i have worked at many hospitals as a traveler in the er, and i have to say, this seems to be a universal problem. the following are my pet peeves about transferring pt's from the er to the floor/icu:
1. it is very irritating to be told a nurse from the floor or icu can't take report because the bed is dirty, he/she's on break, in the bathroom, busy, etc.... there are other nurses on the floor, someone must be able to spare 2 minutes to take report.
i dont think the bed being dirty is a good excuse and neither is that the nurse is on break, someone is covering her/him. it is reasonable that we may not be able to stop what we are doing to come and take report for many reason. i'm starting an iv, im doing a dressing change, im with an unstable patient, the list goes on and there are many valid reasons. however i think the person that is supposed to be getting report should call back within 10-15 minutes and if that is not an option for a valid reason then my charge nurse should take report.
2. being asked to wait 30 minutes to bring someone up because "we just got another admission." um, yeah, let me sit on this patient for another 30 minutes while my hallways & waiting room fill up so that you and your co-workers can check in one patient that has been nicely pre-packaged for you by the er (iv started, foley in, ng in, etc.....). i wish we could tell ems- "please drive around the block a few more times, we just got another ambulance in....."
i dont understand this one either.......what would be the purpose in waiting. the patient will rest better on a bed in a room rather than in a stetcher in the ed. however the pre-packaged comment, out of line we have lots of paper work to do when the patient hits the floor so your iv stick (which by the way is always in the ac and beeps all night), labwork and foley is only a minute beginning to the admission process.
3. being asked things that do not pertain to the patient's condition. example: being asked about bowel sounds in someone being admitted with pneumonia, etc.... you know what? if my patient is in the er for respiratory issues, i don't listen to their bowels! does that mean i'm a bad nurse? no- it means i'm an effecient er nurse- we do focused assessments in the er, don't ask me about my patient's ingrown toenails when they are here for pancreatitis.
flip side of that is the ed nurse who wants to tell me about the ingrown toenail on my chest pain patient, but when i ask what the second troponin was ......"oh ill try to get that before i send him up", thanks since the first one from 6 hours ago was elevated.
4. getting phone calls from the floor 2 hours later wondering why i didn't do this or that from the admission orders. they are admission orders- if it doesn't say "stat" or "now," it is to be done on the floor, not in the er.
5. nurses refusing to take report at shift change. you know how badly you want to give report to the next shift so you can go home? well guess what? so do i! i have no control over admissions waiting until 10 minutes before shift change to give me a bed, but now that i have it, just let me call report so i can go home. my report will only take 2-3 minutes, so it would be common courtesy to not make me stay 30-45 minutes late just to give it.
so this one just burns me. i come on shift and i have to get report on five patients and ed is on the phone ten minutes into my report wanting to give report. i tell them, im getting report i will call you back in 15 minutes. oh ed nurse if you were standing beside me and i was talking to someone getting report, would you interrupt me and cut off the other nurse so that you could give your report to get out sooner than the other nurse you just interrupted????? if you did that would be very rude, just like it is rude to call up to the floor and insist that we take report so you can go home. give report to your oncoming staff and she can call it later.
6. floor/icu nurses who have a problem with the admission orders, and give me grief about them. know what??? i didn't write them! if you have a problem with the orders, call the doctor.
most of the orders that i have seen have been taken by the nurse and written for the doctor, those can sometimes be cleared up by the nurse that took the verbal order, otherwise yes the nurse needs to call the doctor.
7. nurses refusing to take a patient because "they need to go to icu, ccu, telemetry, another hospital......". the physician specified what type of bed he/she wanted. if you have a problem with this, take it up with the doctor- it is not up to me what type of bed the patient goes to, it is decided by the doctor & by what's available in the hospital.
just the other night i took report on a patient and told the nurse that i wasnt so sure that the patient needed to come to our floor. i took the reporting nurses name and extension. normally i work on a cardiac floor, but i had picked up a shift on the observation unit. they called me a 50 year old female that was transported via ems with a heart rate 180s, adenosine 6,12,12 was given by ems. in the ed she got 6 more of adenosine and then a cardizem bolus. the carotid massage brought her down to 110. first troponin was 0.046after receiving this report i was not so sure that the woman did not need to be on a cardiac floor. im a cardiac nurse i could have cared for her........but the placement was not appropriate. house super sent her to a cardiac floor.
thanks for the chance to vent..... admitted a lot of patients last night, had to deal with a lot of the above........
glad you vented, i appreciate your perils in the ed. we know that you are busy down there. personally i try to be courteous to the ed nurses. my best friend up home is an ed nurse. she's funny she tries to appreciate the floor nurses too. whenever she can, because i crab about it:idea:, she tries to not start ivs in the ac haha. happy nursing everyone!!