the patient was a "hot mess" (as some of my younger coworker friends would say 
) And after a unit or two of blood, pushed D50 two or three times with no improvement of blood sugar and AND increased fever (going septic). He was transferred to higher level of care. How could someone give report to a volunteer. It doesn't matter to me that this nurse was from the ER, they could have been a nurse from any department. Now when I give report (especially to a SNF) I ask if they are an RN, LVN. So I can document correctly. 
while this isn't the fault of the ed, of course, it is at the root of the animosity of hearing 'oh, you'll love this easy patient!'. jme.
morte, LPN, LVN
7,015 Posts
Remember, you asked....
As numbered above
1)Enthusiastic can be interpreted as: I really want to get rid of this guy.
2) Dilaudid has a very short half life, over half of the first two doses were gone by the time
the fourth was given. And how big was the guy? These fx's are/can be excurcicating.
3) Don't sound so uncertain, either he will or he won't, it isn't your problem if the docs change their minds later.
4) This makes him sound like he is only looking for drugs.
5)The short answer should have been "none". To go on as you did, makes it look like you are questioning yourself.
yeah, the floor nurses need the orders in black and white, they don't have docs lookin' over their shoulders, ya know?
And be on guard, her asking for your name was a pretty clear threat.
Though this would have been a pertinent lab to draw.
If I rec'd your report, I wouldn't have had a problem with it, just trying to trouble shoot/give suggestions.