New Admissions

Published

Before I say anything else, let me say that I am not meaning to step on any toes of ER nurses. We have some really terrific ones that I think a lot of other than the problem I'm about to discuss.

For some reason, our ER tends to send patients up to our floor either just before or just after shift change. Sometimes, they'll call while we're in the middle of report, demanding to give us report immediately on the patient coming up. If we ask that they hold the patient long enough so that we can assess the patients we've just received before getting the new admission, the ER nurses get very upset. I can't tell you the number of times that I've admitted a patient around midnight and found out they have been in the ER since that morning. So, I have a hard time understanding why the patient needs to come right THEN instead of giving those of us who have just come on time to check our other patients that we are responsible for first. Can someone enlighten me, please? I mean what if I have a patient with something serious going on and I don't even know it for another half hour or more because I was admitting a new patient before even checking the ones I just accepted?

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.

Same thing happens just about everywhere I've worked. Must be in the ER policy manual. :lol2:

Up Vote Up Vote ×

Maybe it's because the ED has been trying all evening to get the pt upstairs and wasn't getting cooperation. Maybe there's a trauma coming in and they need to clear out as many people as possible as soon as possible. Maybe there are mobs of people in the waiting room needing a bed. Maybe there are two ambulances coming in and they need the beds.

We've had a ton of these threads. What happened to me when I would try to call report, say like at 0600, would be "His nurse is doing final med pass, can you call back in 1/2 hour?" Call back at 0630, "His nurse is taping report, can you call back in fifteen minutes?" Call back at 0645, "I can't find his nurse, can you wait til after report?"

I've had floors dodge me for two hours or longer; that's when I got the supervisor to intervene.

We didn't hold people downstairs just to screw up everyone else and play games. Sometimes when you would have been ready to take the ED pt., the ED nurse was receiving an ambulance pt., tied up with another pt., talking to Med Command, out in triage, etc.

ED can't set census caps and can't turn away pts. who walk in. EDs rarely go on divert these days.

We all work hard, OK? Why not try to support each other, instead of turf wars?

Up Vote Up Vote ×

I do believe you and I promise I'm not trying to turf wars. I'm sure it is frustrating when you have a nurse who is trying to avoid getting report. Personally, I don't understand why they do it. The patient is going to come anyway, so why not just go ahead and take report as soon as you can. This post was started about the ones who hold a patient until the end of their shift and then send them up. The ones who do this (and I'm not saying all nurses do it) usually have had orders from much earlier in the day to admit to such and such floor.

Up Vote Up Vote ×

In my exp., I never intentionally held a pt. downstairs for hours if there was a bed available, and I never saw any of my coworkers do this. I did have delays getting pts. up to the floor when there was craziness going on with other pts. Then I'd have the floor nurses yelling at me b/c I didn't get the pt. up there as soon as we had the bed. Can't win for losing.

One thing the floors can control which the ED cannot is pt flow. I had situations where just as I was ready to transfer a pt., and ambulance came in or someone critical showed up in triage. So that pt going upstairs had to be put on hold until the situation was in control down in the ED.

Up Vote Up Vote ×

I have this happen to me often, many of the times it is the cath lab. They call in the middle of report, knowing good and well what time it is. They often times get rude and will call back as soon you ask if you may return their call. After you get report you find out the paitent still has the sheath in place, when it could have been removed 30 minutes ago. GRRRRRR... but they were too busy trying to call you report.

ANYWAY...now that I have "vented"... maybe it wont happen to me next week. LOL

Up Vote Up Vote ×

Yeah, I think it happens everywhere. I float to ED and a lot of times it is because the doc is slower than molasses about writing orders. The ED knows the patient will be admitted, the ICU (me!) knows the patient will be admitted, but there is NOTHING that can be done until the doctor writes those orders. When things are hectic those orders get pushed aside.

:Holly3: Super

Up Vote Up Vote ×

I've noticed it when we get transfers from ICU or tele, they wait until it is too late for them to get another admission. They will call in the afternoon and make sure there is a bed, but they can't seem to give report and transfer the pt until right before shift change. I'm such a sucker that I feel obligated to do the admission because I never want to screw my coworkers.

Up Vote Up Vote ×

I can totally see both sides! I am currently in the ER, but have worked in med/surg.

I will tell you about my pt from yesterday. Little old lady is brought in by her grandkids. She is dehydrated, confused, running a fever (basically just sick!) She has not established care with a doc so we have to scramble to find someone willing to admit her. (high white count, probable pneumonia and uti) I have her in the ER from 1300 until 1800 when we finally find a doc. Doc comes in does a 45 minute workup and procedes to kick back with a cup of coffee while he writes his orders... meanwhile we are getting slammed and I need that room. I call upstairs to medsurg and tell them that I am on my way up with a pt and the doc will bring the orders along in a minute. You would have thought that I had told them I was bringing the plague up. It ended up in a pissing match between charge nurses. It was 1915...just a few minutes past change of shift for us. I tried to explain that we are holding a chest pain, bleeding wound and compound fracture in chairs and we desperately need this bed, but med surg insisted that we wait 15 more minutes to bring up the pt with a bow on her head.

My charge nurse was so frustrated that she took the patient upstairs herself. When she go there she saw that they were short a nurse and desperately trying to find a psych bed for a pt that was threatening to commit suicide with her IV tubing:rolleyes: Then the med surg charge came downstairs to chairs and saw what we were dealing with.

it is the nature of the beast (so to speak) but it would be nice if we could find some common ground.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I echo the above poster; there are a lot of threads dealing with ER versus floor/unit nurses. I think it would be great if each had to step into the others' shoes a while. It's not easy on either end. I certainly don't envy that ED nurse having to find a bed for a patient held for some reason or another for hours there. I also don't envy the unit nurse who has to take an admit at a very bad time. I think communication between the units is so important. Neither has an easy time of it. Time to try and get along and play nice together.

Up Vote Up Vote ×
Specializes in geriatric.

three new admits brought to floor within 30 minutes after getting out of report is a horrible way to start out.

Up Vote Up Vote ×

Yep, this happens all the time in all of the places I've worked.

Up Vote Up Vote ×
+ Join the Discussion