Rad RN's transporting pts

[Kristy K]

I work in a facility that has two free standing hospitals under one ownership. Over the past several years we have been trying to find ways to get both radiology(and other) departments working in similar ways. However, since the two hospitals were separate for so many years it is difficult to overcome the 'tradition' in one or the other. I was recently hired as the Radiology nurse supervisor and have been asked to stream line our Radiology nursing scope at the two hospitals. A major difference I face now is Rad RN's transporting less stable pts to and from the floors. In facility A, the floor nurse brings the pt to radiology. In facility B, the Rad nurse get the pt from the floor and take them back. The expectation of RN face to face report is becoming an issue, thus our Rad nurses are spending a large amount of time transporting. How do you get unstable pts (pts that need RN monitoring) to your department?

[ratchit]

I was the first Rad RN in my hospital and I got to make my own policy. Which I think makes sense- in my experience, other departments don't think rad nurses have much to do; they might think the Rad RN has the time to do all the transporting but they shouldn't make that decision without involving the Rad RN!

I decided that I was not there to be the hospital transporter so we would split the duty- they would drop off and I would deliver them back. Report could be given to me over the phone or face to face depending on whether the patient needed a nurse to transport them or not. I had the labs pulled and knew if the patient was on isolation from the computer before they came down. When I called a floor to say the patient was coming back, I would usually give report in person since it usually involved showing the RN the line, drain, bruise, pulses, etc.

Also, if a patient was in radioliogy over shift change, the floor RN was responsible for giving report to the oncoming shift, not me- I could only report on the procedure and some basic history- not all the details I would want if I was taking a patient over for full nursing care! It worked well. Well, it worked well after the one time when I called our sister hospital (only one IR dept for 2 hospitals) to say the patient was coming back and found out no one had given report to the oncoming RN. I made them call the offgoing RN at home for report- all I really knew was the GT had been clogged since she hadn't given me a report either!)

As the person responsible for the patient while in radiology, I also reserved the right to decide if an ICU patient's ICU nurse needed to stay. I only said "stay" a couple times- once when the patient was getting blood, vented, and on multiple pressors and I thought I might need another pair of ACLS trained hands and once when the nurse (one I knew well and knew she was hard to rattle) was almost in tears from exhaustion and frustration and needed the 20 minutes that procedure took to sit and have a snack in the control room. She agreed that the patient was too unstable to leave me. :)

I would make exceptions- as long as I was ready to go in radiology I did not mind picking patients up from other staff that were willing to lend a hand sometimes, too. Heck, I would even transport non-rad pts from the ER to tele or ICU if the ER if they asked because they were really busy, not because they wanted a smoke break. I don't mean to come across as negative- we all need to work together but the nurses most resistant to transporting one-way were the ones who would do as little as absolutely possible if they were allowed to so some limits had to be set.

[GWVRNS]

This is a big issue at our hospital, too. No matter how unstable the ICU patient is, vented, lines, VS, the ICU will not lend a hand. Do other rad nurses also have to transport ICU patients? We are trying to phase it out at our hospital. Very unsafe.

[shiloh11]

At our facility, the tech in charge of the procedure (CT, US, MRI etc) calls the floor and tells them when they are going to be ready for the pt. They also call our dept to notify the rad nurse. The rad nurse calls the floor and gets report (sometimes not an easy task!) and then the floor sends the pt down via transport. In a case where the pt is a med/surg pt, we meet the pt in the dept, do the procedure, and if they got sedation, we take them back to the floor and give bedside report. If they didnt get sedation and they are stable, they go back up via transport.

If the pt is on tele, the tele nurse transports the pt to the dept. (Unless the MD specifically wrote that the pt can go down w/o monitor). The rad nurse meets them in the dept. The tele RN doesnt stay. The procedure is down and the rad nurse takes them back on a monitor and gives bedside report.

ICU and critical ER pts come down with their nurse from that dept and that nurse stays for the duration of the procedure. We dont go unless they need an extra pair of hands.

We really dont have any trouble with transporting the patients. Our bigger problem is in getting report and being sure that everything was done that needed to be done prior to the procedure (NPO, consents, working IV etc).

:Snow: