Nurse Report please answer

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I'm a new nurse at an ER, since patients are coming and going you may not necessarily have everything done for a patient that you just got at 1630 and got admission ordered at 1700(for example). Sometimes the nurse at 7 comes and gets upset because some stuff have not been done on this particular patient lets say some meds have not been given like antibiotics maybe, or nexium. My question is; what is expected to be done and what can be something that u do not necessarily may complete before 7, leaving this task to the coming-in shift. For example a triage definitively has to be done and some VS as a blood sugar if pt is diabetic or some basic labs like troponin if pt is chest pain.. But as far as meds? and everything else I'M not clear if there is somebody out there that can answer this question to me and tell me how they do it i will appreciate it thank you.

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You get done what you can do. Prioritize to make sure that the sickest patients are getting their interventions the quickest. Let the in-coming nurse know what was done and what needs to be done. Some folks are always peeved about starting the shift with several things to do, but that's just how things go in nursing sometimes.

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Specializes in PICU.

What you're asking is a prioritization question, so it will depend on each patient and each situation. So you need to think about what are the most important things to get done. In terms of meds, if it is just their nexxium they take at home and there is no acute reason to give it, you might be ok being late on that. However, if they have an infection and antibiotics have been ordered, that is going to be important to give asap. Especially if they are immunocompromized and at a higher risk for septic shock. So you need to know what is going on with them to decide what is most important. Medications are generally a pretty high priority. Remember any med not given on time is a medication error. This could be why the on-coming nurses get upset about meds not given. Hope this helps!

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Specializes in Emergency, Med/Surg, Vascular Access.

The most important stuff that needs to be done prior to handoff is the stuff that gets the pts the h*ll out of there. But if you're slammed, there will def be stuff that the oncoming nurse has to complete. That's why we have different shifts...bc you can't stay there all day. o_0 But I try to focus on getting urine sent off, taking pts up to their room if they're being admitted, getting abx and any IV fluids started, bc those are things that will keep the pt. there longer. Also, it's my pet peeve to have to chart stuff that the previous nurse did. CHART AS YOU GO, PLEASE!!! But it sounds to me like you're prob j dealing with a lazy nurse.

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Specializes in Rehab, critical care.

Just prioritize what really needs to be done. Do your best. For instance, if your patient is septic, then yes, you really need to hang that IV abx (b/c timing is very important), and if you don't have time to do it, then ask another nurse or your charge to hang it for you. It's hard being a new nurse...I'm there with you. I'm in the ICU, and I've never worked in the ER, so you may just want to ask the ER nurses on this forum. Best of luck to you...it will get better! Just don't be the one rolling your eyes at the new nurses when you get to be more experienced :). Next time the nurse gets indignant with you, use it as a teaching moment (regardless if she's justified in doing it or not)..say, well, what should I have done? I am doing my best, yada yada.

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Specializes in ER.

I agree to a certain extent with the previous poster. I would simply ask the next time what they would like you to do or what they would have done differently. It's common for new grads to think they are keeping up but they aren't and you have to gently tell them, "hey look, it's important to prioritize xyz."

There are some people who want the whole team straight when they start no matter what but if you are consistently hearing the same complaint then maybe it's time to look at your habits. And trust me, we have all been there.

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Specializes in ICU, Telemetry.

Chart what you did, and do any stat ordered on your time that you have the med for. As someone who does ICU and ER, it's frustrating when someone comes up with orders, and you can't figure out if they got that Vitamin K injection, that stat order of whatever, etc. Our systems between the ER and the rest of the hospital don't talk to each other, except for lab results (and only some of those). So if it's a heart med, a bleeding med, a critical "lives with it, dies without it" kinda med, make sure the receiving nurse knows about whether it was given or not. Nothing like watching someone bottom out because a Cardizem Bolus dose was given in the ER for someone going onto a drip, yet they get to us, looks like they haven't had any because the ER nurse didn't finish charting yet, so we give the push and suddenly it's like, "Uh...where'd their SBP go?"

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Specializes in ICU.

Speaking as a PIA ICU nurse, all i want to know is what meds you gave, what was CT scanned and how many liters of saline were given. I will figure out the rest. I'm ready when you are, roll em on up.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
i'm a new nurse at an er, since patients are coming and going you may not necessarily have everything done for a patient that you just got at 1630 and got admission ordered at 1700(for example). sometimes the nurse at 7 comes and gets upset because some stuff have not been done on this particular patient lets say some meds have not been given like antibiotics maybe, or nexium. my question is; what is expected to be done and what can be something that u do not necessarily may complete before 7, leaving this task to the coming-in shift. for example a triage definitively has to be done and some vs as a blood sugar if pt is diabetic or some basic labs like troponin if pt is chest pain.. but as far as meds? and everything else i'm not clear if there is somebody out there that can answer this question to me and tell me how they do it i will appreciate it thank you.

it will get better. being new is tough in the ed because everything is different. your assessment is more focused on complaint. if they come in for a splinter in their hand, you won't listen to their lungs unless they are blue and the splinter is a branch in their chest. all things in the ed are considered stat.....sort of. everyting needs to be given asap to get them diagnosed and dispoed and out.....asap.

if they come in with a fever and cough and an antibiotic is ordered....that antibiotic is their nitro....give it now. i say asap because if you have been slammed with a mass casuality or three code obviously the codes count and the antibiotic waits. remember with core measures......time the antibiotic counts and you want the department to look good. if they came in with indigestion give the nexium and get them home! wait times in the ed are a big focus for the jc (aka jacho) as qualifying as a delay in treatment (one of the largest reasons for suing and settlements). a glucose on a diabetic is a vital sign and must be done asap. triage is done, completely, with a full set of vitals.... upon arrival. http://www.ahrq.gov/research/esi/ i have to say. if the patient came in a t 1630, got orders to be admitted at 1700.....and is still in the department at 1900.....everything should be done and the patient just waiting for that bed. (unless of course there have been back to back codes)

the idea to get everybody in there and out of there asap is the key. being new this will take time....but if in your mind everything must be done asap/stat might help you. you try to do everything as quickly as possible so the md is to blame for the patient still being there..;). the goal is to leave nothing for the next shift....if humanly possible. the things not done.....most of the admission orders except antibiotics or any stat orders as a general rule. the tough part of the question is what is usually done......nothing is usual in the ed. the constant ebb and flow of patients and acuity is it's blessing and it's curse. it will get better in time...:redpinkhe

i think this is the key.....do whatever it takes to get them in and get them out, where ever out may be(floor. home or morgue)........asap!!!!:smokin:

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Hospital policy also plays a role. At my peds hospital, if a kid comes in with fever and antibiotics are ordered in the ER, those are to be given and then the pt held down there for one hour after completion before sending them up to the floor.

We have ER orders and floor orders, so its often times pretty clear who needs to do what.

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Thank you very much everybody for the responses. I just want to be clear because i like to do my job as best as possible.

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Specializes in Critical care, ER.

what I usually do if I'm not totally slammed to prepare for the change of shift is to make sure pts are d/c or moved to the floor if ready, pts in holding pattern are up to date with vital signs, meds, labs,,etc and any pt arrivals in the last 30 minutes who are stable into my section I will start their tasks etc. That stuff is the easiest to turf to the next nurse because personally, I'd rather start with a new slate of patients than finish up old because I can get to know the whole case from the beginning. Most nurses seem to be agreeable to that. Although u will find some are never satisfied. It takes a while to hit your stride with all the shifting priorities in the ER. Naturally, the emergent stuff trumps everything!

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