Problems transferring pt's to Tele floor

[pokergirl]

I'm just wondering if anyone has some good advise on how to fix this problem we have in our hospital?

I am an ICU nurse and we have such a hard transferring our down graded pt's to tele or m/s floor. For example:

Today, at 1740 I rec'd a tele bed for my down graded pt. I already know that this is probably not going to be an easy transfer because it's getting close to shift change but I cannot wait until after shift change because we are getting an admit from PACU and they are already short on night shift meaning some people will have 3 patients.

I call to give report and the nurse says she's with a Dr. and she'll call me back which she does in about 10 minutes. First thing she says is can you hurry up and transfer this patient before shift change, and not only that, she is so rude to me. And rude the whole time I'm giving her report. I tell her that as soon as I give her report we'll be heading her way. (I don't like transferring my patients that late either because I am either getting another admit or I have things to do for my other patient when I get back, putting me late getting out of there) So, trust me I don't waste time transferring my patient.

After report, the CN and I are ready to go and here comes the pts Dr. He's there for about 5 min, writes orders and we're off. We get to the floor, the receiving nurse is charting next to the pt's new room, sees us but proceeds to not come see the patient. The room is not set up. I have to rearrange furniture just so we can get into the room. I put on the call light to get someone to help us and bring us a tele box. No one answers. My CN sticks her head out the door and asks someone to bring a tele box. The PCA comes to help, but without a tele box. I asked her 2 more times if she could bring one which went ignored. Finally got the pt settled in (still no receiving nurse to be found) so I go to the nurses station and ask for her. She's in a pt's room next door. She comes out, I tell her the three orders the Dr just wrote and she proceeds to tell me to hold on while she goes back into her pt's room! I tell her to call me if she has any questions about the order (which was pt/ot and nutrition eval) and she states "oh so you're just going to leave with out putting the patient on a tele box?" So rudely. Again. I then tell her I have been asking for one and no one will get it and that she needs to come see and assess her patient when we bring them (I mean, she saw us bring the patient while she was charting in the hallway!) Then she tells me that she can't because she is with a Dr and that I should have been up there sooner. I explained to her that the Dr came as we were about to transfer the patient which was out of my control and she cannot just leave her new admission unattended. (Her new admission that she knew was coming btw. Her new admission that the house supervisor told her, even before I called her report, that she was getting.) The nurses take 4-5 patients on this floor and we work in a 100 bed satellite hospital.

I just don't understand!!! This is an everyday occurrence! I have written emails and it has not changed. The nurses NEVER (not exaggerating here) come to receive their patients when we bring them. I always have to rearrange the room, look for an IV pump, settle them in by myself, and then go look for the nurse I called report to. AND the floor nurses are all sitting at the nurses station that we pass right by to get to the room and STILL no one comes! They certainly see us!! It's just so unsafe! And I have floated to this floor many times and half the time the nurses (not all, there are a few good ones. But they tend to not stay around very long because of all the bad ones) are sitting at the nurses station checking their emails or shopping online. One time I floated as a monitor tech and I don't know how many times I would ask a nurse to check the patient's leads and they would respond "that's not my patient!"

I'm just so exhausted dealing with this because I've never experienced this at any other place I've worked. Granted this is a start up hospital and has only been afloat about 3 yrs now so there's lots of kinks to be worked out. I've been asked to join the Staff Advisory Counsel so I'm hoping to find some good ideas to present about what works well for other people. I would REALLY appreciate any input!

[Nccity2002, MSN, RN]

Hi Pokergirl,

If the above situation is a frequent occurrence, I sugest keeping documentation everytime something like what you just described occur. Keeping track of such incidents provides validity to the issue and help zero on specific individuals, circumtances and factors that makes tranfering patients, such a painful experience for everyone. Be part of the solution and join your unit practice councel. Creating an unit transfer guideline sound like a great project for you staff advisory councel.

In the mean time:

a) Avoid transfering patients at change of shift (I know...easier said than done...but we can always try).

b) After report, be specific and ask the floor nurse if the room is set up to receive the patient.

c) If nurse not available to receive patient in the floor, enlist the help of the nurse in change.

d) Get input from the floor nurses...how can the process be improved.

Good Luck

[bobogirl33]

I know what you are talking about!!! I can start the morning in the ICU with a known transfer to the tele floor, be called at 10:30 am with an assigned bed, but then be told it's not ready yet. We will call you when it's ready. ALWAYS, ALWAYS, ALWAYS they drag their feet until change of shift and then call 3- minutes before I am to begin to give report stating they are ready and could we get the patient up there ASAP!! I sometimes feel like saying to them, let me stop dealing with my post open heart patient and delivery this other gentleman right too you!! I have to find someone to cover my open heart pt and then get the other patient out of there.

When arriving on the tele floor the nurse receiving the pt is very seldom there and a CNA comes in and puts the water pitcher on the table and leaves. I would like to know what they are doing up there? One doctor I spoke to said that he doesn't like going on the floor because he has to stroke some egos to get what he wants out of the nurses. Makes me want to just scream!!!

I too wonder when this will get better. I hate transfers at change of shift. SO much gets missed and falls through the cracks when this happens.

[pokergirl]

Thank you ladies! I feel like I just really needed to vent lol. I do like the idea of asking the receiving nurse if she is ready to receive the patient when we come and if the room is set up. Also, maybe calling the CN on the phone if the nurse is no where to be found. Good ideas! Thanks!