I worked 7a-7p yesterday and my charge nurse told me at about 6:30p that we were getting an admit - we printed out her info from the ED even thought we both knew the pt wouldnt be coming up until after I'd left. Well at 6:53pm the ED calls and wants to give me report - I explain that I'd take "report" (most of the time they just say "Have you read the paperwork? Are you ready for them?" and no report). However, I did tell the nurse I wasn't the nurse that would be taking care of the pt - we were at shift change and havent even gotten a chance to start report. She finally asked if we were ready for the pt, so I put her on hold for a second to ask the nurse who was relieving me (who was also charge that night -- our night charges have a full group as well) AND the current charge if they wanted me to ask if they could wait a little.
They both agreed to wait till at least the nurse could get through report. I asked the ED nurse to wait 15-20 minutes, and she says "Ugh... yea, I guess I'll just tell my charge" and hangs up.
I've noticed a pattern of the ED cleaning out their pts that need admitted RIGHT at shift change, which is a pain in the ass for us floor nurses - but is it really too much to ask of an ED nurse to wait a little bit?
I work in an ER. If I can, I try to wait until I know shift change is over before I transfer a pt. But I can't always do that. Sometimes I have the DR or the charge breathing down my neck to get the pt out of there so we can get another one into the room.
What gets to me is when I call to give report and I'm put on hold for > 5 min while they try to find someone to take report. I don't have 5 min! The last time this happened I literally had one pt code while another LOL was trying to strip tease in the hallway. Obviously I hung up, called the code, threw a blanket over granny, and tried to contain the chaos. The floor called back and yelled at me for hanging up! If you can't take my call in a minute or less, just give me a ring when you're ready. It may sound insensitive, but when it's busy, I barely have time to give report at all.
Another time I brought a pt up to ICU. As we were transferring her the nurse made a nasty comment about how I hadn't emptied her foley before transfering her. I did feel badly about it, but when I was caring for her she was on the verge of death and her foley was the least of my worries. In the ER we understand that the floors provide better care for seriously ill, time intensive pts, so we try to get the really ill ones upstairs as fast as possible. We basically stabilize them and transport. This makes sense b/c ICU ratio is 1:1 or 1:2. I still have 3 other pts despite my seriously ill one to care for in the ED.
I always try to be nice and considerate. I don't mind calling back later and holding pts if necessary. I actually do that pretty frequently. It just isn't always possible.
My radical idea is for all units & departments to have staggered shifts & staffing. The whole hospital needs to operate on a 24/7 basis ... not just the ER.
My radical idea is for all units & departments to have staggered shifts & staffing. The whole hospital needs to operate on a 24/7 basis ... not just the ER.
We actually have 1 hour coverage from oncoming shift to off going shift. That's why it is annoying on our end. We also change shifts at slightly different times.
I agree that pts should not be admitted during shift change. This, to me, is very unsafe practice. Now, let me say this, I understand that there are certain pt's that really need to get to ICU in certain circumstances. I'm all for that. But, for floor nursing, this type of admission increases the risk of something going bad real fast. A lot of times a nurse is in report and has no idea the pt is even here. In that type of situation, you have no idea how stable that pt really is. A lot of times, the ER will report that the pt is stable and low and behold, they are a train wreck upon arrival getting ready to code. I think this needs to be worked on in all hospitals. For our pt's sake. I don't blame our ER for this happening. They are only doing what they are told to do. But, managment needs to find a solution. I have worked in more than hospital and it's the same way everywhere. The problem is.....how do you get managment to see that this practice is not in the best benefit for the pt?
I work in an ER. If I can, I try to wait until I know shift change is over before I transfer a pt. But I can't always do that. Sometimes I have the DR or the charge breathing down my neck to get the pt out of there so we can get another one into the room.
What gets to me is when I call to give report and I'm put on hold for > 5 min while they try to find someone to take report. I don't have 5 min! The last time this happened I literally had one pt code while another LOL was trying to strip tease in the hallway. Obviously I hung up, called the code, threw a blanket over granny, and tried to contain the chaos. The floor called back and yelled at me for hanging up! If you can't take my call in a minute or less, just give me a ring when you're ready. It may sound insensitive, but when it's busy, I barely have time to give report at all.
Another time I brought a pt up to ICU. As we were transferring her the nurse made a nasty comment about how I hadn't emptied her foley before transfering her. I did feel badly about it, but when I was caring for her she was on the verge of death and her foley was the least of my worries. In the ER we understand that the floors provide better care for seriously ill, time intensive pts, so we try to get the really ill ones upstairs as fast as possible. We basically stabilize them and transport. This makes sense b/c ICU ratio is 1:1 or 1:2. I still have 3 other pts despite my seriously ill one to care for in the ED.
I always try to be nice and considerate. I don't mind calling back later and holding pts if necessary. I actually do that pretty frequently. It just isn't always possible.
Sounds like a communication problem. This happened just recently to me. The ER was calling for report. I was in the middle of a procedure with a pt. SO, I couldn't take report right that very minute. SO, I asked if they could call back. When they called back the second time, I had a pt that was trying to crash. SO, my charge nurse took it for me. Now, the sup calls back after all of this and the states that the ER nurse is complaining that I refused to take report. Not true! I just couldn't do it at that particular time. I explained to the sup the situation and she understand. This all boils down to lack of communication. I don't understand what's going on in ER at the particular time anymore than they understand what's going on on my unit. It's a vicious cycle that really needs to be addressed.
yeh, well, guess what , medics , codes and pt's don't wait for "shift change in the er", the nurses are flexable. it is a countinuous flow of pt's. we also give report to the next shift. as an icu and an er nurse ,i get so sick of the " shift change excuse". yes we want the bed as soon as it's avalable, the hospital looks at that, if we don't get the pt up within so much time after the bed is avalable then we get a lecture about it. if we wait until you are "ready", then we end up taking the brunt ..... pt's in the hall ways etc,,, the nurses on the floor need to find a way to make it work, if the pt's not critical, then the nt can go take vs, make the pt comfortable etc.. until the next nurse can get in there to start things. so..... as a nurse that has been on both sides of the fence..... i have to side with the er nurse. and, you can continue to complain all you want, but the more the nurse complains to me about it the less i care. now if there is a critical pt they are caring for or some such circumstance, then of course, we can work together, but not the , "shift change", "lunch", "no staff ", tiered worn out excuses. if there's an exuse for not takining pt's , or, er and icu has heard every one of them.
yeh, well, guess what , medics , codes and pt's don't wait for "shift change in the er", the nurses are flexable. it is a countinuous flow of pt's. we also give report to the next shift. as an icu and an er nurse ,i get so sick of the " shift change excuse". yes we want the bed as soon as it's avalable, the hospital looks at that, if we don't get the pt up within so much time after the bed is avalable then we get a lecture about it. if we wait until you are "ready", then we end up taking the brunt ..... pt's in the hall ways etc,,, the nurses on the floor need to find a way to make it work, if the pt's not critical, then the nt can go take vs, make the pt comfortable etc.. until the next nurse can get in there to start things. so..... as a nurse that has been on both sides of the fence..... i have to side with the er nurse. and, you can continue to complain all you want, but the more the nurse complains to me about it the less i care. now if there is a critical pt they are caring for or some such circumstance, then of course, we can work together, but not the , "shift change", "lunch", "no staff ", tiered worn out excuses. if there's an exuse for not takining pt's , or, er and icu has heard every one of them.
i'll bet you're just a peach to work with. thanks for the understanding.......(rolling eyes)
Again, don't know where you guys work...but, no one goes unstable to the floor. Thought that was a rule everywhere! Even unit admits are escorted on drips, monitored, sometimes resident, RN and technician-respiratory too if vented! Can't imagine moving anyone away from a code cart if they are unstable! If that's happening in your hospital, something is screwed up with your system!
Doesn't happen all the time. But, a lot of my pt's are misdiagnosed in the ER. IT is an ongoing problem. Had a pt diagnosed with CHF once. Yeah right! Bun and creatine were high along with a low, very low h&h. Gets to the floor with Resp in the 40's? Doc refuses to give me permission to give fluids for bolus over the phone. BP60's over 30's. Turns out it's a massive bleed. Of course it was total chaos! THis was all during change of shift. Who gets yelled at by the doc? Guess? This is the example of the type of mess that comes to my floor. I just wonder what would happen if a pt would code in an elevator on their way up because the ER manager is insistant on sending the pt RIGHT NOW!!!!
Let me just say this. I'm not against the people that work in ER. They have their own stressors to work with. But, we need to focus on whats in the best interest for our pts. Not how it looks on the books. Pt's safety is compromised with this type of system. Isn't that why we do the jobs we do? Aren't we, as a whole, responsible to give the best care that we can when these people's lives are in our hands? Have we become so money hungry and hardened that all caution is thrown to the wind so that a hospial gets accrediation or funding?
Doesn't happen all the time. But, a lot of my pt's are misdiagnosed in the ER. IT is an ongoing problem. Had a pt diagnosed with CHF once. Yeah right! Bun and creatine were high along with a low, very low h&h. Gets to the floor with Resp in the 40's? Doc refuses to give me permission to give fluids for bolus over the phone. BP60's over 30's. Turns out it's a massive bleed. Of course it was total chaos! THis was all during change of shift. Who gets yelled at by the doc? Guess? This is the example of the type of mess that comes to my floor. I just wonder what would happen if a pt would code in an elevator on their way up because the ER manager is insistant on sending the pt RIGHT NOW!!!!
Don't you have ER attendings? How was a patient with a low H and H moved prior to blood administration or fluids? Who's watching the ER, sounds like scary medicine to me.:uhoh21:
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wildmountainchild
190 Posts
I work in an ER. If I can, I try to wait until I know shift change is over before I transfer a pt. But I can't always do that. Sometimes I have the DR or the charge breathing down my neck to get the pt out of there so we can get another one into the room.
What gets to me is when I call to give report and I'm put on hold for > 5 min while they try to find someone to take report. I don't have 5 min! The last time this happened I literally had one pt code while another LOL was trying to strip tease in the hallway. Obviously I hung up, called the code, threw a blanket over granny, and tried to contain the chaos. The floor called back and yelled at me for hanging up! If you can't take my call in a minute or less, just give me a ring when you're ready. It may sound insensitive, but when it's busy, I barely have time to give report at all.
Another time I brought a pt up to ICU. As we were transferring her the nurse made a nasty comment about how I hadn't emptied her foley before transfering her. I did feel badly about it, but when I was caring for her she was on the verge of death and her foley was the least of my worries. In the ER we understand that the floors provide better care for seriously ill, time intensive pts, so we try to get the really ill ones upstairs as fast as possible. We basically stabilize them and transport. This makes sense b/c ICU ratio is 1:1 or 1:2. I still have 3 other pts despite my seriously ill one to care for in the ED.
I always try to be nice and considerate. I don't mind calling back later and holding pts if necessary. I actually do that pretty frequently. It just isn't always possible.