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.
If I had time to read a chart why would I even need to talk to the ED nurse they never know anything usually anyway since "it's not my patient or I just took over this patient". I'm glad I don't work at the OP'S hospital as it would suck to get a report like that from the OP or even have to talk to someone with that kind of "better than thou attitude".
This is a total myth. Ask any ED nurse anywhere and you will find that we are pushed to get the patient out ASAP. We don't control when beds get assigned and for some reason it always seems like we get them at the end of the shift then we have 15 minutes to move the patient or we have some explaining to do. Holding patients just means we get hall patients added to our assignment and nobody likes hall patients.
How would you like it if I said that floor nurses don't call housekeeping to clean their rooms after discharge so they don't have to get new admits and that's why 90% of the time when I call report I get told the room is dirty?
We don't simply say, hey housekeeping don't clean that bed, let's F#! $ with the ED. Seriously we usually have 2 housekeepers in the evening for 350 beds and one for nights.So seriously not the nurses fault. We know as floor nurses that there's a huge push to get ED pts to the floor. Doesn't sound like you've worked the floor with the challenges the floor faces too. But oh wait, that's not as nearly as important my bad. I don't need to know when their last bm was. I k ow they have an IV somewhere , I don't need to know half of what the ED nurse usually tells me because hey, I can read but thanks anyway.
Thankfully we have good working relationships amongst our units at my current employer, there isn't much of the "we work harder than you or our patients are sicker than yours" attitudes.
I would love to read the chart, however the ED at my organization has a different charting system and all I can see are orders. I can't tell if a med has been given or not. Would rather get a 3-minute report instead of risking double dosing my patient.
Good luck in your career, OP. With that work ethic, it's likely to shine in your work relationships. This was probably the best example of how NOT to be a team player in a patient's plan of care. No matter the department, we all work to get the patient better. There's a lot of stuff the ED could improve on, as with floor nurses. Everyone just needs to help one another, learn from experiences, and move on. Do a good job, give a good report, ship the patient off to the new nurse, and go to work on the new patients. That's your job. Take pride in the care you give and let it shine when you hand off to the next nurse (whatever the department). Perspective.
We don't simply say, hey housekeeping don't clean that bed, let's F#! $ with the ED. Seriously we usually have 2 housekeepers in the evening for 350 beds and one for nights.So seriously not the nurses fault. We know as floor nurses that there's a huge push to get ED pts to the floor. Doesn't sound like you've worked the floor with the challenges the floor faces too. But oh wait, that's not as nearly as important my bad. I don't need to know when their last bm was. I k ow they have an IV somewhere , I don't need to know half of what the ED nurse usually tells me because hey, I can read but thanks anyway.
Thankfully we have good working relationships amongst our units at my current employer, there isn't much of the "we work harder than you or our patients are sicker than yours" attitudes.
Did you even read the context of my post or what I was responding to? My point was that accusing ED nurses of holding patients on purpose is just as bad as ED nurses accusing floor nurses of delaying rooms being cleaned on purpose. There seems to be an enormous amount of gross generalizations and broad brush painting going on here and it's disturbing. Your hostile and rude post is just adding to it. If you are going to quote my posts please do not add things to your reply that I didn't even say (the "sicker patients" or "working harder" bit). You are trying to put me in a bad light and I won't stand for it. FTR, I had a great relationship with the majority of the floor nurses (and yes I did work the floor for a time).
I would love to read the chart, however the ED at my organization has a different charting system and all I can see are orders. I can't tell if a med has been given or not. Would rather get a 3-minute report instead of risking double dosing my patient.
We have the exact same issue in our hospital (or should I say Customer Service Center) as well.
Good luck in your career, OP. With that work ethic, it's likely to shine in your work relationships. This was probably the best example of how NOT to be a team player in a patient's plan of care. No matter the department, we all work to get the patient better. There's a lot of stuff the ED could improve on, as with floor nurses. Everyone just needs to help one another, learn from experiences, and move on. Do a good job, give a good report, ship the patient off to the new nurse, and go to work on the new patients. That's your job. Take pride in the care you give and let it shine when you hand off to the next nurse (whatever the department). Perspective.
OP back from an internet free vacation.
First, I would like to thank you for your good wishes for my career, and concerns with my work relationships.
My career is going great. Having done this for 11 years, I have had the opportunity to work in 7-8 ERs through travel and per-diem, and learned a lot along the way. I earn a full time salary working per-diem in 2 facilities, taking off pretty much whenever I want. I have this opportunity because I am considered competent, reliable, and a good team player. In addition to my required certifications, I maintain CCRN and TNCC, and am shooting for CEN and ENPC- all at my own expense for no extra pay. I do this because it is important to me to be the best nurse I can.
As far as my professional relationships- I have taken care of family members of peers, docs, and administrators, and they seem to really appreciate the care I provide. I get on well with members of other departments and do what I can to help them when I can. I am always congenial when I give report, and usually start with a friendly greeting. If we are slamming the floor with admissions, I try to acknowledge that.
To address a couple of points:
Holding report till shift change- I am sure that this can happen sometimes as I am sure there are lazy uncaring ER nurses in the world. But, for the most part, this is simply not the case. Any nurse doing this is putting an extra work load on their ER peers, and would be confronted by those getting the brunt of their laziness- the rest of the ER team. Self policing, so to speak.
My actual OP: My question centered around facilities in which both nurses have equal access to the chart. There are a number of details that I, as the ER nurse, don't know. While some non ER nurses might find this an egregious breech of responsibility, let's assume I am familiar with the Standard Of Care, and am able to provide it without these details.
So- I look them up in the chart that the receiving nurse has access to. I read them, verbalize them, and often the receiving RN writes them down. This seems inefficient, and has more potential for errors.
Everybody here agrees that all nurses are short on time. Having been in the ICU with the same system, I can tell you that I can read details myself faster than an ER nurse can rad them out loud.
It saved me time to scan the chart for details I need, especially when I know the ER nurse may not know them off the top of their head, and will have to look them up.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
OP back from an internet free vacation.
To address a couple of points:
Holding report till shift change- I am sure that this can happen sometimes as I am sure there are lazy uncaring ER nurses in the world. But, for the most part, this is simply not the case. Any nurse doing this is putting an extra work load on their ER peers, and would be confronted by those getting the brunt of their laziness- the rest of the ER team. Self policing, so to speak.
My actual OP: My question centered around facilities in which both nurses have equal access to the chart. There are a number of details that I, as the ER nurse, don't know. While some non ER nurses might find this an egregious breech of responsibility, let's assume I am familiar with the Standard Of Care, and am able to provide it without these details.
So- I look them up in the chart that the receiving nurse has access to. I read them, verbalize them, and often the receiving RN writes them down. This seems inefficient, and has more potential for errors.
Everybody here agrees that all nurses are short on time. Having been in the ICU with the same system, I can tell you that I can read details myself faster than an ER nurse can rad them out loud.
It saved me time to scan the chart for details I need, especially when I know the ER nurse may not know them off the top of their head, and will have to look them up.
Even in facilities that, in theory, have equal access to the chart, the access is not always equal. We might be on the same charting system as you, but the only computer access I have is in my patient's room. I might not be able to write anything down there because the computer is just hanging off the wall and there's no surface on which to rest a paper or pen. I might not even be able to get to that computer because the patient is using the toilet, resting or entertaining 15 close friends and family members. (Patient/family centered care, you know.) If there is more than one computer at the "nurse's station" it may be being monopolized by medical staff, medical students, nursing students, or one memorable day, by the pastoral care student.
Assuming that the floor has access to computers and someplace to write while using one, and that we're on the same system as the ER, it is also possible that I didn't know I was getting an admission until you called to give me report. Or I did know I was getting an admission but I didn't know the name. Or the secretary wrote the name down wrong and I've been wasting my time trying to look up Gregory Thomas and the patient's name is actually Tom Gregori.
And there are some facilities that interpret HIPAA somewhat differently that you apparently do. I may not be allowed to look up a patient until he hits my unit. My access may be blocked so I am prevented from looking up patients who are not on my unit.
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.
I remember a time when delivering a resp. pt in distress to M/S or transporting a very unstable pt to CCU (as in ready to code) was considered reckless and grounds for dismissal. Not anymore; now they look the other way.
But, if I were to ask for five
minutes reprieve before
taking report or an admission, I will have some irate
and utterly clueless middle manager there in a minute ranting about teamwork in a threatening manner.
My facility considers it a violation of privacy to look a patient up before they are physically on the floor. We cannot even check an H&P or labs until they arrive. So any info I can get from the ER nurse makes my job easier. Do I need an IV pump, SCDs, bed alarm, seizure pads, etc?
And for the ER nurses... is it so hard to make sure all labs are done before you send them up? I can't tell you how many times I get a patient whose cardiac profile was due before they left the ER, or within moments of arriving on the floor!
Most hospitals don't allow the units access to the ER and vise versa, at least not before they've been formally admitted and transferred to the unit. If I don't ask questions, how else can I know that the patient is appropriate for my unit? How do I know what I need to do to prepare for an easy transition? Should the patient be near the station? Is a bed alarm needed? Lunch was served 45 minutes ago, did my patient have lunch? Was the consultant mentioned in the ED MD report called yet? I hate to think how many patients have been sent to my unit where an ED nurse has told me their skin is intact, only to find a stage III wound on their coccyx, or that a patient is continent, only to find they're practically doing the back stroke in the diaper that wasn't mentioned. I've lost count of how many consultants have yelled at me because nobody notified them of the add to their service. How about the patient whose troponin was 79.0, and BNP was 1250 (yeah, you read that right) and they were trying to admit him to the Med/Surg unit!! (Those test results came in between the time the ED nurse was told to admit and my asking what they were). I don't ask the questions because I can't read the chart, I ask these questions to provide the best possible care to my patients and to try to prevent issues before they are created. And lastly, I've found that those who wish to skip the niceties of a good verbal report, are also those who tend to skip on thorough charting and nursing notes (other departments are responsible for recording labs, radiology reports, H&P, etc). And I'm not singling out the ED here, many of the nurses on my own unit are guilty of that!!
Ive been an ER nurse and get how fast paced the care is and how much pressure is on you to clear a patient out, ome way ot another. BUT here is what happened to me recently. I'm currently working a travel gig on a PCU. At the hospital, there is no report from the ER. Most of the time, I'm unaware that my patient even arrived because the tech that brought them up is too busy to let me know they arrived. This baffles me, since it's important to place patients on the monitor ASAP. Well, the other night, I realized my patient had arrived and didn't so much as know the diagnosis. I go rushing in the room because I was very concerned about getting vitals and the monitor going. Turns out the guy was AMS and I may as well walked into a hornet's nest. My safety was very much at risk. Many times at other facilities what may have been considered stupid questions could jog a memory and give me an idea of what to expect. Also, how many times have you passed on that a family member is difficult or thus or that may trigger poor behavior from the patient? You say it, I write it, I remember it.
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.
Asystole721
16 Posts
If I had time to read a chart why would I even need to talk to the ED nurse they never know anything usually anyway since "it's not my patient or I just took over this patient". I'm glad I don't work at the OP'S hospital as it would suck to get a report like that from the OP or even have to talk to someone with that kind of "better than thou attitude".