ER nurse with a serious question. The question only applies to nurse who have access to the ER's computerized chart.
Why don't you just read the chart?
It has all the details you ask me about. In fact, I haven't memorized all those details, I just peruse the chart as you ask me.
I don't mean read the whole chart, I mean scan it for the details you want. I have no idea why you need to know ahead of time what size IV and where it is, but it's charted.
As far as a history? H & P, last visit, etc, is all at your finger tips. As far as what time each med was given- when you ask I open the MAR, and read you the times. I even say "I don't know, but it's been charted, I will open the MAR an look". When I say that, I am hoping you will get the hint that it would be faster for you to have already done that. Somehow, you always miss the irony.
Please don't say that you don't have time. That doesn't make sense. Think about the difference between reading something, and having it read to you. I can scan a chart for 2 minutes, and know just about everything. Add to this the fact that I really don't know all the details you want- I just kind of guess. As an ER nurse I may have received that same PT with a 1 minute report. It's all I need.
There is no question that it is faster and more accurate to scan the chart.
Before I take report, 99% of the time I have reviewed the chart for all pertinent information. I need to know if they're alert and oriented, and a brief overview of systems. So I completely understand where you're coming from.
What I can't get on board with is your accusation that we must have time to take report. No. We don't always. I might have a patient crashing, one whose family is staring at me from the room calling me every three minutes, and a demented patient trying to get onto the elevator. Plus the patient you're sending me. So cool it with the "don't use not having time as an excuse".
I actually suggested to my manager that floor nurses and ED nurses be mandated to float/shadow in each other's positions. It's true that I may not understand the flow of the ER. But likewise, many ED nurses who've never been on the floor have NO idea.
I used to work at a place as a tech where emergency department nurses were no longer required to give any sort of report, bedside or via telephone. I was shocked.
Not surprisingly, the patient satisfaction scores for the ED was atrocious and the hospital has a reputation for being subpar for good reasons.
I don't ask much from an ED nurse report-wise. I understand the ED is busy. But I work on a med-surg floor with five to seven patients. I don't always have the time to shift through a chart.
And I won't even touch the "guessing" comment. Yikes.
Okeedokey, back to the guessing thing. OP here. I don't guess about the patient. I actually try to prep my self by trying to anticipate- IE guess- what the floor nurse will want. The huge variations expressed here should support my claim that there is a wide variety, of expectations of the ER nurse. So, in an effort to be a good team player, I try to guess what the individual will want, and provide it.
And to return to the not having time issue, My op referred to nurses who have easy access to the same records I can access:
You are busy, I am busy.
I know everything I need to know to take care of the pt.
There are things you would like to know, that I do not know.
I am not dumb, irresponsible, or lazy. The reason I do not know these things is because I do not need to know them. If that changes, I have easy access to the information. It is literally seconds away.
When I speak with you, I open up 1 or 2 screens, so I can flip between them to best answer your questions.
As per my OP, you also have access to these same screens. If you do not, the question does not apply to you.
You ask me questions, I look up the answers, you write them down.
So- since are both busy, how does it save time for you to verbally ask me a question, and for me to look it up and verbalize it to you, and for you to write it down? I assume you can read faster than I can talk.
My original question was not a slam or a vent, it was real curiosity. I respect the job of floor nursing, and my goal is excellent pt care, which includes smooth continuity between nurses. Where I work, the floor nurses call us back, and are, by definition, not in the middle of pt care. They call when they feel it is appropriate. The only access to a phone is in front of the computer.
Reading information is faster than listening to it. And, more specific, as it focuses on what the reader wants to know, rather than what the speaker thinks the reader wants to know.
In my ER, we are not required to call report to the tele or the med surg units. We are required to put a quick note in the computer with a call back number for questions. All patients going up to the floor have a documented assessment in the computer which the floor nurses can see. The PMH is in the computer as well and carries over from previous visits. Coming from the floor, I am careful to document IVs. Most of the nurses do as well. It is the techs who are lazy about documentation since that is just about all they really document. We do our own vitals. When patients come in, we write a long note about what brings them in. The triage form has info as well. There is a lot of info in the computer that the floor nurses can see. The ER nurses also are supposed to put in the home meds. I do this about 80-90% of the time. Sometimes I just can't get to it.
You have to understand, that in the ER, there are lots of weird shift schedules that don't exist on the floors such as 3-3, 11-11, 3-11, 7-3, 830-5 etc. This is why the nurse giving you report may not know that much about the patient because they literally may have just been told patient x is here for y and has a bed. They really may not have been told that much info. In the ER, report is pretty short.
Working in the ER has improved my tolerance a lot for when I get admissions at my PRN med surg job (different hospital) . Now, I don't really care what state they are in or whether I get report unless they are not appropriate for med surg. I'm used to getting patients from the field with no IV and no info. If your patient is alert and oriented you can ask them info. You really need to work in the ER to really appreciate just how hard we work. I have yet to meet a lazy ER nurse at my current place of employment. We don't hold onto patients. Beds tend to open up toward the end of the shift. Also, doctors/PAs will go see their patients down in the ER and hold onto their charts for some time. This can also delay transfer because the patient can't go anywhere without their chart scanned.
The floor is hard work and crazy and frustrating, but the ER is busier.
I wonder if the OP has ever worked on the floor/outside of ED....
2 years critical care. While there, I would scan the chart before report and pull the details important to me. I did this because as an ICU nurse I was very busy, and didn't have the time for a lengthy ER report that didn't directly address my chief concerns.
It is faster to read something than to have somebody tell you the same thing. If one of the two nurses was going to look up facts important to me, I figured it would save time if it was me. Having worked in the er prior to the unit, I knew how the jobs differ, and was probably the easiest unit nurse for the ER to give report to.
I did 2 nights of tele- I found it terrifying. All those patients and call bells and maybe 30-40 meds ordered to be given at the same time to 6 different patients. Yikes.
I respect the job. What I am suggesting is that despite a certain process being done for years, there could be a faster more accurate way to do it that utilizes the technology available.
Similar thoughts are echoed with your UK colleagues although our systems are different.
I think often though its just an unawareness of what each team does and expectations of what is done. Having worked on wards and ED for many years I see both sides.
It was not uncommon for me to transfer patients to a ward having met them in the corridor with a porter waiting to move and knowing nothing about them myself apart from what Ive gleaned in the lift! then to be told by a receiving nurse that I havnt completed a bed sore check or finished social assessments, and yes sometimes no matter what you do it often comes across your not good enough and a bad nurse, (yes ward staff this is how you make us feel I know this is not intentional mostly) , and it can seem like an interrogation especially with threats of constant incident reports.
What this then leads to is staff not wanting and dreading the transfers and arriving defensively before anything has even been said.
Communication is so important on the receiving end of hand overs its often been a passing comment from the ER nurse that they deemed not important that has played a significant part in their care because the things we are looking for is different.
The problem as always is unmanageable workloads, if either side truly had time to discuss the patient then this wouldn't even be a concern. Sticking together with your nursing colleagues is key to good nursing care good luck to all you who are still in the battle zones.
It must be a policy for report in your facility. Would you rather give a verbal report of _"just read the chart"....there might be questions and you're there on the phone to ask. Why don't some ER nurses change a wet/soiled diaper, turn a patient....ect
Right there with you. I find that usually with an ED patient the nurse giving report hasn't even seen the patient and is just reading the chart. If I look up this information ahead of report I can usually get what I need and I have even saved myself some grief by avoiding and inappropriate admit, you know the patient who has been sitting down in the ED with a pressure of 60/40 and has not improved despite multiple fluid boluses and really should go to ICU for pressors and if they dump him on me I will need to do all that freaking admit paper during the rapid response I am going to have to call. And yes, this is an actual scenario - I refused this patient - asked the bed queen to please reevalute placement and they went to the icu.
Ive been following this thread since it started but usually don't post much, more of a lurker.
I briefly worked on a gen surg floor prior to starting my CCNP and going to ICU. Because I have worked in different areas, I can appreciate the challenges each area faces.
For example, when I worked in ICU I remember getting patients from ED that were in a literal mess ... Shattered glass (not big shards or anything) under them when we moved them over to the bed from the stretcher, pieces of cut up clothing, random caps off fluid bags and wrappers from whatever was used in emerge to stabilize said patient, lines tangled everywhere, not labeled ... just plain dirty sometimes. I remember thinking "man, how do they leave people like this? How is that safe? Tsk tsk".
Then I went to Emerge, I realized that priorities shift. Making my patient clean, organized and presentable is literally last on my list of things to do. First is lines, bloodwork, monitoring, head to toe assessment, calling appropriate support (RT, docs, more staff, CT, ECG, etc.) diagnostics, wound care (if they are bad), preparing drips and medications (like NOW. Preferably 5 minutes ago), finding an old chart, sometimes running a code or near-code ... My priority is to stabilize and send to ICU where they will get the appropriate long-term care. Basically keep them alive so they can get to a more appropriate care area.
All that to say, report priorities are different for each area, as well. As an emerge nurse, just give me the basics, the rest I can figure out as I go. We are used to working "on the fly" with little to no info about our patients. Floor nurses have different priorities for a more long term care plan, so sometimes I would get (what seems to me) an odd question but hey, if that's what you want to know I'll do my best to answer. Just because I think it's irrelevant doesn't matter. But it goes both ways ...
One of the things I find really frustrating about nursing is that each area thinks they have it harder than the next, and we are all so hard on each other. I wish people would understand that most of us do our best no matter where we work.
I can't really put in my two cents about reading the chart ahead of time because I've always worked with all paper charts. I do think it would be challenging considering how busy the floors can be, but I also understand the point the OP is making that if you're both sitting in front of the computer while on the phone, the floor nurse could maybe sign in and peruse the chart as well. (If you don't take report in front of a computer then you need not quote me saying that. I said "IF you're both sitting in front of a computer while on the phone" ).
It must be a policy for report in your facility. Would you rather give a verbal report of _"just read the chart"....there might be questions and you're there on the phone to ask. Why don't some ER nurses change a wet/soiled diaper, turn a patient....ect
I am confused. Are you saying you don't read the chart because an ER nurse didn't change a diaper?
I found that hand offs with EMR went well when sending nurse and receiving nurse were looking at pstient record simultaneously and used record to guide hand off.
Our facility recenty implemented a system to speed up ER to bed time. If the patient is coming to the floor (to me), we do not get report from the ER nurses at all, all we get from our charge nurse is name, age, and diagnosis. It is then our responsibility to look it up in the ER summary in our EMR. If the patient is going to ICU, the ER nurse does call with report. This was a huge adjustment at first, but our times have improved, and now it really is much more safe because there is no risk for the ER nurse to tell us wrong information. The information, unless charted wrong, is there for all to see.
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Momma1RN, MSN, RN, APRN
219 Posts
Before I take report, 99% of the time I have reviewed the chart for all pertinent information. I need to know if they're alert and oriented, and a brief overview of systems. So I completely understand where you're coming from.
What I can't get on board with is your accusation that we must have time to take report. No. We don't always. I might have a patient crashing, one whose family is staring at me from the room calling me every three minutes, and a demented patient trying to get onto the elevator. Plus the patient you're sending me. So cool it with the "don't use not having time as an excuse".
I actually suggested to my manager that floor nurses and ED nurses be mandated to float/shadow in each other's positions. It's true that I may not understand the flow of the ER. But likewise, many ED nurses who've never been on the floor have NO idea.