So a couple of days ago out ER director told the directors on the floor that the ED nurses will no longer be giving report when they send us patients. True to their word, I received two admission from the ED with no report. They now send us an ED flow sheet which basically just has the patient's name, visit reason, and most recent vitals, as well as nurses notes if they have been entered (mostly the notes are "Reported off to so-and-so, RN).
We are all pretty upset about this. I work on a busy med tele floor and half the time we don't even know we're getting a new patient until were receiving report, at which point we can get ready to get the new patient. Now we really don't know anything until after we have received the patient. I understand the reason for it as it helps move patients from the ED faster, but it's causing a lot of concern for the floor nursing staff.
So basically, I just wanted to get other nurses' thoughts on this. Any input is appreciated!
I work on a medical surgical floor most patients is 6 . But if you get an admision you have 5 patients plus the admission which makes you six..The days we are short we have 7 patients then one admission which makes you 8. we NEVER get report from the ER. The supervisor calls us and asks what bed we have avaialble and then gives us the asssignment then we as nurses look in the computer read the ER nurses notes and ER doctors notes and get an idea of whats coming then anytime the patient can come up. One time I got a patient whos o2 was 62!!!!! He was moaning I was so mad at the ER apparently he was stable and his BP was 200/82 like really??? That is a stable patient?? I called a Rapid he was transfered to CCU and the ER had an IV in his neck that wasn't working. Sometimes I don't look at my admission to later you know thankgod I went right away to assess him. Oh well I'm leaving this hospital!! So hopefully the next one is better
Here in Jacksonville, Florida that's how majority of the hospitals are. We received an SBAR and have 15 minutes to call if we have any questions, they then send the patient up. I rather it this way because I never got a proper report from the ER anyway.
My hospital tried to pilot something similar. We don't have a unified computer system or honestly even working faxes on every unit. So the solution was that the burden was put on the floor staff. We were given one hour from when the bed was assigned to have the patient in the bed. So that includes calling for report, and then actually going to pick the patient up ourselves. Both ER admits and unit to unit transfers. It. Was. Awful. Half the time the ER wasn't ready to give report, the patient wasn't ready to go, we would arrive in the ER (which happens to be two city blocks away from my unit) to find doctors seeing the patient and putting in new orders (including a patient who was receiving concious sedation at the time to have their shoulder relocated), staff on the receving unit had not packed the patients belongings or prepared them for transfer leaving us to do it. I found it extremely unprofessional to have nursing staff serving as escorts for unmonitored stable med/surg patients, not to mention the fact that I can barely pee and yet I'm supposed to take time away from my patient assignment or lose my limited ancillary staff to go traipsing around our large 500+ bed hospital that encompasses 5 buildings and two city blocks? Supposedly it was very sucessful and decreased our pull times, but we basically just stopped the pilot out of protest for the sheer ridiculousness of it.
Can you stop the flow of ambulances and patients walking in, as well?
At least where I've worked, it's known that several of our ED people will "sit" on their patients until the very end of their shift, then call for transport about 20 minutes before their shift ends so they don't have to deal with an incoming pt. You can see when it happens; all the orders were in at 0300, but "transport wasn't available" until 0630 - BALONEY! We've gone back through the logs before to find no one even called transport until 0600 which is actually ED shift change time. The hospital were I work just redid the ED so it's 70+ beds, and is almost never full. This was just my experience.
If we are at capacity, then send them on up! But when you have 5 open rooms all shift, then at 0615 or 1845, they literally have them lined up in the hallway waiting to be moved into their rooms, it makes you just a TAD suspicious. I'm not saying it's everywhere. It just been my experience on more than one occasion.
Can you stop the flow of ambulances and patients walking in, as well?
At least where I've worked, it's known that several of our ED people will "sit" on their patients until the very end of their shift, then call for transport about 20 minutes before their shift ends so they don't have to deal with an incoming pt. You can see when it happens; all the orders were in at 0300, but "transport wasn't available" until 0630 - BALONEY! We've gone back through the logs before to find no one even called transport until 0600 which is actually ED shift change time. The hospital were I work just redid the ED so it's 70+ beds, and is almost never full. This was just my experience.
If we are at capacity, then send them on up! But when you have 5 open rooms all shift, then at 0615 or 1845, they literally have them lined up in the hallway waiting to be moved into their rooms, it makes you just a TAD suspicious. I'm not saying it's everywhere. It just been my experience on more than one occasion.
At least where I've worked, it's known that several of our ED people will "sit" on their patients until the very end of their shift, then call for transport about 20 minutes before their shift ends so they don't have to deal with an incoming pt.
Then this sounds like a problem with hospital and/or ED leadership. I've said this before--if someone does this in "my" ED, they will not be working there for long.
I worked in pcu at a previous hospital where this was done. The patient and a flowsheet would mysteriously arrive, sometimes before the room was even clean. Very frustrating.
Now, as an ER nurse, we call report currently, but are scheduled to change over to the sbar and mysterious patient delivery system at the beginning of the year. I'll let you know how (if) this works out!
At least where I've worked, it's known that several of our ED people will "sit" on their patients until the very end of their shift, then call for transport about 20 minutes before their shift ends so they don't have to deal with an incoming pt. You can see when it happens; all the orders were in at 0300, but "transport wasn't available" until 0630 - BALONEY! We've gone back through the logs before to find no one even called transport until 0600 which is actually ED shift change time. The hospital were I work just redid the ED so it's 70+ beds, and is almost never full. This was just my experience.
If we are at capacity, then send them on up! But when you have 5 open rooms all shift, then at 0615 or 1845, they literally have them lined up in the hallway waiting to be moved into their rooms, it makes you just a TAD suspicious. I'm not saying it's everywhere. It just been my experience on more than one occasion.
We get 95% of our admissions at 1450, 1850 and 2300. Happens every.single.day. Administration has told us it's because of the ER docs and how their shift change goes, they clear out before they leave. Whatever the reason, it is frustrating.
I wish the entire process was different. Would require more staff on all ends though. Many times I feel like from our side, it's a blame the messenger deal. We do not choose where our patient goes, or to which overworked nurse. Frequently the charge nurse or supervisor is chasing us through the ED, repeatedly asking WHY this patient hasn't gone upstairs yet. I personally try to catch my admits up on meds and admission paperwork, I came from the floor, I know how it is, but sometimes it is just not possible. Sometimes I am giving you report while I have hands full of Zofran and fluids, or blood, or tpa....and I am sorry I can't tell you exactly where that IV is right now, truly. I am the kind of person who takes pride in sending my people up neatly wrapped with a bow.
All that being said, there is a percentage of laziness in the ER, just as there is laziness on the floors, just as there is laziness at McDonald's....you don't like them, and guess what? We don't either. Lol.
I wish the entire process was different. Would require more staff on all ends though. Many times I feel like from our side, it's a blame the messenger deal. We do not choose where our patient goes, or to which overworked nurse. Frequently the charge nurse or supervisor is chasing us through the ED, repeatedly asking WHY this patient hasn't gone upstairs yet. I personally try to catch my admits up on meds and admission paperwork, I came from the floor, I know how it is, but sometimes it is just not possible. Sometimes I am giving you report while I have hands full of Zofran and fluids, or blood, or tpa....and I am sorry I can't tell you exactly where that IV is right now, truly. I am the kind of person who takes pride in sending my people up neatly wrapped with a bow.
All that being said, there is a percentage of laziness in the ER, just as there is laziness on the floors, just as there is laziness at McDonald's....you don't like them, and guess what? We don't either. Lol.
Totally agree. All the older RNs complain about the ED all.shift.long. I mean, they complain about admissions. Hello, if we didn't have patients, we wouldn't have jobs. And the expectation that patients will corn in an convenient times for floor nurses is absurd. I do wish there was more a sense of "team" instead of one dept "against" another. We are all here to achieve the same goal. And we should all really try to appreciate and empathize with our fellow colleagues role especially when it's different from ours.
I just found this thread and yeah...we have this and I hate it. Most times I get no notice and the patient's last vital signs come up on a paper towel shoved into a manila folder. Wait, who are you? Why are you here? Why do you have a heart rate of 130?
We also don't have verbal hand off from the PACU - which means I have to pore through pages and pages of consults and doctor's notes to figure out what surgery this person had. It's not even included on the ISBAR! Isn't this something pretty important to know about a surgical patient? And sometimes I have patients who are having revisions on previous surgeries which means going through months and months of consult notes trying to get some idea of what's going on, why they're back, what happened last time they were here. I know the nurses are busy, but a three minute handoff could save me fifteen to twenty minutes of work trying to figure out what the heck is going on.
Jerseygirl12
16 Posts
I work on a medical surgical floor most patients is 6 . But if you get an admision you have 5 patients plus the admission which makes you six..The days we are short we have 7 patients then one admission which makes you 8. we NEVER get report from the ER. The supervisor calls us and asks what bed we have avaialble and then gives us the asssignment then we as nurses look in the computer read the ER nurses notes and ER doctors notes and get an idea of whats coming then anytime the patient can come up. One time I got a patient whos o2 was 62!!!!! He was moaning I was so mad at the ER apparently he was stable and his BP was 200/82 like really??? That is a stable patient?? I called a Rapid he was transfered to CCU and the ER had an IV in his neck that wasn't working. Sometimes I don't look at my admission to later you know thankgod I went right away to assess him. Oh well I'm leaving this hospital!! So hopefully the next one is better