Report without Orders?

Nurses General Nursing

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Is anyone else expected to routinely take report and accept a pt from the ER with out seeing the admitting orders?

I just transferred from med surg to the icu; and I'm now forced to routinely take report on pts without the ER sending me the order. The med surg floor that I came from insisted that the orders be faxed before report was given and maintaining that prevented a lot of problems from ever reaching the floor or the pt. It seems kind of dangerous to me, but I was wondering what you guys think.

Thanks

Specializes in Emergency.

No, but we frequently are expected to take patients from ED without getting a report. And they usually come along with minimal orders.

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No, but we frequently are expected to take patients from ED without getting a report. And they usually come along with minimal orders.

I would not take a patient without report. Send them back. Get the supervisor to have the ED call- this would be a deal breaker for me....

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Specializes in Cardiovascular, ER.

Agree with above. I would not accept a pt from the ER without report. I work in the ER, we fax report to the floors and call 15 min later to ask about any questions. ICU we just call report. As for orders, only if it's a surgical case or the attending is kind enough to come to the ER and write orders. Otherwise the nurse accepting the patient calls the doc when the pt gets upstairs. That's how it was done when I worked on the floor as well.

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Specializes in Emergency.
I would not take a patient without report. Send them back. Get the supervisor to have the ED call- this would be a deal breaker for me....

A good chunk of the ED nurses seem to have this "I'm better than you, b/c I work ED" complex. To them, calling a verbal report is somehow above them. Even though their manager has informed them time & time again that they are expected to give report. And when you ask for report, then get all exasperated like you're completely inconveniencing them. My favorite is when the charge nurse will try to "help," by calling report if the primary ED nurse is busy. You ask questions and their response is, "I don't know, they're not my patient."

We even had a pt arrive to the floor one time, w/o a phone call even informing us that the pt was on the way. We knew they were coming, but no one bothered to try to call report or even say, "Hey, just sent this pt up." Happened to walk past the room & transport was getting them settled in. You can bet that got written up & ED got a not so nice phone call.

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A good chunk of the ED nurses seem to have this "I'm better than you, b/c I work ED" complex. To them, calling a verbal report is somehow above them. Even though their manager has informed them time & time again that they are expected to give report. And when you ask for report, then get all exasperated like you're completely inconveniencing them. My favorite is when the charge nurse will try to "help," by calling report if the primary ED nurse is busy. You ask questions and their response is, "I don't know, they're not my patient."

We even had a pt arrive to the floor one time, w/o a phone call even informing us that the pt was on the way. We knew they were coming, but no one bothered to try to call report or even say, "Hey, just sent this pt up." Happened to walk past the room & transport was getting them settled in. You can bet that got written up & ED got a not so nice phone call.

Totally unacceptable. Who does the ED nurse gets that patient out of her/his hair !! And, for folks who worked the floor (myself included), who weeded through the ED parade, and only sent the ones with some legit symptoms that needed further care? :D

I would not work some place that had no control over how patient care is protected, and continuity maintained. If your supervisor isn't helping, I could not stay....JMHO

I've had VERY unstable patients come up from PACU (the nurses said it was the end of their shift- so I get someone with a BP of 50/20, who was a DNR before surgery, but the doc hadn't written the post-op orders yet, so a full code- and circling the drain big time), and made a huge stink over it. The patient did ok (I had an RN orientee who wasn't cutting it doing the charge position, so I had her babysit the patient, and open the IV, while putting her in Trendelenberg...) This isn't about PACU nurses, but a dud who happened to work in PACU... a dud is a dud.... :D

BTW- if the 'bold' is weird in this, I'm having some issues with my secretarial skills tonight !! LOL

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Specializes in Emergency/Cath Lab.

I work on medical and we can get pts from the ED many times with no orders. Depending on who the admitting doc is, we might not get any for the night. We get the standard ER orders (vitals, activity, diet, that nonsense). If the pt is a pt of the hospitalist, then yes we get a full list of orders. If they come in with a different doc then no unless they are pretty critical.

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I work on medical and we can get pts from the ED many times with no orders. Depending on who the admitting doc is, we might not get any for the night. We get the standard ER orders (vitals, activity, diet, that nonsense). If the pt is a pt of the hospitalist, then yes we get a full list of orders. If they come in with a different doc then no unless they are pretty critical.

At least the standard ER orders make it a legal admission !!! Albeit skimpy :) And God forbid, the patient gets a headache or indigestion before morning! (although I never had an issue calling a doc at night- I don't make him go to med school- lol) :D

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Specializes in ICU, Telemetry.

With us -- nightshift, anyway...

1) we get the heads up that we may be getting one -- we let the ER know know many beds, how many nurses we have. That gives the charge time to decide if we need to find another nurse to come in if we're already running at 3 each

2) We "stalk" the patient in the computer -- look at their vitals, labs, what they say they came in with "abd pain" for example, vs. what the labs/radiology says -- elevated ETOH, or elevated liver enzymes, positive troponins, etc. Helps us determine if they need the most experienced person on the shift, and that one of their patients needs to go to someone else being called in, or if they're run of the mill and any of us can take it.

3) ER calls and formally requests the bed, via the house supervisor (she's like the air traffic controller for the hospital -- "gallbladder-niner, you're clear to approach on ICU room 3")

4) we prep the room -- are they going to need a vent? dialysis? every IV pump in the place? If they're likely to code, we'd rather put them in the larger rooms so the code team doesn't kill each other, so we might call back and say put them in room A instead of room B

5) we get report from the nurse. I hit the high points -- cardiac, resp, gu, gi, iv, drips, any psych issues, basically is this person likely to try to kill us or is the family nuts? Most of the time, we're told "call doctor X when they get to the room" -- the ICU intensivist comes over, looks them over, and then does any stat consults, writes a bunch of labs and orders.

6) We get the patient, and sometimes find that everything we thought ... was wrong. Usually as we're running from the room screaming for security....*grin*

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With us -- nightshift, anyway...

1) we get the heads up that we may be getting one -- we let the ER know know many beds, how many nurses we have. That gives the charge time to decide if we need to find another nurse to come in if we're already running at 3 each

2) We "stalk" the patient in the computer -- look at their vitals, labs, what they say they came in with "abd pain" for example, vs. what the labs/radiology says -- elevated ETOH, or elevated liver enzymes, positive troponins, etc. Helps us determine if they need the most experienced person on the shift, and that one of their patients needs to go to someone else being called in, or if they're run of the mill and any of us can take it.

3) ER calls and formally requests the bed, via the house supervisor (she's like the air traffic controller for the hospital -- "gallbladder-niner, you're clear to approach on ICU room 3")

4) we prep the room -- are they going to need a vent? dialysis? every IV pump in the place? If they're likely to code, we'd rather put them in the larger rooms so the code team doesn't kill each other, so we might call back and say put them in room A instead of room B

5) we get report from the nurse. I hit the high points -- cardiac, resp, gu, gi, iv, drips, any psych issues, basically is this person likely to try to kill us or is the family nuts? Most of the time, we're told "call doctor X when they get to the room" -- the ICU intensivist comes over, looks them over, and then does any stat consults, writes a bunch of labs and orders.

6) We get the patient, and sometimes find that everything we thought ... was wrong. Usually as we're running from the room screaming for security....*grin*

Ah, yes- the computer stalking :D

At a hospital I worked at, we had a frequent flier who would call EMS if she didn't take a dump for more than 2 days (no MOM, no magic bullet first, no Fleets- call the Marines, and get out the Dyson vacu-colon).... She'd demand that the ER sink an NG (who in their right mind asks for a 16 FR hose down their throat?....well, that explains a lot about this one:D). If the sup called and said an admission was coming, the collective charge nurses on any potential floor (OB was L U C K Y ) was online in a heartbeat looking to see if this one's name was in the ER....then we'd call the sup and ask who had her last, and actually get into battles to avoid her - LOL. Once she was admitted, she'd complain about the brand of orange juice we had , and hang on to that stupid NG like it was an Oscar- she worked hard for it, or something...

We all wanted to get her a lifetime supply of prunes and AllBran, and have a phone tree to call her to remind her to drink enough and go for a walk every day... anything to keep her HOME !!

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Specializes in ICU, Telemetry.
Ah, yes- the computer stalking :D

At a hospital I worked at, we had a frequent flier who would call EMS if she didn't take a dump for more than 2 days (no MOM, no magic bullet first, no Fleets- call the Marines, and get out the Dyson vacu-colon)....

LOL @ vacu-colon! And we've got some frequent fliers who'd line up for one! I swear, if I had a dollar for every time I said, "Ma'am, do you usually get up at 3 am and give yourself a soap suds enema? Then why do you want one now, since you just pooped 3 hours ago..."

We need to find whoever's telling these folks they need to go to the bathroom every 6 hours and smack'm with a 2x4....

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LOL @ vacu-colon! And we've got some frequent fliers who'd line up for one! I swear, if I had a dollar for every time I said, "Ma'am, do you usually get up at 3 am and give yourself a soap suds enema? Then why do you want one now, since you just pooped 3 hours ago..."

We need to find whoever's telling these folks they need to go to the bathroom every 6 hours and smack'm with a 2x4....

The Cult of Supreme Colon Consciousness- have to be at least 70 y/o to be a card carrying member !!

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Is anyone else expected to routinely take report and accept a pt from the ER with out seeing the admitting orders?

I just transferred from med surg to the icu; and I'm now forced to routinely take report on pts without the ER sending me the order. The med surg floor that I came from insisted that the orders be faxed before report was given and maintaining that prevented a lot of problems from ever reaching the floor or the pt. It seems kind of dangerous to me, but I was wondering what you guys think.

Thanks

In my experience, no pt. can be sent to the ICU without the basic bridging orders being WRITTEN: airway, cardiac and prn pressor orders, and an Intensivist handoff, PERIOD. Otherwise, it's a dump pt., and they can stay in ER all night for all I care.

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