Just curious as to others experience with getting report during change of shift. Where I work, it seems the ED or other units are always calling to giving report on a patient being sent to our unit right at change of shift (7am, 3pm, 7pm, 11pm). Or in other cases we get report at an appropriate time but the patient gets sent up during change of shift. Of course this is going to happen every so often, it's unavoidable and I understand that and staff needs to team together to get the patient comfortable and ensure their stability before finishing their other change of shift duties.
What bothers me is when the nurse reporting off gives a huge attitude about being asked to call back in 10 minutes or so. I understand it's annoying to hold onto a patient for an extra hour because the accepting floor isn't prepared for whatever reason but I think change of shift is an acceptable time to delay the admission/transfer if possible. Change of shift has been shown to be one of the highest risk times for patients since full attention is typically drawn away to get and give report. I think more policies need to be in place regarding this related to what I've experienced so far.
What are your thoughts on getting report/accepting new admits during change of shift?
I have worked both on a cardiac floor and the ER. On the floor it stinks getting that change of shift admission but you have no idea what is going on in the ER. The three hour time lapse since the bed was assigned could be due to the cardiac arrest that just came in or the three traumas that are unstable or the two other ICU patients I have that are crashing. The ER is unpredictable. I understand that the floor can have rapidly changing situations as well and we try to understand that but we also get push back from our charge nurses to get the patients to their rooms because there are thirty more patients in the waiting room. Floor nurses have also given me push back when I get report from my nurse and have to give them a report on a patient I've known for five minutes. I see both sides and I honestly don't think there will ever be a "good" solution. I hated admissions during shift change when I worked cardiac and I hate it working ER.
There is no way someone had a bed assigned and sat on the patient for three hours. Generally, once a bed is assigned you have 15-30 minutes to give report and get the person to their room. Unless you work it, you can't understand how you have to keep patients moving, as they never stop coming in. You need to get the patient to the floor to take the next patient. And yes, there is ALWAYS a next patient. We once tried not calling reports in the last half hour of a shift. Know what happened? Instead of no report from 6:30pm-7:00, we found that the nurse wasn't available at 6:20, 6:15 etc. The I'll call you back, when you call at 6:10, resulted in no call backs, unable to take report, and then before you know it, it is 6:30, and they can't take report. You end up sitting on a patient for an hour. It's all about throughput. The giving report to the Charge is supposed to stop this, that is why it is done. Charge can identify repeat offenders. Also, the ER doesn't want to pay incremental overtime to the Er nurse so she can wait 30 minutes to give report. Next time right before your shift, take a walk through the ED waiting room, as well as the unit. You stop receiving patients when your beds Re full, but we never stop.
It does happen...last night my admission was booked at 2100 and I didn't get report until 2:30.
I have a feeling this will never change. Continuous problem at our hospital. Now charge nurses are forced to take report if district nurse can't. So interrupt my report so I can give report to the nurse when they're done report? Imagine the possibilities with lost in translation there... We're fighting it, but ER fights harder.
I can say where I work, we only get report from the ER nurse if they've done the admission assessment. Otherwise, it's just a piece of paper. The bed could have been assigned to the patient 3-4 hours ago, but somehow they get roll up at 1915. This happens to our shift at LEAST two of the three shifts we work a week. It's not one patient either, it can be two, three if we have open rooms (one night, they brought us 5 patients in a 30 minute span just after we got report).
When you look back through the admission orders of the new patient, the admission orders were written at 0930, the previous patient in that room discharged at 1430, room was clean by 1600 and the new patient waited in the ER until 1915 to come up(end of our report/shift change). The ER doesn't have to call so it's not a delay d/t ignored report call, and we have transporters who move everyone around, so it's not a case of having an RN/Medic to escort the patient. YES - we have a huge ER and hospital, and it happens quite frequently. NOT THE FAULT OF THE ER NURSES! It's the "fault" of a faulty system between bed placement, ER, floors, housekeeping, etc.
I for one LOVE when ER nurses actually call me report. I can ask questions about my patient; our systems don't cross over, so I'm never sure what meds the patient got after the admission orders are written because that's when they scan in the ER meds given paperwork as well. Even if they've only had the patient for an hour, at least I can talk to a real person about their med administration. I much prefer taking a call from the ER nurse than receiving these paper shift reports that aren't up to date.
It does happen...last night my admission was booked at 2100 and I didn't get report until 2:30.
In those instances, if I am caught up with my patients I will be proactive and CALL the ED for report. The majority of the time they are happy I called and can give me a brief rundown and send the patient up.
I much prefer this then playing the waiting game of 'when will the ED call to give me report,' I don't like waiting or guessing when I can go on break. So instead of allowing the patient to sit in the ED for an additional 5 hours and waiting for the phone to ring.. call the ED and see if they are able to give you report.
It doesn't matter what ER nurses like the the three or four that already posted are going to say because other specialties don't care. ER nurses are some the most wildly hated nurses. They are where most of the new work comes from for all of the other specialties and are the face of the hospital for the patients while they wait... And wait... And... Wait... Not allowed to eat or drink... MD not ordering narcotics... Nothing to distract them for hours from possibly disastrous test results...
I tell everyone this: it's in our personal best interest to help out the floors because, simply put, I don't like being yelled at. I do what I can to make it easy, but I can only do what I'm allowed to do. Many ER nurses are so fed up with just how impossible it can be to help floor nurses that they just stopped trying to help them at all.
The patients are angry that they had to be in the waiting room for hours for their "emergency" hangnail. They think that if its a quick 10 minute thing, they'll be in and out. Instead, they are left sitting there for hours because we see patients by the sickest first. The families are angry because the patients don't have a bed. The floors are angry that they are getting new patients, regardless of what time. The MDs, on-call OR or Cath lab nurses are angry to be called about their patients who have emergently arrived. And who is the face that they see the most for venting all of the anger and frustration at? The nurses.
OP, every specialty thinks they have it worse than the others. Every specialty thinks that the others are lazy. And when a nurse complains about how another specialty is worthless, it's called "The Specialties War". But the reality is that we all know that nurses get crapped on and work so hard that we don't even have to talk about how exhausting and tough our job is.
While I realize that it will never happen, why don't we decide to team up as nurses and encourage each other instead of adding to the crap being piled on?
I always try to call up report and pretty up the pt for the floor. That said, it doesn't always happen. There is a lot of pressure to get that room to the next pt waiting 15 hours. Fortunately right now it's not a concern as we have been full for a couple weeks. So we just sit on our 27 ICU patients and smile at the person lucky enough to get a hall chair after 15 hours
There is a lot of pressure to get someone moved once they are ready. Several times I've been working a code and got a call from charge telling me,"we're taking 37 up to the floor" ok bye 37. Good luck lol.
I know many nurses who try to "hold on" to a patient as long as they can - hours even - so they can leave without getting another patient. Then they try to shove the patient at the next shift during shift change.
It is impossible to convince selfish nurses that this is bad practice. It is also difficult for managers to spot this behavior unless they are specifically looking for it.
Tragedy of the Commons I suppose. Nurses are very often their own enemy.
Because thats when the admit came up. No other reason. Its up, call report get them out and move on to the next one. Ill do what I can to help it go as smooth as possible but we need some understanding from you guys.
In those instances, if I am caught up with my patients I will be proactive and CALL the ED for report. The majority of the time they are happy I called and can give me a brief rundown and send the patient up.
I much prefer this then playing the waiting game of 'when will the ED call to give me report,' I don't like waiting or guessing when I can go on break. So instead of allowing the patient to sit in the ED for an additional 5 hours and waiting for the phone to ring.. call the ED and see if they are able to give you report.
I did. They were waiting all that time for a doc to write orders on this patient who truly probably could have gone home. Total communication failure because the admitting doc was paged several times to see if they could go up to me without orders and they got no response. Turns out his pager was messed up. Nothing more I could have done...trust me I hate p,aging the waiting game and I'm sure the patient did too.
Because thats when the admit came up. No other reason. Its up, call report get them out and move on to the next one. Ill do what I can to help it go as smooth as possible but we need some understanding from you guys.
You need to understand that the in-patients are actually sick and that it's unsafe to have report on them interrupted.
smile_through_it
26 Posts
I have worked both on a cardiac floor and the ER. On the floor it stinks getting that change of shift admission but you have no idea what is going on in the ER. The three hour time lapse since the bed was assigned could be due to the cardiac arrest that just came in or the three traumas that are unstable or the two other ICU patients I have that are crashing. The ER is unpredictable. I understand that the floor can have rapidly changing situations as well and we try to understand that but we also get push back from our charge nurses to get the patients to their rooms because there are thirty more patients in the waiting room. Floor nurses have also given me push back when I get report from my nurse and have to give them a report on a patient I've known for five minutes. I see both sides and I honestly don't think there will ever be a "good" solution. I hated admissions during shift change when I worked cardiac and I hate it working ER.