ER nurses not calling report anymore...

[plinytheRN]

Hey all, our hospital started a new policy where the ER nurses don't have to call report on the patients coming to our floor- they can choose if they want to call report. Most don't call report. It is up to us to find this patient and research all about them before they get to the floor, hopefully. Most of the time, they show up before we know they are coming. It is very frustrating and unsafe, we don't know anything about what we are walking into. I work on a medical telemetry unit, with usually 5-6 pts per nurse, it's hectic and busy no time to be clicking through a computer on a new admit. From what I understand this is a trial to test out this new policy, I am hoping it doesn't last. It seems the only one that benefits from this new policy are the ER nurses, it's definitely not ideal or safe for the patients... Anyone experienced this sort of thing? Thoughts? Thanks.

[GM2RN]

GM2RN:

Any question is relevant. Asking who the admitting and consulting MDs is important, the computer is not always correct, isn't 2 seconds of a question better than finding out out a consult wasn't done because we were expecting the wrong MD.

Except they aren't asking only one question. They are asking me many of their admission questions. Besides, I would have to look up the admitting or consulting doc just like she should be doing. And if the information was wrong, I wouldn't know that anyway.

[ERRN324]

Except they aren't asking only one question. They are asking me many of their admission questions. Besides, I would have to look up the admitting or consulting doc just like she should be doing. And if the information was wrong, I wouldn't know that anyway.

Thats really a great point. If Neurology should be consulted but some how a consult for nephrology should have been done, any nurse should know that. It does not take report. If the wrong nephrologist was called on the other hand, how do you expect the ED nurse to know that?

[MunoRN, RN]

Except they aren't asking only one question. They are asking me many of their admission questions. Besides, I would have to look up the admitting or consulting doc just like she should be doing. And if the information was wrong, I wouldn't know that anyway.

At least everywhere I've worked, MD consults are only communicated to Nursing staff by the Doc saying to the Nurse "I'm getting a nephrology consult", that's the sort of thing that would get communicated in the verbal portion of report that should go along with the data the computer spits out.

[MunoRN, RN]

Maybe it's because I don't just work in the ER, but I really fail to see how it can be argued that report on a patient sick enough to get admitted doesn't deserve at least a verbal addendum to the data in the computer and/or chart. Communication is what makes or breaks good patient care, taking the simple step of ensuring, at least to some small degree, that the person you are handing off to understands report seems so very far from being too much to ask.

Mainly, I think it's offensive to the profession of Nursing to suggest that Nurses have nothing more to offer in communicating the overall story for a patient than what the EMR can spit out.

[herring_RN, ASN, BSN]

All these posts make me think the problem is insufficient nurse staffing.

Floor nurses are too busy with patients to drop what they are doing and come to the phone. The charge nurse probably has a patient assignment too.

ER nurses are assigned too many patients to give report.

If staffing is great there is sometrhing else wrong.

[MunoRN, RN]

I don't understand why the ER nurse is being harped on for "inappropriate admissions". The ER nurse has no control over what pt goes to which floor. If the floor nurse feels the pt is inappropriate then it's up to her or the charge to talk to the admitting doctor, not to take it out on the ER nurse who is just following orders.

I assume I'm reading that wrong and you don't really think that Nurses shouldn't be expected to do anything other than "just following orders", but ER Nurses should have a basic idea of what type patient is appropriate for a given floor, and what isn't, and advocate for appropriate placement prior to transferring a patient.

[uRNmyway, ASN, RN]

I don't understand why the ER nurse is being harped on for "inappropriate admissions". The ER nurse has no control over what pt goes to which floor. If the floor nurse feels the pt is inappropriate then it's up to her or the charge to talk to the admitting doctor not to take it out on the ER nurse who is just following orders.[/quote']

That's true. And I do. That's why I ask all the questions often seen as 'useless'. And you know what I've been told by a few ER nurses when I explained that I asked because I wasn't sure the patient was appropriate? 'Look, I don't care, that's not my job.'

You know, we really are supposed to be in it together, for the same purpose. To get patients the best care, to get them better. So if you see the doctor place an order for admit to a floor that you feel is inappropriate, you COULD question it. Just like we would question any other order we don't think is right for our patient. Patient advocacy IS our job.

[martymoose, BSN, RN]

All these posts make me think the problem is insufficient nurse staffing.

Floor nurses are too busy with patients to drop what they are doing and come to the phone. The charge nurse probably has a patient assignment too.

ER nurses are assigned too many patients to give report.

If staffing is great there is sometrhing else wrong.

Ding Ding Ding- we have a winner!!!!!

[martymoose, BSN, RN]

I don't understand why the ER nurse is being harped on for "inappropriate admissions". The ER nurse has no control over what pt goes to which floor. If the floor nurse feels the pt is inappropriate then it's up to her or the charge to talk to the admitting doctor, not to take it out on the ER nurse who is just following orders.

I guess I should specify- I am not angry at the ED nurse. I'm mad at the bed coordinator who isnt even an RN who assigns the beds. I am angry at the production line mentality of pts. Maybe ED's wouldnt be crowded if 1) people got booted out for stupid stuff like sniffles, colds, etc- innappropriate ED admissions, and 2)maybe we shouldnt be closing down all the outlying hospitals so the Main big cheese hospital gets ALL the business. Of course they can't keep up.Heaven forbid we lose a customer.

[uRNmyway, ASN, RN]

I guess I should specify- I am not angry at the ED nurse. I'm mad at the bed coordinator who isnt even an RN who assigns the beds. I am angry at the production line mentality of pts. Maybe ED's wouldnt be crowded if 1) people got booted out for stupid stuff like sniffles, colds, etc- innappropriate ED admissions, and 2)maybe we shouldnt be closing down all the outlying hospitals so the Main big cheese hospital gets ALL the business. Of course they can't keep up.Heaven forbid we lose a customer.

Ah, the hospital I work for, bed control has no actual control. The doctor places the request for the specific bed they want, bed control just calls to request the bed. All they see is admitting diagnosis, with no clue what the rest is.

[morte, LPN, LVN]

you beat me to it!!!! and as long as one group is willing to chew on the other, instead of b..... up instead, it will continue!!!!!

Ding Ding Ding- we have a winner!!!!!

[Esme12, ASN, BSN, RN]

Ah, the hospital I work for, bed control has no actual control. The doctor places the request for the specific bed they want, bed control just calls to request the bed. All they see is admitting diagnosis, with no clue what the rest is.

IN the old days it was an RN. As a supervisor I processed all beds for a 350 bed facility. When you take the nurse out of the equation there is bound to be problems.