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.
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.
^^This! (sorry to the person who can't stand people saying "this" )
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?
Wow! Missed this post by tacomaster until you quoted it. (So I'm quoting yours...)
How in Pete's sake do you think it's possible to not get any more patients simply by "holding" the ones we already have? Unlike a regular floor, where you can only have so many patients before your floor is full, the ED is NEVER full. If someone comes in and needs a spot, they get one, doesn't matter where, just as long as they get one. Not to mention the flack we get from our change nurses or team leaders for not moving our patients ASAP!
In a sad way, aren't the ED nurses time "more valuable" to TPTB than a floor nurse (like me) since it generates $$ for the hospital in a different way than the floors do?
Nope. EDs are money losers for the hospitals that's why many are closing theirs. The money maker is surgery.
We don't do a phone report from ER (or PACU for that matter). ER faxes up their summary of care about 15 min prior to pt's arrival. It is basically a synopsis of their charting - chief complaint, hx, VS, labs, imaging ordered, meds given, the vitally important IV site...
The nurse calls when they fax it to make sure it isn't overlooked & will use that call as an opportunity to add any info. "Pt confused/combative & family just left." "Woman with pt is the girlfriend; wife called & is on her way."
I've never had an issue with this process as long as ER doesn't forget to fax & whoever takes it off the machine makes sure the receiving nurse gets a copy pronto. Do a quick glance at the info; once in a great while I'll have to call down & ask a specific question but it's pretty rare.
We do the same from PACU. Fax an SBAR form about 15 min before pt is sent to the floor & call to ensure it's received. At that point during the call I may add any additional pertinent info - "SBP 180s which is consistent with preop; anesthesia aware & approved dc from PACU."
IDK. Maybe it's my absolute abhorrence of talking on the phone that makes our process more preferable to me, but it literally takes no time to relay the necessary information.
Continuity of Care, this is why we give verbal reports whenever we hand off care, whether its at the end of the shift or transferring to another unit.
As an RN whom has worked in Med/surg/Tele/ER/ICU I have experienced the whole spectrum of the house. In previous positions, ER ran the house, they didn't care if the room wasn't ready, or if there was a code going on, dump and run was the motto.
While I understand the frustration from the ER's point of view and waiting "forever" to transfer a patient to the floor or unit with 20 patients in the waiting room who need to be seen. But I also understand the reason behind some of the delays of transferring patients throughout the unit, releasing the bed and many at times the unit has to transfer patients to even be able to accept a new one.
As a Unit Nurse, I may or may not have time to sit down and read through the chart (its a slow night if I do) that may or may not be complete.
It is imperative to have a report from someone who has laid eyes on the patient and as we know, the computer doesn't always tell the whole story. A monitor only tells so much and just because someone typed it into a computer screen doesn't mean that is what I will be getting when it rolls into my unit. As an ER nurse we receive report from the EMTs/PMTs what is the difference?
Right here. Just got back from the last of 3 back to back 12s.
First off, thanks for all the responses- this wasn't a vent. If I had wanted to vent, I would have done it over in the ER sub-forum,
Genuine curiosity. I know that a common issue is time. And, I feel that in many cases, report would be shorter, IE save valuable time with a quick chart review. Where I work, we chart in real time, or close to it. The charts are easily accessible, as is the historical chart, which often has a recent H&P or DC summary. I usually start report by asking whether we are starting from scratch, or whether the receiving nurse has read anything. When they have, report is shorter, and more accurate. The nurse who scanned the chart is better prepared, and spends no more time on it.
This is particularly true, as ER nurses don't think like floor nurses. Many here have expressed frustration at how bad we are at report. Maybe it's not that we are bad at it, but we approach pt care very differently. I have worked ICU and am perfectly capable of giving a detailed systems based report. I just think it's an outdated practice that lingers, despite improvements in technology.
To respond to a few specifics:
"As an ER nurse we receive report from the EMTs/PMTs what is the difference?"
This is an excellent point. As ER nurses, we regularly take care of complex unstable patients with a 2-3 minute report. Sometimes less. We also hand off patients to each other with extremely minimal reports, as most of the critical information is accessible. This is part of why our reports to the floor are often unsatisfactory.
We would have to go into the patient's room and log on to a computer, which takes forever. All of our computers are at bedside; we have none at the nurse's desks
Thank you, A direct answer.
What if this were your family member? Wouldn't you want and NEED me to be prepared to care for them?
Absolutely- that's why I think you should have access to the most accurate information. I am well aware that the whole story isn't in the chart, and think report should be limited to what is not easily accessible in the electronic record.
I agree with you - it's a waste of BOTH of our times for you to be talking to me when you don't even know the patient and have to look information up in the chart. Please hand the phone over to the person who knows what's going on, if possible.
I know all of the information that's important for me to care for the patient. If you want details that weren't critical to me, I have to look them up in the same chart that the receiving nurse has access to.
Please don't ever "guess" when it comes to patient care. It is safer to say you don't know.
When I say that I have to guess, what I mean is that I have to guess what will be important to you. As you can see from all the responses here, what the floor nurse expects varies hugely from nurse to nurse. I try to be prepared, and make report go smoothly. I have no problem saying "I don't know". If I don't know something, it' s because I didn't need to know it to safely care for the patient. If I needed to know it, I would.
Any thoughts on how to improve the process? Let's assume, just for the sake of argument, that I am a good nurse, and my primary concern is good patient care. Given the wide variety of what different floor nurse might want, how might I best prepare? Right now I do it by doing a quick review of the electronic record we both have access to.
What about a set format accepted by the hospital?
What if the computer actually generated a concise report with objective facts, and verbal report was limited to broad strokes, and stuff not in the record? The eyes on information and impressions.
I like the SBAR format, personally. One of the hospitals I worked at had the ER fax an SBAR to the floor with the nurse's phone number to call for questions. I liked that process.
If any of you use Cerner, there is an mPage summary or Patient Summary that details the vital things like admitting dx, pertinent history, lines/tubes/drains, recent meds, last set of vitals, consults, recent orders, etc. Epic has a report that you can generate that has the same things. Soarian has a patient summary, too. I suck at McKesson, so I don't know if there is anything like that in it. But all of the computer systems that have the summary have made it printable. The only problem is that the info has to be in the computer first.
"ICU nurses know you from head to toe, ER nurses know you have a head and a toe"
As an ICU nurse, I like this - and not in a condescending way. I realize I am required to know more about my TWO patients than a floor or ER nurse, that is partly why I only have two. In our world, I get dirty looks from docs and peers if I can't rattle off vent settings or important labs from memory. I would never expect anyone besides an ICU nurse do have that kind of memory of their patient.
However, I do find it disconcerting when a nurse from ER or the floor can't answer SOME things from memory. It makes me think you never laid eyes on them. I mean, you have in theory assessed and than charted an assessment on them. Surely from that you can remember major lines and drains coming out of their body? (foley, HD cath, central line, PICC, trach etc) So you can't recall what gauge their PIV is? FINE. I get that. But when you tell me in report they have a PIV to the AC and they roll in with an HD cath and a PICC line I get scared for you.
Some things you should know about your patient without having to look it up. And if it is too much trouble for you to just spit it out in a brief conversation I think maybe you're missing the big picture. If I have to spend time looking up information you can't be bothered (or expected) to know but that I need to know for this patient's care...that is time I am not spending with a very sick patient.
It would be faster if you knew the patient you were giving report on. If a nurse is asking you a lot of questions, you're often not providing nearly enough information in your hand over.
I work in ICU and while I don't expect a lengthy ICU type report from ER nurses, I would expect them to know the position and size of peripheral IV access their patient had.
Why don't I just read everything? Why even bother calling me if you're just wanting me find all this information out for myself? I have room to set up, infusions and vents to prepare, I would like to spend more time doing that then search for answers that you should have been able to provide.
All I expect in report as an ICU nurse is admit reason, current issue. Briefly (very briefly) run down systems with pertinent info.
Generally before we get a patient from the ED the H&P is filled out, I do find the time to read over this prior to taking report. And when the nurse asks "have you had a chance to read about the patient" I'll quickly tell you what I know. If that's all I need to know perfect. Majority of report is done.
Tell me their GCS (do we know baseline or is the patient always off). Last set of vitals. Heart rhythm. Are they on oxygen or tubed? (Generally ED rns don't know why the patient is npo or bowels so I usually don't even ask). IVS and drips. Labs that we are trending etc
We should not be on the phone for more than 3 minutes.
The cutest (although at the time, annoying) report I have received from the ED; with each question I asked the RN responded with 'I don't know' ... at the end of report they asked me if I had any questions.
Floor nurse extraordinaire! Except some questions can't be answered by the chart.
psu_213, BSN, RN
3,878 Posts
^^This! (sorry to the person who can't stand people saying "this"
)