Surgery floor nurses

Nurses General Nursing

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We are continually having issues of patients being dropped to the floor during shift change, when they are not able to get the proper attention in the change over. We have had more than a few bad outcomes, one last week where someone was bleeding badly from their back incision and was dropped at the start of shift change and ended up being transfused all night. Not sure how it ended, not my patient. But you get the idea. Where I previously worked, pacu was not allowed to bring a fresh post op to the floor during shift change due to a patient death, and now I see first hand why this policy was in place.

What is the policy like where you work?

This is just horrible. It is so unfortunate that something like this has to happen to bring about change. It can be a hassle, but I think our policy of the PACU nurse not leaving the room until an RN comes into the room and acknowledges the patient is a good protection for everyone involved.

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.
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Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.

I get in at 1900 so PACU is usually desperately trying to give us patients at the end of their long day. At least that's how it seems. PACU RNs don't come up with the patients, which I think would be really fantastic - no surprises that way. We do phone report but it is often very hurried.

I used to hate the idea of bedside report, but I'm really warming to the idea of it, particularly to the aspect of accountability.

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We have a major problem with this on my floor too. The nurses from recovery and er do not bring he patients up. Transporters do. They don't know or care if the patient is stable. ER likes to send us patients covered in urine ad feces. Got a naked patient a few weeks ago. You really could not take 1 minute to put a gown on someone. Really? My favorite lately is the er telling patients they can't have pain medicine until they get to the floor. The families complain, variances get filled out. Nothing changes. Pacu is better where I work. There are 2 nurses who I know to look out for, who rush the patients out too soon, But for the most part our pacu nurses are great.

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Specializes in Pediatrics, Emergency, Trauma.
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

^Happened to me last night...Got info on the admission at 4 am; got the kid at 6:30.

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We have a major problem with this on my floor too. The nurses from recovery and er do not bring he patients up. Transporters do. They don't know or care if the patient is stable. ER likes to send us patients covered in urine ad feces. Got a naked patient a few weeks ago. You really could not take 1 minute to put a gown on someone. Really? My favorite lately is the er telling patients they can't have pain medicine until they get to the floor. The families complain, variances get filled out. Nothing changes. Pacu is better where I work. There are 2 nurses who I know to look out for, who rush the patients out too soon, But for the most part our pacu nurses are great.

This to me is dangerous. There is no nurse that accompanies the transporter? What happens if the patient becomes/is already unstable during the trip? What can the transporter do in an emergency?

I've never worked in a facility that allows phone handover. It has accident waiting to happen written all over it. Even though it took some adjusting to, I now love bed side report and mandatory documented hourly rounding. Bedside report would have eliminated that other posters scenario where the patient was left in a room and transported to ICU.

The only way changes happen in hospitals is when a major incident has occurred at a patients expense.

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Specializes in Emergency.

^Happened to me last night...Got info on the admission at 4 am; got the kid at 6:30.

This makes me nuts from the er end. We call report, transport order placed and we wait. While 2 1/2 hours is really bad, i've seen it. If it's a tele pt, i often just bring them up myself immediately rather then wait for transport to arrive as i'm going up anyway.

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Specializes in NICU, OB/GYN.

OP, I see how this can be specific to PACU in your situation. But I don't think that this thread should degenerate into attacks on PACU or ER nurses.

L&D nurses were notorious for doing this at my hospital, for instance, and it wasn't always because they were being slammed with new patients; it was because if they got rid of said patient, it meant that they gave report on nobody at all. Consequently, they got to clock out early while the maternity unit nurse stayed late finishing her admission (and after running around for 12- or 16-hour shifts, who wouldn't want to go home early?). It caused a lot of tension and issues between both units, decreased patient satisfaction because patients felt ignored since their needs weren't being attended to in a timely matter at shift change, and it actually led to several occurrences (postpartum hemorrhage being detected late, etc.).

Both units formed a committee to address problems with communication between them (as this wasn't the only issue). This problem was resolved within a month or two after discussing it in a productive fashion. I see that you're already having a meeting to retroactively address a problem stemming from this, but perhaps having a committee that proactively addresses issues is the way to go.

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Specializes in Med/Surg.

Our post-ops are not transferred by a nurse they are transferred by a transporter....and we do not get any kind of report. They come up with a trifold filled out with the meds they were given, what their incision site looked like, IV site, and a written nurse's note if there were any problems.

And at shift change it is very common to see a train of 2-3 post ops rolling down the hall at the same time.

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Our post-ops are not transferred by a nurse they are transferred by a transporter....and we do not get any kind of report. They come up with a trifold filled out with the meds they were given, what their incision site looked like, IV site, and a written nurse's note if there were any problems.

And at shift change it is very common to see a train of 2-3 post ops rolling down the hall at the same time.

This doesn't even sound legal! How do you work under those conditions?

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First of all, I think it's so sad but not surprising that something serious has to happen before changes are made to improve safety.

When transferring a patient there needs to be accountability. One nurse needs to give report to another nurse, who then accepts responsibility for the patient.

I work in Sweden and I've been on both sides, PACU and floor. How we do it is that PACU calls the floor nurses and informs them that patient X is now ready for a transfer. The floor nurses are expected to pick the patient up within 30 minutes. That works most of the time. PACU nurses do not leave the PACU. The floor will send two persons, usually one RN and one aide, sometimes two RNs. (In Sweden we have RNs, BSN and a nurse/aid that scope and education-wise is somewhere halfway between a CNA and a LPN). The PACU nurse gives report and hands over a copy of anaesthesia and post-op charts and the floor nurses transport the patient back to the floor.

As far as shift changes go, our floor shifts overlap. Day shift typically get off att 3.30 or 4 pm and the afternoon/evening shift starts at 1 or 1.30 pm so someone is usually available to take responsibility for the patient. Transporters never ever transfer a post-op patient from the PACU, it sounds like unsafe practice to me.

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