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.
As an ER nurse myself I have to chime in and say I think your expectation of the floor nurses reading the chart instead of getting report is ridiculous. My issue is actually kind of the opposite, I have several floor nurses at my job that don't want to take report until they read the pt chart and then still want a verbal report which just delays the pt movement. If I'm calling report why do need to read the chart first because now I'm giving verbal report and every time I say something you're interrupting me saying that u already read it...with your expectation, what if the charting is not completed, then they are missing information, what if they aren't in front of a computer when you're ready to transfer the pt? These are all huge issues that I see in your expectation...I have heard of some hospitals filling out a written SBAR that is faxed to the floor, there is a certain time period between faxing and transferring the pt and if the floor nurse has any questions they can call the ER nurse during the time lapse or ask when they get to the floor...ultimately I personally like bedside report, but that's just my 2 cents...
Well, for the past 1 1/2 years we've been using computerized charting, so it's easier. But before that, the ed was and no one else was. So to "look it up" was not so easy to do. Their charting was a mess and difficult to decipher, often you couldn't find where things were charted at, or they were charted multiple times in multiple places. Now we're all using the same charting, so that helps.
And have a little courtesy! You should be able to tell the other nurse at least the basics about the patient you are sending. It always seems like they wait until after shift change to have the on-coming nurse call report to the floor, which makes no sense to me...that nurse doesn't have the answers right off the top of their head.
The thing is I have been floated to the ED before but I am a PCU nurse by trade and I would never give a half a## report on any of my patients if I was moving them from my floor to another like I get from the ED. I know that the ED deals with a lot of emergent stuff hence the reason they are made but when you can't tell me the difference between atrial fib verses sinus rhythm or you can't remember where you put the IV 5 minutes ago then I get a little worried. If you know your calling report it takes less than 30 seconds to pull up and look over your charting before calling the floor to give your report. Yes I can look at the chart and truthfully I get a better report from the chart but it should not be that way.
So when the patient comes up and we have to call a rapid response on them as soon as they hit the floor, we have something else to tell the physician other than look in the computer.
On a completely different spectrum - I am a psych nurse on an acute unit attached to the hospital. I will ask questions like "did they come in really sleepy or was that after they admitting to suicidal thoughts and were left alone with their purse". I also ask questions like "yes their blood sugar is 400 but did you give them something?" I don't have the same capabilities as you if a patient has a severely high blood sugar so I need you to stabilize their body before I can stabilize their mental status. I will never ask obvious and stupid questions but there are questions I'll ask that you would normally never have to deal with. Especially if a patient is psychotic and combative and you give them po seroquel. They are now coming into a unit of 14 other psychotic patients and need to be a bit calmer and or sedated.
As a former floor nurse, and now a nurse in one of the busiest Level 1 Trauma Centers in the country, I can tell you, as a floor nurse, you have more time to open that chart than I do. There's a distinct possibility its not even my patient. And I have a Level 1 flying in and no telling what else. And if I can't tell you off the top of my head what you're asking, there's no sense in expecting me to dig for it while you sit there and wait. And not to mention the fact that I don't know some of the things ya'll ask because I don't care when their last BM was! They didn't come to the ED because they didn't poop! Until you've been on the other side, you can't compare the floor with the ED. While my time is no more valuable than yours, I promise you I'm spread thinner than you know. Please, just open the chart
At the the hospital I work at, floor RNs do not even get report from the ER. It is our responsibility to look up all the information when we learn about the admission, before they hit the floor, whenever that may be. And it completely sucks. This became the norm because of your same exact complaint from ER nurses.
It is totally unsafe for us to have zero/minimal communication. Surprisingly enough ED nurses forget to chart meds or don't necessarily chart them on time/in correlation with when we get time to look at your charting. I have seen the majority of med errors stem from lack of charting between the ED and the floor. Whether it was ordered and not given vs ordered, given and just not charted.
It might not be every time and everyone makes mistakes but if it takes the half of a second for it to be said out loud that "yes "blank" has already been given at around x o'clock to clarify for the sake of our license and pt safety, then just suck it up and say it. The amount of paperwork and backtracking that will have to be done if there is an error is so not worth the 30 seconds it takes to rattle off the necessary information!
Uhmm.. my question to you is WHY don't you have the chart open and provide me with the questions I ask of you? WHY are you making it a hassle at all? WHY oh WHY are you making it an ED vs Floor Nurse thing at all? When is this BS going to stop?! It's called giving report .. Situation, Background, Assessment, Recommendations. If you don't already include everything in your verbal report ... I can and will ask questions. Seriously, you know it is in the best interests of the patient and NO I DONT HAVE TIME TO SCAN THE CHART! I have a few patients in pain and one needing to go to the BR ... I haven't even looked at their labs yet today, so .. be a dear and communicate like you were taught to in nursing school. Please keep it professional and not make a problem.
I'm kind of inclined to side with the overwhelming number of people who are feeling very offended at this/think it's a ridiculous. Buuuuuuuut I'm also going to play devil's advocate a bit, because I feel like I have to deal with both sides so very often. Working in a procedural area like GI, I get numerous patients who come from the ER (normally because of bleeds), who come to me for procedures or as the recovery nurse, and then I have to give report to the floor nurse who has never seen the patient before.
Here's my take on why floor nurses want details from ER nurses instead of just "looking in the chart." Some of the time, the ER documentation is incorrect. I don't have the exact workflow that ER nurses have, just like floor and ER nurses don't have access to the surgical suite intra-op chart I have. BUT I do have access to things like the MAR. So when I see that according to the MAR, the patient has gotten TWO doses of an antibiotic that are supposed to be given four hours apart, even though the order was only put in TWO hours ago, I want to hear, verbally, what the heck happened. Is it a charting error that you didn't fix? Or did you double dose, and it's a medication error? Or was it a RBVO that was documented late? And why when I come to pick up the patient is the bag not hanging?
Also, my VERY important question of "where/what gauge of IV does he/she have, and is it RUNNING" is very important. Because when I'm going to get a bleeding patient, in the time it takes me to catch the elevator, you have time to start another IV, an 18 gauge, so that, you know, my patient doesn't DIE. Because if there has to be blood hanging, and there's one line running, which IV are we using to push versed/fentanyl and/or propofol? Or which line are we using if there are NO lines at all that run properly? You don't know our jobs. You don't know every detail of what we need and why, just like we don't know what you need and why.
If we ask for details or clarification, there is a reason. It's not because we're bored. I have a list of eighty million things I'd rather do than wait on hold for you to get to the phone to give me report. And all of them are more important than you being huffy about it. And almost none of them are more important than keeping OUR patient safe.
On the other hand, there are some instances where giving report to floor nurses can be a bit frustrating. If I tell you that the patient had an EGD, and five bands were placed to control the bleeding, and that the patient is on a clear liquid diet until the team re-evaluates the next day, and you ask me what an EGD is, I'll tell you what an EGD is in two sentences. If you ask me for a complete rundown of the entire procedure, beginning to end, then that's something you're going to have to Google on your own time. I can't, nor am I willing to try, to summarize three months of preceptorship, and a year of experience, in a five minute report.
Specializes in Oncology, Med/Surg, Hospice, Case Mgmt..
If the patient is relatively stable, as they should be coming to a M/S floor, I am okay with a brief, just the facts ma'am report. I'm also okay with looking up some of the information, if you are slammed and the patient is stable. If you tell me that the patient is 25 yrs old being admitted for seizures and has no past Hx of seizures, get prepared for some questions. We are going to have a talk. I've had too many what turned out to be unstable patients and patients admitted to the wrong level of care sent to me. If you tell me they are in four point restraints, we are going to chat about that for a few minutes, too.
I don't really know why anyone in the ED would want to tell me everything about the patient. I've got 5-7 other patients, and having someone waste my time while they say "I don't know anything about this guy, I've not seen him, they just called on me to call report" ticks me off. What I DO want to know are the items I can't get from a quick look at the chart - what is the patient's demeanor, how does he/she ambulate, and are they lucid or should I put them closer to the nurses' station so I can run to their bed alarm (not that I'm at the nurses' station very often, but it's centrally located). I don't need you to muddle through the labs, the orders the doctors gave, and where their IV is. If you can't tell me the things that aren't on the chart, all I really need you to say when you call to give report is: I'm bringing you Mr. Smith, to room 1212, correct? He has antibiotics hanging. We'll be up in 5 minutes"
I can find all of that out in a few seconds of looking over their chart.
Specializes in Geriatrics, LTC, ALZ, Managed Care.
Nurses, may I make a suggestion here??
UTILIZE YOUR TECHS!!!!!!
I'm a tech on a multi-speciality unit, and the one thing that I do that my nurses seem to value the most is that I read the chart. I read the chart for my existing patients on a daily basis as a habit formed back in the nursing home. For new admits I read as soon as I get a chance, and most of the time it's long before my nurse has even had a chance to sit down at the computer and try to remember the name that Charge called to say way coming to us. Though I personally have the education/experience to look at the Mars/interventions to get an idea what is going on, it is not my place to do so. However, it is fully within my scope of practice to look at the ED complaint, vitals tracking, and (of most importance to both of our course of care) the medical history and past admissions. on more than one occasion this has made life a lot easier for my nurse who got handed a circus at change of shift.
Just an a few of the things I've managed to unearth before my nurses had the time to look past the pertinent stuff: the exact nature of the infection in a gentleman sent direct admit from primary, that a young woman was drug seeking to the point of being banned from one of the clinics and repeatedly leaving ED in a tizzy because she was on their turkey list, that the guy whose troponin was high after I told her something just wasn't right with him had also had a negative troponin not even 48 hours before that yet the doc's note only says something about the guy being a "puzzle", and lastly confirming that yes this lady had a positive THC on her drug screen today (a full hour before we laid eyes on her).
My point is- your techs can be trained to look at a chart and see what is pertinent to how both of you take care of them. If there are any records beyond the current visit it is easy to tell if this is a recurring problem that the pt is frequently admitted for, something new, potentials to watch out for, family/economic status, baseline as far as ability to perform ADL's and ambulate.
If your techs are taught to look at the chart so they aren't going in blind then they can also alert you to the things they see!
LLBond42
1 Post
As an ER nurse myself I have to chime in and say I think your expectation of the floor nurses reading the chart instead of getting report is ridiculous. My issue is actually kind of the opposite, I have several floor nurses at my job that don't want to take report until they read the pt chart and then still want a verbal report which just delays the pt movement. If I'm calling report why do need to read the chart first because now I'm giving verbal report and every time I say something you're interrupting me saying that u already read it...with your expectation, what if the charting is not completed, then they are missing information, what if they aren't in front of a computer when you're ready to transfer the pt? These are all huge issues that I see in your expectation...I have heard of some hospitals filling out a written SBAR that is faxed to the floor, there is a certain time period between faxing and transferring the pt and if the floor nurse has any questions they can call the ER nurse during the time lapse or ask when they get to the floor...ultimately I personally like bedside report, but that's just my 2 cents...