The War with the Floors

[zima60]

I am writing a paper for school on the all out war that goes on between the ER and the floors. I have worked at several hospitals for the last 27 yrs-it's always the same. They do everything in their power NOT to take report. Is this a problem for you? Please tell me how you handle this at your hospital. Does your administration pamper the floors? Do you utilize fax reports? Do you have a time limit for patients to be sent to the floor? What is working in your hospital? Appreciate your input! Pam

[traumamomtx]

At hospital we have eliminated giving a verbal on the phone from ER. Now they fax a detailed report: meds, hx, abx, everything and just call and ask if we got the report. They send the patient once they are told "yes we received the fax". If we have any questions we call and talk to the admitting nurse; but usually the report is pretty THOROUGH.

[zima60]

Thanks for your reply. JACHO (sp?) will be coming down on faxed reports soon-they want face to face. Our problem is we can't get the floors to call us back OR (and this is new lately) they change the bed assignment which means we have to call another floor and start the process all over!

[ukstudent]

I know the problem from the floor side. There has been too many occasions to count when we have been expecting a patient from the ER and they don't arrive for hours. The Doctor (Hospitalist) is asking where the patient is because they wrote the order to admit 3 hours ago!! And amazingly, 5 to 10 minutes before shift change here is the ER wanting to give report. At that time they get to wait until the new shift is on the floor to take report. If you are have trouble getting the floors to give report, is it happening all the time or worse during certain times such as shift change. Just a thought.

[Tweety, BSN, RN]

Our administration pampers the ER. We are not allowed to refuse report, in fact we get a faxed report. They call to see if we've received the fax and bring the patient up in a manner of minutes. Control is taken out of the floors hands and given to the ER.

I've seen both sides. I've seen the floor nurse play games with the ER and refuse to take report until they are good and ready00 I also recently did an observation in the ER a few weeks ago and sure enough before the 11pm charge nurse arrived they were scrambling to get patients up the unit, and I saw four admissions get transferred to the floors at 10:45.

Good luck with your paper. It's an age old problem. This thread will probably go no where, with floor nurses flaming the ER and the ER flaming the floor nurse. :)

[Tweety, BSN, RN]

Thanks for your reply. JACHO (sp?) will be coming down on faxed reports soon-they want face to face. Our problem is we can't get the floors to call us back OR (and this is new lately) they change the bed assignment which means we have to call another floor and start the process all over!

Our faxed reports is documentation that there is effective communication and is a permanent part of the chart. JACHO requires increased communication between units, this can't only be shown through more paper work. So I don't see that JACHO is asking for face to face, as there is no way to "prove" this is an effective report.

[carachel2]

When we received a bed assignment, we (and the floors) have 30 minutes to call report. They MUST accept unless they are running a code. I have been cordial more than a few times when the secretary says the nurse is in with a patient and such......a little common courtesy goes a long way. But both the ER and the receiving floors understand that the 30 minute time frame works both ways.

[LisaRn21]

We def have this problem... I work on the floors and it seems like we will get told about an addmission at 12 and we won't hear anything from the er until 230 ... or the best is the child walks onto the floor (without orders) and your like I didn't get report and the er nurses sent the respiratory therapist or an aide and they are like I'm just dropping him off .. so you call the ER to yell at them and they say they faxed report and your wanna say "what am I a mind reader? the fax machine is at the other side of the hospital lol" then you go get the fax and all it says is Diagnosis: RAD lol and your like ok?? what else? lol so by this time you wasted 20 minutes trying to hunt down report and you finally give up and try and ask the parents and kids and then go back to the chart... its so stupid.. there needs to be a policy in place.. like no one can be transfered from 230-330 630-730-and 1030-1130 and you shouldn't have to wait hours and hours for pts!!!

[JMBM]

Like many facilities, we use faxed report forms for medical floors (with a follow-up call to confirm) and telephone report to PCU/ICU. Also, having worked on both "sides" at different facilities, I don't see management "pampering" either floors or ER. I also agree that categorically flaming the "other side" is tiresome and useless. In 80% of the cases, report and admits go just fine. So where are the trouble spots? Well, most are when the ER or the floor is getting slammed, including shift change times. Say, in the ER, we'll have a dozen or two in wait, a couple ambulances pulling in and the helo 10 minutes out. We've gotta get folks upstairs NOW! Or, upstairs, the one RN is trying to get meds in, plus the two sterile dressing changes, housekeeping isn't finished cleaning and shift change is only 45 minutes off. Or then there's the patient all packaged up and ready to go, report given, when the doc walks up and changes the orders to give a couple of IV antibiotics before they go. Now, there will always be that "who cares what their problems are" ER nurse or the "if I don't call back, it'll go away" floor nurse, but mostly its just hard-working, good nurses with too many patients and not enough hands. Flaming doesn't help. This is where we need to take a deep breath, figure out the problem and if there's a way to solve it.

[TazziRN, RN]

We don't have a policy in place but usually the problem is with the docs. We find out the pt is going to be admitted and start the process, but we can't call report or transfer the pt until we have orders in hand, and we can't get that if the (&*^%$@! doc is trying to get all the other pts in the ER seen and orders started before sitting down to write the admit orders. Or the admitting doc says he'll come in and write orders but then doesn't show up for an hour or more. OR.....orders are written, report is called, pt is being unhooked from ER equipment, and the admitting doc walks in and wants to examine the pt and amend the orders.

Usually, once we call the floor we can give report and then it's a matter of if the bed is actually ready, i.e., if there is no one in it and the bed is clean and made up. We do have one or two nurses who do everything they can to postpone admits, but then we just call the house supe and she steps in.

[ANnot4me]

I, too, have worked in both areas. In neither case is there a nurse sitting on his or her bum and eating bonbons. I sometimes have to tell my colleagues who have never worked on the floors that if they think it is so easy, then why are they not working med/surg? I just refuse to get emotionally involved in the process problems of the hospital: I try to handover and if I am not able, I inform the charge nurse and document. My job done and on to the next task.

[sjt9721, BSN, RN]

Like many facilities, we use faxed report forms for medical floors (with a follow-up call to confirm) and telephone report to PCU/ICU. Also, having worked on both "sides" at different facilities, I don't see management "pampering" either floors or ER. I also agree that categorically flaming the "other side" is tiresome and useless. In 80% of the cases, report and admits go just fine. So where are the trouble spots? Well, most are when the ER or the floor is getting slammed, including shift change times. Say, in the ER, we'll have a dozen or two in wait, a couple ambulances pulling in and the helo 10 minutes out. We've gotta get folks upstairs NOW! Or, upstairs, the one RN is trying to get meds in, plus the two sterile dressing changes, housekeeping isn't finished cleaning and shift change is only 45 minutes off. Or then there's the patient all packaged up and ready to go, report given, when the doc walks up and changes the orders to give a couple of IV antibiotics before they go. Now, there will always be that "who cares what their problems are" ER nurse or the "if I don't call back, it'll go away" floor nurse, but mostly its just hard-working, good nurses with too many patients and not enough hands. Flaming doesn't help. This is where we need to take a deep breath, figure out the problem and if there's a way to solve it.

:yeahthat: ...one of the best posts I've ever read...