transferring pts. from ED to floor

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Hello Everyone! I've been an ER nurse for almost a year now. I was just wondering what the policy is for your hospital for transferring a patient from the ER to a floor/ICU? It seems like every time I attempt to give report I'm told "The nurse is busy. Can she call you back?" or "That nurse is at lunch and the nurse covering her has 10 patients already and can't possibly take another." It is very frustrating to hear this. I completely understand people get busy, but there's a point where enough is enough.

Specializes in Emergency.
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?

I don't really know the details of how this works, since I've never personally had to do it, but I've heard it mentioned a few times. I think the house supervisor tells the charge nurse that this 'rule' has been enacted, she has to take report, and when the appropriate nurse is available, she can then give the nurse the report. So the patient goes to the hallway spot, under care of the charge nurse, until the floor nurse is ready.

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Thanks to everyone who responded! It is interesting to hear the same problems in many facilities.

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Specializes in LTC.

My only problem is when the ER is told the nurse cannot take report, brings the pt up anyway, then stands there sighing, tapping thier feet, and acting all put out that they had to bring this pt up and stand there waiting to give report. Did they think we were kidding when we said that we couldnt take the patient at that particular moment. The only thing worse is when they simply grab a piece of paper, scribble a quick report, leave it on the bedside table or at the nurses desk, and just leave.:angryfire

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The thread will probably break down into a fight between ER nurses and floor nurses. I never worked the floor when I was in the hospital, except 4-5 times when I was pulled. I was always either in the ER or ICU. I understand the frustration of not having a bed, having said that, there is no way I would work the floor unless I am starving. Way too much to do and not enough nurse to do it.

I would worry about faxed reports, I often find in my job faxes dont go through for one reason or another. No paper, out of ink, etc. What would happen if you faxed a report then dropped the patient off and the fax did not go through?

It is all bs anyway. Admissions should not be the work they are. Lets see, we have to make sure we ask and document the medications you take at home (even though their private doctor most likely knows and the ER nurse has already documented these). Oh yeah we need to ask a bunch of questions, then add these up to determine what consults we need.

I am sorry, just too bitter about nursing the way it is today. Anyway back on the original subject, it is very easy to get frustrated with the floor, but 99 percent of ER nurses would never choose to work the floor.

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Specializes in Emergency, Trauma.
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:

EXACTLY!!!!!

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Specializes in Emergency, Trauma.

We call the floor, if the nurse is busy then we ask to be transferred to the charge nurse to give report...amazing how many times the nurse will suddenly be able to take report rather than pass it to the charge. If for some reason, the charge or nurse can't take report, then we tell whoever is answering the phone that the patient is being sent up anyway, the nurse can call for report when she's ready...this rarely happens, but occasionally we have to revert to doing this (never on an unstable pt). I very rarely have problems calling report to the ICUs-so in the rare instance the ICU nurse can't take report, I believe her and have her call me back.

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Specializes in pre hospital, ED, Cath Lab, Case Manager.

When I worked ED we would fax report then send the pt up 15 minutes later. We developed this when we were building a new ED and had fewer beds. The ED nurse had to complete the initial nursing assessmnet for the admission.

I totally agree with ERRNTraveller - great post.

We found that some beds lisited as dirty were actually clean- we changed the system to have housekeeping call the beds in as clean & ready for admissions.

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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

The above would never happen in my ER. The second we get a bed, we have to call report no matter what time it is. I do not know one charge nurse in my department that would let any staff nurse wait until shift change to call report just to "hold on to the patient". There are times that If I am in another room working a code and I get a bed on one of my stable patients, my charge nurse or another nurse will call report if I am unable to do so. However, "holding on to a patient", in the ER just does not happen. Especially when the waiting room and hallway is full and there are ambulances comming in and three helicoptors are scheduled to do hot off loads with in the next 15 minutes.

When we get a bed from our H.S. we call report upstairs. If that nurse is unable to take report we ask to give it to the charge nurse. Once we call report we take the patient up in 15 minutes.

There have been many times when we have gotten a bed at 17:00. Call to give report and "the bed is dirty". Somehow the bed would not be cleaned until 19:00. Not my fault it took house keeping two hours to clean a room. We started monitoring this by sending up the nursing assistants to see if the room was actually dirty. We found that 8 times out of ten the room was clean. We initaiated a stat housekeeping policy in my facility that if the housekeeper on that floor was busy we could send another team to go and clean the room.

Also discharges are a floor nurses last priority. If a patient is not discharged until 18:00 and the room is cleaned by 18:30, guess what time report will be called? It is always a no win situation. As an ER nurse you are the red headed step child of the hospital. You try to do the best you can with what you got. I have never had someone be happy to hear from me. However, on the opposite end we have a very good relationship with our EMS and flight teams and depend on and respect them to give us information to plan care for the patient. I couldn't imagine having EMS or flight standing in the next room with a patient and tell them, "I am too busy doing this dressing change to check in that patient right now". Also cannot tell the helicoptor to circle around a few more times until I finish eating my lunch.

I don't know what the answer is. We just have to try a respect each other and understand. Even though it's so hard sometimes.

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Specializes in ER, IICU, PCU, PACU, EMS.

On my floor, we usually get a heads up about a transfer from the ER or ICU. I do my best to get the room as ready as possible prior to receiving report. I can't stop doing the things that need to be done: dressing changes, meds, wiping butts, etc in order to wait for a report. Sometimes I am at lunch when I get the call. We carry department cell phones, so...I take the report while I'm eating - just let me get a sheet of paper to write information down. Other times, I may be up to my wrists in excrement, I'll call the ER/ICU nurse right after I'm done to get the report. Rarely does the charge take report for a nurse unless there's some type of emergent patient situation. I want that patient ASAP because I'll have a minimum of an hour of paperwork and all the other crap that goes along with just getting orders verified and meds on the MAR while juggling all the demands of 4 other patients. I do my best - the sooner the patient gets in the hospital, the faster s/he can get out. And I know that for every transfer from the ER/ICU, there's a boat load of patients in the wings waiting for attention.

I couldn't imagine having EMS or flight standing in the next room with a patient and tell them, "I am too busy doing this dressing change to check in that patient right now".

I spent 9 years in EMS and couldn't imagine that either. Everything I needed in an EMS situation was close by, no doctor's orders needed - I could just give the care I deemed necessary under the protocols and I could give my full attention to one patient. Now times the patients by 5 and take away the other paramedic partner and I wonder if they'd say the same thing.

I hope to one day elevate myself to "the red headed stepchild" instead of being the doormat of the hospital. I am literally counting down the days to get off of the floor. Unfortunately, I have to shut up, do my time, then punch out and find something I would like to do.

>

I wish there was some way to make everyone happy and have a flow of patients that would suit us all.

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Specializes in ED.

I have spent a year and a half in med/surg and am about to take the leap into the ER. Like others have said some of the nurses get pretty put out about the thought of ER calling report. Perhaps faxed sheets would be the way to go. I always just thought that it was my job to take new admits if I have open beds but hey, who am I.

And one problem that we do have is that as soon as we hear that we are getting a patient, get the room number assigned and tell the nursing supervisor, the ER is calling within 2 minutes most times for report. So if we are at lunch there is nothing we can do because we really have no idea, although I will be more than happy to take a quick report for a stressed and busy nurse to help them out some. If I have time to settle them into the room while the other nurse is busy I'll do that too.

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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:

:lol2::lol2:I want to fax your post with my report & admitting orders!!:lol2::lol2:

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Specializes in Peds, ER/Trauma.
:lol2::lol2:I want to fax your post with my report & admitting orders!!:lol2::lol2:

GO FOR IT! ;)

One more gripe.... last night I admitted someone to ICU for acute renal failure. He had a foley in, but did not produce any urine until just before I was going to take him upstairs. So right before I left the ER, I sent his UA to the lab. The ICU nurse wanted to know why it took 5 hours from the time the UA was ordered to the time I sent it- HELLO???? He's in RENAL FAILURE! You're lucky to get any urine at all!!!! Also the same pt. (from nursing home) had a duoderm dressing to a sacral area decubitus. The ICU nurse was upset that I didn't remove the dressing to inspect it & report on the stage of the ulcer...... :uhoh3:

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