Why don't you just read the chart?

ChipNurse · Jul 2, 2015

I only want basic info from ER... why are they being admitted, pertinent PMHx, Baseline mental status, current vitals, Fluids, what you did for them (lasix, fluid bolus, blood, etc), did they get any scans, what labs were sent already, what was replaced based on the labs, are there meds that were not given that I need to give (ie: antibiotics). Report should take 5 minutes tops.

FlyingScot, RN · Jul 2, 2015

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.

Which would happen more often if you took report when the nurse who knew the patient called you in the first place. Often times report gets delayed long enough that my shift is over and I'm not staying and waiting for you to call or not call me back.

As for your second statement that's a pretty broad brush you're using. When the nurse taking report is asking about bowel movements for a patient in CHF I highly doubt it's because he/she isn't getting enough information.

flyersfan88 · Jul 2, 2015

Because 9 times out of 10 the ED calls to give report at change of shift after hanging on to the patient as long as they possibly could.

But that's a whole other post.

SteelGrey · Jul 2, 2015

Not really related but when I worked in an equine hospital we had a saying called " READ THE F&%$^ CHART" bestowed upon us by the owner of the hospital. We were responsible to read through everything regarding the patient and what had happen to it since our last shift. We usually got verbal updates at shift changes with the most critical bullet points or safety advice ( if not slammed) but I never truly rely on second hand information. Cover your Ass. The worse thing to happen in a misunderstanding or an error is to be well " so and so told me xyz" The chart is a legal document that you want to get to know very well.

Obviously human hospitals have different policies and expectations. but I think some things are universal.

MJB2010 · Jul 2, 2015

If at any point giving report on your patient becomes too tedious, it might be time to take a vacation. Sounds like you might be suffering from burn out. Seriously, you cant give a verbal report? And the "guessing" is not ok ever. I would prefer to get report form the person that knows the patient. And its a bit ironic that you suggest we need to look at the chart but that you "just guess" instead of doing the same if we have a question. You might need to take a break, get away from work for awhile. There are some things you cant skimp on, communication is key here. Take a few days off. Sleep, rest, relax. Then come back refreshed and ok to do the very basic thing you need to do. We all get burnt out sometimes.

owlhaveyouknow · Jul 2, 2015

As an ER nurse, I'll put my two cents in. I don't mind calling report a bit. I work in a hospital that has an EHR that is available no matter what unit you are in. With this said, I still don't mind calling report. I try to give a concise account of all of the pertinent information and answer any questions. I actually like giving report because I agree that some things just can't be conveyed in the chart (i.e. his wife likes to write everything down, they are stealing all of our gloves etc. lol) In the defense of some of the ER nurses, I have been asked many times if the floor nurse can call me back. Usually I don't mind at all if they call me back, but we have been given timelines by administration that we are to follow. I have approximately 30 minutes to get the patient out of the ER and admitted from the time a room is assigned to them. I will also say that unless it is a critical patient that has been coded/trauma services rendered, there is no excuse for their charting not to be up to date. The only times I can justify a patient leaving my care without their charting being completed would be a STEMI or someone emergently going to the OR. I would also like to give floor nurses some insight on why the person calling report doesn't know a lot about the patient they are sending you: Our nurse to patient ratio in our ER is 5:1and we turn patients over very quickly. We often times have a floater who is able to help where needed, usually on discharges/tasks/etc. So say I have a patient who fell and broke their hip and now has a bed on your unit but I am also in the process of receiving a new patient via EMS, the floater will proceed to call report on the hip fracture (again my charting should be up to date) so that I can devote my attention to my new patient to determine whether or not they are stable and attempt to stabilize them if necessary. I know this isn't fair to you, but it is the most efficient way to handle the situation that I can think of (again, I can't let the patient stay in my room if a bed has been assigned to them upstairs). I usually get along well with most floor nurses and report goes smoothly, everyone just has to be prepared for a little give and take.

NursesRmofun, ASN, RN · Jul 2, 2015

Tell me why they came in, what the working diagnosis is, what you've done for them, response to the interventions, imaging done and results, neuro status, ambulation status, heart rhythm. For AMS/dementia patients, who is at bedside, if anyone. I can easily see the lab results and VS, so you don't have to go over them if they aren't pertinent to the presenting complaint or interventions. I don't care about location/gauge of IV site, but tell me if they don't have one or they have a port or CVL instead.
When I get report from the ED, there are usually NO NOTES whatsoever and no radiology transcriptions, so I absolutely need some kind of report from the ED nurse.
Through a clusterfug of a bed control mishap, I got a patient from the ED yesterday for whom I did not know gender, name nor why the pt was on my floor. I was told only minutes before that I was even getting a patient. I frantically called the unit secretary for any information whatsoever so I could look the patient up before entering the room, and of course, there were no notes. How would you like your primary nurse to not know a thing about you except where your IV site was and labs? After plastering a smile on my face and ********ting my way through introductions, I had to corner the receiving resident to get info on the patient.

Yeah. It stinks to know almost nothing and scramble to know something....and it usually happens when the patient is very sick too. Ugh!

NursesRmofun, ASN, RN · Jul 2, 2015

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?

Agreed.

Ruby Vee, BSN · Jul 2, 2015

Hey floor nurses-
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?

Because it's July and that huge herd of doctors who just got off the elevator are monopolizing every computer in the nurse's station. I don't want to go into my patient's room to use the bedside computer because it would be difficult to hear you over the noise of five celebrating visitors and the crunching of the fried chicken they're not supposed to have brought into the room. And the room I'm setting up for the patient you're bringing is missing a mouse . . . I sure hope they bring me one before your patient gets here!

FlyingScot, RN · Jul 2, 2015

Because 9 times out of 10 the ED calls to give report at change of shift after hanging on to the patient as long as they possibly could.

Do you work in an ED and know this to be an absolute, indisputable and undeniable fact or does it just feel that way?

If you do work in an ED and you participate in this behavior then shame on you.

If you work the floor and are just repeating what someone else told you and you really don't know this to be a fact but you're just cheesed off and want to paint all ED nurses as lazy, selfish uncaring people then shame on you.

Also can you point me to the study that shows "9 out of 10" shift change calls are a result of us hanging onto the patient for as long as possible?

amzyRN · Jul 3, 2015

A good clear concise hand off can take 5 minutes or less. Bedside hand off is ideal. In fact, the last facility I worked at made ER nurses transport their patient up to the floors and give report in person. Many things can be looked up and I prefer to read the chart for most of the info, it's usually much clearer. However, sometimes there isn't time. If I don't have a computer in front of me and if I just found out about an admit when you were calling to give report I expect report nevertheless.

Generalizations are never very accurate anyway, right? Aren't ER nurses supposed to have those critical thinking skills honed? And I get sick of receiving unstable patients up on the floor, like with a BP of 220/118 and active chest pain and no orders for any PRN BP meds nonetheless. But I know that to generalize saying that ER nurses do this all the time would be wrong, since I'm sure many people know not to send an unstable patient up to the floor.

Hey OP, if someone annoyed you when you were giving report, maybe you should ask them why they don't look at the computer.

KelRN215, BSN, RN · Jul 3, 2015

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.

I agree with this. I don't need to be told that the patient has a 22g in his right hand, I can see that in his computer. What I want to know is when this IV was placed, were these stat labs that were ordered hours ago sent? What about that stat Dilantin bolus for the kid who came in seizing? Saying "Neuro ordered that so we don't have to do give it" is going to get the patient blocked from coming to the floor until it's given.

Or, my personal favorite from the ER. A kid with febrile seizures came in with a temp of about 40C . Reporting nurse says "Because his temp was so high we put him on precautions." Kid was booked into a double room. Mind you, the kid was also diagnosed with Otitis Media while in the ER so I said "does this kid really need precautions? He's febrile because of the OM and he's not booked for a precautions room. So if he needs precautions he can't come up until we rearrange beds." Nurse went to check and then called back and said "well the doctor said he's febrile because he has otitis." Right, that was my point.