I read in another thread how a non-ER nurse (sorry, didn't see what specialty) was angry that the ER nurses don't start any of the admitting orders at her hospital. So, I wanted to ask the ER folks here, how does it work at your ER?
By the time I get the chart and admitting orders back from the doctor and the secretaries (who are the people that write down the room number and floor), the floor is usually calling for report in 10-15 minutes. Sometimes I have a chance to start IVF and sometimes I don't. Unless it is something that patient needs RIGHT THEN, such as pain or nausea medication, I don't have time to start the admission orders. Frankly, I don't feel that is part of my job if I am busy with my other ER patients.
Last week I was giving report and the other nurse gave a huge "sigh" after she asked if any of the orders were started and I said no.
Specializes in ED, Tele, Med/surg, Psych, correctional.
Having worked on med-surg and tele floors in the past in my current hospital, I have the luxury of knowing many of the nurses I am giving report to. This makes it easier for me when I call because they can't pull the "you don't know what it's like on the floor" crap. Newer ones try but I always remind them that I've worked both sides so cut the crap. It's not fair to the ED patient who now has a bed after 8 hours of working up and 2 hours of waiting that he needs to wait even longer because the nurse won't take report (their in the bathroom, theor on lunch, they're in a room with a pateint, they're discharging a patient, they just got a post-op, etc, etc,).
As far as orders go, I am pretty good at getting them started. Not just from a teamwork perspective but from a length of stay perspective. The way I see it, the longer patients stay in the main hospital, the longer I have to wait for beds. If I can send down the extra labs the specialist wants or get the MRI checklist done and get them down for the test BEFORE they go to the floor..the faster the results come back and sooner they will get discharged. If they wait til the next day to get the labs drawn and tests done..that's one more day they are waiting..adding to backlogs in ER holding.
Granted, if I have critical patients then the routine orders are completely ignored while I stabilize someone's breathing/BP/etc. However, I do try to get as much done as I can. Many times when I call to give report I'll say "Look, I've done everything already..no meds are due til the next shift and they're completely comfortable. What's the problem?" I think the floors are so stressed that they are gonna get a trainwreck from the ER with nothing done that they already are giving grief before they even hear anything.
As far as physical assessments go when giving report...I have no problem giving MY assessment but I always hate this line of questioning because I expect YOU to listen to his lungs when he gets there not just assume that because his wheezing cleared after 3 treatments here that he will still be that way in an hour when he gets to you. He may have had +1 dependent edema when he arrived but he has had his legs up on a stretcher for 8 hours and now he looks a lot better. I'll give you MY head-to-toe but that doesn't take the place of YOUR assessment when he arrives..patient's conditions can change rapidly in the first 24 hours.
That being said, I do go above and beyond to initiate orders, call in consults, etc. It not only helps out the floor, but the patients as well.
My ER has a rule that any and all patients admitted need to be up to there room within 30 minutes or less once the room is ready. We get cards that have perks such as being able to pick a day off in the next schedule, pick your 1st on call sign-up before anyone else, pick your assignment for the day, etc....if we get them up before the 30 min. This has been nice for some nurses, but I must say they haven't honored my request to pick my assignment on 3 different occassions...ticked me off, but oh well....
As far as starting admission orders....I do not have time most of the time. Unless it is on a 1:1 patient and they absolutely need the order completed, I have enough of my own job to do without doing admission orders.
I have on many occassion though drew MI panels needing done, converted the angio and have done the ekg admit for the Chest pain center.
It seems like it depends on how busy the ED is at my facility; whether they are slammed or like a ghost town makes a big difference in how much they get done before the patient arrives to the floor. Sometimes they are really nice and do the med rec. Other times, I'm lucky to get a medication list at all. I don't really expect the ED nurses to start on admission orders, but it's nice, if for instance, IVF are ordered, if they have the time, to start that. Or if ABX are ordered, to run the first dose. Or, if you can anticipate that there are no reasons to keep the patient NPO, to please give grandma a little snack if you know she hasn't eaten in several hours and won't be going up to the floor for a while yet. Or if their IV site looks a bit gruesome, maybe clean it up a bit so I have access when they get to the floor, and I can start on their treatment right away.
But I certainly don't expect it. That's not their function. Their function is to triage the patients, treat the most immediate and life threatening problems, and get the patient either out the door or up to the floor. Why would I expect them to do my work for me?
I see the frustration from their end as well. I know the pts are tired of being down there and ready to get into their bed on the floor, and the delay between the decision to admit and the time they actually get into their bed can be excruciating. I know that they need to turn over their beds quickly. What I'd like the ED nurses to understand is that it's NOT my fault if the room isn't ready yet. Some of our housekeepers are great and can turn over a room quickly. Others, not so much.
Just last night we were blessed (cough cough) with the Slowest Housekeeper on Earth, and PACU had to wait an hour and a half to send me their postop patient. They called me no less than four times, interrupting patient care, to ask me if the room was ready yet, despite my earnest assurances that I would call them the very MOMENT the room was ready; and I did (I also stopped answering my phone after the fourth call, so they called the front desk, the CNA, and the charge nurse). I did not take my dinner break, despite the fact that I was starving, until after that room was clean and the patient brought up and tucked in (ED nurses have done the "call a bazillion times to see if the room is ready yet" thing too).
So please, if I tell you that I'll call you the moment the room is ready, please don't keep calling me, interrupting me while I'm elbow deep in poop or pushing an IV medication or discussing a patient's condition with their worried family, or simply trying to get my assessments charted so that I can focus on my admit when they arrive (or on the toilet emptying my bladder for the first time all night). And please forgive me if, by the third phone call, I start to sound a bit cranky. I might even offer to let you come clean the room yourself if you think that would move things along faster.
As for report, I definitely get a different kind of report from the ED than I get at shift change on the floor. That doesn't really bother me. Our focuses are different. I'd like it to be brief and to the point, actually. I'll learn all about their favorite color, how many times per day they poop and what it looks like, and what brand of toilet paper they prefer, by taking care of them up on the floor. Just tell me the basic facts, and I'll take it from there.
Really, I don't expect the ED nurses to start admission treatments on the patients they send to me (with the obvious exceptions of nitro and heparin gtts for chest pain admits, diltiazem gtts for A fib with RVR, stuff like that).
Specializes in CNA, Surgical, Pediatrics, SDS, ER.
If we do not have admit orders started when the pt goes to the floor they are ticked off. They expect the IV to be started, fluids running, foley in, meds administered ect. ect. It's fine if I have the time but if I don't then it should not be a problem for it to be initiated on the floor. Of course if it's emergent it will be done but if I'm drowning I need a bed and I should not be wasting time doing admit orders that could be done on the floor. Our focus is to stabilize the pt and either street them,admit them, or xfer them. I am not doing an indepth assessment I am not the ICU so don't expect a indepth assessment from me. You will be doing your own more focused assessment.
I will assess their immediate need and nothing more unless it is necessary. If they come in w/ SOB don't expect me to know when they had their last BM. And yes I probably am reading the orders to you because I more than likely just got them right before I brought the pt to you. I will tell you what was done in the ED any pertinant info from my assessment and what needs to be done according to the admit orders. In the ED it is a fast and focused assessment I'm not the unit so don't expect every inch of the pt to be assessed. ED and floor nursing are very different so please try to be understanding.
I have been a floor nurse and I understand how bad it sucks to get people up from the ED at inconvienient times but I'm also seeing a lot more pt's. I don't have a set # that I'm assigned to for the day. I do try to initiate what I can before going to the floor but sometimes it just is not possible.
So please, if I tell you that I'll call you the moment the room is ready, please don't keep calling me, interrupting me
I hate to do it (keep calling) but when this situation happens every once in a while, the charge nurse is on my butt telling me to keep calling the floor to see if the room is ready (while staring at me). I don't like to do it, but I have no choice!
Specializes in ED, Tele, Med/surg, Psych, correctional.
re: the room being ready...granted there are some good apples that call me back..I already know who they are so when they tell me something they are usually pretty true to their word and I believe them. However, I've been burnt far too many times to mention. When they tell me the room isn't clean, I call the housekeeping supervisor on his pocket cell phone and tell him the room number. He is dispatched to the room to verify the information. I have had him standing in a clean room calling me from the room telling me "I'm looking at a clean bed". Then I call the nursing supervisor.
I don't bother calling the floor over and over. Our policy is first call if there are no takers, the floor has 15 minutes to call back. If they don't we call them back and if still no takers the patient goes up without a verbal report. Haven't had to do it too often but we do. Then we get a frantic call from someone looking for report.
Our hospital admissions dept employs a beeper system to assign beds to us. The bed is not assigned until it is confirmed clean by housekeeping through the computer system. So if we are getting a bed then it is highly unlikely that it is dirty.
I call the nursing supervisor quite often when I get no report takers on the floor. Reason being is that I have to move this patient because I have a 3 hour wait in the waiting room. If I don't call the supervisor then she comes down and starts asking why WE haven't sent the patient "she's had a bed for 45 minutes!". Yeah we know. Many of my co-workers aren't as persistant as I am because they don't want to deal with the aggravation. Problem is that it backs up the waiting room even more.
That sounds very uncomfortable. Just remember that if the floor nurse sounds irritated after the third call, it's not personal. Most likely you've called them right in the middle of patient care and the room still isn't ready, which is why they haven't called you back yet. I'll try to keep your situation in mind the next time I'm on the receiving end of multiple phone calls, though, and be extra patient.
jenfromjersey, I guess I'm one of the "good" apples. If I say I'll call you the moment the room is ready, I will. I'll even postpone my own dinner break until I've received the pt., because I know that the ED needs to move em out. Unfortunately, our facility, in its infinite wisdom, cut back on housekeepers and elminated the bedmakers, so rooms will sit there dirty sometimes for an entire shift after the pt. has been DCd. Then when we start admitting, all the empty rooms are dirty, and we have to get housekeeping to come clean them stat. A few of those housekeepers seem to lack a sense of urgency, which doesn't help things much.
I've received a patient without getting a verbal report one time (it was a mistake; the EMTs brought him to the wrong floor, but our CN decided to keep him since he was there). Fortunately, I was already familiar with him and all I had to do was look at his paperwork to see what he was there for, what medications had been given in the ED, and which doctor would be admitting him. I can do my own systems assessment pretty quickly, and with our computerized system, I can pull up his previous records and see when he was in last and and why, as well as read previous H&Ps to find out his medical history. It was really no big deal, and I did not bother calling the ED for report, since I was able to find out everything I needed to know just by looking at the patient and his paperwork.
That sounds very uncomfortable. Just remember that if the floor nurse sounds irritated after the third call, it's not personal. Most likely you've called them right in the middle of patient care and the room still isn't ready, which is why they haven't called you back yet. I'll try to keep your situation in mind the next time I'm on the receiving end of multiple phone calls, though, and be extra patient.
jenfromjersey, I guess I'm one of the "good" apples. If I say I'll call you the moment the room is ready, I will. I'll even postpone my own dinner break until I've received the pt., because I know that the ED needs to move em out. Unfortunately, our facility, in its infinite wisdom, cut back on housekeepers and elminated the bedmakers, so rooms will sit there dirty sometimes for an entire shift after the pt. has been DCd. Then when we start admitting, all the empty rooms are dirty, and we have to get housekeeping to come clean them stat. A few of those housekeepers seem to lack a sense of urgency, which doesn't help things much.
I've received a patient without getting a verbal report one time (it was a mistake; the EMTs brought him to the wrong floor, but our CN decided to keep him since he was there). Fortunately, I was already familiar with him and all I had to do was look at his paperwork to see what he was there for, what medications had been given in the ED, and which doctor would be admitting him. I can do my own systems assessment pretty quickly, and with our computerized system, I can pull up his previous records and see when he was in last and and why, as well as read previous H&Ps to find out his medical history. It was really no big deal, and I did not bother calling the ED for report, since I was able to find out everything I needed to know just by looking at the patient and his paperwork.
Oh how I would love to work with you:)) I have to agree with the previous posts that there are nurses that say that they will call back, and they do. But then there are others. I even tried to call report one time with about an hour to go until shift change and NO ONE would answer the phone! So charge nurse suggested calling from an outside line and what do ya know, they answered on the first ring! The nurse on the phone procedes to tell me that they "have an emergency going on" and she will need to call me back. So our ER doc is all ready to run to a code blue on that floor. Charge nurse calls the nursing supervisor to see if a code was called and we missed it. Nope she had just arrived at the floor in question and there was NO emergency. That is the stuff that irritates me. Just tell me you are swamped and maybe we can work something out, but don't lie to me. BTW, they were not swamped that night either, just didn't want another pt before shift change.
I can understand not wanting to take an admit during shift change, but to me, an hour before shift change is perfect timing. I can get the pt. tucked in and take a quick peek at their orders to check for anything stat, then get an admission history so our shift gets credited for the admit, then pass the rest along to the next shift. The next shift is happy because the patient's already been tucked in, their stat orders have been started, and the admission history has been done. It's perfect. I think maybe some of those nurses who don't like getting admits during the last hour of their shift may be those who save all their charting for the end of their shift. Not a wise strategy, IMO. Sometimes it is a necessary evil, but it can also be a matter of habit.
I'll start your admitting orders if you come down and get my work started finished, updated, etc......I'll do my job you do yours I guess it was I think. It floors me why some feel I should start someone elses job when I got my own stuff to do. I don't have enough time with my patients now, let alone doing the admission orders.
BTW: Stat orders are normally starting in the ER....except for stupid things that came wait and shouldn't have been stat in the first place.
I can understand not wanting to take an admit during shift change, but to me, an hour before shift change is perfect timing. I can get the pt. tucked in and take a quick peek at their orders to check for anything stat, then get an admission history so our shift gets credited for the admit, then pass the rest along to the next shift. The next shift is happy because the patient's already been tucked in, their stat orders have been started, and the admission history has been done. It's perfect. I think maybe some of those nurses who don't like getting admits during the last hour of their shift may be those who save all their charting for the end of their shift. Not a wise strategy, IMO. Sometimes it is a necessary evil, but it can also be a matter of habit.
IN THE ER...THERE IS NO WAITING TO CHART AT THE END OF OUR SHIFT... IT WOULD BE A LUXURY TO BEABLE TO CHART AT THE END OF OUR SHIFT....THAT ONE CRACKS ME UP...HAHAHAHAHA
FIRST OF ALL....REPORT SHOULD BE TAKEN THROUGH SBAR....IF THE NURSE CAN'T TAKE IT....HER SUPERVISOR SHOULD OR ANOTHER NURSE ON THE FLOOR. A GOOD REPORT IS ESSENTIAL, BUT IT'S UNFAIR THAT IF THE ASSIGNED NURSE CAN'T TAKE IT TO BE FORCED TO CALL BACK TIME AND TIME AGAIN. (AND YOU WANT US TO START YOUR ADMISSION ORDER....PLEASE)
IN THE ER...THERE IS NO WAITING TO CHART AT THE END OF OUR SHIFT... IT WOULD BE A LUXURY TO BEABLE TO CHART AT THE END OF OUR SHIFT....THAT ONE CRACKS ME UP...HAHAHAHAHA
FIRST OF ALL....REPORT SHOULD BE TAKEN THROUGH SBAR....IF THE NURSE CAN'T TAKE IT....HER SUPERVISOR SHOULD OR ANOTHER NURSE ON THE FLOOR. A GOOD REPORT IS ESSENTIAL, BUT IT'S UNFAIR THAT IF THE ASSIGNED NURSE CAN'T TAKE IT TO BE FORCED TO CALL BACK TIME AND TIME AGAIN. (AND YOU WANT US TO START YOUR ADMISSION ORDER....PLEASE)
Huh? I'm a bit confused. First off, why are you yelling (using all caps indicates that one is yelling). Second, I never said I expected the ED nurses to start admission orders. In fact, I specifically stated that I do NOT expect them to do so.
As far as the floor nurse not being able to take a report at the moment that you attempt to call, I'm sorry, but that will take a little bit of a cooperative attitude on your part. I have no problem, if I am in the middle of patient care and cannot step away to take report, with asking the ED nurse if I can call them back in a minute. Our facility is so huge that you cannot simply step out of the patient's room and find another nurse to hand the phone to. My supervisor is the charge nurse, and he is very hard to find because he is busy placing patients and taking the admits that the nurses on the unit cannot take because they are swamped, and pulling sheaths because nobody else on our shift is trained to do it, and nobody has time to take away from their patient load to be trained to do it.
I worked an entire eight and a half hours last night with not a single break, not a bite to eat, not a sip of water, and not a potty break. In fact, I am on my period and did not even have time to change my pad, and could actually smell myself by the end of the night. It was humiliating and demoralizing. I had to stay over a half hour because my relief for one of my patients was a no-show, and the nurse assigned to take report on the patient had absolutely no sense of urgency about doing so. So please do not try and insinuate that we up on the floor do not understand what it is like to be busy.
It is a matter of mutual respect. I will respect your position and your need to get the patient stabilized and out of the ED as promptly as you can, and all I ask is that you respect my need to have some semblance of control over how my time is used. If we respect one another, and have an attitude of cooperation, then things will be much better.
I have taken report from ED nurses while dancing around trying to keep from peeing my pants, then running to the bathroom as soon as they are off the phone to relieve myself. I have put off my dinner break while starving and hypoglycemic, just to be sure I can take report and accept the patient from the ED. I have set aside my own needs, both basic physical needs and getting patient care done for my other patients, in order to accomodate the ED nurses. So please, do not assume that you, the ED nurse, have a monopoly on being far too busy than any person should.
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jenfromjersey
44 Posts
Having worked on med-surg and tele floors in the past in my current hospital, I have the luxury of knowing many of the nurses I am giving report to. This makes it easier for me when I call because they can't pull the "you don't know what it's like on the floor" crap. Newer ones try but I always remind them that I've worked both sides so cut the crap. It's not fair to the ED patient who now has a bed after 8 hours of working up and 2 hours of waiting that he needs to wait even longer because the nurse won't take report (their in the bathroom, theor on lunch, they're in a room with a pateint, they're discharging a patient, they just got a post-op, etc, etc,).
As far as orders go, I am pretty good at getting them started. Not just from a teamwork perspective but from a length of stay perspective. The way I see it, the longer patients stay in the main hospital, the longer I have to wait for beds. If I can send down the extra labs the specialist wants or get the MRI checklist done and get them down for the test BEFORE they go to the floor..the faster the results come back and sooner they will get discharged. If they wait til the next day to get the labs drawn and tests done..that's one more day they are waiting..adding to backlogs in ER holding.
Granted, if I have critical patients then the routine orders are completely ignored while I stabilize someone's breathing/BP/etc. However, I do try to get as much done as I can. Many times when I call to give report I'll say "Look, I've done everything already..no meds are due til the next shift and they're completely comfortable. What's the problem?" I think the floors are so stressed that they are gonna get a trainwreck from the ER with nothing done that they already are giving grief before they even hear anything.
As far as physical assessments go when giving report...I have no problem giving MY assessment but I always hate this line of questioning because I expect YOU to listen to his lungs when he gets there not just assume that because his wheezing cleared after 3 treatments here that he will still be that way in an hour when he gets to you. He may have had +1 dependent edema when he arrived but he has had his legs up on a stretcher for 8 hours and now he looks a lot better. I'll give you MY head-to-toe but that doesn't take the place of YOUR assessment when he arrives..patient's conditions can change rapidly in the first 24 hours.
That being said, I do go above and beyond to initiate orders, call in consults, etc. It not only helps out the floor, but the patients as well.