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.
Because when I look at the chart there is nothing in there. Nothing is filed, no ed doc note, no vs, no dx. By the time I find out I'm getting an ED admission, I'm calling you to let you know you have a bed for the patient. I want report right then to prepare for patient arrival. I need to set up my ICU room and call any ancillary staff that may need to be present upon patient arrival. And being an ICU nurse I've learned over the course of my career that you ED nurses are tricky, and like to pass the buck. There is no way I'm letting you transfer a patient with a HGB of 3 without starting blood. And yet you try time and time again. You are also supposed to secure a line in the ED and not just transfer the patient up with an EMS IV site. BP 270/154 and you gave PO lopressor 8 hrs ago, I'm making sure you get PRN IV med orders so I can at least have something to work with when to bring the pressure down when the patient comes, or if I so happen to float to the floor, I'm not gonna let you transfer the pt until the pressure is within an accebtable range. I can go on about the sneaky stuff you do ED nurse...that's why I want a verbal report. To make you accountable for actually treating and stabilizing your pts.
First, let me say I didn't read all 206 replys so this opinion may have been covered.
Second, aren't we all here to help the patient no matter how it gets done?
Third, I guess I'm lucky to work where I do. If I'm really busy I can ask the ED nurse if I can call back in 5 or 10 minutes and it is usually OK. I know most of them and they know me. They know that I'm not stalling. I am aware of pt. flow and our ED has a time limit on how long they can hold a pt. but they are flexible. I do have time (usually) to review the chart prior to getting report. I usually know everything I need to know before I pick up the phone. Labs, chief complaint, and P+H are all available to me. However it's great to get a brief head to toe assessment from the ED.
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 worked ER, med surg and ICU. Your rant is unwarranted. The OP is saying.. they don't have time to give report. All I want is 3 minutes of discussion (report) on what is happening with the patient. These are not DETAILS! This is a required legal hand off.. that promotes continuity of care.
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
Wow, really? Look who's full of themself. Don't get it twisted - you are not more important than nurse working other floors or areas just because you are in the trauma unit.
Ok....my turn....why do you ED nurses hold my admission right up until the change of shift and then send it when I only have 20 minutes left to go home? What, oh, when I read the EMR it says that patient was ready to be admitted 4-5 hours ago!?!
Oh, because YOUUUUU don't want a new patient on the stretcher before YOUUUU go home. Got it. Thanks.
Ok....my turn....why do you ED nurses hold my admission right up until the change of shift and then send it when I only have 20 minutes left to go home? What, oh, when I read the EMR it says that patient was ready to be admitted 4-5 hours ago!?!
Oh, because YOUUUUU don't want a new patient on the stretcher before YOUUUU go home. Got it. Thanks.
Admitted & bed available are 2 completely different things. We send/call report when the room is ready. Change of shift not withstanding.
New patients are coming to us regardless. That's why we get to do codes in the hallway. Lighten up Francis.
Ok....my turn....why do you ED nurses hold my admission right up until the change of shift and then send it when I only have 20 minutes left to go home? What, oh, when I read the EMR it says that patient was ready to be admitted 4-5 hours ago!?!
Oh, because YOUUUUU don't want a new patient on the stretcher before YOUUUU go home. Got it. Thanks.
No way!
Believe me... ED nurses like nothing less than an admit hold. The longer the patient is in the ED, the more floor stuff you have to do. ED people don't like floor stuff. And if your beds are full, you'll just get additional patients in the hall.
The hospitalists would admit the patient, then the pt would sit around for hours sometimes waiting on Bed board. We can't send them up until we know where to send them. Occasionally, the admit doctor would hold up the transfer for procedures and labs (they wanted to do most procedures in the ED vs. in the pt's room because there is more staff to help and we're better equipped to handle an emergency), but that's rarely the hold up.
Honestly, I can think of no ED nurse who sat on a patient because they wanted. Admitted patient tend to be more work and mess up the flow because now you have to call pharmacy to process and send meds and wait on lab draws and start doing things on schedules and help them to the bathroom and call central supply for random things like compression socks and other stuff that doesn't belong in the ED. There was a small celebration when bed board called and we could get them out.
Ok....my turn....why do you ED nurses hold my admission right up until the change of shift and then send it when I only have 20 minutes left to go home? What, oh, when I read the EMR it says that patient was ready to be admitted 4-5 hours ago!?!
Oh, because YOUUUUU don't want a new patient on the stretcher before YOUUUU go home. Got it. Thanks.
One thing about, at least my ER, is that most of the nurses are mid-shifters. Yes, you have your 0700-1900 and 1900-0700 nurses. But the traffic in the ER doesn't really get going until the unemployed roll out of bed at noon, the drunks wreck havoc in the afternoon and evening, working people get off of work, etc. Therefore, we and 9-9, 10-10, 11-11, 12-12, 2p-2a shifts, you get the drift.
Which means that our shifts don't mirror standard floor nurse shifts, so it's not a conspiracy.
It seems like departments always try to demonize the other departments. Can't we all just work together so we can determine the problems with the system and work together to find solutions? Huh? No? Too much?
I work in a NICU now and there are huge divides between NICU and L&D and Mother/Baby (big birthing hospital, each department has around 200 nurses).
Nightnurselife
4 Posts
Because when I look at the chart there is nothing in there. Nothing is filed, no ed doc note, no vs, no dx. By the time I find out I'm getting an ED admission, I'm calling you to let you know you have a bed for the patient. I want report right then to prepare for patient arrival. I need to set up my ICU room and call any ancillary staff that may need to be present upon patient arrival. And being an ICU nurse I've learned over the course of my career that you ED nurses are tricky, and like to pass the buck. There is no way I'm letting you transfer a patient with a HGB of 3 without starting blood. And yet you try time and time again. You are also supposed to secure a line in the ED and not just transfer the patient up with an EMS IV site. BP 270/154 and you gave PO lopressor 8 hrs ago, I'm making sure you get PRN IV med orders so I can at least have something to work with when to bring the pressure down when the patient comes, or if I so happen to float to the floor, I'm not gonna let you transfer the pt until the pressure is within an accebtable range. I can go on about the sneaky stuff you do ED nurse...that's why I want a verbal report. To make you accountable for actually treating and stabilizing your pts.