The hospital I work for has a goal for admitting patients from the ED. All patients admitted via the ED, the hospital wants these patients to be on floor, in the bed within 60 minutes of informing ED and my med/surg unit that this patient was being admitted. This is a great goal, because so many times patients have to linger in the ED for hours, and most of time may not be very comfortable on stretcher as they would be in a bed on the floor.
Here is the problem: about 2 weeks ago, I came into work, my nurse:patient ratio is 1:6. I was sitting at the nurses station with night shift nurse receiving report. The unit clerk this hands me a index card to inform me of a new admit from the ED. I took card a set it aside and continued receiving report and reviewing the last 24 hrs of orders. When we were on the last patient, the other day time nurse took answered phone from ED. The nurse told the ED nurse that the nurse who would be getting patient was in report, she was about to say could you hold on when the ED nurse started screaming at her, yelling saying getting the patient up to floor in 60 minutes was a priority over getting report for patients already on floor. I took the phone from the nurse I would be working with, and I talked to the ED nurse. He proceeded to tell me how he needed to get that patient up to floor now, and how getting patient up in 60 minutes were more important. He said if somebody doesn't take report I will just be bringing patient up. I told him I would be receiving patient and I needed him to hold on as I was in middle of report and I had not even gotten the fax they are required to send for me to review and ask any questions. He just continued to be very rude so I told him again to hold on, he just wouldn't he said what ever I was doing could be postponed and I could look at sheet after taking report. Finally I just told him that NOTHING is more important that patient safety and that unless I was given oppurtunity now to review patient data I would not take patient right now, I told him if has a problem he could call my charge nurse, and I gave him the extension and hung up.
This scenario keeps happening at the hospital I work for. Most times when the ED is not busy, they take their time bringing the patient up and I usually have to chase down the nurse to get report. When it is busy they want everyone up to floor immediately.
My problem is I feel like I am being rushed to take patients and I end up having more questions about patient from nurse in ED, but for the most part after they fax transport/report sheet you will see ED techs bringing the new patient. The techs of course can not really answer any questions I have for the previous nurse.
So since I have not gotten adequate report I don't except responsibility for patient, I tell the ED tech and my charge nurse (well charge nurse in training) that I cannot safely take care of patient. The reason I did this was patient safety. On a previous occassion around change of shift, I got a patient from ED, I got the info as I was going for lunch. When I came back there was no transport/report sheet, no chart, and I couldn't find the index card, so I went back to taken care of the patients I had before. Around 630p light goes off in room at end of hall, which is were the new patient. I went in to room and the patient and her husband were in the room, I asked how long they had been and he said an hour. Apparently when ED tech brought patient up they just left her in her room, and her paperwork so nobody new she was there. So I had to hurry somewhat to at least get her vitals well that patient O2 Sats were 80% on room air. So I had to get some O2 on her. The girl was in severe pain (sickle cell crisis) and was ordered a dilaudid PCA. So I had to call IV team to get a line in her. IV nurse start a new IV Lock only to then find out patient has a mediport.
I think sometimes that as nurses so much is put on our shoulder in terms of giving patient care, providing support for patient and family, that things like being in a rush to get patient up to floor or anything else should trump patient safety.
