Why don't you just read the chart? - page 3

Hey floor nurses, ER nurse with a serious question. The question only applies to nurse who have access to the ER's computerized chart. Why don't you just read the chart? It has all the... Read More

  1. by   icuRNmaggie
    I have two serious, not intended to be snarky, questions too.

    Why does the ER try to call report ahead of shift change as in:

    "he won't be coming on your time but can I give report now?"

    The receiving nurse on the next shift is the one who needs the report, not me, in order to provide basic nursing care.

    Is the oncoming ER nurse expected to assume responsibility for a human being in her care and know nothing about the patient?


    example:
    I admitted a GI hemorrhage pt with an INR of 8 and the ER nurse responsible for this person had no idea how many units of blood products were given and actually said "I don't know anything about this patient." The off going ER nurse called "report" to the unit on the previous shift and apparently forgot to address the orders for blood products.

    I read the chart, which was a waste of time, because nothing was documented about transfusions, there was a triage note, two sets of VS three hours apart by the tech and not one other factual piece of information to go on.
    Last edit by icuRNmaggie on Jul 1, '15
  2. by   dudette10
    Tell me why they came in, what the working diagnosis is, what you've done for them, response to the interventions, imaging done and results, neuro status, ambulation status, heart rhythm. For AMS/dementia patients, who is at bedside, if anyone. I can easily see the lab results and VS, so you don't have to go over them if they aren't pertinent to the presenting complaint or interventions. I don't care about location/gauge of IV site, but tell me if they don't have one or they have a port or CVL instead.

    When I get report from the ED, there are usually NO NOTES whatsoever and no radiology transcriptions, so I absolutely need some kind of report from the ED nurse.

    Through a clusterfug of a bed control mishap, I got a patient from the ED yesterday for whom I did not know gender, name nor why the pt was on my floor. I was told only minutes before that I was even getting a patient. I frantically called the unit secretary for any information whatsoever so I could look the patient up before entering the room, and of course, there were no notes. How would you like your primary nurse to not know a thing about you except where your IV site was and labs? After plastering a smile on my face and ********ting my way through introductions, I had to corner the receiving resident to get info on the patient.
  3. by   soushee
    The I think the worse was one time I was getting a hip fracture patient and the ER nurse could not tell me which hip it was, and if it was broken. I was told "Um, they have a hurt hip." Seriously? I get we're all busy, but that blew my mind when I received that report!

    I do like to know access, if there's anything running (fluids, antibiotics, etc), mentation, latest vitals, prn's given that might be continued on floor (usually last dose of pain meds, or if something for blood pressure, etc). I try to skim the chart if I have time, but it can be hit or miss, and most of the time the physicians have not entered their notes, so I'm just seeing a lot of "gave patient warm blanket."
  4. by   dudette10
    Quote from icuRNmaggie
    I have two serious, not intended to be snarky, questions too.

    Why does the ER try to call report ahead of shift change as in:

    "he won't be coming on your time but can I give report now?"

    The receiving nurse on the next shift is the one who needs the report, not me, in order to provide basic nursing care.
    As a day shift tele nurse who has had receiving floors for transfers request the night shift to get the patient due to staffing issues, I have given shift report to my fellow tele nurses (including the one with responsibility for physically transferring the patient) and walked to the receiving unit to give report again to the night shift nurse there.

    It's a must for continuity of care and patient safety. I personally think everyone should do that if the transfer will happen at shift change.
  5. by   Graduatenurse14
    My Hospital is on a thing to get the ED turnover to be faster as well and if we don't call back in 15 minutes, they are coming up anyway. I'm sure it will be that we have to get on the phone regardless of what we are doing soon just like another poster mentioned they have to now.

    In a sad way, aren't the ED nurses time "more valuable" to TPTB than a floor nurse (like me) since it generates $$ for the hospital in a different way than the floors do? I have my own experience to maybe understand their somewhat greedy point:

    I few years ago I got into a fight with a fan and lost. Went to the local ED and when we had to wait too long, we left and went to Med Express 5 minutes away and got all sewn up. My point is, the ED lost a "customer" do to long wait times.
    Last edit by Graduatenurse14 on Jul 1, '15 : Reason: added info
  6. by   SierraBravo
    Quote from hherrn
    Hey floor nurses-

    ER nurse with a serious question. The question only applies to nurse who have access to the ER's computerized chart.

    Why don't you just read the chart?.

    It has all the details you ask me about. In fact, I haven't memorized all those details, I just peruse the chart as you ask me.

    I don't mean read the whole chart, I mean scan it for the details you want. I have no idea why you need to know ahead of time what size IV and where it is, but it's charted.
    As far as a history? H & P, last visit, etc, is all at your finger tips. As far as what time each med was given- when you ask I open the MAR, and read you the times. I even say "I don't know, but it's been charted, I will open the MAR an look". When I say that, I am hoping you will get the hint that it would be faster for you to have already done that. Somehow, you always miss the irony.

    Please don't say that you don't have time. That doesn't make sense. Think about the difference between reading something, and having it read to you. I can scan a chart for 2 minutes, and know just about everything. Add to this the fact that I really don't know all the details you want- I just kind of guess. As an ER nurse I may have received that same PT with a 1 minute report. It's all I need.

    There is no question that it is faster and more accurate to scan the chart.

    So- why don't you?
    #1 - read the excellent PP's comments about why a verbal report IS faster than looking things up in the computer (assuming that you have completed your documentation, which we all know is less comprehensive in the ED than it is on the floor).

    #2 - If you haven't already, may I suggest you spend some time working the "floor" and then re-evaluate the question that you asked?

    #3 - A better way to have approached this topic would have been to ask how the ED and the floor can facilitate better transition of patients.
    Last edit by SierraBravo on Jul 1, '15 : Reason: spelling
  7. by   BuckyBadgerRN
    Up until just a few months ago, our ER used a completely different charting system than the rest of the hospital. Crazy? Yes. The entire hospital used EPIC, the ER was phased in last. If you had said "why don't you read the chart?" as an ER nurse to a med-surg nurse, you'd better expect to have your ears chewed off!

    Quote from hherrn
    Hey floor nurses-

    ER nurse with a serious question. The question only applies to nurse who have access to the ER's computerized chart.

    Why don't you just read the chart?.

    It has all the details you ask me about. In fact, I haven't memorized all those details, I just peruse the chart as you ask me.

    I don't mean read the whole chart, I mean scan it for the details you want. I have no idea why you need to know ahead of time what size IV and where it is, but it's charted.
    As far as a history? H & P, last visit, etc, is all at your finger tips. As far as what time each med was given- when you ask I open the MAR, and read you the times. I even say "I don't know, but it's been charted, I will open the MAR an look". When I say that, I am hoping you will get the hint that it would be faster for you to have already done that. Somehow, you always miss the irony.

    Please don't say that you don't have time. That doesn't make sense. Think about the difference between reading something, and having it read to you. I can scan a chart for 2 minutes, and know just about everything. Add to this the fact that I really don't know all the details you want- I just kind of guess. As an ER nurse I may have received that same PT with a 1 minute report. It's all I need.

    There is no question that it is faster and more accurate to scan the chart.

    So- why don't you?
  8. by   vanilla bean
    Quote from hherrn
    Hey floor nurses-

    ER nurse with a serious question. The question only applies to nurse who have access to the ER's computerized chart.

    Why don't you just read the chart?.

    It has all the details you ask me about. In fact, I haven't memorized all those details, I just peruse the chart as you ask me.

    I don't mean read the whole chart, I mean scan it for the details you want. I have no idea why you need to know ahead of time what size IV and where it is, but it's charted.
    As far as a history? H & P, last visit, etc, is all at your finger tips. As far as what time each med was given- when you ask I open the MAR, and read you the times. I even say "I don't know, but it's been charted, I will open the MAR an look". When I say that, I am hoping you will get the hint that it would be faster for you to have already done that. Somehow, you always miss the irony.

    Please don't say that you don't have time. That doesn't make sense. Think about the difference between reading something, and having it read to you. I can scan a chart for 2 minutes, and know just about everything. Add to this the fact that I really don't know all the details you want- I just kind of guess. As an ER nurse I may have received that same PT with a 1 minute report. It's all I need.

    There is no question that it is faster and more accurate to scan the chart.

    So- why don't you?
    I would like to extend your proposal to the report that happens on the "front end" of the ER patient transfer - the one that happens between EMS and the ER. Why should EMS be wasting everyone's time calling ahead? What info could they provide that can't be found in the paperwork they leave when they drop the patient? You'll be able to see what lines (if any) are present, whether or not intubated, etc. when the patient rolls in. When was the last epi given? It's right there in the paperwork... just scan the paperwork for 2 minutes and you can know just about everything.
  9. by   tacomaster
    A few things:
    The EHR software in the ED is different then the EHR software on the floor so we can't see what you see.

    I need report from you because at my hospital, about 90% of the time we get patients when the ED nurses are about to leave their shift. They like to hold onto the patients so they don't get more. Last week I got a patient up to the floor, situated, etc and then my charge nurse decided to move him to another section of the unit and I lost them. If I didn't have report, I would have been at a lost.

    I had an ED nurse, who actually worked on my floor for like ten years up until January, start out the report by saying, "why can't you just look this up?". This was the admission diagnosis for Pete's sake, not the IV site or anything like this. I told her to just send me the patient and I hung up on her. I don't have time for that nonsense.
    Last edit by tacomaster on Jul 1, '15 : Reason: more info
  10. by   greenerpastures
    The organization I work for has two separate systems. We can't see what the ER does. They may have given the IV abx, but the Meds given list was scanned 5 hours ago when the admission order was written, so we have to ASK you to tell us what they've received between then and now, as well as what's changed. I get people from the ED all the time that don't have an IV. Sometimes they call report, sometimes they don't. When I call to ask why the pt doesn't have an IV, I usually get, "oh, it blew so I took it out." Well great, now I have to put one in to give the 3 bags of blood you didn't start down there.

    I truly hope you are nicer than this to people when you call report. Perhaps it would be good for you to go to a floor and work there to see the opposite side of the call.
  11. by   MunoRN
    Even when floor nurses have access to the EMR used in the ED, charting on a patient they are receiving often isn't available to them while the patient is still in the ED, and when it is available I don't think many ED nurses realize how useless their charting becomes after the ED EMR has it's way with it. Just in general though, I don't see giving report as being a nuisance, it's a core part of my job and my responsibility to the patient. If I'm going to spend my time and energy working on a patient I'm certainly going to make sure the next nurse has a good understanding of what's been done, otherwise it makes most of what I do pointless.

    Patient history, labs, etc usually are available to the receiving nurse, so when they ask "what were all their labs" I explain to them where that can be found in their charting system. Anything notable I'll point out in report (their K was 7 on arrival, now 5.3), but no, I'm not going to look up and tell you what exactly their H&H was, "normal range" is all that matters in report.

    One of my biggest pet peaves is "where is there peripheral IV in their arm"? I have serious concerns about a nurse's basic thinking process when they consider that to be a relevant question on report. It's the brightly colored thing taped to their arm.
  12. by   psu_213
    Quote from icuRNmaggie
    "he won't be coming on your time but can I give report now?"
    This is a tricky one. Shift change in the ED is the same time as on a floor/ICU. Beds seem to magically appear at change of shift, which is frustrating for both sides. So at 1835 a bed is assigned. Either (a) you have the ED nurse who took care of the patient for 2 hours, and (hopefully) knows that patient fairly well--not to the level a nurse who has the pt. for 12 hours would know that patient, but "well" by ED standard--gives report to a floor/ICU nurse who is leaving at 1930, likely before the pt. will arrive. Or (b), the new ED nurse who started at 1900, who knows very little about the patient will give report to the fresh floor/ICU nurse who will have the pt. for 12 hours. Obviously, both options have their ups and downs.

    The ideal would be for the off going ED nurse stays a bit late to give report, however, that is not always feasible, is not really fair to that nurse, and will definitely not be allowed by those who watch the budget.
  13. by   OneDuckyRN
    It's probably been said more than once, but I wanted to get my thoughts out while I still know what I want to say on this topic.

    Sure, I've read the chart if you give me more than 5 seconds between the admit being paged, and you calling to see if I've looked at the chart.

    I've also read what precious little has been charted there. Half the time, the ER has put in a Foley and not charted it. I've seen more IV's started and not charted. So...is that a field start I need to take out and re-start? Or did you start that in the ER? Also, I can't get a good picture of what's going on with this patient if the physician/practitioner hasn't actually written a note. 3/4 of the time at my facility, that hasn't happened yet. And yes, I see that you put in 7 nursing notes about this chart. "Pt transported to CT." "Pt returned from CT." "Up to commode." Those are not as helpful as you might think. I need an idea of WHY this pt is here. It's also helpful to know WHY meds were given. You gave 80 of Lasix? Great! Why? If there aren't any notes for me to read, I can only make an educated guess.

    So yeah, when the charting is not great, I'm probably going to ask you a few questions. Please don't bite my head off. I really want to do the best I can for this patient, but if I don't know anything about them ahead of time, it's hard for me to know what to have at the bedside, and what other things I might expect over the course of a shift. See, that's the difference between ER nursing and inpatient nursing. We're pretty much stuck with our patients for the whole shift. You get them for a little while and either send them home, or send them to me.

    I realize the tone of this might not come across very well, and that's not the way I intend it. ER nurses work very hard at what they do, and they're very busy. I get that. I'm busy too. But what really cheeses me off is when I'm expected to read minds. Or non-existent charting.

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