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?
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.
Great story right?
Again, bad system-how is your transport allowed to drop someone in a room? Ours is not allowed to deliver, or take a patient without first consulting the nurse. If the nurse is unavailable-regardless of the reason, then the charge nurse is notified. That should never happen, without knowing, you did say you were told a patient was coming...was it a miscommunication or do you think deliberate? If deliberate it should be written up! As I said in my last post, if patients are to go the floor and they are stable, they are pulled out and new sick patients placed in ER rooms. Therefore, either your ER is not busy like mine, or someone hasn't figured that out yet!
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 don't disbelieve you. I just want to know where this Utopia is, where there aren't 10 patients in the waiting room/coming in by ambulance waiting for each of those beds where those patients are hanging out in the ER. 'Cause it's sure not the same dimension in the space/time continuum that I work in.
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>
What you're describing scares me. I've never heard of non-ACLS staff transporting monitored patients, let alone critical ones.
I don't think patients should have to wait in ER either, no matter if it's change of shift or not. What I don't understand at all is that fully 90% of our ER admits come to the floor at shift change. That is terrible for both the staff and the patients. Why 90?!!!!
I feel for both sides (2 yrs as an ER Tech, almost one in Tele, ICU as a LPN/RN).
On my tele unit, If I can't take an ER admit because I'm dealing with my current patients or giving report, I can't take it. Period.
It's not my fault that the ER's are crowded and I won't compromise my current patient load for that.
On the other hand, it doesn't take long to get a patient in the bed, get a 30 sec bedside or phone report, and make sure the patient is stable (on tele - different for ICU). I generally take ER (or PACU, Cath lab, transfers, etc.) admits at any time with no questions. The biggest problem that I have is from the nurse that I'm giving report to having attitude because he/she has to finish the admit.
That's where my beef lies. I think the ER folks rock!
We change shifts twice a day; that leaves 22hrs to transfer pts. .
AMEN!! Funny how a patient can spend HOURS in ER...then...BAM 6:30-7:00 the same bed that has sat empty on the floor ALL DAY needs to get filled NOW!
Amazing what the ride up in the elevator does to the perfectly "stable" pt, must be the altitude. .
LOL!!! We have the same altitude issue at my hospital!!!
Bottom line is sending pts to the floor at shift change is potential dangerous and the nurse receiving the pt is the one whose butt is on the line.
In all seriousness I wish that the ER nurses would consider that the oncomming shift is not only getting this new pt. but also the other pt's on her assignment are new to her too!
IF we are lucky enough to have had the pt's the nite before..not so bad
IF the other pt's are stable...not so bad
IF we are staffed appropriately...not so bad... but those sure are an awful lot of IF'S...
It's a system problem not the result of ER nurses trying to stick it to the floors. Carping about it isn't go to fix anything. You've identified a problem ("90% of patients are admitted at shift change") Now prove it. Start an admissions study log with time report was called or patient comes to floor. Don't fudge the numbers to prove your point though as you will eventually be found out and nobody will listen to you again. If your results bear out what you are saying take it to the ED management so they can find out where the break in their system is (which, BTW, is usually the physicians and bed-control not the nurses). Form a committee with some ER nurses who want to improve the system. Throw around phrases like "patient through-put" and "increased patient satisfaction"... management loves those kind of things...they'll probably spring for coffee and donuts. Act like adults and recognize the difficulties on both sides and come up with a solution. Find out what other hospitals are doing. For example, as I mentioned earlier, an admissions nurse position (could easily do both admits and DC's), standardized faxed reports so you don't have to come to the phone unless you read it and have questions, teamwork-willingness to take report on someone else's admit if that nurse is busy, appropriate staff for transport and maybe a little flexibility on everyone's part. We are smart people we should be able to figure this out and end all the mud-slinging...it doesn't get us anywhere in the end.:deadhorse
Specializes in ED, Cardiac Medicine, Retail Health.
I do not understand the patient flow dynamics of the ED, but often wonder why at change of shift there is the urgent need to get the patient to the floor while the patient had been sitting in the ED for hours. seems to be a universal problem I see.
When asked about this situation at my hospital, I was told that there are certain times of the day when the patient census on the floors is updated. After the update, the wheels are put into motion to notify ER and floor nurses of pending transfers and calling report. It always seems to happen around shift change.
If I happen to discharge a patient during the afternoon, I am certain that I'll get another eventually. I'll get the room ready after it is cleaned and try to catch up with my other patients if possible, but we all know how that pans out.
I never once thought that ER nurse were trying to hold a patient. I figured they were as interested in transferring as I was in receiving the patient.
I find that at the hospital I work at there are a couple of reasons ER nurses wait until shift change to give report and sent patients to our unit. First, the census in the ER dictates their staffing. If they have a very low census, but another unit is understaffed, they may have a nurse pulled to staff that unit, and therefore less nurses to staff the ER.
We also have a good amount of agency nurses that go to which ever unit needs help the most. So if the nurses hang onto the patients long enough, they will appear that they need more nurses to staff the high census of patients in the ER, making it so they have a lower nurse to patient ratio, and makes them better staffed in case of a massive influx of patients. Either way, hanging onto the patients for as long as possible before shift change makes the staffing situation better for the next shift.
The second reason is that the longer the nurse holds onto the patient, the fewer new patients the nurse will get. I guess it's the way of survival in the ER. Sucks for us floor nurses, but I can understand why they do it.
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!!!!
This reminds me of the time when the ER tried to send us a patient whose CT showed a dissecting AAA Now, wouldn't be so bad if I worked at a large hospital, but I work midnights on a telemetry unit in a community hospital with no surgeons in house (but I guess either way, this guy needed OR stat). The ER nurse called down to us and gave us a heads up about the CT results and the the ER doctor knows the results but is still admitting the patient to our unit under doctor such and such :uhoh21: WE had to call the admitting doctor before the patient was transferred down and let him know about the CT results, which the ER doctor apparently didn't find important enough to notify the admitting doctor about. Boy, was the admitting doctor upset when he heard that. The patient was never sent to our unit, he ended up being air lifted to the nearest major medical center immediately after the admitting doctor called the ER livid.
Now, wouldn't be so bad if I worked at a large hospital, but I work midnights on a telemetry unit in a community hospital with no surgeons in house (but I guess either way, this guy needed OR stat). The ER nurse called down to us and gave us a heads up about the CT results and the the ER doctor knows the results but is still admitting the patient to our unit under doctor such and such :uhoh21: WE had to call the admitting doctor before the patient was transferred down and let him know about the CT results, which the ER doctor apparently didn't find important enough to notify the admitting doctor about. Boy, was the admitting doctor upset when he heard that. The patient was never sent to our unit, he ended up being air lifted to the nearest major medical center immediately after the admitting doctor called the ER livid.
MAISY, RN-ER, BSN, RN
1,082 Posts
Again, bad system-how is your transport allowed to drop someone in a room? Ours is not allowed to deliver, or take a patient without first consulting the nurse. If the nurse is unavailable-regardless of the reason, then the charge nurse is notified. That should never happen, without knowing, you did say you were told a patient was coming...was it a miscommunication or do you think deliberate? If deliberate it should be written up! As I said in my last post, if patients are to go the floor and they are stable, they are pulled out and new sick patients placed in ER rooms. Therefore, either your ER is not busy like mine, or someone hasn't figured that out yet!
JMO
Maisy