Feel stupid

imonte · Apr 14, 2017

I'm a new grad, starting in the ER. I have worked as an ER tech for 10 years and this is an exciting pathway. I have given report and escorted patients to the ICU a few times already. Remember, when you give report to the floors, they are usually intimidated by the ER. They know it is a whole different world. I give the facts pertinent to the chief complaint, what was found and what was done. As far as ICU goes, if I get push back I remind them that they are getting a pt with a diagnosis, a luxury we did not have when the patient came to us unresponsive. That usually is sufficient to quell any complaints.

DayDreamin ER CRNP · Apr 15, 2017

Keep your reports short and to the point. I tell my new orientees to stick with an SBAR approach and start from the top...

Situation - what brought the pt to the ED to start with.... "Mr. PDQ is a 77 pt of Dr. XYZ that came by ambulance from home with a c/c of right flank and RLQ abdominal pain for the past 4 days getting worse last night. He c/o of N/V but denies any diarrhea."

Background - "He has a history of..... and is allergic to....

"His belly was soft and tender in the RLQ to palpation and he did vomit twice before we gave him 4 & 4 that we gave through an 18ga in his right forearm and sent him to cat scan where they showed him to have a kidney stone..."

"He also got a liter of fluids and we hung some ABX that is currently running on a pump so I'll need to swap one out when I get there."

You get the point. I don't review a ton of labs unless they are pertinent to the patient's diagnosis / problem. We have floor nurses that will ask about your entire assessment and I just don't give that. I politely say something to the effect that she should do her own assessment. If the patient is here for a respiratory problem I will say, "He had rales in the lower right and diminished bilaterally" or whatever and then give a re-assessment after a breathing treatment so the receiving nurse can have a baseline to compare. That IS important. Doing a head-to-toe assessment for the floor nurse is not. Same for a nearo patient.

I got written up by the floor one time for not treating a pt's blood sugar that was 212. The patient's K+ was about 2.2 and she had a small bowel obstruction and was headed to the OR later that afternoon. I purposely didn't treat that sugar because #1 I was treating that hypoK+; #2 that's probably the patient's normal glucose and #3 the patient was NPO for the surgery so I was pretty ok with that 212 sugar. Oh, and let's not forget that the floor isn't always on the ball getting to the room to see the patient nor check a sugar so I didn't want to treat that 212 not knowing how long it would be before anyone came around to check back on her. I'd rather have a 220 sugar than one in the 20s.

I didn't accept that write up but wrote my own response to that instead. I think the floor was pissed because I called five time in a 45 minute period to give report and no one came to the phone so I took the pt up to give bedside report.

By the way, you mentioned holding for ten minutes. I NEVER hold for longer than 5. That's my limit. Our charting system timestamps everything and it cannot be adjusted. I drop my "Report called to...." template in there and it time stamps me. It also time stamps the last time that field was accessed so it will show my five minutes of waiting.

Our unofficial policy is to just give a BS report if you've called three times and no one answers.

I wouldn't sweat that blood sugar really. We get flack all the time about not treating but I just say that we were treating the patient's acute problems and got 'em stable for ya. If the pt is there for a prolonged period of time you should treat it but it isn't always possible when you are actually treating bigger problems.

gemmi999 · Apr 16, 2017

Speaking as someone who still has to take phone orders from admitting MDs, there are nights when I don't even know my patient's labs until I have the doc on the phone and the computer in front of me. If it isn't critical then it isn't necessarily an ER problem. Now, if a patient's sugar was 27... well, that's totally different. :)

Something that I still have to remind myself about--nursing isn't 12 hours and it's over. Nursing is 24 hours a day. There is another nurse to take care of the patient after you're done, which means they can continue care.

Kuriin, BSN, RN · Apr 17, 2017

I wanted to be in the ED, but decided to do medsurg to stay close to my husband. Let me tell you this: most ED nurses don't look at the WHOLE picture. They focus on what is happening there. Most ED nurses at my hospital do not fill out the entire doc flowsheet (neuro, GI, GU, etc) unless it's pertinent. Don't worry about it. The only people who will make you feel stupid are the ICU nurses who ask the most ridiculous questions ever (how do I know? Because I precepted in the ED, lmao).

madea82 · Apr 20, 2017

Love your post

Cat365 · Apr 21, 2017

Love your post

I'm finding my feet with great advice!

**canoehead, BSN, RN** · Apr 29, 2017

With patients constantly coming and going, I flip through the labs just before giving report to make sure something new and horrible hasn't come back that needs to be fixed. I also give reports with the labs in front of me. It's easy to get mixed up on what patient had which result, and you'll be more confident/look smarter with your answers.

bgxyrnf, MSN, RN · Apr 29, 2017

Every once in a while you'll get a nurse who'll say things like, "don't worry, I'll take a look at the meds and labs myself. Is there anything I need to worry about in the next hour? No? Cool. Send 'em on up."

Some floor nurses seem to want to make a game out of the report process or want you to recite the entire chart to them. With some experience you'll get to realize what matters and what doesn't. Don't be afraid to say, "I don't know" and then ignore their snarky huffs and comments. Also don't be afraid to say, "oh, that's in the chart."