Why don't you just read the chart?

/username, BSN, RN · 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.

By that logic, nobody should ever get/need report ever... I also appreciate that you are saying there's some kind of difference in assessment skill, implying that yours is somehow superior, and then describe what is done on the floor as being exactly the same as what you do.

Maria425 · Dec 22, 2015

I agree with OP!! I am a floor nurse but totally think not only does it save time for the receiving RN to look into the chart but it is the safest and most responsible thing for the nurse to do! Otherwise report from nurse to nurse is just a long game of 'telephone' and we all know what happens in that game!! All I want from the ER nurse is what their assessment was and anything else immediately important. When my PT hits the floor I will find out for myself where their IV is.

because even if they told me I will want to double check anyways! After too many inaccurate reports I just realized that the documentation is the best bet for accurate information.

chemdawg, MSN · Dec 26, 2015

I know this is an older post but wanted to put in my take on this. Hand Off is one of the NPSG's and vital to the safe continuation of care for patients that meet the criteria for hospitalization. As someone mentioned before the gauge of a patient's IV is vital in determining if it is appropriate for giving blood or going to CT. If you have tried multiple times to place one and the IV is a 24 G in the right thumb it may behoove me to find my best IV therapy nurse to come take a gander when the patient comes to the floor knowing that they will be getting Vanc Q8. I can appreciate the fluctuating pace of the ER and that the faster we can make the transition is better for all. If there seems to be a problem with lengthy report in your department I would recommend coming up with a standardized form that can be filled out with the determined pertinent information that is required at hand off. This would allow for even the oncoming ER nurse to have a quick easy reference to what has been done, is currently happening and still due to complete.

kpalffy · Feb 26, 2016

I have had the experience that most things are not always charted, so getting a few minutes to ask questions is helpful. There is nothing worse than receiving an patient that was told many things, and having no notes or orders to back up what they say. No notes if family is at bedside and coming with the patient. No IV charted, no Foley charted. Meds charted as given hours ago, but the IV med clamped and hanging on the pole not finished.

The EC gets busy just as the floor does too. I realize that charting sometimes has to wait, so a two minute phone call can help buy some time. I really miss receiving report from the EC.

juljube94 · Feb 28, 2016

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?

Agreed. I'm fairly new to the ED, and have worked for years on the wards. I discovered once I arrived in the ED that it's the ER DOCTORS that determine when the pt will go up...The Pt can't go up until the ER Dr writes the order. That's often the hold up. In our hospital, the doctors get off shift one hour before the nurses. THEN they write the orders, call specialists, confer etc. THEN the pt goes up. Usually about an hour and a half to two hours after the Dr is off...guess when, you got it. Right after shift change.

Annoying for the ward nurses? yes.

ER nurses "fault"? Not at all

Brandidrn · Mar 7, 2016

Well I guess floor nurses think down in the ER we have ideal ratios and we have the time to read it for you. So the fact we have to do the H, &P and the IV line run labs and charted it all. Oh yeah we also have 4 to 6 other patients we are taking care of that we are figuring out what is wrong. The infarct needing a cath being externally paced patient can wait for the dopamine ordered his pressure is only 60/20 it can wait as well as the level one trauma patient flown in after being cut out of her car that needs intubated and lines a Foley an NG tube and contrast for the scan to look for any bleeding she is good to wait too so I can look up the patients IV size and placement and the times meds were given so in the event you need to give blood which will take at least an hour to be ready you won't have to put another line in. Oh yeah the puking abdominal pain patient can either lay on the dirty cot it is fine no worries. Is there more of your job I can do so the 6 patients you have are all cared for tucked in snug cause my 5 patients with new orders can wait as long as you need to prepare the room for the admit. ARE YOU KIDDING ME??? Be happy you get what you get!! We are swamped down in the war zone and don't have the luxury of time as it may kill someone. Floor nurses do have a lot to do but we do too and our unit isn't a same type of patient unit we have no diagnosis on anyone when we see them. We have to put all the information in the computer and start all their care. So thanks for calling me an hour after the bed was assigned he is ready to come to the floor now and will be up in a few.

thenightnurse456 · Mar 7, 2016

Well I guess floor nurses think down in the ER we have ideal ratios and we have the time to read it for you. So the fact we have to do the H, &P and the IV line run labs and charted it all. Oh yeah we also have 4 to 6 other patients we are taking care of that we are figuring out what is wrong. The infarct needing a cath being externally paced patient can wait for the dopamine ordered his pressure is only 60/20 it can wait as well as the level one trauma patient flown in after being cut out of her car that needs intubated and lines a Foley an NG tube and contrast for the scan to look for any bleeding she is good to wait too so I can look up the patients IV size and placement and the times meds were given so in the event you need to give blood which will take at least an hour to be ready you won't have to put another line in. Oh yeah the puking abdominal pain patient can either lay on the dirty cot it is fine no worries. Is there more of your job I can do so the 6 patients you have are all cared for tucked in snug cause my 5 patients with new orders can wait as long as you need to prepare the room for the admit. ARE YOU KIDDING ME??? Be happy you get what you get!! We are swamped down in the war zone and don't have the luxury of time as it may kill someone. Floor nurses do have a lot to do but we do too and our unit isn't a same type of patient unit we have no diagnosis on anyone when we see them. We have to put all the information in the computer and start all their care. So thanks for calling me an hour after the bed was assigned he is ready to come to the floor now and will be up in a few.

Don't make it an "us" versus "them" argument. ED and the floor are both extremely busy and demanding areas. One isn't more important then the other.

canigraduate · Mar 7, 2016

Well I guess floor nurses think down in the ER we have ideal ratios and we have the time to read it for you. So the fact we have to do the H, &P and the IV line run labs and charted it all. Oh yeah we also have 4 to 6 other patients we are taking care of that we are figuring out what is wrong. The infarct needing a cath being externally paced patient can wait for the dopamine ordered his pressure is only 60/20 it can wait as well as the level one trauma patient flown in after being cut out of her car that needs intubated and lines a Foley an NG tube and contrast for the scan to look for any bleeding she is good to wait too so I can look up the patients IV size and placement and the times meds were given so in the event you need to give blood which will take at least an hour to be ready you won't have to put another line in. Oh yeah the puking abdominal pain patient can either lay on the dirty cot it is fine no worries. Is there more of your job I can do so the 6 patients you have are all cared for tucked in snug cause my 5 patients with new orders can wait as long as you need to prepare the room for the admit. ARE YOU KIDDING ME??? Be happy you get what you get!! We are swamped down in the war zone and don't have the luxury of time as it may kill someone. Floor nurses do have a lot to do but we do too and our unit isn't a same type of patient unit we have no diagnosis on anyone when we see them. We have to put all the information in the computer and start all their care. So thanks for calling me an hour after the bed was assigned he is ready to come to the floor now and will be up in a few.

Sorry your work life sucks. It's not the floor nurse's fault. If it's so bad you can't take five minutes and pass on the important parts of your patient's care, then you need to take it up with your management/administration.

Marothk · Mar 25, 2016

I have only been a nurse for a year, but I have worked at two hospitals now and here's my answer to your question...because there's nothing there. Anytime I am told I'm getting an ED admission I ask for the name and look up the chart. 9 times out of 10 there is little to nothing charted other than a few meaningless nursing notes like "MD at bedside" or "blood cultures drawn". IV access isn't charted, urine output, whether they have foley or not, there are no details about what even brought them to the hospital sometimes. If they are a current patient within the hospital system I might be able to dig up something, but if they haven't been there before their history is blank or incomplete. We appreciate that you have a time crunch to get patients to the floor, but in my experience, the person calls to give me report isn't the nurse who took care of the patient and didn't intend to give me any useful info, they just want to say they called report and get the patient out of the ed asap, but it's not always safe. I may have a patient currently crashing or a million other reasons why I am hesitant to accept the patient at the time, but it's not because I'm lazy and just don't want to take the time. There seems to be an ongoing battle between different types of units, ED and floors/ICU, PACU, etc. Let's focus on what's safe for the patient. I have had doctors yell at me and make me call the ED nurse to find out details because they aren't charted.

I think we should all appreciate one another and the unique challenges of each unit. Work together, if you are confident that you charted these details then say so, but usually I try to only ask questions that are not charted and that are significant to prepare for safely receiving the patient.

ittibittinurse · Mar 26, 2016

My hospital has the ER nurse, who has been caring for the patient, to bring the patient to whatever unit, the ER nurse has a report sheet(approved by the hospital) that is brought with the patient. Any questions can be asked and answered. There is no stupid question. We are supposed to be professionals. Our focus should be on the patient receiving safe care, not the petty stuff. The original post seemed to come from a smart**s ER nurse...who seems to think her job and her time is more important than any other nurse's job and time.i actually have actually had ER nurses tell me that, when I have to go to the ER to get my patient(this was hospital policy in one hospital where I worked...the patient was not brought to the units anymore). I have worked ER, ICU, progressive care, and medical/surgical units. The only nurses, who have ever talked down to me have been ER nurses. We are all nurses, working in different areas. We should work as a team. Our communications, especially report at the bedside, via phone, or written documentation needs to be professional succinct and nice.

siwamn · Mar 26, 2016

I have been on both ends of this post-the med surg nurse and now ER nurse. When I was working on the floor I was upset qhen a lot of times patients were sent without any report, but I also appreciated when the call was made...now I'm looking from a different persepctive....you say , ypu have 2-4 critical patients that you take care of-I assume if it's icu, you either have 2 critical ill, intubation patients, or 4, who were critical, but are stable now and waiting for the transfer....im not sure if you are aware how ER nurse job looks like....a lot of times, we have 2 critically I'll patients on top of other 3 other ones who are sick, but not as crital. On top of that, we might have another one come in, who was intubation in the field, and need care asap....a lot of times, in my hospital, parents stay in the ER for 2-3 days due to no avail beds somewhere else....we get orders every 10-15 min, and need to follow up on them....critically ill patients needs charting d assessment every hour, on top of other 3, who require every 4 hr....so now, just look at this and think...during the report, that as the author asks things that can be easily found on the chart (and we always put either 20 or 22 gauge, and yes, you can transfusion blood on 22), that can take sometimes min 5 minutes or more, how much the ER nurse can do???let's not minimize and criticism everyone's job....nursing is 24/7, anywhere in the hospital....

Mrissler · Mar 29, 2016

You do realize that as an ER nurse there are many times that we are giving report while trying to clear a bed for an unstable critical patient. Or we have 3 other patients that are still unstable that we are trying to get back to after we give report to you? The key word being unstable. You worry about a small gauge iv..well at least they have access...you worry about what fluids...we worry that they are still breathing when they get to us. Yes you have a lot to do but until you have worked an ER shift please don't assume that we are not just as busy as you are. You get a new pt you keep for the rest of the shift. Mine are changing constantly. Without report or even a name at times. Yet I can still manage to care for the patients that get thrust at me. So take 2 minutes to read the chart. I usually haven't read the H&P I might know they have history of chf but if they are in for a broken hip I'm not concerning myself with that. Yes it is necessary to know when you are giving meds but for me stabilizing the hip is priority. Their ongoing care is yours. So when I give report I will tell you how she broke her hip I'll tell you I have put in a Foley and an iv and we've done exrays and I've given pain meds I will also tell you a bit about her family and how she's coping. The things i cant chart about like the family arguing over her DNR. But it is a waste of my equally valuable time to have to read the H&P to you.