Surgery floor nurses

silverbells_star · Mar 12, 2013

Where i work, ER and PACU often do this to us, some days they even call report early, but then the patient doesn't show up until 5 minutes before shift change or after, so we're in the same boat. Thankfully, we haven't had any bad outcomes. Often though there is some snarkiness between shifts on who should be responsible for checking the patient in. I can appreciate that neither department can hold patients until a better time for the floor, but it seems to happen so often that we get the impression that they are holding onto patients until shift change so they don't have to take any new ones.

sarah

SionainnRN · Mar 12, 2013

As an ED nurse we have no say in when we transfer pts, usually we try our hardest not to do it during change of shift, but when you have pts in the hall and 15 in the waiting room, when we get a room we gotta move 'em. I've also worked on the floor so I know how much it sucks to get a pt at change of shift. Maybe when one comes during that time, the charge nurse should be the one to tuck them in and make sure they are stable until their nurse can do their assessment.

SoldierNurse22, BSN, RN · Mar 13, 2013

At my previous hospital, we didn't take transfers between 1815-1930 / 0615-0730. They actually made it a policy.

It made a HUGE difference after we had an ICU transfer try to code when they arrived on the floor at 1845. That and several other instances basically forced the leadership's hand in the matter.

Roseyposey · Mar 13, 2013

Okay, I'm going to talk from the other side. I am a PACU nurse. We don't transfer during shift change, which is from 1845 to 1915. I do not "drop" patients in room; I do not leave the patient's room until an RN comes into the room, which I think is a great policy - that way we are both laying eyes on the patient at the same time. I plug in, set up, transfer beds, and do as much as I can to help make the transfer smooth. I will go grab warm blankets for you, I will grab a cup of ice, I will help in any way I can and that I have time for. That being said, the problem we run into is that shift change starts to inch out in each direction. 1845 turns into 1830, 1915 extends until 1940. I try to be reasonable; I worked the floor once too. I do not call at the stroke of 1915 expecting to transfer immediately. I have, however, had nurses complain when it is 1815 and I have a patient ready for transfer. Is it fair to keep a patient, at a premium cost, for another hour to 1.5 hours? We will start calling at 1800 and have the floor nurse ask for just three more minutes. Well three minutes turns into 45, and then we are told that it is shift change and they won't take any patients. When patients come flying out of the ORs at the same time, there is no shift change, there is no nurse off the floor, there is no hang on I'm in a room, passing a med, etc., etc. I have a limited number of PACU bays; patients who are recovered need to be moved - patients are absolutely not held in the OR.

I try to find out who is taking my patient and give them a head's up 15 minutes before I am going to call report so they can be ready - sometimes it works, many times it doesn't. I want my patient to be well-cared for, so I want the receiving nurse to be prepared to care for them.

We don't have a "shift change" time in the PACU; we stagger in and stagger out. Maybe someone smarter than me can come up with a solution to this problem; it just doesn't seem fair to the patient to be transferred to a nurse who is angry that they were transferred to them, nor is it fair to the patient to have to pay for our convenience. I have the feeling with the changes to healthcare reimbursements, premium charges like PACU will be examined even more closely.

SaoirseRN · Mar 13, 2013

Teamwork is key and so is communication. I do what I can to accept my patients back from PACU as soon as I can. In turn, if I need a bit of time they are usually able to accommodate that. Same with ER admissions. I take them as soon as I am able, so when they call to give report, they believe me if I say I need half an hour. Likewise, if PACU or ER calls and says they have an emergent situation, I will take that patient now so they can focus on the impending crisis. I realize not everyone does this, but I try to be consistent with it, and have even had supervisors say, "If Saoirse needs half an hour, she means it."

dah doh, BSN, RN · Mar 13, 2013

Everyone drops patients off near shift change; ER, PACU, ICU, OR, med-surg, etc. At my hospital, ER and PACU are notorious for it. ER because they have to get their patients out ASAP because there's usually another patient in the bed before the nurse even gets back from transporting the first patient...at least that's what happens to me when I work ER. PACU can get busy too, but they usually have another patient coming in or just want to go home when it's their call shift. However they do help set up the patient prior to leaving. OR...it's a direct recovery in ICU or a dump of crashing patient. For ICU, its usually a staffing issue...no nurse to care for patient the next shift...and ICU will still admit from the other areas of the hospital if the patient crashes regardless of staffing issues. For med-surg, it's usually a crashing or unstable patient. It doesn't really matter what unit the patient comes from or why: we're here to care for the patient so just help your fellow nurses out and go with the flow!

BSNbeauty, BSN, RN · Mar 13, 2013

I've been on both sides of the fence. If I'm in the ED and I can wait to transfer after shift change I will, and most times I did this. I know what it is like to get a patient during shift change on the floor and patient care does suffer. Ofcourse, if the patient is really sick and going to ICU then yes, the transfer should take place right away. I cannot speak about surgery or OR nurses. I'm sure there is probably no way around it, depending on the how many cases they have.

This is hospital nursing for ya. I already prepare each shift with the mindset that a possible transfer could come at change of shift. I'll do what ever I can documentation wise but then the next shift will have to complete the admission. We are dealing with people here, and not everything could run on a perfectly timed schedule.

Bringonthenight · Mar 13, 2013

This happens all the time to my floor it is so irritating and dangerous. The PACU/ED nurses where I work just don't seem to understand the importance of an un interrupted change over, I have even had a PACU nurse say "well i need to go home it's near the end of my shift I'm bringing the patient up now". Oh and our floor nurses don't want to give report and go home on time either? Doesn't matter what we think, hospital policy dictates the change of shift is not an adequate enough reason to delay the transfer of a patient.

I also hate when they call and say they are on their way up so i get all prepared, set the room up etc and then they don't show up for an hour- when they finally decide to show up there's no apology or explanation. I get they could have had an emergency to deal with, but how about a call to let me know "hey its Jane from PACU again, sorry about the delay on bringing up Patient X, we just had a code blue, We are on our way up now". Yet when they show up and they don't find a nurse in the room ready to take hand over they go ballistic and write us up regardless of the chaos we're dealing with: fall/angry Drs/ emergencies. There's definitely a superiority complex with the pacu nurses I work with. They are always rude/give attitude. I respect their unit and their nurses. I'm always polite. Yet they get to play by their own rules.

My post just turned into a vent. Sorry everyone. And to those PACU/ED nurses who are going to flame me, keep in mind I have worked in both specialties and understand how critical they can be and how you're all pressured to move patients out quick so you can get the fresh ones in.

I'm simply referring to the nurses I currently work with. Poor attitude should not be acceptable in a caring profession like nursing.

MJB2010 · Mar 13, 2013

Well looks like things are going to change. The patient from last weeks incident is on a vent. The pacu nurse has been suspended for leaving the patient without anyone there to receive them and there is a big mandatory meeting we all have to attend about the incident. The patient was transferred to icu and then had a heart attack. The H& H was critically low. The family had been left in the room with the patient (and no staff) and they were the ones that saw all the bleeding and ran for help. Bad all around! Sad that this is what it takes to change things. The weird thing is, the pacu nurse had called to give report, the nurse was unavailable, so another nurse was handed the phone to take report. No one knew she had taken it, until well after it was too late. Thats what happens when everyone is busy during changeover. Glad I was spared from being directly involved.

wooh, BSN, RN · Mar 13, 2013

Perfect example of nothing changing in a hospital until it costs the hospital money and/or a patient gets hurt.

Roseyposey · Mar 13, 2013

I'm not going to flame you. I understand the patient safety issues regarding shift change. Nobody should be rude; I don't understand why nurses don't support each other better. It is courtesy to inform about delays. Also, you struck one of my nerves regarding the write ups - that is an ongoing theme it seems, nurses using incident reports to write each other up just for spite. I have, however, been held hostage for up to an hour in a room waiting for a floor nurse to come accept their patient (when they were given report 15 minutes prior to transfer). (for the record, though, I did not write this nurse up. I prefer to talk things over)

Maybe a change that needs to happen is that hospitals shouldn't have every nurse coming and going at the same time? This seems to be a widespread problem. I know in my PACU, we stagger in and out - not one of us works the same hours as the floor nurses to try to avoid this problem.

This happens all the time to my floor it is so irritating and dangerous. The PACU/ED nurses where I work just don't seem to understand the importance of an un interrupted change over, I have even had a PACU nurse say "well i need to go home it's near the end of my shift I'm bringing the patient up now". Oh and our floor nurses don't want to give report and go home on time either? Doesn't matter what we think, hospital policy dictates the change of shift is not an adequate enough reason to delay the transfer of a patient.
I also hate when they call and say they are on their way up so i get all prepared, set the room up etc and then they don't show up for an hour- when they finally decide to show up there's no apology or explanation. I get they could have had an emergency to deal with, but how about a call to let me know "hey its Jane from PACU again, sorry about the delay on bringing up Patient X, we just had a code blue, We are on our way up now". Yet when they show up and they don't find a nurse in the room ready to take hand over they go ballistic and write us up regardless of the chaos we're dealing with: fall/angry Drs/ emergencies. There's definitely a superiority complex with the pacu nurses I work with. They are always rude/give attitude. I respect their unit and their nurses. I'm always polite. Yet they get to play by their own rules.
My post just turned into a vent. Sorry everyone. And to those PACU/ED nurses who are going to flame me, keep in mind I have worked in both specialties and understand how critical they can be and how you're all pressured to move patients out quick so you can get the fresh ones in.
I'm simply referring to the nurses I currently work with. Poor attitude should not be acceptable in a caring profession like nursing.