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.
We are not allowed to research patients prior to admit for 2 reasons- 1, it locks the chart so docs & ER nurses can't access it, and 2 HIPPAA. What if the patient dies & I never see them? Or leaves AMA? Not my patient yet, not mine to know yet.
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.
Been there, done that. The treat'em and street 'em mentality at it's finest. In this case, the street is the med-surg floor.
Because you are giving me report. And when I in turn give report to the next shift, I don't tell them just "read the chart." It is how nurses communicate with each other, we give a quick report.
Specializes in Nursing Education, CVICU, Float Pool.
Personally,
I concur with some of the other nurses. I need a verbal report because it helps me innthebfollowing ways:
1.) It starts my care planning process so that I can anticipate what will be required to care for this patient and what I may need to gather before their arrival (such as extra suction canisters, padding for seizures, extra IV tubing, certain med drops from pharmacy).
2.) I can get a better feel for the patient's condition truly is, in most cases, when speaking with the nurse. I get to learn all of the extra information that isn't on the chart and how that will relate to my care. (things like a lot of family members are here waiting to see them etc....)
3.) Verbal reporting/interviewing helps me solidify the over all picture of the patient in my head.
I am one that tries not to ask question that someone wouldn't reasonably know. Every single lab result. I am an ICU nurse by trade so I will ask in depth questions be if they're coming to me, they more than likely need a considerable amount of attention.
Finally, I've worked in hospitals that have an ER EMR that didn't show upon the units charting system (how a company can let that happen, idk) and we've missed some we've had some near misses bc of a lack of an adequate EMR and a thorough report.
I'll tell you exactly why I ask details in reports: half the time the charting is wrong or inconsistent!!!!! Especially from the ER/OR/etc.
So sure I could look it up, but then I go in and find an 18gauge in the left AC that you started in a hurry and forgot to chart instead of a 20 in the right wrist (according to the chart) that accidentally got pulled by the patient who was rushing to get up and have a bloody stool when his main complaint (according to charting) was shortness of breath. Then Dr. ER wrote in his notes that the patient had come from a nursing in Smalltown but the patient had actually been living at home and Dr. ER had just seen too many damn patients and accidentally mucked up.
Of course, this is a bit of an extreme example, but my point is that the charting is often off on many details. I like having a good clinical picture of my patient before they get to my ICU if possible, then verify it by my assessment. Also, there are often important details that just simply never got charted either because you forgot or some other reason. Not to mention that you get a better feel for how the patient is by hearing the nurse talk about it.
OP, you may be an impeccable and super thorough charter and be on top of everything, but many people are not and when a nurse verbally gives you report it not only forces them to rethink the details, but often reminds them of something they had forgotten to chart or had charted in some obscure place you may not have looked.
I am a floor nurse at a hospital but I have shadowed a few days in the ED. As floor nurses we are detail oriented but the ED is an entirely different animal. It is too easy for us to blame the ED nurse for anything that the pt didn't come up with, completing our nice neat packages that we like to keep our patients in. They literally don't have time. There is only so much you can do in a day. Well, there is only so much you can do in an hour with that pt while they are getting 7 other patients who are yelling, fighting, trying to leave, getting restrained, active strokes and MIs. Studies have shown that if a pt gets to the floor quicker it decreases mortality rate. So yeah, it's not fun, it produces anxiety and it means you are having to spend some time with a pt when they first come up, but it is what it is. We do not get report from the ED. We see it come up on our bed board, assign it, and the nurse starts looking it up if she has time. If not, we settle the pt and start looking up orders. Team admissions helps this bit. One person is hanging fluids, another is giving meds, one is asking questions, another is assessing. Admission done in like 10minutes. And honestly, who cares about IVs? Anything could happen between that pt being in the ED and arriving to the floor. I love being prepared but this is the name of the game with the ED. ED nurses are not lazy, they are smart, agile, and have a lot of endurance. So before you take something out on the ED nurse, understand a day in their shoes. If you were a nurse in the ED would you want ppl talking about you or blaming you? Whatever state that pt comes up in, we will handle it quickly and efficiently and we won't moan and groan about it, because we are professional nurses that are trained to handle these situations. Let's not get caught up in the details and the blame game.
I have been nursing for 10+ years and have worked nearly all aspects of bedside nursing, except L&D and postpartum. Getting and giving a good detailed report on a patient is very valuable in providing excellent patient care. When I don't receive a good report it leaves me with the impression that you are either a non-caring nurse or one with poor skills, which in either case , is a poor excuse for nursing. There has been times I have had to look at a chart to find information that I need because my counterpart was clueless, which hurts continuity of care. I honestly sometimes want to tell some patients it's a good thing you made it to me. I don't claim to be the best nurse, but I do provide patients with the best care I possibly can.
I currently work in a CVRU where sometimes things that our cardiothoracic surgeons tells one shift is not getting relayed to the next shift. We are currently looking into a way to improve this as well. As it causes us to make undue phone calls or may do something that the surgeon didn't exactly want done at that point of the patients care, as every case presents different challenges. Therefore, a good report is always a valid part of providing excellent patient care!
I have been on both sides of the fence. As a current ER nurse we can't give you a very detailed report because we also have 6-10 patients to care for and we can keep getting patients because that ER door doesn't close. In my current hospital we only have to give oral report if the patient is going to ICU or CCU. That's it. In my previous hospital it was the same policy. Floor nurses are also given minimum of 30 min before we send the patient up, time to read patient's info.
I do make phone calls to the floor if there are exceptions, such as BiPap, patient doesn't have a 20 gauge IV, why abx was put on hold, etc ...
But yes, most of the stuff I do can be found in the computer system.
I wish all of you just worked one shift in the er, like really worked it. Our report???? Usually whatever the patient can tell us, we have to search for most of our answers or figured them out on our own. We get a minute report from ems and then if it's a nursing home patient, have to find the answers in the chart they send us, which usually is not utd and doesn't usually have our answers, those patients we don't know their weight, their ambulatory status or their baseline function. We often are treating patients without knowing the info or with very little information. We are running between 4-5 patients "just trianging them", as you say, but we are also starting ivs, drawing labs, doing ekgs, medicating them, getting them ready for tests, and toileting them and assessing them and documenting everything . You may think we have less patients than you, but take into account we are constantly having a new patient, we don't sit in report and find out all this great info about them, we often don't have time to chart, let alone look at their lab results. We often have to search for why they are being admitting. We send you the patient with as much of this stuff as we possibly can. We get them with sh** up to their wars, covered in vomit and or urine and clean them up. AND remember that we aren't trying to rush and hand off our patient to you to go eat bon bons, it's because there is a waiting room full of patients, patients in the hall, or an ambulance with a sick patient waiting for that room. So we can start the whole process of guessing and researching and doing the whole lab/ekg/triage and asses routine over again. So we can answer all those questions that we get attitude about if we don't know the answer. Forgive us, sometimes when we've had our 20th patient, it all runs togethee, or when we come back from a code blue or a trauma alert, it can all kind of mush together.
With that being said, I know I couldn't do your job, but please understand that we aren't just trianging patients and that we aren't given the answers to your questions, so if the patient can't tell us, we aren't going to know.
QUOTE=TakeTwoAspirin;8573906]I know, let's not communicate at all with one another! Fantastic idea, just think of all the time we will save! Can't possibly see any problems with that affecting patient care/safety!
ER here. We fax report for stable pts. The sbar printout includes dx, admitting doc, consults, most recent vitals, iv sites, infusions running, skin condition, critical labs & isolation status. We hand write any other pertinent info.
For unit pts, we still call and do a traditional rn to rn report. I also will call for a stable pt in those cases where there's just too much to write (i first send the fax). My evening charge doesn't want me doing that, but i still do.
I guess the bottom line is that we do different kinds of nursing. You are an ED nurse. You focus on the quick, top priority. Floor nurses have to focus on in depth patient care. We require much more information than ED nurses do. It's just the nature of the beast so to speak. I work in both environments. It has been very enlightening. I strongly suggest we take turns to walk in each others shoes.
Been there, done that. The treat'em and street 'em mentality at it's finest. In this case, the street is the med-surg floor.
Skykomish
8 Posts
We are not allowed to research patients prior to admit for 2 reasons- 1, it locks the chart so docs & ER nurses can't access it, and 2 HIPPAA. What if the patient dies & I never see them? Or leaves AMA? Not my patient yet, not mine to know yet.