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

[danigirl58]

At my hospital we now use faxed reports however ours isn't very thorough. At times its hell because we will have just discharged a pt, the room isn't clean and nurses may be on breaks. We tell the ER this and they say they will wait until the receiving nurse calls down, but more times then not we wind up finding a pt on the ward and have no idea when the pt came to the unit because the nurse or desk wasn't informed that the pt was brought up or better yet we didnt know that a report was faxed up...... can you tell i'm not a fan of faxed reports

[vampireslayer]

We also used faxed reports and call to make sure they got the fax. Our problem, like mentioned previously, is that we are supposed to get the patient out of the ER within 30 minutes of having received a bed assignment. Course that rarely happens, but that's the goal.

I'm a midshifter, I dont' work the standard 7a-7p, so "shift change" means very little to me. I know I should try to keep it in mind, but usually I'm oblivious to the shift change going on! (Don't the floors have "midshifters"? Maybe they should, and those should be the nurses who get the patients that come up at shift change time!) And the problem is also that nothing happens instantaneously...once we are given a bed assignment we do a last set of vitals and fax the report. That could be a good half hour or more before shift change. If the patient could go up immediately they might get settled in with no problem before shift change. But what happens then is that the chart has to be copied, then transport has to be called, and the patient has to be hooked up to a monitor for the transport, if O2 is needed, the oxygen tank might have to be replaced before we can go. Then the nurse has to be available (for ICU and tele patients) to go with the patient and the transporter. If it's a vented patient, then respiratory has to go too. So getting all these things done, getting all the people in the same room at the same time to take the patient up takes time. And of course there's always those last minute orders, or the patient that WAS "call for orders" is now having their orders written by the doctor who decided to go ahead and write them since he happened to be down in the ER anyway. So delay, delay, delay, and all of a sudden it's shift change as we make our way upstairs.

We honestly don't try to take patients up at shift change...and honestly, since most of the ER nurses are 7a-7p or 7p-7a, they don't want to be transporting at shift change either. I guess a lot of those patients going up at shift change are the ones that don't need to have a nurse accompany the transporter, or like me, have a nurse that's a mid-shifter.

VS

[nialloh, RN]

My floor and ER get along most of the time. I'm on a tele unit, and the most pt's we admitted in one day was 21. It is a 40 bed unit. This means we don't have time to play around. If the ER calls to send a pt after being assigned a bed, we have 15 minutes we can tell them to wait and they send anyway.

But as I said, we get along well (most of the time). If we are ready, we tell them to send now,or if we are getting slamed, they often give us more time. This means that we arn't in a rotten mood when the pt gets there, and they get their pt's in faster.

If floors and Er's were more understanding of each other, it would be much smoother.

[jeff121]

It's funny to read these posts and realize that the "floor vs. ER" feud is everywhere...lol. I work at a level 1 trauma center and we have in the past had problems with the floors taking our admits. We fax report ahead and then call to a) make sure they got report and b) to see if they have any questions. This USUALLY works pretty well, but occasionally we'll get a response that "no we didn't get it" despite the fact that the confirmation says that they did. We then re-fax it and most of the time it amazinngly goes thru. The only time we don't fax report is when the patient is going to MICU,TICU,PICU,NICU or some other critical area. In this case, we call to make sure the floor is ready and they get bedside report there. There seems to be fewer problems with these areas vs. the faxed reported ones. The fax report then becomes part of the chart. I guess we'll always have some nurses who feel like we are just dumping our patients on them but we see over 300 patients a day and they obviously all don't go home...lol. :argue: :argue: . Most of the time however, the transition goes well. I think that we all (ER and floor) need to remember that the patient doesn't care about faxed reports and shift change or any of that. They just want to get into a room where they can get some rest. Isn't that what's important??? PATIENT CARE!!!!

[JessicRN]

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.

Our facility just instigated this for the 2nd time the first time was last year and It did not work.We have the same system. Our problem is the nurses on the floor keep saying they did not get the report. I sit on the phone as I fax it so I know they got it. Yes we have many situations where the bed is changed but unless it is changed to a different floor the pt goes up.

[SouthernLPN2RN, MSN, RN, APRN, NP]

When I worked the floor, any nurse available would take verbal report. Then they went to faxes. I personally prefer verbal, but a fax with a contact person and number is always nice. :)

[zima60]

Thank you all for your input. We all know this is a problem but WHY? and WHAT can we do to resolve this? We have had meetings with the floor nurses and came up with a 30 minute rule-no ER reports between shift changes and hired an admission nurse to do all the paperwork in the ER. Problem still exists. The floors are not happy when admissions come at end of shift but here's the reality. The doctors work shift work too and they are the ones writing the orders-so end of their shift is when the orders get written. We have also instituted a 30 minute timeframe for residents to see patients in the ER-then the ER doc writes transitional orders (doesn't happen as it should) I am very interested in hearing the other side of the story from the floors (my collegue from the floor will be writing her paper on thier side of it) WHY do you as ER nurses think this war exists? Thanks again! Pam

[Tweety, BSN, RN]

We honestly don't try to take patients up at shift change...and honestly, since most of the ER nurses are 7a-7p or 7p-7a, they don't want to be transporting at shift change either. I guess a lot of those patients going up at shift change are the ones that don't need to have a nurse accompany the transporter, or like me, have a nurse that's a mid-shifter.

VS

On my floor our shift change can be 7a, 3p, 7p, 11p and 7a. Asking the ER to mindful of such shifts changes is asking a bit much because chances are the patients are going to come at an inconvenient time for us. Getting an addmission rocks my world no matter when it is, I just bite the bullet and take the patient whenever the ER wants to send it without agruement, and then move about my business. No need for me to get bent out of shape about it.

[RN and Mommy]

We (the floor) had a big problem with the ER this week, they called to ask if a room was clean and was then told "No, the patient is still here". The next thing we know is a new patient is on a cart outside of the room and they are saying they were told that the room was clean. They wanted us to move the previous patient out into the hall to finish his lunch, then get a stat clean on the room while they left the new patient lying on the cart in the hall (we were full). We were like noooooo. It actually escalated to having the house supervisor being called for her to say, "Absolutely not! Take that patient back to the ER!" This wasn't the first time that has happened either.

[rninme]

I've worked in both the ED and ICU. When working ED, we call and give a "heads up" to the admitting floor....you'll be getting this patient. Seems to work well. When working ICU, I really appreciate the notice. It gives me time to get everything done for my other patients if possible, or call for help if I am going to need it. My goal is to get the new patient in the unit ASAP. There are nurses that will "shuffle off" an admission until change of shift...I've been on the receiving end of that before too...and I don't like it. I've stayed over to help the next shift with new admissions that come at shift change and they in turn have stayed to help me. I have also gone to the ED from ICU to help when things are in chaos. Fortunately, where I work..there doesn't seem to be an ED/Floor/ICU battle, just certain staff members that are a problem.

[DONN]

I work on the floor and we are never busy. We just sit around the nursing station and wait for the ER to call and then we delay delay delay until w are finished with our card game and beer. We are only there to fill water pitchers and tell the people we cant help them with anything. We also know that the ER is the only place in the hospital that actually works hard so try not to be too ticked off with us floor nurses because we are busy doing "other" things and we try to work in a little nursing during commercials, or right after our naps...................................

[rninme]

I work on the floor and we are never busy. We just sit around the nursing station and wait for the ER to call and then we delay delay delay until w are finished with our card game and beer. We are only there to fill water pitchers and tell the people we cant help them with anything. We also know that the ER is the only place in the hospital that actually works hard so try not to be too ticked off with us floor nurses because we are busy doing "other" things and we try to work in a little nursing during commercials, or right after our naps...................................

:biere: TOOOOOO funny!!!