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?
iIwork on a med-surg floor and I hate when the er nurse sends a pt. during shift change, after reading some of the responses from the er nurses, I :nono:have a better understanding. I think the best solution is to have an admission nurse at all times. my hospital had an admission nurse but turned her into a discharge nurse. how stupid is that:bugeyes:,when the need is more on admissions which takes more time. another suggestion my hospital wants is to have the report faxed. i dont know about your place, but my floor is way too busy and papers get lost. I like the verbal report followed by a fax, then again if I tell the er nurse I will call back I normally do.
We are expected to have a bed ready for ER within 15 minutes of them calling. If the room is dirty we just have to get a stat clean. But it's not just a matter of tucking a new patient in, or doing a quick assessment. Often the doctor will be expected to show up within an hour, he will ask questions, the medicine sheet needs to be ready for him to sign, the patient and family are scared and in pain, etc. I HATE to stay over for all that, but I would also hate to get all that dumped on me first thing after report when I haven't even seen my other patients yet. And yes, most of our ER admits come up within 30 minutes of shift change, before or after 7 p.m.. I still don't know why. Our ER uses a team approach, so it doesn't make sense they would hold onto a patient. And we can't deny a bed or refuse to take report. Am I just ******** without a solution? Yes, but sometimes it helps to vent. I've been to my head nurse but it hasn't helped, so...
YUP...happens to all of us. We have an ED doc who will sit on them for hours, only to decide @ 6:25 to send dispatch them all to the various departments for admissions. WHAT A CROCK!!! our pharmacy has left for the day, shift change is starting in a few minutes, the families who have sit with these folks all afternoon are seething and wanting to get their family member admitted and get the hell home to try to salvage what's left of THEIR day. A big cluster muck!!
I'm a ED nurse, first I'll like to say ed nurse don't change sifts like floor nurses. I work 9-9p now but use to work 1-1a I have 5 UC rooms that I may turn over anywhere form 5 to 15 times a shift. Most of the time my pt go home but sometime things start one way and end in an admission. I not only have to talk to you for report but take order from the doctor find charge nurse to give admission to, too get a bed( while still taking care of the other pt. Sometimes I'm to busy to call when I first get orders, due to the ed off shift hours I'm not thinking that nurse is trying to go home or give report when 10 people are waiting on that 1 bed.The turn over rate is very high in the ed it times I have to stay so I dont drop such a heavy load on the nurse taking over for me. What I've learn every day is not going to be picture perfect and to get over it.
Transferring pts at shift change is dangerous. If the pt is unstable, they do not get the appropriate attention during report. Period. You need to talk to your manager
One thing the floor nurses must understand is that in the ER we have a constant flow in, any chance to get people out is taken no matter what time. On the floor you can only take so many admits and then you are full. ER can have 50 people waiting for a bed in the lobby plus the ambulance pt's rolling in. Also, your shift change is the ER shift change, is it fair to ask the ER nurse to wait for 20 or 30 minutes at the end of their shift when you just have to get the pt settled and the next shift can take them?
I've been on both sides and when I was on the floor I never quite understood the ER side. Once you see ambulance pt's sitting in the hallway bleeding or vomitting you understand why once the ER gets the ok to send someone upstairs they do it no matter what time. Basically, the ER is never really "full" and always has more pt's coming in. I wish I could just hold the pt's I have sometimes for hours and then at shift change magically get rid of all of them just to avoid the next train wreck or drunky drunkerton coming through the door.
Transferring pts at shift change is dangerous. If the pt is unstable, they do not get the appropriate attention during report. Period. You need to talk to your manager
Unstable patient shouldn't be transferred at all let alone at shift change! The ER nurses I know would never do such a thing.
Only ICU/CCU patients are transferred with possible instability...and that's monitored and with help.
That being said, I guess it would depend on what you consider unstable...sick patients are sick! That's why they are in the hospital. Conditions don't resolve that quickly, so they may be very sick when they leave us! Not necessarily unstable, but sick!
Once you see ambulance pt's sitting in the hallway bleeding or vomitting you understand why once the ER gets the ok to send someone upstairs they do it no matter what time.
Sounds like the day before yesterday
In a 2 hour period, we had two stabbings, 4 chest pains, an acute MI (stabilized and flown out), an acute stroke (stabilized and flown out) and four abdominal pains (one of which turned out to be an AAA - had to be flown out). I got one of them 4 chest pains first and by the time the 2 hour period was up, he'd been shuttled between 4 different rooms and finally ended up in the hall on a portable monitor - because all our other acute rooms were full. It was nuts
We're a 57 bed ED and last month saw over 250 patients a day - on average. And this isn't even the "busy season" (October to March, when our volumes typically double and sometimes triple)
I have worked both sides of the fence. Receiving an admit at shift change is a pain in the backside. If possible, I will hold the patient to just after shift change (within reason and if I don't think the receiving nurse is trying to buy extra time). If we need to move the patient to make room for another waiting patient or medic patient, then I have no control over that and shall do what is profitable and safe for all parties involved. By all means, the patient must go up immediately, but as a responsible ER nurse I will be sure that the patient is stable and as much completed as possible. I have been nursing for 12 years and in ER for two years. It is sad to say this, but even though I love most of the nurses I work with in the ER, most of them are ****-poor in attitude towards the floors/units. WE ARE A TEAM --or should be. It is often times difficult to reach a resolution about certain instances, and truthfully, everyone is not going to be happy most of the time. Some on the floors are angry because they are getting admits. There are ER nurses that get angry when the floor ask them to hold when the ER is slow and there is no reason why they can't. Play safe, play as a team, and accept that things are not going to be perfect always.
Don't know about your place, but our ICU residents change things constantly and drive us nuts! There are many patients that would've been telemetry, but no bed...stay with us...upgraded after bad turn to ICU....hang out waiting for ICU bed.....gets better, downgraded to tele...
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RN516
13 Posts
iIwork on a med-surg floor and I hate when the er nurse sends a pt. during shift change, after reading some of the responses from the er nurses, I :nono:have a better understanding. I think the best solution is to have an admission nurse at all times. my hospital had an admission nurse but turned her into a discharge nurse. how stupid is that:bugeyes:,when the need is more on admissions which takes more time. another suggestion my hospital wants is to have the report faxed. i dont know about your place, but my floor is way too busy and papers get lost. I like the verbal report followed by a fax, then again if I tell the er nurse I will call back I normally do.