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?
It is great for you to call report before you leave because you know the patient- but only if they are ready to come up. If they are going to be down in the ED for 2-3 hours receiving more tests and waiting for orders to be written, then the oncoming ED nurse has plenty of time to get to know them.
One of the things that I wonder sometimes is if the ED nurses see report as a inconvenience that they need to get out of the way. ED nurses never know what is coming in the door, so I think that they forget how much more prepared we can be to treat the patient with a timely and thorough report. I have always seen report as a necessary component to continuity of care, and I like to know what is going on, to myself and the other nurses on the floor, we see report as much more than a mark in a required box.
If it's going to be a couple of hours, I let the oncoming nurse give report. I'm talking about what usually happens, when the bed is requested after everything has been done and admission orders have been written. Half of the time I have everything ready and I'm just waiting on that bed assignment to pop up on the screen. We usually give faxed report and don't call, so anytime of day I will fax report as soon as I finish it (half of the time I have it filled out just waiting to fill in vital signs and the bed assignment).
If I get a bed from 6:20-7 am: If it's the ICU or Peds floor, I will call around 7 and ask to speak to the day nurse (i'm nights) and the first thing I say is, "I won't send them until 7:30, but I would like to go ahead and give report.". They're usually OK with that, and the oncoming nurse is usually happy to transport the patient for me, so I can go home.
If it's a faxed report I go ahead and fax report but I don't request transportation (for non-monitored patients) until 6:45. Transportation usually takes a good 30-45 minutes to come get the patient so they won't get there until shift change is over.
Like I said before, I'm not holding patients waiting for my shift to end so I won't get any more patients. Usually I've got the sheet ready and as soon as I see the bed number on the screen, I get the sheet faxed and get the patient on their way. Why is this? Because most patients have no idea about shift change or anything, they are just on their call lights every 10 minutes asking "when am I going to go upstairs?". That grates on your nerves after a while. So I get them going ASAP.
This is so interesting! We really are all in the same boat here, aren't we? I was just talking about this issue with a friend of mine in Gainesville, an ER nurse, and I'm an ICU nurse. She told me about a busy busy night was trying to give report on someone that needed to get moved out to a room but the nurse kept putting her off. The charge nurse on the floor called the charge in ER to ask for more time before the transfer because the nurse receiving the patient had just been through a code and needed to regroup, emotionally. My friend had to hold her patient. She said to me, "Can you imagine an ER nurse asking the EMTs to hold the patients outside in the ambulance until we took extra time to get regrouped emotionally? We don't have that luxury, they shouldn't either." As an ICU nurse, I am on the receiving end, and we certainly have had our share of shift change admits too. On the other side, sometimes the ER doctors sign a bunch of them out to the floors just as they are wrapping up their shift also, and it's their fault for playing that game.
it's just a matter of discussing it, on how to deal w/ new admits at shift change...if you come to think of it...the one responsible should be the incoming nurse, if she is already there, usually there are hospital policies that you must come in 15 minutes before your schedule...so i say there must be a written policy to avoid any misunderstanding.....whatever the rule is,then it must be followed, anyway whats the use of having supervisors and chief nurses..right?
I work in the Ed and it is very difficult getting pt's to the floor at shift change. But a lot of times that is when the beds all the sudden become clean and available. It does seem like a lot of games are played on how long can we stall before we are forced to give a bed to the ED. We also have nurses in the ED that will hold their pt so they won't get the next new pt. Bottom line it is all about patient satisfaction. None of them want to lay on our uncomfortable bed's in the ED, for that matter they really don't want to stay in the hospital period. Well most people don't:) But we really need to do what we can to make them feel comfortable. After all they are our job security! We just started faxing reports to the floor this past week, I'm not sure how well that will work, it does free me up from being put on hold for 15-20 minutes everytime I try to call report.
As a new nurse and while being a nursing student in school, I witnessed serveral occasions where it was 6:30 or later when another unit (not just the ER) called to transfer pt and give report. Even my preceptor and more experienced RN's have admitted that there are some nurses out there that tend to be a little lazy and would rather wait to transfer so they don't have to get any new pts before their shift is done. While I'm sure this is not the case most of the time (at least I hope it's not), I do think it's rude and disrespectful. Those people that are guilty of doing this I say: Do onto others as you would want done to you. I also agree that a lot of the time, we don't control schedules/transfers and it just works out that the pt needs to be moved close to shift change. You just have to do what ya gotta do and move on.
I work ICU registry and in the ER so I see both sides of things. When I ony worked the floor I wasn't very sympathetic to ER but since I have worked there more, I see how frustrating the whole "getting a bed and calling report" thing can be. Many times we don't get notified that the bed is ready until the end of the shift, which can be hours afte the bed was assigned. As a floor nurse, you could let the ER know that when the bed is ready instead of waiting for that info to go through all of the channels. As an ER nurse, you could check with the floor directly to see if the bed is ready and just hasn't been noted that way in the computer.
One thing I could usually work out with the floor nurse is that I would wait the few minutes it would take for the next nurse to get there but then give her report before they start in on report and then I would give them that 30 minutes before taking up the patient. Since I do work both sides, I can get into the floor's computer program and do something nice like put in the med list or something like that. It akes me about 5 minutes and it is one less thing that the floor has to do. That also eases any frustration for the floor when I tell them they have one less thing to do.
The charge nurse on the floor called the charge in ER to ask for more time before the transfer because the nurse receiving the patient had just been through a code and needed to regroup, emotionally.
Wow, wouldn't you then give the incoming admit to another nurse? Geez. That's what I'd have done as charge. That's ridiculous!
At my hospital, once we give a bed number out for an ED pt, the ED nurse has to wait 30 minutes to send them up. But, that way the floor nurse knows they have 30 minutes to get ready for a new admit. We don't get report over the phone anymore. It's all computerized, so there's none of that "I'll have to call you back" crap. Really it's not that difficult to receive a new pt. If you're busy, just run in, get a set of vitals, do a quick assessment and move on. The paper work can wait!
Didn't read the whole thread, but this is an issue I deal with frequently. (I'm on the floor)
Giving everyone the benefit of the doubt and assuming no one is doing anything on purpose to make anybody else's job more difficult...
We need POLICIES!! Sometimes we have a patient care coordinator on who will help do a change-of-shift admit, or if we have a free-charge (no pt assignment) and she's not slammed, she will do it. But this is only M-F. I try to always say yes (it's a personal problem sometimes), but it makes me rush sometimes. I will get home and realize I didn't chart something important. It could be dangerous... so if it were up to me, I would write a policy that says the FLOOR nurse does not do admits after 6:30. If there's nobody else to do it, it should have to wait till the next shift can take report, no later than 7:30.
Exactly how safe is it to have a 45 year old man with chest pain or maybe a 25 year old in early pregnancy with abdominal pain, possible tubal pregnancy, waiting in the lobby because EVERY SINGLE inch of floor space in the back has a patient on it and there is absolutely no place to put them. At least your patients have been evaluated and treated by a physician and I'm sorry but the horror stories of unstable near-death patients being dropped off on the floor although not out of the realm of possibility are not the norm.
Again, the only way to fix the problem is to actually sit down and try to fix it. We can b***ch all we want but it's going to get us nowhere. Why don't those of you who work at a hospital that HAS a system that works, at least most of the time, identify where you work and what your system does so those of you who work in places that have a problem can go to your managers with useful information. All this blaming and excuse making isn't doing anything!
We have a policy that no patients can be transferred to the floor and report can't be give during "quiet time" it is supposed to be from 7AM-7:30AM, 3PM-3:30 PM and again at 7PM. We now call it "happy hour" :wink2: as 15 minutes before the hour and another 15 minutes after quiet time ends we are lucky to get anyone to answer the phone!! We can't tell the ambulances coming in it's quiet time and I sure don't want to be the one to go out to the lobby where there are 20 people waiting and explain the whole "quiet time" to them.
Hi- I'm an ER nurse and this looked like an interesting topic. I didn't read all 8 pages of comments so probably what I have to say may have already been covered. I always like to think of what is best for the patient.
If a patient gets a bed assignment just before shift change, I think it is in the best interest for the nurse who has just cared for them for the last 8 hours or whatever to give report to the oncoming floor nurse. It doesn't make sense for the ED nurse to give report to an ED nurse who likely will not even lay eyes upon the patient but would have to report to the floor's next shift and not really be able to answer any questions that are not in the written report. I work nights and have asked floors to have their oncoming nurse take phone report from my offgoing nurse BEFORE they go into their full shift report, but that rarely happens. When space permits, we would prefer to have the offgoing nurse give report and then send the patient up in a half hour, but again, get a hard time from the floors.
We often get beds assigned when pts go to OR or floors have not removed someone from census and the bed is not 'discovered' till start of business day. In my hosp. the admitting services sometimes come around and evaluate/admit pts in bunches so that is another problem. Bottom line is that our doors never close, we can't refuse incoming patients and are always looking to open more beds for the next people to come in the door.
We traditionally do phone report, but often the floor nurse is busy and can't come to the phone, etc. etc. We recently initiated a written report sheet on all patients for which we collaborated with floor nurses to develop. We also call phone report. We are supposed to send a patient up with written report if the floor does not take report within 15 minutes but we rarely do. The floor staff finds that to be 'punitive' and goes crazy if we do. The actual policy is that the floor is supposed to call US within 15 minutes after a bed is assigned but that happens maybe 3 x a year! I know we need to change our behavior and either get people used to the written report and not feel its punitive which would also get patients upstairs sooner.
Oops= digressing off the topic. In my ER, we don't have nurse:patient ratios, so if you purposely hold an admit patient (as mentioned in one of the first replies, so that the nurse would not get new patients) you will just have more patients, as you will continue to get patients assigned to you. It is in our best interest to get rid of whoever we can. And its not fair for the patients to be holed up in our hallway on a stretcher and not receiving optimal care, we are busier with the incoming people. It is not ideal for anyone to have change of shift admits, but it does happen and we need to work together to do what's best for the patients.
luckylucyrn
124 Posts
If it's going to be a couple of hours, I let the oncoming nurse give report. I'm talking about what usually happens, when the bed is requested after everything has been done and admission orders have been written. Half of the time I have everything ready and I'm just waiting on that bed assignment to pop up on the screen. We usually give faxed report and don't call, so anytime of day I will fax report as soon as I finish it (half of the time I have it filled out just waiting to fill in vital signs and the bed assignment).
If I get a bed from 6:20-7 am: If it's the ICU or Peds floor, I will call around 7 and ask to speak to the day nurse (i'm nights) and the first thing I say is, "I won't send them until 7:30, but I would like to go ahead and give report.". They're usually OK with that, and the oncoming nurse is usually happy to transport the patient for me, so I can go home.
If it's a faxed report I go ahead and fax report but I don't request transportation (for non-monitored patients) until 6:45. Transportation usually takes a good 30-45 minutes to come get the patient so they won't get there until shift change is over.
Like I said before, I'm not holding patients waiting for my shift to end so I won't get any more patients. Usually I've got the sheet ready and as soon as I see the bed number on the screen, I get the sheet faxed and get the patient on their way. Why is this? Because most patients have no idea about shift change or anything, they are just on their call lights every 10 minutes asking "when am I going to go upstairs?". That grates on your nerves after a while. So I get them going ASAP.