I've only worked in two ED's, but have noticed that both have the same tension between the ED staff and the floor nurses. When we're calling report on an admit, they seem to be really snarky and nasty to us. They'll grill us about why the doctor hasn't addressed this lab result, or why the doctor hasn't ordered a foley and why we didn't ask for said order, and get really nasty if we don't stop our report, go address whatever they think needs done before we transport, and then call them back to give report again. Or get nasty because we're transporting without waiting for that gabapentin to be sent up from pharmacy so we can administer it instead of them.
I tend to think it's because if they haven't worked ED, they have no idea the kinds of pressures we're under - not just with the patient we're transferring, but the other 3 patients who are at various levels of stability and needs. If we've made the doctor aware of an out-of-range lab value, and the doctor didn't think it needed addressed in the ED, I don't have time or the inclination to second-guess him. If the admitting doctor didn't order a foley, I don't have time to track him down wherever he is in the hospital to get the order so that I have to place it and not the floor nurse.
I know that floor nursing has its own challenges, and I try to be sensitive to that. I don't repeatedly call back every 2 minutes to try and give report when the receiving nurse is in a room or in report, I try to get all the information they need and the patient tasks as caught up as possible. I do everything in my power to make sure my patient is as well packaged as I can before I send him up - patent IV, antibiotics started, BP in a decent range, etc. Sometimes we just can't have the patient perfectly packaged, and all the meds given before we send them up. Sometimes things like how mobile they are or a complete skin assessment wasn't translated in report from the previous shift, and I just don't know the answer. It's not necessary to beat me up over it or imply that I'm a lousy nurse, yanno?
Anyway, I am not trying to go off on a rant... I'm honestly interested in if this is common, and if anyone's hospital has had success in putting a stop to this and how. It's not feasible to have every nurse in the facility shadow and ER nurse for a shift, though I'd love to see it. (And vice versa... I know sometimes ER nurses get high and mighty with the "lowly" floor nurses -- I don't see it that way, we have different focuses is all.) After all, the goal should be providing the best care for the patient, not proving that we're better than the other guy.
Yeah that's no bueno. How about the floor nurse responds to the stroke with ya and the report gets done after
Can't wait for someone to come up with something that keeps all the pts safe. The pt in question, the other pts on the floor assigned to the nurse taking report, and all the pts coming into the Ed. That's what it is ultimately about.
I wouldn't mind giving two reports at shift change. One to the incoming Ed nurse, and one to the nurse getting ready to take that or in the floor. but of course lining that up probably wouldn't work.
That's what I got the other night. Bed bugs? Let the new grad do it turns out it was just a tweaker with a rash. He wanted to make sure it wasn't measles or "The Ebola" as well...
We have a 10 minute policy. 10 minutes from bed assignment to report.
The ER doesn't close. We don't get to turn away patients. We can't tell EMS that the bed is dirty and they have to wait.
We can't say we're hungry or we need to pee so the pt needs to wait.
There is no waiting, the patients keep coming. If it's 1 minute to shift change, guess what, I have to deal with the patient.
Patients keep getting admitted. I have a near brick wall when I try to call report. Stalling and more stalling. I get it, I'm the bad guy because I know you're stressed to the max and here I am giving you more to do.. It's not me, it's the nature of the beast. These patients need to get out of my ER.
Just want to comment about the high bp upon floor Transfer. Many times the ER doc wont address it because they want the admitting Dr to decide and or cardiologist to decide treatment. Also, I've been told by ER docs that pt who live with chronic high bp - it could potentially be dangerous to aggressively treat their "normal" 2xx/1×× bp. Plus, if I'm lucky -from arrival to bed assignment is less than 3 hours and that really doesn't give me much time to allow po htn to really kick in. Also, I can't tell you how many times I'll get a pt who has been noncompliant with their htn meds - couple doses of home meds and they are fine. Sometimes you can't acutely fix a chronic problem esp with pt who are med noncompliant. :)
Exactly!! I just got home from a busy shift in the ER and every single one of my admissions was a tooth and nail battle to give report. And when I finally get the floor nurse on the phone they give me attitude.
One nurse told her clerk to tell me she's busy and she'll call back. I wait 30 min and then call again and guess where she is??? On her lunch break!! I'm eating my lunch right now at home at 8:20pm.... I started work at 7 am.
And then of course there is this magical time from 6:30 to 7:30 where the floor is supposedly off-limits and nothing, not even a phone call, can come through. 30 min on either side of shift change? So that's potentially an hour that I'm supposed to sit on a patient who is ready to go upstairs? All the while actually sick patients don't have a bed because it is taken up by a Med/Surg patient?
I know we all have different factors that make our jobs difficult and that floor nurses have to work just as hard as ER. But, please, stop making excuses and just take the patient.
I called to give report to an ICU nurse one time and the secretary said, "I really don't like you guys in the ED." And I said (with a smile in my voice) "But administration loves us because we are filling the hospital with patients." "Oh," she said, "What I really meant is that you are always bringing us work." Of course.
I called to give report to an ICU nurse one time and the secretary said, "I really don't like you guys in the ED." And I said (with a smile in my voice) "But administration loves us because we are filling the hospital with patients." "Oh," she said, "What I really meant is that you are always bringing us work." Of course.
What many floor nurses are not aware of is that the ED is under constant scrutiny for throughput times. We have a mandate to move patients through the ED as efficiently as possible. Once the decision to admit has been made, the clock is ticking.
This is why we generally do not start admitting orders, unless there is time. Any ED orders should be addressed in the ED, with some exceptions- such as a blood transfusion is ordered, but the blood won't be ready for an hour, and the patient has a bed assignment and is otherwise ready to go. There is no reason for the patient to sit in the ED for an extra hour waiting for the blood, when they could go to the floor right now.
Some ways I have seen this addressed:
1) Getting rid of verbal report. Report is faxed to the receiving unit for the receiving nurse to review, and call the ED with any questions.
2) No moratorium on admits during shift change. If the patient has a bed and a nurse, the ED is to send them. It is up to the floor to strategize on how to handle admits during shift change.
I have worked on the floor also, and so I know how inconvenient it is to be elbow deep in C-Diff and have the ED call to give report, or to have your patient roll in just while another patient is circling the drain. This is why it is essential to have the nurses on the floor working as a team to handle their patient flow. The ED does not have the luxury of asking the medics to drive around the block a few times and kill 15 minutes because we're in the middle of something else, and we don't have the luxury of telling the patients that come in through the lobby to come back in half an hour because the triage nurse is on lunch.
To the OP, getting snarky with you when you're giving report is uncalled for and unprofessional, but it's also symptomatic of a bigger problem. It sounds to me like there is a problem here with expectations of the floor nurses and the ED nurses not matching up. It sounds to me like the managers for each unit need to collect information from their nurses about their perceptions and meet with one another to strategize on how the process could be smoothed out and the nurses understand one another's positions a little better. Can you talk to your manager about this?
It sounds to me like the managers for each unit need to collect information from their nurses about their perceptions and meet with one another to strategize on how the process could be smoothed out and the nurses understand one another's positions a little better.
I have yet to work anywhere where this would ever happen. Is there such a place??
NurseOnAMotorcycle, ASN, RN
1,066 Posts
That's for sure! I hope it doesn't last long!