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?
Again, this topic wasn't created to rag on ED nurses or nurses in any other speciality. It was created to spark conversation on the topic in general and discuss my experience.
I work in the Ed as well as the floor. I always try to get patients out of my unit which ever location ASAP. I think the floor doesn't realize if I don't send the patient on my shift, its just the same as passing to a nurse without the knowledge of the patient and now both RN's have no direct care. What burns me up is every time I try to wait on night shift or delivers the patient to the floor shortly after shift change and stay over, they are never accommodating and it takes me twice as long. So much for continuity of care or helping your fellow RN out.
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.
I could never work ED, and I'm not making any judgment calls as to why, but we have an electronic "board" that shows when our beds are assigned from the ED. And they are sometimes booked for 6+ hours before we receive report. So your hospital sounds a lot more efficient than mine. And yes we do call for report or to see what's going on when the bed has been booked for awhile. Sometimes it's canceled, pt goes to ICU or gets discharged but most often it doesn't change when they come up.
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.
That sounds like a med error waiting to happen. I'm glad our ED is now on the same med admin program we are on.
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.
That's a completely different story than "The ER nurses hold on to patients for hours."
If you can stop the constant flow of ambulances and my clear my waiting room of 30-40 patient waiting to be seen, I'll happily hold on to the admitted patient with a diagnosis until it's convenient for you to get report. In fact, I make it a habit of doing just that, when the flow of my department allows for it.
We have recently been hosting some of our floor nurses down in the ED in a *hold* role. Lately we have had anywhere from 10 to 30 admitted, boarding patients with no place to go. Watching them try to call the floor to give report is enlightening for all. Or was...we have in the last week gone to a process where our secretary calls the receiving RN, gives them the name of the arriving patient. They have 5 minutes to review the ER summary and call ER with questions if they have any. No word from them = mysterious patient delivery. The end.
Isn't getting report on your patients what's supposed to happen during change of shift? It doesn't matter if one of your patients is physically still located in the ER or not, it's your patient so get report on them.
Floor nurses should be able to take an ER patient during shift change like they do all of their other patients. At the same time, I do agree that too often as ER nurses we fail to do our job which is why floor nurses end up feeling like they can only take an ER admit if they have an hour or two to devote to catching up on a patient that's been neglected in the ER for too long. I work both ER and other units, which makes it easier to understand what amount of stuff left undone is appropriate when handing off a patient to another nurse, and I'm of the belief that nobody should work only ER or only the floors. Basically, the ER needs to needs to respect the nurses on the floor and not leave them with a preventable train wreck, and floor nurses need to remember that that is their patient in the ER and make an effort to take them as soon as possible.
We have recently been hosting some of our floor nurses down in the ED in a *hold* role. Lately we have had anywhere from 10 to 30 admitted, boarding patients with no place to go. Watching them try to call the floor to give report is enlightening for all. Or was...we have in the last week gone to a process where our secretary calls the receiving RN, gives them the name of the arriving patient. They have 5 minutes to review the ER summary and call ER with questions if they have any. No word from them = mysterious patient delivery. The end.
I do understand that from the time I spent in ICU and medical. Ive done both. I get it. No time is a good time for an admit.
And no offense but people in the ER are sick too.....
Yes, but to talk to most ED nurses, you'd think they were the only ones who ever have emergencies, sick patients, or people waiting. Let me be clear, I have no issue with taking report on the patient during shift change; I do have an issue with a patient rolling up at 1905.
I do believe my opinion right now is colored by a very unsafe admission situation that my unit recently experienced from the ED (it was not change of shift). It just reinforced my already extremely low opinion of their consideration for patient safety outside the ED.
I think the entire issue revolves around unsafe staffing on all sides. When you staff a bare minimum and for everyone to be maxed out from the get go, what is the contingency plan for when the sh*t hits the fan? Someone or everyone gets an unsafe amount (or acuity!) of patients. Instead of bickering, in L♡vER's utopia we all stand together and demand safe working conditions for our patients and our licenses.
Why is this a universal problem??? It's not one or two floor nurses c/o change of shift admits from the ED...it's all over the place. Multiple states, multiple hospitals, multiple nurses.
Look, I know that a couple of my coworkers delay ED admissions. I was sitting next to one the other day who gave some ******** reason why she couldn't take report, although she had been sitting on her dainty ass for 45 minutes.
I also know it may hours before we get a call for report from the ED after the bed is booked, and they all seem to come up between 1700 and 1900.
The floor can't be the only procrastinators in the blame game.
That Guy, BSN, RN, EMT-B
3,421 Posts
I do understand that from the time I spent in ICU and medical. Ive done both. I get it. No time is a good time for an admit.
And no offense but people in the ER are sick too.....