ER nurses not calling report anymore...

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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.

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.

I'm not arguing against a verbal report at all. I like giving a verbal because you can communicate things that you would never get from just charting. I just don't like spending unnecessary time answering questions that are readily available in the chart. As for who is being consulted, that information IS readily available on the admission paperwork that goes to the floor where I work.

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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.

I just left a job where I did the same thing for a similar sized hospital. When I was first hired, the manager said that they had tried non-nurses in the position and it didn't work as well. I thought we did a fabulous job and it worked well for everyone concerned. The doctors would put in an admit order for med/surg, tele, or ICU, but we determined what floor to send the patient to. We had access to the patient's chart through EPIC and if we thought the patient should go to a cardiac floor we had discretion to send them there. We would also communicate with the ED docs if we thought the pt needed a higher level of care and get the appropriate order. It was the best system that I have seen, and patients would be assigned to a bed within minutes of the admit order in most cases. Sometimes, of course, patients would have to be moved to accommodate the ER admit and it would take longer, but the majority of patients had a bed assigned right away.

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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.

Nobody said that the information was "useless." The argument has been against the method for obtaining some of the information.

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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.

I think this is true in many cases, but I have to stick up for management at my hospital when it comes to staffing. Our ratios are currently 4:1 and if we end up with an ICU patient, a nurse is assigned to take care of that patient on a 1:1 or 2:1 depending on how many critical patients are in the ER at a given time. Management does a good job of staffing us appropriately, and in cases where we do happen to work short, non-critical patients wait, and nurses in the ED to a great job of working together to get patients taken care of in the quickest time possible so that wait times are not any longer than necessary.

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Upon reading the title, I thought you MUST work at my hospital.

Here, the ER nurses called report to the floor when they were ready. Now, the floor nurse is supposed to call ER within 20 minutes of bed assignment. I NEVER speak to fewer than 4-5 people before I get the right one and about half the time they aren't ready for report. If we don't call, they can send without report. Not safe at all in my opinion.

THEN the powers that be decided to go a step further and start sending patients to the floor without orders. Genius I tell ya. We can't do anything or give anything for or to the patient. It might be hours before the doc gets orders entered. It's crazy! And all of this is supposed to increase safety and satisfaction?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I just left a job where I did the same thing for a similar sized hospital. When I was first hired, the manager said that they had tried non-nurses in the position and it didn't work as well. I thought we did a fabulous job and it worked well for everyone concerned. The doctors would put in an admit order for med/surg, tele, or ICU, but we determined what floor to send the patient to. We had access to the patient's chart through EPIC and if we thought the patient should go to a cardiac floor we had discretion to send them there. We would also communicate with the ED docs if we thought the pt needed a higher level of care and get the appropriate order. It was the best system that I have seen, and patients would be assigned to a bed within minutes of the admit order in most cases. Sometimes, of course, patients would have to be moved to accommodate the ER admit and it would take longer, but the majority of patients had a bed assigned right away.
I would also make sure the patient was appropriate for the floor. I know some MD's would admit to the floor to prevent them from coming in which IS the case with ICU admissions....the had to be sen by an ICU intensivist/"certified" ICU admitting MD
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The main problem I have is the quality of report from the ER it's bluntly atrocious. I get that they are super busy but often basic info is lacking. Ad when I question it becomes obvious they don't know either. I get they're busy but how can you take care of a patient if you don't know the basic? Some of it is staffing but there are a few that really truly scare me. Often I have no way of knowing if the patient is appropriate until they come up and I can acess

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Would you guys believe that I read every post from this thread? I did. As a new GN, I am fascinated about many topics. This one was no exception. I can see both sides of this. Being a novice, I know I am going to be asking a lot of questions that seasoned nurses may not, so, ER nurses, please be patient with us newbies.

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Specializes in Case Management, ICU, Telemetry.

We also just instituted this policy at my hospital... I don't really care. Honestly, the report that I usually got back when we still got report was very incomplete, usually inaccurate and left me with a false sense of "knowing what was going on with the patient". I'm not a really big "report" person anyways... As long as the charting is accurate...

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Specializes in Med/Surg, Academics.
In each case there was nothing to shake my firm belief that voice report would add nothing to what was clearly laid out in the EMR.While efficiency is not the paramount goal, it is a very important goal and mandating a telephone call for each transfer is pointless; the vast majority of m/s and tele admits simply don't need it.[/quote']I need some sort of report because often test results are not transcribed by the time the patient reaches the floor. We can see it was ordered and done, but not the results. Labs, yes. Radiology, no. Also, the H&P is not always available, just the ED nurse's 1-line CYA notes. Maybe the issue is with medical transcription, but I would know next to nothing without a verbal report.
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Specializes in Med/Surg, Academics.
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.
No nurse is "just following orders." If the ED nurse feels that the patient needs a higher level of care or care on a more appropriate floor than the bed assigned, I would expect her to speak up! Why in the world would you want to delay appropriate care by washing your hands of it and leave it up to the floor nurse (who has laid eyes on the patient all of 5 seconds) to deal with?
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Specializes in Emergency Room, Trauma ICU.
No nurse is "just following orders." If the ED nurse feels that the patient needs a higher level of care or care on a more appropriate floor than the bed assigned I would expect her to speak up! Why in the world would you want to delay appropriate care by washing your hands of it and leave it up to the floor nurse (who has laid eyes on the patient all of 5 seconds) to deal with?[/quote']

Very rarely have I seen an ER pt go to the floor when they need to be on the unit. Rather it's the floor nurses who don't want to do the work and that's why they ***** and moan and say the pt needs a higher level of care.

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