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.
There should be a report from the ED nurse to floor nurse, and yes it should be no more than 3 min. At my hospital we are not able to look at the Pt's chart till the Pt hits the floor. We are not allowed to check the chart of assigned Pt while they are still in the ED, or other department. I have been in a situation where the Pt was brought up from ED without report because the nurse forgot to do so. Not fun or safe.
I'm going to have to come to the defense of the OP here. I think many of you are not really reading what she's saying. She never said that verbal report shouldn't be given. Obviously there are times when a thorough report is necessary, but the point that seems to be missed here is that IF the floor nurse can peruse the chart prior to the admit being received, then the verbal report would be much more efficient and less time consuming. There will always be some instances when the floor nurse is swamped and/or can't get to a computer, but in general and when the floors have access to the ED chart it should be standard practice to read the highlights of the chart. If you don't have access to the same charting system, then the original post doesn't apply to you.
At the hospital I'm at now, it is standard practice for the charge nurse to send up an SBAR to floors (mostly just med surg and intermediate floors) and then call to make sure it was received. There is no verbal report in these situations. The ED nurse is usually busy with other patients and may not even know one of their patient's has a bed assigned that is ready. Often on floors that do get verbal report, its the charge calling or another nurse who is floating who is attempting to get the patients upstairs. Obviously it is ideal for the nurse who is taking care of the patient to call, but sometimes that just isn't feasible. As the OP suggests, and I agree with, its easier for the floor nurse to look in the chart for answers than it is for the ED nurse who doesn't know the patient to look in the chart and then read the answers to them. I'll mention again though, that I do understand that sometimes the floor nurse won't have had time, in which this case, there does need to be a certain amount of understanding and respect between the nurses.
If I am able to call report, it is insanely frustrating to get asked non-pertinent questions. I understand that floor nurses of any specialty have a different focus than ED nurses (I spent 4 years on the floor), but there are just some things we don't ask. For example when I get a 40 year old guy with chest pain through the doors, I don't ask him when he last pooped or look at his rear for breakdown. I've had these questions asked many times and I often get the feeling that the nurse asking them is just looking for questions that they know I won't be able to answer. I wish I could answer ALL of your questions, but there simply isn't time in the 1-2 hours that I take care of a patient to get down to that kind of detail.
As far as things not being charted being the reason for not looking at the chart, personally I keep my charts as up to date as I can. If I don't chart a line relatively soon after I start it, I probably never will. Two plus hours later, I can't remember where I put that line on my fourth chest pain of the afternoon. I would like to think that most ED charts are up to date, but besides codes or STEMIs I can't imagine not keeping up with it.
Hopefully you guys don't rake me over the coals with my response - but basically I think that if you can look over the chart, then you should, simply to save time on both ends. If you can't, then verbal report would definitely need to be more detailed.
Sounds like us ER nurses are in the minority here (we're used to it) but the issue comes in because we are ALL short on time. I get it and I do try to understand, but what is the point of sending an SBAR And taking the time to include every detail if I just have to repeat the entire thing over the phone. It's frustrating and ER nurses are pressed to get the patient up ASAP. It's nothing personal but for some reason there is constant flack..
This backbiting has got to stop. We are nurses and the reason that we are being walked on by administration and our governmental rules is because we do not band together. We are falling victim to a very wealthy organization that doesn't want us to have decent conversations about our work. It's easier to keep people under a thumb by having them disagreeing with each other all the time. The question was not asked with the most tact, but at least it was asked.
I have worked in the float pool, working floors, ICU's, ER's and as a travel nurse. Every hospital I have worked at has the same issues. Nobody gets along. We need to talk, we need to discuss our issues openly and have interdepartmental functions. In the ER you have attending ER Dr's, residents and admitting Dr's spouting orders constantly. We are required to chart on patients sometimes as often as q5minutes. We have anything and everything walking through the door at any given minute. We have call bells and hourly rounding just like the floors. We are required to collect med lists, triage patients and get people to surgery/cath lab/hyperbaric chamber and other places within very tight time frames. And we serve drinks and snacks to every Tom, Dick and Harry that rolls through. When we get a bed, no less than three people tell you that you have a ready bed and we have a very few minutes to get them to the floor. We call report in the midst of chaos.
When working the floor, I can be in the middle of giving a bath, delivering comfort care, headed to the bathroom, trying to stick an IV, sending someone to the ICU or delivering snacks and I am required to stop and take report.
Its all very frustrating, but if we bite each other, we give the powers that be more control!
Shouldn't everything that happens with the patient be in the chart? If it's something that needs to be communicated to help you care for the patient it should be in the chart as well.
I think it is an honest question. Here is my honest answer. I could go through the chart and find all the info I think I need to know for the case. However, doing live or phone report has two distinctive and important advantages to me. 1) The ER nurse can present the most important info first, they can stress certain info, give their insights and concerns, and many times they may report on data that might have been skipped for the type of case. Pt in for left big toe cellulitis and "Oh by the way, his troponin was 1.2". And 2) it is an interactive process. I can ask questions. "Hey, did you get a blood sugar, I don't see it entered".
Going deeper into human communication, there are mechanisms built into languages that help weed out errors. If I said, "A 36 year old male, and her vitals are"... You would stop me and ask "wait is this a male or female we are talking about". This is a sort of builtin redundancy. Phone communicate also has similar builtin error checking over just reviewing a chart. Why do we need to perform 5 rights on meds AND scan them? What if the EMS just dumped the pt in the ER with the paper chart on his chest and said, "I'm outta here". I am a med/surg RN, not an ER nurse so I don't know if this is a fair comparison. No sarcasm intended. But it seems similar to me.
Lastly, I think speaking to a real person is important. It help us get to know each other and helps us be more of a team. When I see the ER nurses bringing up pt it is nice to put the face with the voice and I truly believe it fosters a team mentality. I think questions like yours help us (differing departments) get to know each other better and can only improve our practice. Thanks.
I'll be brief and simple- It's called "Report" for a reason and it's a part of YOUR job.
Edit:
But I will say that every nurse's "report" is different and you'll never satisfy every nurse with your report. While I agree that someone asking about a lab that isn't pertinent to the patient is ridiculous- Reports should be basic information so that the floor nurse can do their job. name, dx, symptoms/hx, lines, fluids, meds, psych, etc. There's reasons for the questions- get over it and do your best.
I cannot speak for the people who say they just "don't have time." I have worked in the ED and now in ICU and I can see both sides of the coin. The reason I want to hear a report from a real live person rather then just reading the chart is not because I am busy. It's because YOU are busy. A week or so ago I received a patient from the ED with CC of GI bleed. I looked at the chart, as I always do. On paper this patient looked completely fine. His labs were great, pain was charted at 0/10, vitals were fine. When I got report from the ED the real story was what HADN'T been charted. The fact that he vomited 600cc of blood and at the same time dropped his pressure into the 60's/30's, The fact that he was on Xarelto, the emergent K-centra, the rapid blood transfusion. None of which was charted because the ED nurse was just a little too busy saving the man's life to be bothered with a chart update. So the reason I want to hear a nurse-to-nurse report isn't so I don't have to read the chart. It's so I get to know everything that isn't in the chart. Ya know, the important stuff.
Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.
I will first say that the PTB tick me off. Administration wants everything done now, now, now and sometimes good transition of care takes a little time. I hate how we have to rush so as not to get in trouble.
What I need from the ER, because I try to look the information up, is any priority labs/antibiotics/medications I will need to handle right away. That's it really. Because if I'm busy (as everyone is), my admission will get a quick look-over in person and a quick order check. I may not get to check everything in depth for quite awhile. So please just give me a heads up on any urgent priorities, that's all I want.
ETA: ER please, please send up the medication list if the patient/family brought one. Many times (especially at night) the list is left somewhere in the ER and the family has left knowing the patient is being admitted. Then I end up with a confused as heck 90 year old that knows nothing about their medications. And when I call the family they get angry and say "we gave it to the ER nurse!" I can't go by the chart as I don't know if the ER had time to update the medication reconciliation and that part of the Drs note is usually very wrong.
If only ER nurses documented enough for me to just look at the chart. Until IVs, meds given, assesments are fully documented questions will continue to asked. I work in a neuro ICU, every patient needs to be on a cardiac monitor and a full neuro assessment needs to be completed, there is obviously a reason why they need to be in intensive care. Questions are asked based on the floor nurse's desire to fully understand the situation and care that needs to be administered.
Personally, I don't trust other nurses to chart completely or accurately - especially in a setting like the ER. I wouldn't want to rely just on the chart. I always want to hear significant details from the mouth of someone who actually knows what's going on. This post is pretty rude and inconsiderate of floor nurses.
For the same reason that an ED RN will document "Awake, alert and oriented x 3" when the patient can barely tell you their own name. Or document that skin is intact when they know they haven't looked thoroughly. Plus is it not possible that you could forget or fail to document something important? The type of stuff that ER nurses get away with would get me written up on my floor. I understand it's an emergent area but come on. We get stuck finishing/fixing all the things you guys don't do so please don't complain about giving me a decent report so I can take over your mess. The reason you don't want the floor nurses asking questions is because we call you out on things. I once saw an ER nurse try to send a patient to the floor with a Mag 1.3 and no orders for replacement. Keep in mind it was 3 AM. Imagine calling a dr at that time for something that can easily be ordered by an ED physician?? We on the floor have licenses just like you and forgive me if I don't want to stake mine on saving you a few minutes. I understand that this may seem like ranting but I find the original question offensive, like dealing with a floor nurses questions is below an ED nurse. We are all a team and we need a decent report to maintain patient safety and continuity of care.
AutomanRN
5 Posts
There should be a report from the ED nurse to floor nurse, and yes it should be no more than 3 min. At my hospital we are not able to look at the Pt's chart till the Pt hits the floor. We are not allowed to check the chart of assigned Pt while they are still in the ED, or other department. I have been in a situation where the Pt was brought up from ED without report because the nurse forgot to do so. Not fun or safe.