Why don't you just read the chart?

NurseGLC · Dec 8, 2015

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!!

MirwinRN · Dec 8, 2015

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.

iShaybie, ADN · Dec 8, 2015

I agree with you! Isn't that the point of everything being logged?

Samu0016 · Dec 8, 2015

On my floor we sometimes have 15 ADMISSIONS on a shift. Im moving fast, my patients are often SICK and I don't have time to sit down or fire up my COW to read a chart when you're just gonna call me anyways. I don't need all the details, just general story of why they came in, whether they can walk, talk, if they have an IV and if their lytes or trops are abnormal enough to matter. As irritating as this is to you I need to know this stuff because it helps me pick what room they go into (if they can't walk and are in with a GI bleed I can bet I'm gonna have to colon prep them and I won't put them all the way down the hall), what supplies I need in the room so I can get them settled before the doctor butts in, and if they don't have an IV I'll put a request in for one prematurely since my IV team only comes around like q2. My personal feeling is that the irony comment was sorta backhanded. It's sometimes irritating to us that you don't know information about the patient you've supposedly been caring for. Is there an equal explanation for why you guys always seem to need to read the chart to give report?

mrsjonesRN · Dec 8, 2015

I floated to ER from icu recently...everyone is taking care of everybody's patients down there, doing multiple tasks to multiple people. Then, a code came in. I was asked to call report on a patient I didn't know a thing about. I can totally see how things get crazy and confusing.

dudette10, MSN, RN · Dec 8, 2015

My facility considers it a violation of privacy to look a patient up before they are physically on the floor!

That is just so stupid. HIPAA interpretations gone wild. Bed assignment made, nurse assignment made, but the assigned nurse preparing for appropriate care is a violation. Do they also withhold name, age, sex, and chief complaint/diagnosis from the receiving nurse? Good lord...

LaurenGentry · Dec 8, 2015

I read the chart (if I have time because I usually have 4-5 other acutely ill patients and/or am administering chemotherapy and/or tending to the actively dying pt/pt's family included in those 4-5), but I ask questions too because I do expect you to remember if this r has an IV, has a Foley, does need to be on droplet/contact precautions and is A&Ox3. I might have to change room assignment or supplies depending on your answers and I'd rather do that ahead of time than when you a here to dump the pt (as so often happens).

As the last RN in charge of the pt, I'd rather have a personal, 1st hand account about this person you're transferring care of. I get far more information from that than reading ticked off boxes on the chart. If you don't know these basic things without searching the chart yourself, I wonder if you really made an effort to care (even just briefly) for this pt and what kind of state they will arrive to me in.

If you don't have time to know your pts even a tiny bit, maybe turn towards management for staffing concerns/pt load than the RNs receiving your pts who had no influence on any of the former.

Tink2008 · Dec 8, 2015

OK, so I have been reading the responses to this post for quite some time now. I think the bottom line is that we ALL need to try to respect each other and their busyness on their unit. Most of us floor nurses are FULLY aware that ED is a busy place and that the ambulances and walk ins don't stop for shift change. BUT ED needs to realize that you are NOT the only place we get patients from either.

Case in point: A few years ago I(with 21years if nursing currently) went from being a med/surg nurse to a pediatric/maternal child nurse. A few months ago I was working in my peds department with a full floor (12 pts) and a PICU pt. My only other PEDS nurse was in the PICU which left me to be charge with 2 nurses floated from MB to help. Now since neither of these two were "able to do discharge paperwork or admit new patients" that leaves me with not only the job of admits, discharges and Dr rounds, but ALSO taking the harder/sicker patients on the floor.

So I have a (at the time) 17 year old FULL CARES CP patient with tube feedings, IV and Gtube meds, and a Braden of 13, on top of my other patients and the rest of the jobs I also have to make sure my PICU nurse has access to everything (meds, water, food for self and pt, bathroom breaks, etc) that she needs.

Most of the day (7A-730P), we are managing...getting what patients discharged that we can, listening to float people fuss bc they "haven't had m 15 min break", "NEED to go take lunch" (nevermind that I have barely been able to pee let alone take ANY kind of break).

Fast forward to 5:30 pm get a call from bed placement that we are getting an adult male from OR AND an adult male from ER as the "hospital is getting full". No, we do NOT have a Tech to get rooms ready or anything like that. So I am getting 2 rooms ready for admits (which I will get to do) when I get a call from bad placement again for a pediatric admit from ER as well. OK...as I am getting that room ready as well PACU calls with report...stop what I am doing to get report....they will be up in 10 min. Great...should have enough time to give tube meds quick and pour more formula in tube feeding bag. Oops there is phone. ER is calling to give report on adult pt. Tell ER that Pacu is on the way with their patient and as so as I have him settled and monitors on I will give them a call back. 5 min later ER calls AGAIN to give report on same pt and Pacu is coming down the hall. Tell them AGAIN that I will call as soon as I have surgical stabilized. Get PACU pt to room paged to phone for ER to try to give me report on peds pt. Have most of rooms we got discharged STILL waiting as housekeeping does NOT see peds as a priority for cleaning!

Inform ER that I can NOT accept 3 pts at the same time and will call as soon as possible. Call house supervisor and ask her to stress to ER that we are JUST A LITTLE BUSY RIGHT THIS SECOND, need a LITTLE patience. MB nurse comes to me and tells me that her peds pt has not peed for10 hours. Tell her to call on call for that group and talk to him. Back to finish settling PACU pt. Come out to find on call was in house and is now on floor asking questions and giving orders for NG tube. HOLY CRAP IT'S 1845 and next shift showing up. One nurse throwing fit about being assigned CP pt "For the THIRD day in a row" welcome to my world and the MB nurse can't take him! Picu nurse reports off, I'm STILL trying to put out fires so she comes to MY rescue. Dr in pt room with her and another night nurse to place NG. Give CP pt report to new nurse then she is on phone to get ER report on adult (1910). 2 pts JUST had surgeon come up and give discharge orders...MB>>>"can you do those for us?" not right this second. Dr comes out wanting IMMEDIATE information to set up transport for pt to childrens hospital. One of night shift nurses call house supervisor who comes to floor to find out "why we are so busy". Adult pt from ER being admitted by night shift while us 2 day shift nurses are getting things ready for transfer. Nurse comes out from ER admit and states "this pt is detoxing" NOT appropriate for us! as House supervisor is looking for a bed we hear YELLED swear words coming from down the hall. Thinking id ER pt house sup heads down the hall, returning to tell us it is adult OR pt who is yelling and refusing to use call light "Mother******* nurse can just get her ******** a** in here!" Guess who is ALSO going to be transferred off unit?!?!

Get peds pt transferred, both adult pts off the floor to new rooms and get reported off all while getting discharges finished to fine MB nurses left floor to "Go finish charting where it is quiet" and discover it is 2130. Gee no break once AGAIN. oh well I do have a couple of days off....

Come back to work to find out that I was written up that night (at 1905!) by ER nurse because "she refused to take a pt for 2 hours , said she would call back but didn't call back before her shift was over at 1900"......UMMMM WHAT?! You were giving report to a nurse at 1910 AND I was still here at 2130....I understand ER was busy too but SERIOUSLY?? You have techs AND more nurses down there!

Like I said...bottom line is we ALL need to try to respect each other and realize that just because you think the other team isn't busy doesn't mean they aren't swamped. And WE get patients from ER, PACU, ambulance transfers from other hospitals, and direct admits as well....so we know that walk ins still happen!

BTW...YES, this whole thing resulted in a "write up" in my folder...even though there were SEVERAL other nurses that backed me up that we were NOT able to do anything different than what we did that night....

LoriDurham · Dec 9, 2015

I'm saying this as both an ED nurse and having worked a floor - You say you are taking care of 4-5 other patients? I've just had someone pass out, another vomit, another unit of blood hanging, 1 demanding discharge papers, EMS just filled my only available room with an 80 yr old DIB and we are 30 deep in the waiting room. Sorry you are busy with your 4-5 pts. I'm turning over an average of 20 plus a shift and that means starting IV's, new pt assessments, labs, X-rays, urine specimens.........

Yes read the chart.

No I don't know where I put that 12th IV of the night, you can look when they get there.

I say this because it's been my experience having worked in more than one hospital that no one will get up from the desk to help transfer the pt over. The rooms are rarely if ever prepped and most of the time you are asking questions about a history that wasn't pertinent to my EMERGENT end of their care.

I don't care if they had a tonsillectomy 20 years ago but you might.

FYI it is NOT my job to stabilize, that's what OR and ICU are for. It IS my job to keep them alive and get them ready for what may come next.

you want ED nurses to show you some respect or communicate with you, stop ripping us apart every time we do call to give you report.

We each of us have a job to do. A little respect on both ends goes a long way. Rarely do I get anything but grief and a "those stupid ER nurses" attitude from floor nurses.

yes I've worked the floor before so I understand you are equally understaffed and over worked. So are we.

canigraduate · Dec 10, 2015

Instead of all these BS "my work is harder than yours, and it's your fault" tantrums, why don't you try to cooperate with each other and gang up on the administration that makes the environment necessary?

**sigh**

No wonder your work lives suck. Y'all have no backbones and are content to work in unsafe conditions.

Trauma Columnist · Dec 10, 2015

Lets take a deep breath everyone please! This is an issue for which there are many opinions, many variations.

We encourage lively debate but please remember to debate the topic, not the poster.

Thanks!

ShiloB · Dec 22, 2015

I currently work in the ER, but I worked on the floor for many years as well. The big difference I see is assessment skill. In the ER we assess a patient and initiate intervention based on that assessment. When a patient arrives on a unit, they need to be assessed by their primary nurse, and then interventions initiated. I don't see why this should be any different than when I receive a patient. I don't get a pretty bow on a report when I receive a patient, I use my skills to get to know my patient and what they need. So should the floor nurses.