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.
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.
Thank you.
FWIW- I generally start out by asking in a non-judgmental tone: "Do you know anything about Mr Smith, or are we starting from scratch".
If they have scanned the chart for details, I focus n the subjective and not charted stuff. They my be A & O x 4, bit maybe a family member mentioned sundowning, or something that leads me to think they are a fall risk.
I generally finish by asking if there are any questions.
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.
So- why don't you?
Contrary to the allergy to assessment that many ED nurses seem to have, you are responsible for knowing what's going on with your patients (including where their IVs are and approximately when important meds were given). As you mention, not everyone has access to the charting from the ED, but most of the time I find that easier to follow than the useless reports I get from the ED that make me wonder if anyone has actually looked at the patient.
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.
I quit a job over the implementation of just such a system. It's designed to improve bed flow in the ED without any regard whatsoever for the safety of the patient coming to the floor or the throughput needs of the floor. The opportunity to ask questions of the nurse handing off is important (despite the fact that it's usually useless, sometimes it helps in gauging whether the patient is appropriate for the particular floor).
Weird, I always wonder the same thing about most of the ER nurses I take report from - why don't they just take five minutes to read the chart before they call me to give a "report" on a critically ill pt they apparently know next to nothing about?
Honestly, I've grown tired of it. I just deal with the train wreck when it pulls into the station these days, because I figure if they know so little about the pt, I don't want the pt there one minute longer than necessary.
We call report when the bed is ready. If that's shift change, so be it. Ambulances and walk-ins to the er don't stop because we have shift change.
I understand this concept. I know that there are a lot of super awesome nurses in ER who are professional, and this quote applies to them.
I also know that some ER nurses (like any floor) are not awesome.
And I know they are holding a patient until shift change because I know my charge told me (s)he gave the bed away hours ago, and when I finally do get that report called (from the elevator) during shift change, I can see that they had been in the ED for 8+ hours and that they had a status of "admit" for as many hours as it has been since I was told the bed had been given away. This is usually the same nurse or two that do this it regularly. It is obviously on purpose.
I know not all ER nurses do it, but let's not be so huffy in defense that we deny that some ER nurses absolutely do it.
I understand this concept. I know that there are a lot of super awesome nurses in ER who are professional, and this quote applies to them.
I also know that some ER nurses (like any floor) are not awesome.
And I know they are holding a patient until shift change because I know my charge told me (s)he gave the bed away hours ago, and when I finally do get that report called (from the elevator) during shift change, I can see that they had been in the ED for 8+ hours and that they had a status of "admit" for as many hours as it has been since I was told the bed had been given away. This is usually the same nurse or two that do this it regularly. It is obviously on purpose.
I know not all ER nurses do it, but let's not be so huffy in defense that we deny that some ER nurses absolutely do it.
And you know what was going on in the ED when the bed was assigned because you were down there in the middle of it? Your charge nurse only knows she assigned it. She does NOT know for a fact that the ED nurse was "holding" the patient intentionally until shift change and neither do you. You are making a lot of assumptions here. Again, there is no advantage to holding an admit patient until shift change. It does not prevent the ED nurse from getting a new patient like it does the floor nurse. In fact, it makes the job even more difficult because you have a cheesed off admit patient waiting on a hard cot without a bathroom or a TV and you are now providing care to an additional patient in a hall bed.
You'll notice none of the ED nurses here are accusing the floor nurses of pulling any of the shenanigans we suspect they do to avoid taking the patient. I'm pretty sure you know what they are but you'd be pretty ticked if you heard any of us speaking in negative absolutes as many of you have about us.
I'll admit that when I'm slammed, haven't peed for six hours, am dealing with chest pain (mine and/or a patient's), haven't been able to stop long enough to chart a single assessment, and am needed in three rooms RIGHT NOW, I don't notify housekeeping to clean the room for at least half an hour or so.
I'll admit that when I'm slammed, haven't peed for six hours, am dealing with chest pain (mine and/or a patient's), haven't been able to stop long enough to chart a single assessment, and am needed in three rooms RIGHT NOW, I don't notify housekeeping to clean the room for at least half an hour or so.
Thank you for your honesty, Canigraduate, but I can promise you this... every single ED nurse has been in the same spot (repeatedly) but we don't have the "luxury" of holding off a patient for even 5 minutes and to be accused of this over and over by people who really do not know is tiresome.
Thank you for your honesty, Canigraduate, but I can promise you this... every single ED nurse has been in the same spot (repeatedly) but we don't have the "luxury" of holding off a patient for even 5 minutes and to be accused of this over and over by people who really do not know is tiresome.
Why do we put up with this crap? I am really beginning to get sick of being treated like that. What is so godawful important that we can't have one more nurse available so we can all effing pee three times a shift?
This is just the sort of attitude that causes errors and poor patient outcomes. To top it off this post is pretty rude and shows a lot of disrespect towards your fellow nurses. If a doc or resident called asking you for this info is that how you would react?
Specializes in M/S, Pulmonary, Travel, Homecare, Psych..
As a teen, I worked at a local gas station part time. It was perfect for me, I was considered the extra helping hand. My hours were always evening, starting two hours before the deadline for playing your lottery numbers and ending one hour after. I mostly did lottery and other odd jobs other people just never seemed to have the time for.
The man who worked evenings was an interesting case. Very much a believer in getting along with coworkers. He became a friend of the family in fact, came to my HS graduation. I thought him odd at first though for a number of reasons:
1. On the nights I wasn't there, if the lottery customers became too much to handle, his solution was to pull the key out of the lottery machine and hang a sigh that said "Sorry, no lottery today." The manager would literally scream about this the next morning and threaten to fire him every time. He'd inform her he couldn't handle evenings alone and if there wasn't a "helping hand", he wasn't going to make himself crazy trying to do the work of two. She'd end it with another threat, he'd shrug it off and do it again.
2. He never talked about teamwork, he just did it. His number one concern was that we (as in me and him, the workers and the customers) were safe. After that, he got as much as he could done but he never seemed stressed.
3. He never bad mouthed the company, but at the same time you could just tell they didn't "own" him. He was loyal, to a fault at times, but he kept things in perspective. He was quick to decline new responsibilities if he felt he couldn't really do them, but always eager to make the place run/look great.
Being a gas station attendant is super hard work. People always wonder why they are all so grumpy and stand off ish. You not only have to attend to the customers, and it's never very long between one and the next........but the manager forever leaves mile long lists of things for each shift to accomplish on the side of taking care of customers. Paperwork, stocking the cooler, cleaning, ordering things in and all sorts of stuff. It gets to the point where you can lose your perspective and common sense goes out the window. You get so engrossed with "the other stuff", you start to treat the customers like a nuisance. You feel too busy for the things that matter most, because you're head is spinning with all the things that need done and not getting them done makes you feel insufficient.
I want to preempt this with, I don't mean to sound like I'm on a soap box and I'm not talking directly to anyone in particular, but this whole thread has me shaking my head. The ER nurse posts some frustrations with hand off report, the floor nurses jump down their throat and the whole "Unit A vs. Unit B" war starts.
I think both sides miss the point a good bit. It has nothing to do with the report, how long it takes or what kind of questions are being asked. It seems plain to see, to me, that if you are to the point where giving hand off report is "in the way" and you're too busy, there are problems that transcend how well the floor nurse receives report going on. It's like I was at the gas station, so insistent on getting my tasks done according to the manager's plan, essential things like........oh, I don't know......collecting payment for gas from the customers started feeling like a bother.
The gentleman I worked with had the right answer too, in my opinion anyway. He took the problem to the ones who could actually do something about it. He did what he could with what they gave him, made no apologies and put the ball in their court to correct it. When they didn't, he didn't stress it, he just continued doing the best he could.
I do believe on some level, administration likes the fact that we turn on each other instead of them. Somewhere, I can picture a CEO of a major healthcare provider chuckling and puffing his cigar as he reads this. Truth is, we're all stressed and have too much to do, too little supplies to do it well and no support for when things don't go according to plan. Grabbing each others throats over details about report giving isn't going to correct any of this. But, we're afraid of the administration, they can fire us. On the other hand, popping off at the nurse from another unit about a mistake or oversight that takes two seconds to fix presents no threat to us.
That makes about as much sense as, well, imagine if the gentleman at the gas station were to holler at me all day long because I couldn't come in every day of the week to be the helping hand. It's directed at the wrong person, the company should be giving him enough help.
Which takes me back to something I talked about in one of my first posts here. My first preceptor ever drilled it into my head to get along with other units and other workers because at some point, you're going to need them. I like to think, when the ER calls the unit to give report, they're glad to hear it's my voice when I say "Oh, I'm the nurse, let me grab a pen." I accommodate them in every way I can. I don't make remarks about how it's the end of the shift, point out mistakes or any of that. I ask for pertinent information if it's not given and if they don't know, I'll find out myself (by reading the chart , yes, I can do that).
I don't do this for altruistic reasons though. I'm very selfish. I have a firm belief that ER nurses start to recognize your voice and know who you are. I want good karma with them, for sure. My hope is, since I'm not a thorn in their side, I can cash in my chips when I need to. And I have. I do say "I simply can't take an admit right this second. If it's not unsafe for you, can I have thirty minutes." They oblige me more often than not. Had a nurse, on her way to lunch, leave with a terrible hand off report that included "I think my guy in room 102 might code, keep an eye on him." Yeah, my team was super busy and she leaves me with a patient that she thinks is gonna code soon. She's gone five minutes and the ER calls to tell me an admit is coming. I was super uncomfortable. I told them my situation. The ER nurse asked when my coworker left for lunch, and sent the patient five minutes after she was due back.
That's how my friend from the gas station would have done it. "Turn around times" ceased to be a priority because, well, obviously there wasn't enough help and things were going downhill for us on both sides. If turn around times aren't enough of a priority to the admin., at least not enough that they staff a little better, how can it be a priority to me (well, the ER nurse in this example)?
I just wish we'd sometimes take the venom and nail spitting that goes on in here to the people who deserve it. I don't think we deserve it, not from one another anyway, we're all trying our hardest.
, yes, I can do that).
Guest219794
2,453 Posts
Thank you.
FWIW- I generally start out by asking in a non-judgmental tone: "Do you know anything about Mr Smith, or are we starting from scratch".
If they have scanned the chart for details, I focus n the subjective and not charted stuff. They my be A & O x 4, bit maybe a family member mentioned sundowning, or something that leads me to think they are a fall risk.
I generally finish by asking if there are any questions.