transferring pts. from ED to floor

pink2blue1 · Jul 4, 2007

I'm a floor nurse and I try very hard to take report when the ED or PACU calls to give it. The fact of the matter is that I do have 5 patients and a lot of the time I am in the middle of something when someone calls. Depending on what I am in the middle of I can take report or not. Like ok, if I am starting an IV and someone calls to give report, I can't just stop what I am doing. If I am taking someone off the bedpan and cleaning them up I can't stop what I am doing. If I can't take the call then, I do my best to call back within 5 mins. Also, if I am at lunch when a call comes, well I can't very well help the fact that the person calling to give report didn't know that I was at lunch. On my floor depending on the charge nurse, she will take report.

On the same token, it seems like at our hospital people tend to want to call towards the end of a shift. I don't mind taking a stable ER patient in the last 30 mins of a shift, but I think taking a fresh PACU patient is dangerous!

It sucks, but it's part of the job. Someone is always going to be un-happy with the way something is done.

bill4745, RN · Jul 4, 2007

In our ED, we fax report. Advantages: 1. A written record of report - no more floor nurses saying they were not told something. 2. No one has to stop what they are doing to take report. 3. The report is more organized because the ED nurse can take a few minutes to go over the chart and write thngs down, instead of shuffling through the chart over and over while giving a verbal.

nuangel1, BSN, RN · Jul 4, 2007

once supervisor assigns bed .we write a transfer note -its a standard form used thru out hospital and is used to give report .floor has 15 min to call with questions.sometimes they do some don't .i usually call speak to nurse receiving pt if no questions pt goes up .for most part it works .if we get repeated delays we call supervisor.

littleRNthatcould · Jul 4, 2007

This topic has been the subject of many a "town hall meeting" or as we like to call them "come to Jesus meetings" at my hospital:lol2:

Having worked the floor, the ICU and the ER, I think I have learned to walk well in the shoes of others. Most of the time, it's not a problem getting patients to the nursing units from the ER. But there are a few nurses that will act so put upon regardless of how much time you give them to accept a patient or what that nurse has going on at the time.

Honestly the biggest complaint we hear in our department is that we want to call report during shift change. What we can't seem to get the floors to understand it that we often apply for a bed at say 1700 and the folks at Patient Placement don't assign a room until 1830. The ER has no control over when we are assigned beds for patients.

I did have one floor nurse leave me on hold for 10 minutes only to yell at me saying, "WE just got a patient from you guys!"

I said, "I'm sorry to push everyone at you so quickly, but hey at least when your beds are full, they're full, you're done!" When my beds are full, I still have 40 people waiting in the lobby for one to be empty":lol2:

At the end of the day, you just have to roll with it. Regardless of department, we're all still a team!

Aggie RN, ADN · Jul 4, 2007

My favorite from ICU is "that patient isn't stable enough to come to us." I've never understood that. I think people say that, thinking we've got the ER doc to write orders for the pt. Well, that ER doc has already turned over care to the admitting doc. So he/she won't even begin to write orders.... "That's not my patient anymore. Call the attending." We then end up doing all the phone calls to get that blood pressure from the high 80s to the low 90s. I also think the unit feels like we're trying to dump a crashing pt. so we won't have to deal with a death.

I'm aware that ultimately this is probably best for the patient... i.e. no delay in care. However, as somebody mentioned when you've got a full waiting room, and ambulances coming at you it's hard not to get frustrated. Plus, the time spent with that one critical takes me away from helping others in our ER right now. So a somewhat catch-22 situation.

Another pet peeve is how our ER process works (which appears to be common). We wind up transfering admits right at shift change. The floor nurses think we're out to slight them. I have no desire to go into detail, but I will just say we aren't looking to dump our patients at shift change! It's just the way our system works (or fails to work).

I have a question in relation to this. My perception is that our department is the most despised in the facility. No one wants more work, and everytime we call our report the floor staff has a bad attitude because our call represents more for them to do. Do others get this vibe?

nrsang97, BSN, RN · Jul 4, 2007

The major thing that aggravates me about the ER is that they call report at 1905 and then we are right in the middle of shift report. Our charge usually puts the kabash on that and tells them "we will take your number and call within 15-20 minutes to get report so that the nurse can at least get report on her other patient." This doesn't happen frequently but once in awhile. Usually PACU is trying to send us someone new at shift change without recovering them first. That is another thing entirely. I also worked the med surg floors and sometimes I couldn't take report right when they called. I was usually in the bathroom,starting a IV, on the line with a attending, cleaning up poo or pee, doing a dressing change,etc. I would ask the secretary if the charge nurse or another nurse could take report for me if I couldn't or if they would take the number and I would call back ASAP.

A thing that aggrivates me is the fact that when I ask diagnosis related questions like pupil size for head trauma the RN doesn't know. I cannot tell you how many times this has happened. I am not perfect but I am not asking you anything you shouldn't already know, and the response is I didn't look let me go and look, or The doc looked at them and didn't say anything so I didn't look. I am asking so I have something to compare to and know about anything abnormal. I did like the written report I got from one hospital I worked at because it was typed. The written reports we get from PACU and ER are terrible because they are handwritten and sometimes hard to read.

I don't think that there is anything we can do with timing because I think that is something for admitting. But if a bed is given to me for transfer I try to wait about 15 minutes before I start to get my stuff together for report. I gather my charts and labs, explain to the patient what will happen and that they will be going to a new room and offer to call family. I then call reprot and if the nurse is unavailable then I ask if I should call back in 10 minutes or may I give report to another nurse or charge nurse. Sometimes it is hard for us to get the floor nurses to take report from us in the ICU. I only had trouble once transferring to the floor. I was transferred to about 5 nurses before someone would take report. I finally said I have to give report to someone becasue PACU needs to send me a post op crani. I hated calling report to the ICU when I worked medsurg because they always put us off. I was sending them someone I couldn't pay enough attention to and I was usually told I couldn't give report because the bed wasn't clean, or the nurse was at lunch, or they thought the patient should stay on our unit.

I do understand where the ER nurses are coming from about needing to clear the bed so someone in the waiting room or ambulance can have that bed. Sometimes we aren't being evasive about taking report we are in the middle of something where we cannot talk. I also understood where the ICU nurses were coming from when I worked the med surg floors. Sometimes we need to put ourselves in the other person's shoes and have a little patience and understanding.

S.T.A.C.E.Y, LPN · Jul 4, 2007

In our ER we call the floor and usually get the "the nurse is busy can she call you back." Most nurses give the floors a break and give them about 30-45 mins to call back before they start to get antsy. At 30-45 mins if the floor hasn't called back, we'll try a second time, and also see about giving report to the charge nurse. Any problems transferring patients, or lengthy delays are recorded in a special book with patients name, and story of the problem. The manager uses this to identify trends among certain floors with admissions. If there is a lengthy delay for transferring, either on the nurse's part, housekeeping's part, or whatever, the hospital now has a new rule. If there are X number of patients in the waiting room, the admitting units have a certain amount of time to accept the patient before the charge nurse is given report on the patient and the patient is sent up to wait in the hall of their new admitting unit, no saying no. If the patient will only be sitting in the hallway in the ED, they can do just the same up on the floor. This rule was started as a means to hopefully to relieve some of the presssure on the ED during busy times.

ERRNTraveler, RN · Jul 4, 2007

I have worked at many hospitals as a traveler in the ER, and I have to say, this seems to be a universal problem. The following are my pet peeves about transferring pt's from the ER to the floor/ICU:

1. It is very irritating to be told a nurse from the floor or ICU can't take report because the bed is dirty, he/she's on break, in the bathroom, busy, etc.... There are other nurses on the floor, SOMEONE must be able to spare 2 minutes to take report.

2. Being asked to wait 30 minutes to bring someone up because "we just got another admission." Um, yeah, let me sit on this patient for another 30 minutes while my hallways & waiting room fill up so that you and your co-workers can check in ONE PATIENT that has been nicely pre-packaged for you by the ER (IV started, foley in, NG in, etc.....). I wish we could tell EMS- "please drive around the block a few more times, we just got another ambulance in....."

3. Being asked things that do not pertain to the patient's condition. Example: being asked about bowel sounds in someone being admitted with pneumonia, etc.... You know what? If my patient is in the ER for respiratory issues, I DON'T LISTEN TO THEIR BOWELS! Does that mean I'm a bad nurse? NO- it means I'm an effecient ER nurse- we do focused assessments in the ER, don't ask me about my patient's ingrown toenails when they are here for pancreatitis.

4. Getting phone calls from the floor 2 HOURS later wondering why I didn't do this or that from the ADMISSION orders. They are ADMISSION orders- if it doesn't say "stat" or "now," it is to be done on the floor, not in the ER.

5. Nurses refusing to take report at shift change. You know how badly you want to give report to the next shift so you can go home? Well guess what? SO DO I! I have no control over admissions waiting until 10 minutes before shift change to give me a bed, but now that I have it, just let me call report so I can go home. My report will only take 2-3 minutes, so it would be common courtesy to NOT make me stay 30-45 minutes late just to give it.

6. Floor/ICU nurses who have a problem with the admission orders, and give me grief about them. Know what??? I DIDN'T WRITE THEM! If you have a problem with the orders, call the doctor.

7. Nurses refusing to take a patient because "they need to go to ICU, CCU, telemetry, another hospital......". The physician specified what type of bed he/she wanted. If you have a problem with this, take it up with the doctor- it is not up to me what type of bed the patient goes to, it is decided by the doctor & by what's available in the hospital.

Thanks for the chance to vent..... Admitted a lot of patients last night, had to deal with a LOT of the above........ :uhoh3:

purplemania, BSN, RN · Jul 4, 2007

I have seen this work the opposite way too. As a floor nurse I knew who was working ER by the way the patients were being transferred! Some ER staff would hold onto a patient in order not to get another assignment, then dump them all at once. Had three come to the floor in the same elevator one time. This was on a unit with only 2 RN's and one CNA working! So it goes both ways. We give report to the charge nurse and get the patients in the room ASAP. Someone besides the primary nurse can get them in the bed & get vital signs.

Ann RN · Jul 4, 2007

In our ER we call the floor and usually get the "the nurse is busy can she call you back." Most nurses give the floors a break and give them about 30-45 mins to call back before they start to get antsy. At 30-45 mins if the floor hasn't called back, we'll try a second time, and also see about giving report to the charge nurse. Any problems transferring patients, or lengthy delays are recorded in a special book with patients name, and story of the problem. The manager uses this to identify trends among certain floors with admissions. If there is a lengthy delay for transferring, either on the nurse's part, housekeeping's part, or whatever, the hospital now has a new rule. If there are X number of patients in the waiting room, the admitting units have a certain amount of time to accept the patient before the charge nurse is given report on the patient and the patient is sent up to wait in the hall of their new admitting unit, no saying no. If the patient will only be sitting in the hallway in the ED, they can do just the same up on the floor. This rule was started as a means to hopefully to relieve some of the presssure on the ED during busy times.

Sorry, but - if you drop the pt. off in the hall of their new unit and a nurse does not accept the pt., that is patient abandonment. OR am I missing something?

aberrn · Jul 4, 2007

My favourite is the CN saying "I don't know who's going to take that pt".

Why not?. Lets see,4 empty beds,at shift start CN says,Nurse A you get first admission,Nurse B,2nd etc,etc..Not rocket science..

ER nurses wouldn't have to call at shift change if,when bed was requested at 4pm,the floors didn't wait until 1830 to give bed # to house super. Who in my opinion should know whats available anyway.