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?
Specializes in Utilization Review/Case Management.
I work in the ED, and used to work med/surg. So I can see both sides.
TPTB monitor the length of stays in the ED, and if we keep patients too long, we definitely hear about it, and not in the good way. Plus, most ED nurses want to move on to the next patient. Or we already have 4 (or more) patients, sometimes all of them are "critical". For example, I had one patient s/p syncopal episode/TIA; one possible PE; one vomitting blood, possible need for transfusion; and one with an acute MI, all at once yesterday. Plus I was assigned the first "critical" patient (none of these fell into this category BTW) I dreaded each time EMS called that there would be a CPR in progress on the way.
I for one never want to "hold" a patient. But sometimes a more critical patient will take my time away from getting an admission upstairs right away. Plus, we do not have transport personnel, so I have to actually leave my other patients to bring one up. If one is unstable, I cannot leave until that is handled.
The problem also lies in the time it takes to get patients admitted, and the way our physicians work. They do not like to pass off a patient to the next doc. So they push to get their patients either admitted or discharged before they leave. In our ED, this often translates to about 2 hours before the nurses shift change. So then the process of getting an accepting physician, admission orders and room assignment often ends up near nursing shift change.
When I worked med/surg (at a different hospital) we were not allowed to refuse an admit. But if we got an admission close to shift change, we made sure they were stable and comfortable. Then the next shift completed the admission paperwork. It worked well most of the time. (nothing is perfect:rolleyes:) Plus, my motto was "fill the rooms, they can't bring me any more if there is nowhere to put them!" Boy did that change when I switched to the ED. But I love it .
Not to mention the fact that ED stretchers are uncomfortable, we don't have TVs or phones, no bedside tables for water pitchers/cups, it's noisy and only 2 bathrooms for all the patients and family members (20 beds and visitors. Don't even talk about the drunk/psych patients going into other patients room/bay. It's just safer and more comfortable to move the admits "upstairs" as soon as possible.
Nurses these days are all spread too thin, with fewer ancillary staff and more acute patients. "Us" vs. "them" only hurts all nurses. We need to work together for ourselves and our patients.
Specializes in Utilization Review/Case Management.
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!!!!
I agree this is a dangerous situation. However, it is not the nursing staff that mis-diagnosed this patient. And the ED manager that insists on moving an unstable patient is wrong unless the ICU staff is ready for them, and the staff is available to assist in transport.
But I understood this thread to be about holding stable patients in the ED so the ED nurses don't have to work. That is totally off the mark.
Also, which doctor did you call? If it was the admitting doctor, he should have listened to you and done what is best for the patient. If it was an ED doc, was this even this patient's doc while in the ED? Had he or she signed over care to the admitting doc? If so, the ED doc cannot just jump in and give orders because it is no longer ( or never was ) this doc's patient. (medicine works very differently than nursing, not always the best for the patient, IMHO).
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:
Maisy
Yes.....we have attendings. Scary isn't it? Had a doc write orders for 80 of kcl 4 times a day!Who do you think got yelled at for that one? Like I can explain why that idiot would order such a high dose? UGh....! I just wish doc would do their jobs safely so I wouldn't have to babysit them. Very frustrating. It's very frustrating to me as a floor nurse. I work on a cardiac intervention unit. I also deal with some med/surg in there. Most of my pts are very, very sick. If they can't make it on my unit they go to ICU. I do like my job and coworkers, it's just some days are better than others. Do you ever get the feeling that your whole shift is fixing mistakes from docs or the previous shift. Well, that's me.
Wouldn't it be nice if hospitals had a team of Admitting and discharge nurses, that would go and do all the paper work to admit and discharge, and get the paitent settled in, then pass off report. Just getting them settled in and the paper work, not all the critical things would help tremendously.
Specializes in Utilization Review/Case Management.
A lot of times a nurse is in report and has no idea the pt is even here. ?
One way we solved this problem at the hospital I used to work at is by having a "hand off" sheet that both the ED/transferring and the floor/accepting nurse had to sign upon transfer of the patient. We had to get the pt. in bed and vital signs, and the MS nurse had to be comfortable with the patient's status before the ED nurse can leave.
I agree this is a dangerous situation. However, it is not the nursing staff that mis-diagnosed this patient. And the ED manager that insists on moving an unstable patient is wrong unless the ICU staff is ready for them, and the staff is available to assist in transport.
But I understood this thread to be about holding stable patients in the ED so the ED nurses don't have to work. That is totally off the mark.
Also, which doctor did you call? If it was the admitting doctor, he should have listened to you and done what is best for the patient. If it was an ED doc, was this even this patient's doc while in the ED? Had he or she signed over care to the admitting doc? If so, the ED doc cannot just jump in and give orders because it is no longer ( or never was ) this doc's patient. (medicine works very differently than nursing, not always the best for the patient, IMHO).
Maybe I am off the mark. I could have misunderstood the thread for my own purposes. Sorry about that. Had a bad weekend. I agree, it's not the nursing staff that is misdiagnosing. But, the report is way off the mark compared to how the pt really is when they get to the floor. Let me say this again. I am not against ER nurses nor do I think I could do their job. IT's just some of the times, I wonder, where they get there assessments from.
I called the admitting doc about that particular pt. Mind you, the night nurse that excepted that pt at 6am called the doc 3 times prior. SO, when this doc's associate came in, after me begging them to do so, I got reprimanded by them . I should have done this, I should have done that. No......you and your associate should have gotten your butt out of bed and taken care of business. There was no one else on the case. Idiots. I understand the mechanics of responsibility of pt care with pts. It's just that the attending and her associates screwed up and then wanted to blame the nursing staff. Thank GOD for documentation. I never heard anything about it afterwards, but, the attendig's associate was never nice to me after that. So,that explains alot to me.
One way we solved this problem at the hospital I used to work at is by having a "hand off" sheet that both the ED/transferring and the floor/accepting nurse had to sign upon transfer of the patient. We had to get the pt. in bed and vital signs, and the MS nurse had to be comfortable with the patient's status before the ED nurse can leave.
I think that's a great idea. Problem is....RN's don't transfer our pts. BUt, I will bring this up at the next meeting since it's becoming a problem for our units. Yes, I think all critical pts need to be transferred with a RN. Ohhhh....boy.....won't the heads roll then.LOL>
Specializes in Utilization Review/Case Management.
Wow, that is really scarey. I agree totally that was inappropriate for the docs to blame the nurses, however, that is sometimes all too common. Guess that's another whole topic, tho.
Specializes in Utilization Review/Case Management.
I think that's a great idea. Problem is....RN's don't transfer our pts. BUt, I will bring this up at the next meeting since it's becoming a problem for our units. Yes, I think all critical pts need to be transferred with a RN. Ohhhh....boy.....won't the heads roll then.LOL>
It applied to anyone transferring a patient to any other unit, but an RN had to accept the patient. Hope it works for you. I personally never just leave a patient, but make sure that someone knows they are there, even tho we don't have to do that where I work now.
Ugh, shift change admissions!! I used to be a tech in the ER of the hospital I work at (I now work on the floor), and I know for a fact that our ER (not all!) does this totally on purpose. Their shifts end at 8pm/8am so they dump them at 6:50 so they are less likely to get a new patient. It is so dangerous!
I once got in at 6:40pm for my shift and was told I was getting a patient. I said "ok, whatever" and went about getting report from the off going nurse. Well, little did I know that the ER was down the hall dropping off the patient. Later around 7:45 I was just finishing up my assessments and went into the room where the patient was going to be admitted to get the room ready. Imagine my surprise to see a woman in the bed! Now, mind you that I hadn't even gotten report yet! And unfortunately, she wasn't ok! She was left off her o2 and her sats were in the 70s, and her IV was infiltrated from the NS running wide open because they never put it on a pump! I was soooooo hot . It took me awhile to get her stabalized and all, and when was I done I called the ER to try and talk to that nurse. Of course she'd gone home already! I spoke to the charge and filled out a safety report and that is the last I ever heard about it.
. It took me awhile to get her stabalized and all, and when was I done I called the ER to try and talk to that nurse. Of course she'd gone home already! I spoke to the charge and filled out a safety report and that is the last I ever heard about it.
trudlebug
92 Posts
I work in the ED, and used to work med/surg. So I can see both sides.
TPTB monitor the length of stays in the ED, and if we keep patients too long, we definitely hear about it, and not in the good way. Plus, most ED nurses want to move on to the next patient. Or we already have 4 (or more) patients, sometimes all of them are "critical". For example, I had one patient s/p syncopal episode/TIA; one possible PE; one vomitting blood, possible need for transfusion; and one with an acute MI, all at once yesterday. Plus I was assigned the first "critical" patient (none of these fell into this category BTW) I dreaded each time EMS called that there would be a CPR in progress on the way.
I for one never want to "hold" a patient. But sometimes a more critical patient will take my time away from getting an admission upstairs right away. Plus, we do not have transport personnel, so I have to actually leave my other patients to bring one up. If one is unstable, I cannot leave until that is handled.
The problem also lies in the time it takes to get patients admitted, and the way our physicians work. They do not like to pass off a patient to the next doc. So they push to get their patients either admitted or discharged before they leave. In our ED, this often translates to about 2 hours before the nurses shift change. So then the process of getting an accepting physician, admission orders and room assignment often ends up near nursing shift change.
When I worked med/surg (at a different hospital) we were not allowed to refuse an admit. But if we got an admission close to shift change, we made sure they were stable and comfortable. Then the next shift completed the admission paperwork. It worked well most of the time. (nothing is perfect:rolleyes:) Plus, my motto was "fill the rooms, they can't bring me any more if there is nowhere to put them!" Boy did that change when I switched to the ED. But I love it
.
Not to mention the fact that ED stretchers are uncomfortable, we don't have TVs or phones, no bedside tables for water pitchers/cups, it's noisy and only 2 bathrooms for all the patients and family members (20 beds and visitors. Don't even talk about the drunk/psych patients going into other patients room/bay. It's just safer and more comfortable to move the admits "upstairs" as soon as possible.
Nurses these days are all spread too thin, with fewer ancillary staff and more acute patients. "Us" vs. "them" only hurts all nurses. We need to work together for ourselves and our patients.
:yeah:GO:yeah:TEAM:yeah: