ER nurses not calling report anymore...

Nurses Safety

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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.

Specializes in Emergency/Trauma/Critical Care Nursing.
ED nurses not giving report on patients seems inexcusable to me. I'm so tired of ED nurses who think that they're too busy saving lives to do small tasks, like phoning report, when the truth is that unless you work in a big city trauma center, you're dealing with sprained ankles and rashes a majority of the time. So pick up the phone & give report!

When is the last time you worked in an ED? If you EVER have, then you'd know the majority of ED patients are coming in for abdominal pain, chest pain, shortness of breath, etc. All of those require full work ups, radiology tests, and medications. Multiply that by anywhere from 4 to 10 pts depending on the ED, and you have the ED nurses assignment.

I agree that some sort of report should be given, but to insinuate that us ER nurses aren't calling report because we are lazy or feel that we are above floor nursing, is incorrect and disrespectful. Lets all work together to make positive changes like ensuring safe nurse to patient ratios, instead of belittling each other...

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Specializes in Cardiology, Cardiothoracic Surgical.

At my facility, the ER nurses would hold the patients right up until shift change to avoid getting new patients, then want to call and give report right in the middle of floor report. Patients arriving at 7:15? Are you kidding me? Are we trying to make this any more unsafe? Plus the floor nurse gets stuck with the new admission before she/he can go home.

This has created a minor war between the ER and the floors, and it's still probably going on to this day.

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At my facility, the ER nurses would hold the patients right up until shift change to avoid getting new patients, then want to call and give report right in the middle of floor report. Patients arriving at 7:15? Are you kidding me? Are we trying to make this any more unsafe? Plus the floor nurse gets stuck with the new admission before she/he can go home.

This has created a minor war between the ER and the floors, and it's still probably going on to this day.

Odds are that you don't really know what is happening in the ER and the reason for getting patients to the floor at that time of day. Once it's past a certain time of night, ER doctors often hold off calling admitting physicians until 5-6 am when they feel that they won't be disturbing the sleep of the admitting doc. That then causes a cascade effect of getting bed assignments, calling report, and sending patients up during shift change in an effort to clear the ER to make room for new patients coming in on the day shift.

Even if the above scenario isn't what's happening at your place of employment, I highly doubt that the ER nurses are all consistently and deliberately holding patients just so they don't have to get a new patient. I would much rather get rid of the admitted patient and have a new one to work up! When holding patients in the ER, regardless of whether it's self imposed or because I am waiting on a room assignment, I would have to start any floor orders that were necessary to start right away, and if holding long enough, I'd have to implement all of them the same as if they were on the floor. NOT something that an ER nurse ever wants to deal with! ER nurses work in the ER for a reason, and it's NOT to take care of patients beyond the point of admission any longer than we have to!

Now that's not to say that a few nurses might not be hanging onto patients longer than necessary on occasion, but I don't believe that that all of them are doing it all of the time and for the reason that you stated.

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I also don't believe that management would allow your ER nurses to get away with consistently holding admitted patients just to avoid getting a new one. It just doesn't pass the smell test.

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I insist on talking to the RN before I come down to get the patient (yes we are required to leave our pts and come down to get the ED patient). I need to know ahead of time if they are on O2, need monitoring during transport, unstable in some way, have their emergency trach supplies including a suction machine, and other very useful info.

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.
At my facility, the ER nurses would hold the patients right up until shift change to avoid getting new patients, then want to call and give report right in the middle of floor report. Patients arriving at 7:15? Are you kidding me? Are we trying to make this any more unsafe? Plus the floor nurse gets stuck with the new admission before she/he can go home.

This has created a minor war between the ER and the floors, and it's still probably going on to this day.

I'm waving the BS flag. You don't really know this for a fact. We had the same problem and it was bed placement and the physicians that were holding things up. Believe me there's nothing an ED nurse likes to do more quickly than get rid of an admitted patient. We'd rather do full work up after full work up then have to mess around with feeding, toileting and explaining that no we don't have a TV for you.

How would you feel if I said that floor nurses all lie about beds being ready, delay calling housekeeping, hold their discharges, refuse to come to the phone for report, go to lunch on purpose to avoid getting the ED admit and drag their feet to try to force the next shift to take it.

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Believe me there's nothing an ED nurse likes to do more quickly than get rid of an admitted patient. We'd rather do full work up after full work up then have to mess around with feeding, toileting and explaining that no we don't have a TV for you.

QUOTE]

Amen to that!

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Specializes in Medical-Surgical, Supervisory, HEDIS, IT.
I'm sure you don't really think that's what I think of ED Nurses!!

That was not meant to be a dis to the NURSE.It's a dis to the drive thru mass production corporate mentality that we get a patient a bed. ANY bed. And lets close all the local hospitals so we can have all their "customers".

THAT is what I mean. sorry I wasn't specific.

OMG!!! I HATE calling them "Customers" or "Clients"

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At my current hospital, the ED nurses are in a mad rush to unload patients. They often call to give report before we (the floor nurses) even know we're getting a patient. It's incredibly irritating. We have a doctor who flips if IV fluids aren't hung and started immediately upon arrival on the floor so I like to have it set up and ready to go. Since we don't have enough IV pumps to go around, this can sometimes be a chore.

In our ER, no one nurse is responsible for a patient. They just kind of tag team. So, we often get "Well, I'll tell you what I know about the patient." Thanks. We are always getting info in report that is different from what is documented in the ER paperwork and then the patient has something completely different to tell.

Or we get nurses that take down the patient's home meds and then tell a family member to take them home. Fine, right? Except they will enter the name of the medication and nothing else. No dosage, no frequency. Nothing.

ER nurses aren't required to enter their IV starts in the computer but we (the floor nurses) are required to enter THEIR IV start. I don't know who started it, how many attempts there were, etc.

I once asked in report if a patient had any skin issues. I was told no. Turned out she had a sizable hole in her chest from a port infection. There will be meds ordered that were never given or they SAY they gave it but it's not charted. Sigh.

So, we do get report but it's often useless.

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Specializes in PeriOp, ICU, PICU, NICU.

The last hospital I worked at went to no nurse report as well; however, a faxed face sheet with basic pt information were given to the admitting nurse. Didn't last very long due to many mistakes being made such as re-administering meds, missed info such as isolation precautions and missed medications pre written on the faxed sheet of treatments and meds that were never performed for whatever reason.

I got out of that place and in a much happier place.

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Specializes in PCCN.
OMG!!! I HATE calling them "Customers" or "Clients"

me too-but I think that's what's driving this drive thru mentality of the suits.more "customers" more payments to make up for the recent readmits(aka frequent flyer

Therefore , that's why they push 'em through ED.Can get more in the door that way.So what if a few details are left out......

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At my current hospital, the ED nurses are in a mad rush to unload patients. They often call to give report before we (the floor nurses) even know we're getting a patient. It's incredibly irritating. We have a doctor who flips if IV fluids aren't hung and started immediately upon arrival on the floor so I like to have it set up and ready to go. Since we don't have enough IV pumps to go around, this can sometimes be a chore.

In our ER, no one nurse is responsible for a patient. They just kind of tag team. So, we often get "Well, I'll tell you what I know about the patient." Thanks. We are always getting info in report that is different from what is documented in the ER paperwork and then the patient has something completely different to tell.

Or we get nurses that take down the patient's home meds and then tell a family member to take them home. Fine, right? Except they will enter the name of the medication and nothing else. No dosage, no frequency. Nothing.

ER nurses aren't required to enter their IV starts in the computer but we (the floor nurses) are required to enter THEIR IV start. I don't know who started it, how many attempts there were, etc.

I once asked in report if a patient had any skin issues. I was told no. Turned out she had a sizable hole in her chest from a port infection. There will be meds ordered that were never given or they SAY they gave it but it's not charted. Sigh.

So, we do get report but it's often useless.

You know, it's really difficult not to reply to some of this with a sarcastic remark. It is obvious that you haven't spent any time working in an ER or it has been so long ago that you don't remember what it's like.

If it seems like ER nurses are "in a mad rush to unload patients," we are! The pressure is constantly on us to move patients out the door or to the floor so we can take care of the next patient in the line that at times seems endless! Floor nurses too often forget, if they ever knew, that we don't get to cap the number of patients that we care for during our shift. As long as sick people are coming in the door, we have to make room for them to be treated, and that means that we have to "unload" the admitted patients as soon as possible. We are given 30 minutes to get our patients to the floor from the time that a bed is assigned, and if we call to give report before you know that you are getting a patient, well, sorry Charlie, but I don't have ESP to tell me when you floor nurses have been informed that you are getting a new patient!

Floor nurses also really need to get over the fact that in the ER, we do FOCUSED assessments. SOMETIMES we turn patients and check for "any skin issues" if it's relevant to the chief complaint, but more often than not we don't specifically check for skin breakdown. That's the way the ER operates and the sooner that floor nurses accept that the ER functions differently than the floors, the better off we all will be.

I try to give as much information about my patients in report as I can, but it's also irritating for me to have to try to provide every detail that the floor nurses want (at my hospital) just so that they can pre-chart on the patient before they get to the floor! ALL of our patients, for instance, are admitted with an IV, so it's annoying as all get-out for our floor nurses to ask me if my patient has an IV! I mean, we drew blood, he got IV dilaudid and Zofran, and we gave IV antibiotics, so is this question really necessary??? And the floor nurse is required to do an assessment when the patient gets to the floor anyway, so why oh why is it necessary for me to inform the floor nurse in report WHERE the IV is located? So she can get her admission charting done before patient gets to the floor, that's why!

Now, I do sympathize with the rest of your post. I don't like the tag team approach to caring for patients that you describe and I can see how it would be rife with problems. There's also no excuse for incomplete medication information if the prescription bottles are available. But the other stuff just shows a lack understanding of what it's like to be a nurse in the ER!

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