Now Ive heard it all!!!

nursepenny · Nov 15, 2003

Just wanted top respond a little to this thread. I have worked both sides and understand the aggravation of not being able to send a patient to the floor or the nurse not taking report. (we still do it the old way, calling).

On the other hand, in the hospital where I used to work, it was always busy. It was a tele floor, we had to take any and all patients who presented with chest pain. (Except, of course the patients who were havin an MI or who were sent to the unit). but the majority of the time, we had to move patients from one floor to another to make room for the new admit. Cannot tell you the nights we played fruit-basket-turnover. One night in particular, I had 15 different patients. {came in to 10 in my section and transfered 5 to other floors, then received 5 new admits.} And we did not have an admit nurse. Everything was left to the primary. Needless to say that is one of a long list of reasons I no longer work in that facility.

Where I now work, (small ICU), we have 5 beds and still have to move patients and the nurses have to clean the rooms after 3PM. But at least it is not 10 LOL.

kiss kiss :lol2: :lol2:

Anyone can count the seeds in an apple, Only God can count the apples in a seed

Anon.:

rstewart · Nov 15, 2003

In my opinion this is a perfect example of nurses being "set up" by the system. Of course there are lazy floor nurses/ICU nurses just as there are Emergency Departments who hold patients until shift change and move them all at once-----and when you look at their orders you see the patient was there all day and few of the orders were actually done. But does anyone really think that these are the most common reasons for the all too common strife between the ED and the in- patient areas?

EVERYONE is stretched beyond their limits. As long as the mentality is that if we have an empty bed we can fill it regardless of the nursing resources available, such problems will exist.

Who could argue with the ED nurses who suggest that the in-patient area nurses should come down and see what they are up against? But I must tell you that the in-patient areas these days have their own challenges. Patient transfers highlight hospital wide deficiencies because often many departments are invoved: nursing, respiratory, housekeeping, central supply, transportation etc...........and all are working short of manpower for one reason or another. And you might be interested to learn that the consultant groups that recommend efficiencies in care delivery for the most part conveniently ignore the fact that you need more manpower to run a floor whose census turns over frequently.

Administration does not want the hospital to go on divert and EDs have to deal with people coming through the door no matter what---so the ED gets the bulk of the support when difficulties arise, particularly when it appears that a bed is vacant because an order to transfer has been made which should "free one up" for an ED admit. But it's not like flipping a light swith on and off. The increased patient load and acuity, the additional paperwork, and the lack of adequate support services of today's nurse take their toll----delays which back up the ED are just one manifestation of that reality which the powers-that-be can not easily ignore. But they refuse take an honest look at the system; rather, they will analyze timing of the transfer in isolation, rather in the context of the nurse's overall load---and then blame the nurse. Much attention is focused upon getting a patient into a bed; much less attention is given to insuring that a nurse will be able to adequately deliver care to that patient once they arrive.

nursemary9, BSN, RN · Nov 15, 2003

HI

My problem has been just the opposite, lately!!

Last night the ER called me with report on a patient to be coming up. It was shortly after 0100. What time did I actually get my patient--after 0500--after several calls--like is he still coming??

No, they had not been doing scans ot x-rays or anything during that time!!

That threw my organization for the nite all out of whack!!

NYCRN16 · Nov 15, 2003

I am not talking about if I call report on the nurses break and she will be back in an hour, fine. We are all entitled to our break. And I dont call report at 1900 either, I will wait until at least 2000, usually its more like 2045-2100. If the nurse just got a patient in the same district from the ED, I will call back later. These are legitamite reasons not to take report. But when I call over a period of 3 or 4 hours or more and she is still on break?? I dont think so. I dont intentionally send the patient up at 0600, but if they have been playing games all night, and now I finally got a hold of the nurse at that time, too bad they are getting the patient. The charge nurse will call, nobody will answer the phone, so we wind up calling all night long. I dont have time for these games. The point is, its not the fact that the nurses on certain floors really are on break, or the bed really isnt ready, its the fact that they get to pick and choose when they can take a patient or report. You get that option of saying "I cant take report", in the ED we dont get to say "oh no its 700, we dont want another patient". If they walk through the door, its ours whether we like it or not. Interestingly enough, we rarely have a problem with the tele floor. The doc up there gets on our and thier a$$es to get the patient up right away. He gets on them to take report and if the patient isnt sent up right away, he will come down the the ED and yell at me as well for not sending them up right this second. The main problem we have with that unit is that there are usually no beds, but that is nobodys fault. It seems that its 2 particular med-surg units in my hospital that seem to be the most troublesome. That is what needs to be addressed and what my main complaint is. They know its these particular floors and nothing is done about it. Nobody is held accountable, and it makes more problems for both the floor nurses and the ED nurses.

ER-RN2 · Nov 16, 2003

I have worked both Tele and ER so I have been on both sides.

Where I used to work, you had to take report no matter what time it was. It was the rule.

Now where I work, it seems like the floor nurses take report when they have time...well I won't put up with that uness they have a good reason not to take report at that time. Usually I go ahead and make the charge nurse or someone else take report and send my patient on up to the floor. And by the time I get back from taking a patient to the floor, there are patients already in that ER room and a million waiting in the lobby.

Another thing I hate is when that some floor nurses don't realize that we do FOCUS assessments, not head to toe. We just don't have time for that. I had a nurse yell at me and then hang up when I didn't know what something was when it was unrelated to the chief compliant. I understand that head to toe assessments are important in the long run but when you are slammed with other stuff, there isn't time. Besides. don't the MDs assess them too.......

barb4575 · Nov 16, 2003

My clinical background in hospital settings is on Med-Surg and ICU units. I do not think ER nurses should try and call report when we are in report, otherwise, I have to accept their call.

On the other end of this spectrum, I do not appreciate ER nurses and docs sending me patients who are extremely unstable and that happened to me many times in Med-Surg this summer. It was like they just wanted them out of their ER...even when they were not busy. When I have the responsibility for six patients, with three of them really belonging in the ICU and I receive another unstable patient from the ER...this is unreasonable and unsafe. But, the bottom line is that they are my responsibility. So, when I assess them and find out that the ER should not have admitted that patient when they did to the floor or when I find that this is really an ICU patient, I call the ER Dr. Funny thing is that I have yet to have one say send them back...so, I end up calling the attending physician who is blatantly frustrated with the contract ER docs. Through all of this, the unstable patient sits and waits on me. I recall having one patient with CP and one with a BP in the 200's/100's that the ER had sent to me and then the ER nurse calls again with another admission...so, I quite simply informed her that when I got the last ER admission stable and convinced the attending that the patient with chest pain should be in ICU with a NTG gtt, I would gladly take another ER admission...the ER nurse hung up on me. SO, there you have it from the other end of the spectrum...and don't offer the suggestion of calling the Supervisor because she could not help if I told her what to do...she just sat there watching me through all these phone interactions and running back and forth to the unstable patients. What upsets me the most is that I am now preparing students to enter this chaos and how can one prepare anyone for such shifts, which are common, not rare?

CCU NRS · Nov 16, 2003

Barb makes a good point which i see at my facility quite often.

ER/ED will send Pts that are obviously ICU/CCU Pts like the one barb mentioned C/P requiring Ntg Gtt to the floor and turf them and they will send Pts that are obviously floor Pts like SOB that is resolved with 02 2l N/C to ICU/CCU. Now I understand that some of the docs may be writing these orders and one may feel the need for ICU/CCU for their little Pt with SOB without any real criteria and the other may feel that the C/P will resolve with SL NTG and the PT doesn't need ICU/CCU but my question is... In these intsances should the nurse that has been providing the care go to the doc and say "ya know this little lady is really pretty comfortable on 02 2l and she is no longer in distress and she doesn't have any real need of ICU/CCU and my guy with the C/P is unrelieved and he may need to be on a little NTG gtt so it would really benefit him to be in ICU/CCU. I ask ER/ED nurses all the time when they call me report on "floor Pt" what criteria does this Pt have that requires Intensive care or Cardiac care? "Well the doc ordered it" Well can you wait a few minutes while I call him or the primary and explain that this Pt does not meet CCU criteria and see if we can avoid going on divert for a Pt that does not really need our bed?

Obviously ER/ED nurses are busy and the docs are as well but I think that you should at least take a minute to give the doc your brief assessment and throw in what type of admission care might be best suited for this Pt.

OK I guess that was another little rant... I have the utmost respect for ER/ED nurses and I am equally appreciative floor tele med surg nurses... we all do a difficult job and one of the biggest probelms in Nursing as I see it is that we don't all watch each others backs this board is a prime example we should all work as if we are all one team not the ED vs Med-srug CCU vs ED we should all attempt to work toward a goal of recieving the appropriate level of care for every Pt and in this way Med-surg won't have to attempt to send a Pt to CCU that they never should have recieved and CCU won't have to wiat for a bed for a Pt that was able to be on a non tele floor from jump!

Nurses UNITE bond and begin to strengthen the force of our chosen field by working together not tearing each other down thereby making it easier for all others to come between US!!!

ps. I worked 8 years as an agency nurse and worked every field you can name except psych which I just won't do for pesrsonal reasons.

I do know that the things I mentioned happen and I do know that if you take a minute to tell a doc your opinion it may or may not be taken into account but at the very least you can try.

RN~in~CT · Nov 16, 2003

I work on a very busy surgical floor. When possible, I always take report when called ~ except when:

(1) I've just come on shift and am in the middle of report.

(2) I've just received report on my post-op that is heading up/just received a post op.

(3) I'm at dinner ~ at best we get 30 min, usually only 20.

(4) One of my pts is currently crashing/coding.

In all instances I phone the ED as soon as report is finished, post op checked to be sure they are stable and settled, I'm back from dinner, and the unstable pt is made stable or transferred to ICU, etc.

I do not think this is being unreasonable at all. We are all overworked and overwhelmed ~ we need to work together and support each other.

BBFRN, BSN, PhD · Nov 16, 2003

I am in agreement with RN in CT and would like to add a couple of things:

Sometimes the room actually isn't clean. One thing that helps in my hospital is the House Mgr makes rounds and checks on the rooms to see if they are available/clean. The House Mgr. is also a good resource for getting housekeeping up to the floor after we call them several times with no results.

Sometimes I am in the middle of something like a dressing change, or suctioning a trach, etc., and I can't leave the patient right at that second to go take report. I will call back as soon as I'm done.

Sometimes, bed control opens up the beds for admit all together, and I am still admitting the patient one of your coworkers just sent me

If you're having problems with specific nurses, call the house manager to go up and see what's really going on (if they're available to do so), or write that nurse up. It doesn't help anybody to assume all floor nurses are blowing smoke up your butt with excuses, and those who are giving you BS are making it hard on everyone else.

teeituptom, BSN, RN · Jan 6, 2004

When I started in ER, all I needed to do was call the floor where the pt needed to go, talk to the charge and get a bed. That was it.

Now it has turned into a process, had to have been invented by those Republicans.

Doo wah ditty

Marie_LPN, RN, LPN, RN · Jan 6, 2004

We have the opposite problem (althought similar to what a lot of people have said here). We've had our ER call and say they are sending someone right when the paper's coming through the fax, and the majority of the time we're on the phone with that nurse who has JUST said this person is coming up, and lo and behold, i'm watching them wheel on by. And no one's prepared, since we've had all of 30 seconds to learn of the new pt.

I could almost see it if they are busy down there, but when this happens, it's always been on their slow nights. Suposedly each floor is having a meeting over this to work on a compromise, since our floor isn't the only one having this problem. We'll see. :rolleyes:

ER Tigger Girl · Jan 10, 2004

I can understand the frustration of the delay tatic's! I can only speak from the ER side. Our facility does faxed reporting which we went to because of the nurses upstairs never being available to take report or sitting on hold for 10 min at a time-

When a bed is assigned we fax report. THe patient goes up in 15 min. Lunches, changes of shift etc does not matter- only if there is a code on the floor. The ER cannont stop accepting EMS and walkin patients because it is change of shift or lunchs/breaks. We keep moving regardless.

One delay I have seen that we have no control over is the attending doctors coming to the ER and seeing the patient down there, doing their H&P, adding on "Stat" orders etc and this always seems to happen just after we faxed report! I know that sometimes my patient has been delayed coming to the floor for this reason. Also, if I have another critical patient then the admitted patient sits until I have time to finish up and fax report. Our rooms are everchanging and we have to reprioritize constantly to incoming patients and acuity. I know it is frustrating to all sides but we have to realize that we are a team together and work together for the best of the patient and not take it out on each other.