ER nurses not calling report anymore...

SionainnRN · Jan 10, 2014

we had someone from ed- a tech bring up a pt the other day. no one had informed us that the room was even booked. didnt even get a name. so had no idea what their dx was. how safe is that. tech was told by superior to bring pt up. coordinator said no was answering the phones on the floor. we had some critical stuff going on , and all the phones were in use. we dont have call waiting- duh!. so they said send em up anyway.or lately, the room will be booked, but we get a call that pt is already on their way up.doesnt even give us 30 seconds to look up info. so not safe [/quote']
That is hugely different than a nurse not calling report. Where was the house sup or bed controller? The charge nurse? There are many steps that were missed in this scenario. I've had trouble getting a pt up to the floor but everyone knew the pt had a room and was coming.

martymoose, BSN, RN · Jan 11, 2014

lol- it was the charge nurse's bed/ pt.

coordinator said no one answered the phone, so sent them up. as if to imply we don't answer the phone so we dont get a pt? seriously everyone had situations going, and there was no secretary. charge carries full pt assignment

SionainnRN · Jan 11, 2014

lol- it was the charge nurse's bed/ pt. coordinator said no one answered the phone so sent them up. as if to imply we don't answer the phone so we dont get a pt? seriously everyone had situations going, and there was no secretary. charge carries full pt assignment[/quote']
Yeah that's not cool. It's one thing if it's hospital policy that report isn't called but come on someone has to know the pt is coming!!

Gabby-RN · Jan 11, 2014

In the ED where I work, once the MD decides a patient will be admitted, they put in an order requesting a bed. On the nurses screen we see a little icon of a bed. In the order it specifies the level of care the ED physician is requesting. At some point an inpatient MD comes to the dept and evaluates the pt. The inpatient MD determines if the placement is appropriate. Sometimes the ED doc will ask for an ICU bed but the ICU doc decides the pt doesn't need that level of care, so they put a request in for a step down bed, the inpatient doc from the step down unit assesses the pt and either determines the pt is appropriate and puts in admitting orders or confers with the ED and ICU docs until they make a decision as to where to place the pt.

Once the inpatient doctor accepts the pt, the ED nurses screen shows a red dot which basically just starts the process where the bed manager finds this patient a bed on the unit type. For the ED nurse this prompts us to do an SBAR nursing note, which we update until the pt leaves. Some info is transcribed automatically like the IV sites diagnoses, last set of vitals, inpatient docs etc, the nurse has to manually enter head to toe info and a short narrative about the pt.

The red dot eventually turns to yellow when a unit is selected and green when the unit and bed are selected. Once the green dot appears we have to call the unit and let them know the sbar is complete and then document in a note that we called the unit and who we spoke to. We can tell whomever answers it does not need to be the nurse.

Then the orderly prepares to transfer the pt. The nurse must go with the orderly if the pt is on a cardiac monitor, high flow oxygen, or if the pt is going to an ICU or step down/progressive care unit. Then the nurse must give a quick verbal report at the bedside. If the nurse who cared for that pt cannot accompany the orderly and another nurse must go, the nurse must call and attempt to give a verbal report to the nurse and if they can not be reached, the charge nurse.

Its not a perfect system by any means. Its a long process with many kinks that need to be worked out. Like how once the inpatient orders are out in all the ED orders are discontinued, or how difficult it can be to get a call back from the inpatient doc to ask for prn pain meds or IVP zofran for the pt that just started vomiting or to ask if the pt can have a drink or eat since they forgot to put diet orders in. Or when you call up to the unit at 5pm because there is a green dot saying the room is ready and the secretary tells you the room is being cleaned and to call back in 30 min or puts you on hold forever while they try to figure out who is taking the patient only to find out its the nurse who is changing a wound vac right now so you have to call back but then your charge nurse says we need the bed empty now and tells you to give report to the floor charge nurse who you think might only be half listening to what you are saying because they are super busy managing the unit and you hope she tells the nurse taking the pt what you said about the patients preferences cause it will save them a lot of time and energy.

I have worked both on the floor and in the ED and I wish there was a way to make it better for both sides. The floor nurses are busy and so are the ED nurses. Just the other day there were 70 pts waiting in the waiting room/triage, we were holding more than 30 pts waiting for beds on the floors. Usually each nurse is assigned 4 rooms. This day, Every nurse had their 4 pts plus 2 hall pts. Two of my six pts had been waiting for beds for over 20 hours and were not happy campers and had a lot of needs/orders/meds. One of my pts was waiting for a bed in the ICU for 4 hours and was obviously very ill. Which meant for those 4 hours I was caring for an ICU pt and 5 others with minimal assistance from fellow nurses cause they were in the same boat. During those 4 hrs I turned over 2 patients (discharged 2 then got 2 new pts), I hung a unit of blood, inserted 1 foley, 2 straight caths, started 6 IV's, inserted an NGT, gave countless IVP meds, tracked down 2 sandwiches-1 for a pt and 1 for their spouse who did not ask for food but I knew had not eaten all day because they didn't want to leave their loved one's side, checked a lot of vitals, titrated a drip, and countless other things I have since forgotten. Oh and after bringing the ICU pt up to their bed I came back to find that room being cleaned because I had an unresponsive pt coming 5 min out. Every day is not like this of course but when sh** hits the fan you just have to do what you can do as best as you can and move pts along as efficiently as you can. I would love to be able to give a proper face to face report that is not rushed every time but its just not always possible. Just like its not always possible for the floor nurses to answer the phone when I call to give report or even go meet me at the bedside to take report on their new patient. I would love to have the time to check what type of bed every admitted pt is waiting for and advocate for all of the patients that need a different level of care. Sometimes that is not possible. There are so many things I would love to have the time to do every day that I work. The ED nurses are busy, the floor nurses are busy but they are completely different types of busy. The floor nurse is upset that I am bringing a pt up to the floor 15 min before shift change, I don't blame them. It sucks. Trust me I know that all too well. Especially since when I get back down to the ED I am sure a new pt will be in that bed waiting to be seen. Maybe with CP or actively vomiting or some other complaint that needs attention right away.

HeartRN054 · Jan 13, 2014

According to the Joint Commission, an estimated 80% of serious medical errors involve miscommunication during handoffs and transfers. I'm no mathematician but 80% seems like a pretty significant number. In no logical world can I even begin to understand how a hospital can implement a policy that allows patients to be transferred without a verbal report. It's simply unsafe and unacceptable.

In 2009, the Joint Commission announced Hospital National Patient Safety Goals included NPSG.02.05.01 which states, "The hospital's process for effective hand-off communication: Interactive communications that allows for the opportunity for questioning between the giver and receiver of patient information." Furthermore, in 2012, Joint Commission introduced a new, customized tool to improve hand-off communications, part of the tool states, "Allow opportunity to ask questions, which includes using critical thinking skills when discussing a patient's case as well as sharing and receiving information as an interdisciplinary team (e.g., a pit crew). Receivers should expect to receive all key information about the patient from the sender, receivers should scrutinize and question the data, and the receivers and senders should exchange contact information in the event there are any additional questions."

In a perfect world, all hospital policy would require that the nurse that has been caring for the patient to call the receiving nurse and give a full report based on the SBAR. But we don't live in a perfect world. An ED nurse that hasn't cared for the patient is calling report for a colleague that has been pulled into a trauma, the ED nurse is getting slammed with squads and has to get the patient to the floor ASAP to make room for the next patient, report is called or a patient is transferred to the floor during shift change. Those situations are unfortunate and reduce safety upon transfer but at least there is some form of report, an opportunity for the receiving nurse to ask questions.

A situation where there is no report... I just can't understand. Aside from the safety issues, what are the legal ramifications? At what point does that patient's safety transfer from the ED nurse to the Floor nurse? Nursing shortages are common. What happens if the patient arrives on the floor, there is no one at the front desk, all of the nurses and techs are in other patient's rooms, and the newly admitted patient is left on the floor without notification? Some hospitals use transporters or medics to take patients to the floor and the information is left at the desk, regardless if there is someone there to receive the paperwork. What if the patient is left in the room and codes, or falls, or any adverse event occurs? Who is to blame? If the hospital has a clear and WRITTEN policy that states patients can be transferred without a verbal report, I think the hospital would be liable. Regardless, if a patient that was supposed to be transferred into my care was injured, died, or otherwise neglected, I would feel a sense of responsibility even if I wasn't made aware of the patient arriving to my unit. Ultimately, I wouldn't risk my license or my conscious by working at a hospital that allowed transfers without report.

As for the rift that seems so common between ED nurses and Floor nurses, please stop. We have chosen a stressful career and don't need to add to that stress by creating conflict between departments. No one benefits. I'm a Floor nurse and yes, it can be frustrating to receive a patient whose linens are wet, hasn't eaten in 12 hours, with an annoyed family at the bedside. I'm stressed for time, sometimes lacking proper staff, with a million things to get done before my shift ends, but I don't expect a patient to come from the ED wrapped in a perfect little package with every little need already addressed. It's just not the way it works. When I get report I don't expect the ED nurse to be able to tell me if the patient has skin breakdown on their coccyx or the date of their last bowel movement (unless it was in the ED and smelled of c.Diff). I expect critical findings, the down and dirty, basic information that I need to safely assume care for the patient.

So the next time you the (ED nurse) calls report to the floor and the nurse asks for more time, try and remember how stressed you may be, how you may need more staff, how you are getting pressured to get the patient to the floor as soon as possible, please remember that the Floor nurse is probably dealing with the same or similar issues. And the next time you the (Floor nurse) receives a call from the ED nurse that is trying to send the patient to you with a quickness, remember that they are dealing with the same or similar issues. Be respectful, be polite, be kind, and apologize if the situation warrants an apology. We need to start fostering a better working environment, build each other up instead of tearing each other down, and fostering a system where mutual respect is the standard, not the exception. So next time you pick up that phone to give or receive report, be mindful of how your tone of voice and the words you choose is going to impact the other person. Idealistic, probably, but then again, I haven't been part of a hand-off where either party was rude since I made a conscious decision to be mindful.

Here.I.Stand, BSN, RN · Jan 15, 2014

As for the rift that seems so common between ED nurses and Floor nurses, please stop. We have chosen a stressful career and don’t need to add to that stress by creating conflict between departments. No one benefits.
We need to start fostering a better working environment, build each other up instead of tearing each other down, and fostering a system where mutual respect is the standard, not the exception.

Hear, hear!! :up:

kryn115 · Oct 5, 2014

That's if you can actually get the ER nurse on the phone!

Beverage · Oct 5, 2014

I Am always courteous to the ED nurse regardless of how busy or annoyed I may be at getting a patient at shift change because it serves no purpose and can't be helped. I got one this evening at 1835, we change shift at 1845. All I could do in 10 minutes was skin assessment for breakdown, change his gown and get a set of VS. I felt bad that NOC shift had to finish the admit but I'm not staying over my 12 hours. I had a brutal day with a confused pt screaming and bed alarm going off all day, giving blood, Afib RVR I started on a gtt, and 2 post op CABG pts, one I discharged home. I took lunch at 1530 and held my own phone. Some days it just is what it is.

GM2RN · Oct 5, 2014

That's if you can actually get the ER nurse on the phone!

I know, right! Cuz it's not like we have patients to take care of or anything, I mean besides the one we are supposed to give report on. So we just go out of our way to make it difficult to give report so we don't have to get another patient right away! :banghead:

martymoose, BSN, RN · Oct 5, 2014

I lately wonder why the pts even stop in ed in the first place. just send em up. We don't get any information on them anyway.The person bringing them up usually tells me they have no idea why the pt is here. They 're just transporting the pt.

I even had someone come up on a cardizem gtt with no report. diagnosis in chart was urinary retention. But they were in rapid afib apparently.

I guess it's put up or shut up.....

GM2RN · Oct 5, 2014

I lately wonder why the pts even stop in ed in the first place. just send em up. We don't get any information on them anyway.The person bringing them up usually tells me they have no idea why the pt is here. They 're just transporting the pt.
I even had someone come up on a cardizem gtt with no report. diagnosis in chart was urinary retention. But they were in rapid afib apparently.
I guess it's put up or shut up.....

You're right, we really should just get rid of the emergency room altogether because the only nurses that know what they're doing work on the floor anyway. Us ER nurses are just useless!

Livingdeadnurse · Oct 5, 2014

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.

I am an ER nurse I would rather give report so something doesn't get missed. Since this is a new policy. Write up issues you have. Things that were missed, patients that came up without knowledge. If you can make your case you can get the policy changed. We had the same issue. We used an SBAR. I hated it. I want to tell you about their state of mind or the family. Sometimes the SBAR doesn't ask all the questions. I prefer calling my report. What I hate is patients I can't get upstairs. 80 yr old lady should not have to lay on these crappy stretchers. Remember the ER patients continue to come in.