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.
IV gauge is very important if Hmg are low and the patient may be getting blood (fairly common reason for admission onto my floor) or the patient may be getting a contrast dye for a scan...it also prepares us for how hard this patient will be to get IV access in. If a patient is coming up with a 22 gauge from the ER, I know that they are either very dehydrated or may be a potential PICC line patient since I know that ER nurses are experts at placing IVs.
Actually it is not, because either way you have to assess your patient when he hits the floor, and you should immediately see the gauge when you look at them. It's not a secret code that only I can see, but if you need a cheat sheet to know which colors each size catheter is….
But I have never had a ED nurse not tell me if they are a hard stick, which is subjective.
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.
There seems to be a consensus here that the ER nurse is a poor source of information from a floor nurse perspective. I doubt that there are many experienced ER nurses who would disagree. It's pretty easy to tell by the frustration expressed here, as well as while actually giving report, that we aren't the best source of information. Whether you attribute that to the different types of nursing, or a belief that we are irresponsible lazy slackers is irrelevant. We just aren't a great source for the the information you want.
The difference between the two views on nursing reminds me of a Bill Engval routine, with this line: "
I really think that if you work in an area with decent and accessible EHR, that is your best source. As far as not having time: I can get an incredible amount of information in 2-3 minutes. I sat down and timed it. That's less time than it takes most people to poop. And, no matter how busy you are, most nurses opt to take a poop when needed rather than just doing it on the run. It's a matter of priority. In the long run, investing that time will pay itself back with interest. It's like doing the annoying prep work went painting, or many other chores- doing prep ahead of time saves time in the long run.
I, in no way, think ER nurses are lazy. I know that they are focused on the issue at hand whether it be chest pain or whatever, get them stable and get them out of the ER. Totally get that. I do know that ER nurses are far too busy to know everything about every inch of the patient's body. I have seen many nurses get really frustrated when the ER nurse does not know if the patient has perfect skin or not. As far as ER nurses giving the wrong information, it does not happen often, but we all make mistakes in charting and giving report. ER nurses and floor nurses are competent nurses. I agree that reading the chart is the best way to ensure nothing is lost in translation.
Thank you for keeping it in perspective, from the floor. As an ER nurse, we are usually giving report, while looking at our next patient, waiting with EMS, on me to get the patient I am calling about, out of the room. Then, I have to clean that room, before checking the new one in. We do this over and over, for 12 hours. Not to mention, the charge nurse ans triage nurse always calling, wanting to know if any of my rooms are empty, because there is a chest pain that just checked in, or stroke alert. I have gotten STEMI's, stroke alerts, seizures, all back to back, and I am only one person with 3 rooms. I LOVE my job, and would not want to work anywhere else, but if I'm calling report to a nurse that's asking a LOT of questions, when I've got a non-STEMI that needs heparin and I've got a stroke alert coming in from triage, while a helicopter is on the way from the scene, repeating information that can be accessed on the computerized chart gets frustrating as well. What bothers me MOST, nurses are the first and worst to criticize. Again, thank you for showing me your world on the floor, I will try and keep perspective. :)
At my hospital, if we uncover a dressing, we have to leave it open for the floor nurse to see and treat, which often leaves the patient very anxious(if they are aware of what is going on), therefore, we usually don't attempt to look at wounds. You also said very correctly, if someone comes in having a stroke, my priority will not be a diabetic ulcer that they've had for 10 years. :)
Just to add- most of my floor nurses who get (for lack of a better word) pissy about admissions are old school. Part of our orientation now includes shadowing different departments including ED. I think some of the older nurses *on my particular floor* could use some experience. I told my asst clinical manager than half the drama stirred up between our floor and the ED is actually our evening charge nurse. I think our jobs are just so completely different between the floor and the ED it's hard to see the forest through the trees sometimes.
Here's the thing: I do read the chart. But there's a great deal, as a floor nurse, that I need to know prior to the patient's arrival that the chart just doesn't tell me.
When I take report, I'm systematic. I want you to tell me the things I can't possibly know because I wasn't with the patient for the better part of the day/evening. I don't need you to rattle off labs unless it was run in an iStat and not uploaded. I don't care what IV access they have--I'll see it once they get to the floor. But please, PLEASE tell me if you haven't inserted one, or you tried multiple times or need clinical support. I rely on you, as the ER nurse, to tell me things I can't know from the chart. And really, it only takes about 5 seconds.
For example: don't send me someone without addressing their mentation in report. A simple "AAOx3" does wonders. I have had several patients arrive to the floor completely disoriented and I haven't known if this happened in transit or is baseline. Those types of things are important. And no, I can't know that from the chart.
At my hospital, if we uncover a dressing, we have to leave it open for the floor nurse to see and treat
Sorry to sidetrack the conversation, but this policy seems a bit weird. I cover almost all wounds that I uncover with at least a temporary dressing. It might not be the most beautiful of dressings, but it beats having the open wound directly on the stretcher or bleeding/draining, etc. Also, in my experience, many times the physician wants to see a wound to be sure nothing crazy is going on.
And to bring it back to the issue at hand, I can chart on and and pass it on in report so the floor isn't left with a stage IV surprise.
I am witnessing a substantial incidence of deficient reading comprehension throughout this thread. Given the OP's need to issue multiple clarifications about the subject of "guessing" and other misunderstood points of order, maybe expecting others to READ a chart is much too tall of a order.
I am an ER nurse. When I give report, I systematically use SBAR. When I am finished, I always ask, "What else would you like to know?" What irritates the crap out of me is to be interrupted with questions about "skin issues" and code status when I haven't even gotten beyond, "This is an 89 yr old female who came in via EMS tonight from ABC LTC facility with c/c of fever." I have adopted a little scripted answer to those who interrupt me that goes something like this: I ask that you please hold all comments, questions, and applause until the end of the performance. If you insist on interrupting again, I will answer only the questions you specifically ask of me and will divulge no further information or data. Shall we do this my way or yours?"
I am an ER nurse. When I give report, I systematically use SBAR. When I am finished, I always ask, "What else would you like to know?" What irritates the crap out of me is to be interrupted with questions about "skin issues" and code status when I haven't even gotten beyond, "This is an 89 yr old female who came in via EMS tonight from ABC LTC facility with c/c of fever." I have adopted a little scripted answer to those who interrupt me that goes something like this: I ask that you please hold all comments, questions, and applause until the end of the performance. If you insist on interrupting again, I will answer only the questions you specifically ask of me and will divulge no further information or data. Shall we do this my way or yours?"
I am pretty sure tat the interrupting and wanting stuff in a certain order probably comes from having a brain sheet that customarily gets filled out during a regular floor handoff where they have a certain rhythm.
eroc
218 Posts
Actually it is not, because either way you have to assess your patient when he hits the floor, and you should immediately see the gauge when you look at them. It's not a secret code that only I can see, but if you need a cheat sheet to know which colors each size catheter is….
But I have never had a ED nurse not tell me if they are a hard stick, which is subjective.