Frustrating

[nursebeth77]

I work on a Med-Surg unit and lately we have been getting a lot of unstable pts from the ER. So the other night I am getting report on a pt from the ER around 2100 and the nurse states "to be honest with you I've never even seen the pt, I'm just reading the SBAR". So of course I had an attitude with him and ask him why he has not seen his pt and why he was giving me report on a pt that he has not seen? He got mad at me and said it happens all the time and that I should try and work in the ER, and you can't see everyone! I have, and I've never once not seen a pt that I was sending somewhere else. Thank God the pt was stable when she came up. So, am I just being picky? What would ya'll do?

[Kooky Korky, BSN, RN]

Okay, I have a question for you then and I'm NOT being snarky. What do most patients with pneumonia sound like and is there any reason to expect differently? How do their breath sounds change your immediate plan of care? I'm talking breath sounds not respiratory distress.

Now, if this person was caring for the patient and didn't know that's one thing. But if they are giving report for another person who cannot, for whatever reason, they are not going to assess the patient rather they are going to be the messenger and deliver whatever information they have received. One would hope that they would have been made aware of significant issues but if they don't that's not on them. Generally speaking someone giving report for another is usually done on the fly because something is happening that prevents the nurse who primarily cared for the patient from coming to the phone. My experience has been, and yours may be very different, outside of codes coming in the only reason I had to have someone else give report for me was when I tried to call it nobody from the floor would take it.

Or maybe more correctly, COULD take it just when you found it convenient just then to call.

And if the substitute reporter has not been made aware of significant issues, oh well???

Pity the poor patient.

If I were going to give report, I would see the pt quickly first and review the records before calling the receiving nurse. It could be dangerous not to and could come back on me for not relaying certain information.

[caronbell]

I work at a regional university hospital, and take in patients from many outlying hospitals in the tri-state area. I recently had a direct admission from an ED in a small town several hours away. We knew they were coming...and then the transport showed up without ever receiving any report from the ED there. Keep in mind the patient was in transit for several hours. My charge was livid, the house administrator got involved...and eventually I got a call from a very sweet nurse who had absolutely no clue about the patient; she literally read the ED doc's note to me over phone, so I got the same info as when the patient got there and I read the admission packet. I (hope) I was kind and gracious and didn't give her any trouble, because she certainly didn't know anything but was trying her hardest.

Things happen. I hope she had a good rest of the day.

[nursebeth77, ASN]

Ok, just to be clear, this was his patient not another nurse giving report for him. I do understand that if I'm getting report from another nurse that they most likely have not seen the pt.

I understand things can get busy in the ER as well as the floor. I was not expecting him to spend a great deal of time with the pt but I did expect him to at least see the pt.

I did answer the phone when he called because I was expecting him to call. But sometimes I can't just drop everything because ER is calling to give report. We do get very busy also.

[Wuzzie]

Ok, just to be clear, this was his patient not another nurse giving report for him. I do understand that if I'm getting report from another nurse that they most likely have not seen the pt.

I understand things can get busy in the ER as well as the floor. I was not expecting him to spend a great deal of time with the pt but I did expect him to at least see the pt.

I did answer the phone when he called because I was expecting him to call. But sometimes I can't just drop everything because ER is calling to give report. We do get very busy also.

And sometimes the ED nurse can't drop everything to give you report when it's convenient for you either (or get the patient up before shift change). It goes both ways and, bottom line, still isn't a reason to cop an attitude. That was where you erred. Creating animosity between the two teams does nothing to better patient care or provide a solution to smooth the process. And I doubt you felt very good after that exchange, it probably set the tone for the rest of your shift. I find if someone does something that irritates me my sympathetically asking them how their day has been and then why things happened the way they did usually gives me a broader perspective instead of my own myopic view. Generally speaking this usually results in the guilty party apologizing for dropping the ball and then working hard to make sure it doesn't happen again. Over time it allows relationships and trust to be built (yes even between floor nurses and the ED) and events like this become a rare occurrence that gets laughed about later over a drink together.

[Mags_RN, BSN]

At my facility, there is no RN-RN report anymore for patients coming from ER (only ICU does, and that's because the ER RN moves the pt to ICU personally).

Yeah, no report at all, you are to look at the information in the computer EMR before they come up. you do get this computer generated report that's printed out by the ER rn (includes cc, last vs, rn triage note, meds given, iv access - nothing that the ) and tubed to you ~10min prior to pt arriving to your unit. so if you're sitting around and available when the charge assigns you a patient then you might have a chance to look up what kind of pt you are going to be receiving but if you're busy in a room and the charge calls you and tell you you're getting an admit and the report was already tubed to the station, there's always a chance you will be meeting you're new admit in their new room without knowing ANYTHING about them. It kind of sucks. i guess if you want to speak to the er rn you can call him/her.

we (floor rn's ) keep trying to fight this method but the er wait times have improved greatly and i guess no sentinel events have yet happened so it's not going to change.

[nursebeth77, ASN]

Wow that's crazy! I worked in the ER for over a year and I always gave report. I didn't know it didn't happen everywhere else. I worked at a level one trauma center then and we had too. I've been a floor nurse at a different hospital for a few years now and I still expect it, I guess I'm lucky I got a report at all.

[Natasha A., CNA, LVN]

I'm a newbie and love to learn from others. OP, thank you for sharing your story.

Also, OP I see why you can be frustrated but every challenge is an opportunity. Just so i can fully understand where you are coming from did you work in ER at a different unit or the one the staff member works? I'm curious to know when you found out that this was a common situation, have you looked into collaborating with your staff member to come up with a solution to prevent this from happening again? Also, pass the solution to the charge nurse and nurse educator to have staff meetings. I'm sure you are not the only nurse frustrated and you can help make a bigger difference within the unit. :) I look forward to hearing back from you. Please update us with the outcome :)

[nursebeth77, ASN]

Yes, I worked at a different hospital when it was mandatory to give report. I couldn't do what a lot of the nurses here in our ER do. No, I'm not the only nurse that complains about some of the reports we get from our ER. We get unstable pts all the time and the common excuse is "they weren't like that down here" yeah we have a magical elevator that pts decline in rapidly. But when it's appropriately ok for ER nurses here to not even see the pt, how would they know the pt is declining.

Yes, things have been reported to hospital.

No, I'm not a perfect little nurse that loves complaining. I have worked in ER, ICU, pedi, medsurg and an EMT in the military and on a city ambulance. I know how busy nurses can get but I've never not seen my pt and I've been in the medical field since 1997. I've also given report on my own pt, I've never expected anyone else too. If they can't handle being busy they need to find another job because nursing is a very busy field to work in.

[Natasha A., CNA, LVN]

Nursebeth77, It seems you may have a compromise solution to the issue. Since you have worked in ER before and were able to admit pts in a timely manner, why not share your efficient way to management which will demonstrate your competence and leadership?

[martymoose, BSN, RN]

Hi , yes , we only go by sbar. Sometimes the pt is brought up by only a tech, not on tele( but should have been).

I'm over it. I'll just do it on the fly. Although I like the fact that pt usually comes up with at least an IV in. I suck at IV's.lol