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.
I agree that calling report should take no less than 3 minutes. All the nurse needs to know is why the pt is there, pertinent medical history, recent VS, and that an IV is in place and if it is heplocked or with fluids, and any abnormal labs and if they have been replaced.
Those who still get a phone report are lucky. For those patients on the med surg floors, IMC, and telemetry they do not get any report before a patient comes. They must look in the computer. Sometimes this causes an immediate rapid response as the patient really is not stable for the floor they were sent to. The JC says we should have the opportunity to ask questions.
I totally see where the ER nurse is coming from, but sometimes the charting in the ER is not up to date and we on the floor cannot see where the IV is placed or that fluids are running, or that drip was started.
Yes I do read the charts because the reports I get are crap and I'd rather just read and receive the patient.
When I do get a report, I like a brief background and little subjective information that may not be charted because I will be dealing with the patient for the duration of my shift. If the person giving report doesn't have anything more to offer that what's on the online kardex, the conversation with me is quite brief.
My organization is in the process of adopting 100% face-to-face handoffs as recommended by patient safety research. Bedside Shift Report is the standard. Actually "laying hands" on the patient as we examine lines, drains, dressings, etc. is our expectation. In addition to reassuring the patient and family that all caregivers understand what is going on, it gives them an opportunity to contribute (e.g., level of pain, most comfortable position, understanding of treatments). And, of course, it helps eliminate all those nasty surprises like that IV that must have 'just' infiltrated during transport, right?
I don't want to believe that any patient is not important enough to merit a structured conversation between nurses who are caring for her.
Specializes in Medical-Surgical/Float Pool/Stepdown.
I agree that it's better and faster, although it looks like I'm in the minority here. When I get report, I only want to know what's NOT in the computer. It drives me crazy when someone tries to read me each lab result.
This seems to be the problem at my hospital though, most of the pertinent info I would need that would take me a few minutes to view is often not entered yet! I realize the ED is super busy and a revolving door but not much emphasis is place on charting it! So if I have questions, usually it means that no basic H&P is in, no IV's are charted but the MAR shows a bolus given, or a ton of meds have been "cabinet overrided" and I'll be calling that ED nurse (that may not be there any longer when I get a chance to again, say two minutes later!) to fix the charting. It's good to to know things like "hey, General Surgery has already talked to the Pt and they should go to the OR soon" or "English is not their language"...or...or...or maybe when I'm gifted with telepathic communication skills I'll be straight! Otherwise, my ED nurses rock!!!
Did I read your post right, where you said that when you don't know you "guess"?
Please don't ever "guess" when it comes to patient care. It is safer to say you don't know.
I understand that you're busy in the ED but safety is always priority and that included giving a concise/accurate report.
I am the easiest nurse to give report to. If you tell me you don't know something I'll figure it out. If you lie, I'll take the time to write up the incident report. If you send me my ICU patient on an esmolol drip that is moments from running dry with just a clin tech and NOT on a monitor.. yeah I will find you in the ED.
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.
So- why don't you?
Sooo many things to say.. I'll be brief..
Starting with"Hey Floor Nurses" then ranting about something is a good way to make someone defensive..
You said you GUESS on things you report.. Uhhh???? Why? If you don't know just say so. I would write up a report in a second if I knew a Nurse was guessing with patient report.. I think it's ridiculous that you would do it, and then admit to it as if it isn't serious.
We are ALL TOO BUSY. Sadly it's the nature of the beast right now. Working together is not only safer, but save times for all involved with care. I'm still shaking my head on this one..
Can't we all just get along. There is basic common sense. If I get too much info over the phone (while I'm busy and can't write it all down) I will forget over 1/2 of it. Common sense, the key highlights, what vital, important, critical interactions were done or will soon need to be done is usually enough.
I can't figure how ER nurses can give bedside reports.....not enough ER nurses are staffed for them to bring up their patient and give bedside report where I've worked?
Well, I guess I'm in the minority and agree with the op. The fine details are there, and you will be double checking anyway. Getting Just the basics in report are fine with me.
My hospital, screwed up as it is, is insisting on mandatory bedside report between floor nurses, but has eliminated any report between ED and the floor. Because that was the major bottleneck in getting these patients admitted. So now we have to rely on the chart for everything. Problem is, the narratives are usually not in the emr when the patient arrives to the floor. So now I know vitals, meds given and tests/labs performed, and a basic admitting diagnosis, because I had to look it up myself, but the rest is a mystery. Kind of unprofessional in my opinion, when you walk into a room saying, "so what brings you to the hospital today"?
i would love to return to the days with a verbal report from the ED nurse. She can give me the big picture, and I'd be very happy to look up the details myself.
As an ED nurse, I have no problem reading of my assessment, nurse notes, meds I gave, etc. to the receiving nurse. My issue comes with having to read off all the normal lab and rad results that are in the computer. For example...me: "everything in the BMP is within normal limits." Receiving nurse (and I realize he/she is busy and likely running around like crazy): "Well, what was the potassium? What was his BUN and creat? Did you draw a troponin? Why not?" Me: "His chest x-ray was normal." "Well, what about his heart size? Did you do a head CT? Well, why not?" I used to work on the floor. I understand the frustrations of getting a patient from the ED when you are overwhelmed with the patients you already have. However, it is very frustrating to the ED nurse to be trying to get from section to section of the chart to find the answers to the questions when: (a) the floor nurse is capable of looking up these normal results when he/she gets the chance and (b) you're trying to get in a quick report so you can go in and chart/push meds for your other patient while he/she is being intubated.
Everyone in the hospital is busy. I wish both the floor and the ED nurses realized their "opposite number" is busy too. We all have stuff that can pull us away from an effective report, and both sides need to recognize that those pulling factor exist on both sides of the equation.
Starting with"Hey Floor Nurses" then ranting about something is a good way to make someone defensive..
You said you GUESS on things you report.. Uhhh???? Why? If you don't know just say so. I would write up a report in a second if I knew a Nurse was guessing with patient report.. I think it's ridicuouls that you would do it, and then admit to it as if it isn't serious.
We are ALL TOO BUSY. Sadly it's the nature of the beast right now. Working together is not only safer, but save times for all involved with care. I'm still shaking my head on this one..
i think op means she is guessing what you want in the report, not what was actually done for the patient. Maybe you should re read what they wrote.
I'd much rather give verbal report than written and I'm more than happy to give a thorough one but when the receiving nurse asks me when my acute CHF exacerbation patient last moved their bowels I get a little crispy. Yes, that really happened.
As a PACU nurse who brings patients to the floor or phase II all day long, I'll weigh in.
First, I have receiving nurses who say, "I've read the SBAR" and don't want to hear anything else. This throws me for a loop because I have to remember if everything has been charted (yes, in an ideal world, I finish charting before I bring you the patient, but neither of us works in an ideal world, and can I just tell you WHY I gave this med and how the patient responded to it in case you want to give some more?).
Then there are receiving nurses who do ask 8 zillion questions, God love them, and ask me to repeat everything two or three times. Meanwhile, my other patient is downstairs being watched by an antsy coworker and I'm going to get reamed for giving long report. No real strategy to speed the plow for these folks. Luckily my colleagues know who they are and will usually forgive me.
Finally, there are my dear sisters and brothers in the ICU, who ask me the most amazing questions that I have NO IDEA of the answer when I bring them patients. Talk about feeling like I haven't spent the past 1-2 hours with this patient! But it's nothing like spending 12 hours with the patient, and I have learned to go through the chart in a little more detail on my ICU pts so I can help their receiving nurses get on track quickly. (Plus I know they're going to read the entire chart anyway!) I've also learned not to take it personally when they drill down on stuff they think I should know; if we spent that kind of time learning every nuance of the patient, they would never leave the pacu!
Generally it works out fine; the vast majority of my receiving nurses fall between these extreme examples. I use my own little cheat sheet to stay organized and will look up other things they need on the fly. I'll tell them what fluids are up and whether they are on "their" tubing/pump or still on plain tubing. I don't mention the IV site unless there is a problem; if there is an issue with how it was documented when I got the pt, I've fixed the EMR by the time they get him/her. If you ask, I'll tell you. I'll also tell you if I'm not done charting. I won't guess, but I reserve the right to say, "I have no idea," and move on with my report.
When we get preop patients from the floor or from the ED, we use a report sheet to get all the essentials (this is much less detailed than what a floor nurse needs when getting report, but it is a good place to start). I do not want to just read the EMR because not everyone charts to the same level of detail, and again, I know the charting may lag. I'd rather have a 2 minute conversation and be sure I know what I'm going to find when I walk into the preop bay!
One last pet peeve: when anesthesia gives report to me, some of them list off the meds they think I should care about and omit the others. I do read their paper record anyway, but if you had to give vasopressors in the OR, please tell me and let me work out whether it's important to my care or not. If I have to read the paper record to get the full story, then a) please work on your penmanship, and b) don't bother telling me any of the meds. I tell the floor nurses every drug the patient got in the OR and in PACU and let them write down what they want.
(Good grief, that got a lot longer than I anticipated. Sorry; hope some of it helps!)
nrsang97, BSN, RN
2,602 Posts
I agree that calling report should take no less than 3 minutes. All the nurse needs to know is why the pt is there, pertinent medical history, recent VS, and that an IV is in place and if it is heplocked or with fluids, and any abnormal labs and if they have been replaced.
Those who still get a phone report are lucky. For those patients on the med surg floors, IMC, and telemetry they do not get any report before a patient comes. They must look in the computer. Sometimes this causes an immediate rapid response as the patient really is not stable for the floor they were sent to. The JC says we should have the opportunity to ask questions.
I totally see where the ER nurse is coming from, but sometimes the charting in the ER is not up to date and we on the floor cannot see where the IV is placed or that fluids are running, or that drip was started.