When will everyone understand things are different in the ER

LiLev · Jul 16, 2017

I don't know about Mayo clinic but I know in my hospital when we are really busy or most of the beds are filled with 'holds' the triage nurse orders labs and diagnostics and sometimes the doctor sees them in the phlebotomy/EKG room just off of the waiting room. I've had it happen quite a few times that I will get a new patient and before I can even meet them they are discharged or admitted.

Sorry, meant this as a reply to the post about being astounded by the Mayo clinic moving patients in 30 minutes or less, didn't 'reply' properly.

Kooky Korky, BSN, RN · Jul 17, 2017

I don't butt heads over questions that I can't answer... I just say, "I don't know" and leave it at that.
What I find frustrating is the refusal to answer the phone to take report followed by protestations of "I didn't know that I was getting that patient" followed by "You'll have to wait so that I can find a bed for that room" and all the other stalling tactics.

It seems like having a bed in the room would be fairly important.

For OP: For nurses to still be facing this kind of situation in our modern era is ridiculous. It shows a total lack of leadership by those who should be eliminating warfare between the ER staff and floor staff. It is disrespectful of both ER and wards.

Kooky Korky, BSN, RN · Jul 17, 2017

Floor nurses annoy me to no end with their stupid questions they want on report. I mean i can see the relevance to some but a lot of them they ask just so they can bypass half their charting and assessments by just going off of what you tell them.

They would not be asking if they didn't need to know.

And if you do know the information, why would you not just share it?

You are rude and/or lacking in awareness to consider your colleagues' questions stupid instead of trying to comprehend why they might ask if the pt has had a flu shot (because they have to give one if he hasn't and it's during flu season) or if he's voided or has bowel sounds x4 quadrants.

Julius Seizure · Jul 17, 2017

I don't butt heads over questions that I can't answer... I just say, "I don't know" and leave it at that.
What I find frustrating is the refusal to answer the phone to take report followed by protestations of "I didn't know that I was getting that patient" followed by "You'll have to wait so that I can find a bed for that room" and all the other stalling tactics.

I don't know about other places, but in the unit I worked in, that was (sadly) sometimes an actual problem. If there wasn't already a bed in a room (for whatever reason), we couldn't just go get one ourselves, we had to call housekeeping to deliver one to the room. We also weren't supposed to have a patient brought up until a bed was present for them. So, yeah, it was sometimes an actual thing that delayed a patient being transferred and it wasn't because the nurse was trying to stall. Which is crazy, and definitely evidence of a systems issue that needed improvement!

*One can, of course, still take report on the patient, but the patient just couldn't actually be delivered to the new room. Not the fault of nurses on either end -- and yet, who gets dinged for it? Like Kooky Korky said, the fact that this kind of this is an issue is the fault of people above my pay grade.

Julius Seizure · Jul 17, 2017

I think that many people (ER, ICU, and floor), seem to have frustration over the kinks in the system, which is totally fair. Hopefully most of us don't turn that frustration into thinking our fellow nurses in other specialties are stupid or asking stupid questions. They aren't stupid questions, they are just being asked at the wrong time or of the wrong person. I totally agree that sometimes walking a mile in the other nurse's shoes would help with gaining some perspective of the other side. I think its worthwhile to remember that this is largely a systems problem and an education problem - not a "stupid nurse" problem.

CardiacDork, MSN, RN · Jul 17, 2017

As an ICU Nurse myself, and as fellow critical care nurses --- I understand the absurdity of some questions when you spend 90% of your shift pushing medications and hanging drips. But all I ask is for the ER Nurse to know a few things...

Why are they here?

Are they breathing? if so, how? ETT? NC? RA? BiPAP?

What's their baseline mentation?

You don't have to tell me every single access they have ... just tell me... do they have two large bore IVs? a central line?

What's their last set of vital signs?

and did you give any important meds that I will not find on the electronic medication administration record or paper record? Just tell me, please.

Literally, that is ALL.

bgxyrnf, MSN, RN · Jul 18, 2017

It seems like having a bed in the room would be fairly important.

It's helpful but it doesn't preclude the patient from clearing the ED for the next one. They can stay on the gurney in their room until they can locate a bed.

bgxyrnf, MSN, RN · Jul 18, 2017

As an ICU Nurse myself, and as fellow critical care nurses --- I understand the absurdity of some questions when you spend 90% of your shift pushing medications and hanging drips. But all I ask is for the ER Nurse to know a few things...
Why are they here?
Are they breathing? if so, how? ETT? NC? RA? BiPAP?
What's their baseline mentation?
You don't have to tell me every single access they have ... just tell me... do they have two large bore IVs? a central line?
What's their last set of vital signs?
and did you give any important meds that I will not find on the electronic medication administration record or paper record? Just tell me, please.
Literally, that is ALL.

And you, my friend, would be a delight to report off to.

Guest957596 · Jul 27, 2017

Do any other fellow ER RNs butt heads with other departments when transferring a patient up from the ER? I think sometimes other departments forget I only had this patient for 30 mins and for 27 of them I was trying to keep his heart beating. So no, I don't know when his last BM was or if he got a flu shot this year....

I am a med-surg nurse that is moving soon to the ED. I don't care when the pt had their last BM or flu shot. I can ask the pt, if they can answer, or ask the family. I will say that floor nurses do not have an appreciation or understanding of the ED. The ED is an arena they are unfamiliar with. It's a case of apples and oranges. I recently did my BSN clinicals for Community Nursing in the ED and I loved it. Getting back to med-surg, I find that a lot of the admission data is there, and sometimes the flu/pneumonia vaccination. Again, if it's not, I ask my pt or their family. It's not a showstopper. Don't worry about it. It's two different worlds.

Racer15, BSN, RN · Jul 29, 2017

I try my best to give a thorough report. But sometimes I get busy and things just get forgotten. Tonight the ICU called to complain about me because I sent a patient up with only one line. They were also upset because it was only a 20 gauge and I was transfusing PRBC through it which was "unacceptable". NUMBER ONE: When I called report, I stated they had one IV, it was a 20, and I was infusing blood through it. The nurse taking report never said a word(don't call my charge to complain after the fact, say it to my face please). NUMBER TWO: I have read a lot of EBP studies that show you can infuse through even a 22 with no increased risk of hemolysis. NUMBER THREE: I forgot to put a second line in (my bad) because at the same time I found out this completely stable pt was going to the unit, we had a pedi trauma, geriatric trauma, and a chest tube insertion going on in my 26 bed ER, 30 minutes after I was supposed to go home. I really try to do my best with report. I will even offer to hang around and help with particularly sick patients. But getting reported for such petty crap when I obviously have a lot going on really frustrates me.

tsm007 · Jul 29, 2017

I am considering a move to ER right now so I stumbled across this post. Nurses that ask dumb questions in report or take forever to give report run the spectrum. It's not just a floor nurse versus ER nurse thing. I find it totally annoying some of the dumb questions people ask. I have equally seen ER nurses who suck at giving report. They will list off normal vital signs and normal labs and stuff that just isn't important from a floor nurse perspective. (Let me clarify saying vitals signs stable is sufficient, CBC and BMP all came back normal is sufficient. I don't need those numbers.)I think that more training could be done in that respect on what stuff is important to give in handoff and which stuff can and should be looked up in the chart.

JKL33 · Jul 29, 2017

(Let me clarify saying vitals signs stable is sufficient, CBC and BMP all came back normal is sufficient. I don't need those numbers.)

That runs the risk of being accused of not actually knowing what those numbers are, of course. I will say that there's nothing concerning on lab work, but as for most recent vitals, I give numbers.

Or, the vitals are "great" from ED perspective but someone upstairs freaks out anyway...such as a b/p of 166/90 for a divertic patient.

I seriously don't think we need more rules for stuff like this. People who can't figure out how to give a decent report, along with those who can't figure out what is important to know, are not going to suddenly become stellar by adding in more restrictions and guidelines that others can use to nit-pick the rest of us.