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ER nurses not calling report anymore...

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by plinytheRN plinytheRN (New Member) New Member

plinytheRN has 2 years experience and works as a RN Surgical ICU.

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You are reading page 10 of ER nurses not calling report anymore.... If you want to start from the beginning Go to First Page.

RainMom has 7 years experience.

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Just a scary update on this situation' date=' ER sent up a patient with no report. They came in for hyperglycemia in addition to something else (not my patient). They came at a time when the BG didn't have to be checked, but the receiving nurse knew better, and assessment tipped her off, and found them to have a BG of 27. no insulin was charted, there was no way to know what they had been given except to call and ask, which isn't going to happen when you are dealing with a BG of 27... Frequently the ER does not chart meds they have given. Not to mention a sticky situation that happened the other night when a pt was sent up at shift change, no one knew they were there (not sure all the details) and they coded and died. Scary stuff. Such a lack of communication and patient care suffers.[/quote']

....or is non-existent in your last example. I hope this was the final straw for actions to be taken and changes to be made. Heads would roll if this happened where I work.

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5,031 Visitors; 180 Posts

I don't think you understand, it's not that if we leave inpatient orders to the floor, then we will have more time for eating Bon Bon's, it is that there is ALWAYS someone to take the place of the patient being sent upstairs. longer the patinet stays in the ER room, the more crowded the waiting room gets. Where I work we have 15 minutes to get the patinet out of the ER when a bed is assigned. Report is called into a messaging system, where receiving (floor) RN retrieves report and call call back if they have any questions. My experience is that they very rarely do. Exceptions are verbal to ICU, IMCU and Cath Lab, where an RN transports them anyway. Works well. Eliminates the phone tag situation which delays care for the patient.

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martymoose works as a rn.

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We are doing this now(sbar) . I also get an actual report if pt isMI, cva, gtts, etc. I still get a poopy report most of the time- ie: hmm , why's pt coming up with transport wearing a gown? Ooohhh, they're cdiff- hmm, left that detail out,. Whatever.

I think the whole point of this is that the hospitals who cant cut it with the new ACA plans, have closed, and the remaining hospitals are picking up the slack( now overcrowded) and the whole point now is to mass expedite pts through, just like an assembly line.I think the plan is to have mass production to make up for the lack of payments that the hospitals won't be receiving .

Why do we bother going through ed- just send em straight up to the floor.

Seriously- on an IMC floor , I had a person who had cardiac ARRESTED in the field- was shocked,cpr, b/p soft, some residual amnesia( hopefully not permanent) , who was sent up to the floor 2 hours after coming in. Everyone I asked thought this was unusual too.

IMC floors are going to be the new ICU's , and ICU's will be the absolute last ditch effort floors.

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5,031 Visitors; 180 Posts

Level of care assignments are made by physicians, case managers and house supervisors not ER RN's. I find it very hard to believe that a full arrest went to an IMCU. I have never seen it, never heard of it and would bet money if it was truly an arrest, it didn't happen.

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martymoose works as a rn.

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It was a true arrest- had cpr for about 4 minutes until someone found an aed- and it was a shockable rhythm.Then ems got there spouse witnessed the whole thing, and after pt kept asking " why is my chest so sore" repeatedly, was told that the guys really pounded on the chest well.B/p 105/60 hr 105 sr 95 3 liters nc. I guess thats considered stable enough for IMC floor.

We have inappropriate assignments all the time, but that one took the cake. Like I said, my cowrkers couldnt believe it either.

Our bed coordinators seem to make the assignments- lots of times MD's say pt should be in micu, but they prefer them to be on our floor:facepalm:

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ChristineN works as a RN.

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Our bed coordinators seem to make the assignments- lots of times MD's say pt should be in micu, but they prefer them to be on our floor:facepalm:

How on earth can a bed coordinator over ride a doctor's order for an ICU bed assignment?

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SubSippi has 2 years experience.

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This sounds similar to my hospital. I also work on a tele/critical care unit. I know if I'm getting an admission, but will have no clue when they're getting there and will often walk past a room and just see a patient laid up in the bed, with their papers on the counter!

I hate not knowing when they're coming, because I at least want to introduce myself and lay eyes on them as soon as they get to my floor.

This can also be dangerous. A couple nights ago I had a patient appear in a room...apparently had been there about 45 minutes, but I didn't know because they were on the end and I was having a crazy night. The bad part was this patient was on a heparin drip, and the nurse who brought the patient up didn't put the tubing in a pump, they just hung the bag up on a hook and left. And of course the IV was in the AC and the patients arm was bent so I'm sure it was occluded for who knows how long...

They had an NA sign off that the patient had arrived, but I don't blame the NA for not coming to find me immediately because she didn't realize how important it is to not stop a heparin drip!

I get that ER nurses don't have time to hunt for us or wait around, but a 30 second phone call would be nice.

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MunoRN has 10 years experience and works as a Critical Care.

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Level of care assignments are made by physicians, case managers and house supervisors not ER RN's. I find it very hard to believe that a full arrest went to an IMCU. I have never seen it, never heard of it and would bet money if it was truly an arrest, it didn't happen.

There was a time when a post-arrest meant automatic ICU level admission, I remember those days fondly. Acuity in all areas has been rising continuously, and it's not unheard for a post-arrest who is now stable, particularly when a reversible cause was found and fixed (STEMI, for instance) to go to a non-ICU level floor. You have remember that the typical ICU patient 15 years ago is now on the floors, it's a trend that doesn't look like it's slowing down.

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martymoose works as a rn.

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How on earth can a bed coordinator over ride a doctor's order for an ICU bed assignment?

No , what I meant to say was it seems the docs want the pt on the IMC floor, then we wonder why we end up having to transfer them to MICU when they've coded and should have been there in the first place. Actually had a guy code within 1 hr of getting to the floor. Should have never come there in the first place.

As MunoRN says, this kind of thing is happening more and more.

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itsnowornever works as a Studying like a madwoman until exit exams and NCLE.

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I am an ER nurse in a Level I trauma center which is also a teaching hospital. On any given day' date=' there are no LESS than 30 people in the waiting room, and it takes an act of God to get us closed or put on diversion. Therefore, we are open to EVERYTHING and the ambulances just keep on coming. I used to work on the floor prior to becoming an ER nurse so I get it from both sides. In our hospital, we fax report, confirmed it was received by the floor nurse, we wait 15 minutes (if we can) and then we take the patient up. We also give a quick bedside update once the pt is on the floor if needed. When I was a floor nurse, I knew the minute after report if I had an open bed, so I prepared myself for an admission from the ER that can come anytime during my shift. Also, the floor nurse can see the ED triage note, as well as the ED nursing notes and the doctor's H&P. I used to look this information up once I knew I was getting an admit so by the time the ED did call me for report, all I needed to know was the last set of vitals, as well as the IV placement and if any meds were passed or if I needed to pass certain meds. Now, the floor nurses complain that the fax report does not provide certain information, like skin issues. There have been several meetings between the floor directors and the ED director, explaining that the ED does focus assessments only based on chief complaint and once the patient gets orders from the admitting doctor, the ED is responsible for STAT orders only. I don't know how many times the floor nurses are upset that we did not draw their scheduled AM labs although the patient was sent up 3-4 hours before they were due. We used to call report to the floor, but half the time, it was refused because the nurse was not available. Then the nurse would call back 30 minutes later for report, then spent 20 minutes drilling the ED nurse for every single detail about the patient, while we have an ambulance patient waiting in the hallway for said bed.[/quote']

AMEN!!!!!!!

Posting from my phone, ease forgive my fat thumbs! :)

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itsnowornever works as a Studying like a madwoman until exit exams and NCLE.

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No insecurity issues here. I've just seen more than my share of lazy and/or inconsiderate ED nurses who will do whatever it takes to empty their rooms by the end of their shift.

And we've seen the lazy and inconsiderate floor nurses who expect us to do everything for them and then scream when they have to do anything no matter how busy we were.

Posting from my phone, ease forgive my fat thumbs! :)

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Esme12 works as a emergency ,critical care,cath lab,open heart,traum.

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Ok....here is what I think....I think we need to be considerate of each other as co-workers and professionals. Calling each other lazy isn't going to be conducive to an effective work environment

There are many factors that go into bed assignments and acuity. MOST facilities have (or should have) admission and discharge criteria that deem a patient appropriate/inappropriate for any given area. There have been time I have nixed an ICU admission and sent it to the step down after careful consideration of the patient and what I have waiting in the wings. While an alert stable post code, no drips, should be monitored in the ICU.....there may be a patient intubated on drips in recovery that needs that bed more.

It is a matter of acuity, triage and knowing the bigger picture.

I think sending patients without calling is bad nursing....I have worked both sides of that fence and I have supervised and assigned the beds. There is no excuse.

There is also no excuse for bad nursing. NO NURSE should be leaving a heparin gtt without a pump.....so it is a poor practice issue of this nurse and not an "ED nurse" thing. Of course there are many times in the ED when the patients come in IV's are in the AC or can only be started in the AC. Patients are anxious and cold...constricted and sometimes no other vein can be found....once they arrive on the floor...warm and comfy the veins appear.

On the flip side....the floor should NOT EXPECT the ED nurses report to contain admission assessment information ....so they can fill out their admission paper work.

Now we are sounding like the government....blaming each other for our own shortcomings.

We are all being asked to do more with less. We need to help each other and not tear each other apart. I blame administration and the managers for not enforcing good nursing practice and developing policies and procedures that reinforce safe practice.

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