Getting report during change of shift

NICUmiiki, DNP, NP · Jan 14, 2015

At my hospital...

Frequently, beds open at change of shift in the morning because of better staffing during the day on the floors. So it looks like we're holding the patient until shift change, but we're just getting the assignment from bed board. The ER nurses don't want to give report to the day person for them to turn around and give the floor nurse a report on a patient they don't really know.

We have this system in place for shift change time reports. The oncoming floor nurse arrives at 6:45 and is made aware of his/her patient in the ER. The oncoming floor nurse calls the ER and gets report on the patient from the leaving ER nurse FIRST. The ER holds the patient until 7:30 (or later if requested) to allow the floor nurse to get report and check on his/her other patients already on the floor.

It seems like a good compromise. ER and floor nurses seem to like it better, and compliance has been good since it started.

#NurseB · Jan 14, 2015

ED nurse here...

Sheesh!

First, let me just say this post doesn't differ from what I experience every day at work. It seems us ED nurses are always at odds with the other floors.

I personally send patients up as soon as a bed is available UNLESS I am with a STAT patient OR if I need to get a med started before sending the patient. I don't ever wait for a certain time. And you better believe our charge nurse is breathing down our necks to make sure when that admit bed is ready, we are sending our patients up so the charge nurse can put a new patient in that room.

I also will send report up and call to give report. If nobody answers, I will call until I get somebody. Even if that means calling the charge nurse and giving them report.

Yes other floors have emergencies but I've been on the floor and worked in ED and find our ED to be full of critical patients, especially all the STAT respiratory patients this winter.

I don't truly think anyone can have empathy for floor/ED nurses until you've held that position.

NurseKatie08, MSN · Jan 14, 2015

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.

Right. I wasn't blaming the ER nurse in the least...just offering a possible (though hopefully rare) scenario.

dream'n, BSN, RN · Jan 14, 2015

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.

5 whole minutes? Sure I can finish walking Mr. 'shuffle walker' to the bathroom and back, put him in bed, check his PICC line for blood return and flush, do patient teaching and hang my chemotherapy within 5 minutes so I can get ED report. Sure I can do that.

Lâ™¡vER · Jan 14, 2015

I get it, I come from the floor. This was enacted after it was necessary to go to the house supervisor, nearly EVERY TIME, to give report...leaving the ER overloaded and absolutely slammed with inpatients who have beds. After so many other tries to remedy the situation over a years time, this is what management came up with.

I was not involved in the decision for the record lol

VANurse2010 · Jan 14, 2015

I get it, I come from the floor. This was enacted after it was necessary to go to the house supervisor, nearly EVERY TIME, to give report...leaving the ER overloaded and absolutely slammed with inpatients who have beds. After so many other tries to remedy the situation over a years time, this is what management came up with.
I was not involved in the decision for the record lol

Sounds like your management needed to come up with a collaborative solution with the in-patient side instead of sledgehammering a decision that only benefits the ED.

AZQuik · Jan 14, 2015

What a great topic for me as a new grad/new Ed nurse. I have 4 Pts. 3 are icu holds, 1 is going to the floor. I get pressure from several of my superiors to get that pt to the floor. I tell them I can't get to it. They hit a couple buttons on their CPU and BOOM that pt is headed to the floor. If the floor is lucky a warning call will be made. Not a report, but,"hey mr jones is headed up. Call 8657 with any questions. But when they call I am documenting a code, or assisting with an rsi, or, or, or, and I don't answer. By the time I can answer the floor nurse is done trying to call and combs the chart (that hopefully is current) and I move on.

Last night a totally stable pt needed orders changed to be cleared for a respiratory virus before going to the floor. I paged several numbers and hunted several more. No call back from admitting doc. Lab wouldn't run the specimen until the order was changed. I spent the next 3 hours dealing with not 1 but two ems etoh Pts tossing urine, fighting with staff, being restrained, needing a basic work up because they were found down, and my stable floor pt waiting for me to figure out the admitting doc pager number waited.

Fortunately the floor nurse was great. I called her up. Gave her a super quick run down. Told her I would do XYZ before I put in for transfer and asked her what else she needed. "Nothing I've been combing through the chart. Is it current?" "Yep" "cool"

I thought of this thread right away lol

BSN GCU 2014. ED Residency

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Despareux · Jan 14, 2015

I don't think it's a good idea for a new patient to arrive right before shift change--I think it's a safety issue. I would much rather take report for the new patient and do my own assessment, rather than getting a half-assed report from the previous shift nurse who barely lays eyes on the new patient.

NurseOnAMotorcycle, ASN, RN · Jan 14, 2015

Wait a minute, who could possibly feel attacked? What in the world would make the E.D. nurses feel attacked?

" Jan 13 by CTnewgrad826

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."

"...What bothers me is when the nurse reporting off gives a huge attitude..."

"...A thorn in my side!! "

"...Sorry, no empathy from me..."

"...selfish nurses..."

"...my already extremely low opinion of their consideration for patient safety outside the ED..."

Most E.D. nurses have come from the floor. We already know how much it sucks to get new patients. We aren't trying to make your life harder, we are just doing our job. I'm sure you don't want someone coming in and saying these hurtful things about you.

**canoehead, BSN, RN** · Jan 15, 2015

I've worked both sides. You can't plan your day on the floor when an admission can show up at anytime with 5 minutes notice. But as an ER nurse when the floor asks to delay report for 30 minutes so they can do anything, the 30 minutes has never been less than 2 hours. Unless I get the supervisor involved. I think 30 minutes notice is reasonable, and as ER nurses we should try to get people moved in a timely fashion.

We had a huge problem with change of shift admits in one ER...we knew the patients were going to be admitted, but they sat for hours waiting for the admitting doc to come in and write orders. The docs would all arrive at about 1700, after office hours, and the admission orders would be done...right at shift change. Meantime we've had ER beds clogged for 5-6 hours, and needed to move waiting room people into treatment, so there was no mercy for the floor nurses. It was not a nursing issue, and the docs didn't see the problem. And there we sat. In other hospitals the ER doc could write covering orders that would last until the admitting doc could get in, but some ER docs don't want the responsibility.

AZQuik · Jan 15, 2015

I don't think it's a good idea for a new patient to arrive right before shift change--I think it's a safety issue. I would much rather take report for the new patient and do my own assessment, rather than getting a half-assed report from the previous shift nurse who barely lays eyes on the new patient.

I agree. Of course then you are getting the same report from the Ed nurse who just came on. There is a good chance that Ed nurse doesn't know anything other than, "I walked by the room, and the pt had their own airway. Let me look at the chart...." Gee thanks lol. Like I can't look at the chart

BSN GCU 2014. ED Residency

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Loo17 · Jan 15, 2015

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 work in the ED and trust me its just as frustrating on our end. It seems that the hospital bed manager always makes beds available at change of shift-probably due to staffing. We (the nurses going home at 7:30pm) are pressured that we need to call report before we leave since we took care of the patient and as to not burden the next shift. When we call to give report and the floor nurse asks us to call back in 10 minutes it can be stressful because then the night nurse wants us to not go home until report is given, and to transport the patient before we leave (if a nurse must go on transport), management is also putting the pressure on us to punch out on time.

The department also tracks how long it takes us to give report and get the patient to the floor once the bed is available. I wish their was a better solution for all sides because really it doesn't work for the nurses in the ED or on the units. They have considered a change in shift times as a solution - like the ED shift change at 6a,2p, 6p, & 10p and the units at 7a, 3p, 7p, 11p but I am not sure that will ever happen or if it would solve the problem.

I'm sorry the ED nurses give you attitude :-(. I wish hospitals provided opportunities for the ED and inpatient nurses to meet and discuss stuff like this and come up with ways to make it better. We are all in the same team and want the same things. This is a problem nationwide.