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.
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.
The thing is you shouldn't have to guess at this. As an ER nurse, you perform focused assessments on patients all the time. You just need to better know your audience. I've been a nurse for a year on the floor, but when I have to transfer patients to other units/levels of care I focus my report toward the parts of the assessment that are relevant.
If my heme onc patient goes into rapid uncontrolled A-fib... I'm not going to report to the CTICU nurse what day they are of their chemo and all the details of their FISH study and leukemia subtype. That nurse probably doesn't know what any of that means, and thusly doesn't care. Similarly, I'm not going to give report to dialysis about the patient's premed requirements for blood products and that they take Roxy instead of dilaudid before their bone marrow biopsies.... because its irrelevant. I'm going to tell them: Recent pressures, urine output, edema, relevant labs and what meds I gave and held.
Focused report of focused assessment.
I made a thread so maybe we can share our wants and needs from inter-unit reports here. Hopefully we all can learn something.
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?
Of course not. It varies by hospital. Our hospital has one of the best ratios of this. They only call report at shift change for that reason 50% of the time.
My favorite part of receiving report from the ED is when the nurse that is giving me report has never even assessed the patient. So I ask of the ED nurse sending me a patient that was given Lasix 80 mg IV when was the last time the patient voided or does the patient have a urinary catheter and either way what has the UOP been. What are heart and lung sounds like? Any shortness of breath? What IV fluid and rate are you running and through what IV catheter size? Yes, I could look at the chart and from the few responses I've scanned in response to the OP it is plausible that it would save the OP or like-minded ED nurse's time, but have you laid eyes on and put a larger picture together of the patient you are caring for, what you or the person before you was doing for the patient and why, and then transferring all of what you know and don't know about the patient into my care? It's possible, as others have mentioned, that I have several catastrophes that I have had to delegate to another nurse or two and a larger patient group that I can't transfer out or ignore to take report from you or risk angering the Gods of patient flow or worse yet be written up for "refusing to take report" especially on shift change when I may or may not have completely received report on all my other patients. It is possible I want a complete picture of what is coming and what I need to do to prepare and what I need to get done that hasn't been that you would be in the best position to tell me as the nurse that is currently providing care to the patient. After all if I were down in the ED providing care for that patient myself then report wouldn't even be necessary but it so happens I'm not. Not to mention before you've given me report you're already up with the patient in a gurney even though you've been told the room either hasn't been cleaned or is being cleaned. Why haven't you looked at bed status in the system before wheeling your patient up to me? There is no question that it is faster and more accurate for you to look at any number of things in the system that would enable you to cooperate with me and not be at odds in providing high quality, seamless attitude free care to the patient. So--why don't *you*? As others have said both the ED nurse and floor or unit nurses are under pressure and trying to do less with more. What makes you think thorough communication and a safe, informed patient transfer isn't in the best interest of everyone including you, the floor nurse, and the patient?
I too personally enjoy the SBAR fax, but I would like the ink to be dry on it before you call to ask if I have any questions. The fax is easy to read and is system by system. The only other problem can be handwriting at times.
Also our ED is not yet on the computer system, so I have no clue until I get said fax.
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.
Okeedokey- Back to the guessing.
I don't guess about the patient.
I guess what the floor nurse will want to know. I have to guess, as I have only worked 2 shifts on the floor, and don't think like a floor nurse. AND, as you can see, there is a wide variety of things that different floor nurses would like to get in a verbal report. So I prep myself to give report based on what I think the floor nurse will want to know. I also open multiple computerized documents so that if asked a question I didn't need to know, I can provide an answer.
Where I work, the nurse I am giving report to is sitting at a nursing station with access to the exact same information. Given that we both have equal access to the information, it would be faster for that nurse to access it, rather than for me to access it, verbalize it and for her/him to write it down. Since the focus here from floor nurses is that they are busy, I would think they would want the fastest most accurate transfer of information. For all the nurses who have explained logistical problems of accessing the info, I completely get that.
Back to guessing- oddly, when it comes to guessing, I don't have to guess for ICU. Often, the least smooth handoffs are ER to ICU. I spent two years in ICU, maintain my CCRN, and try to stay current on best practices. I actually created a tool for new ER nurses to use to give an ICU report. I encourage them to spend a few minutes drafting report, on paper before giving it. After doing it a few times, they learn the rythm of an ICU report, and it goes pretty smoothly.
I also strongly encourage cross training for new nurses. If an ER nurse spent a week caring for 6 tele pt's, he/she would understand what the floor nurse is looking for in report. And, if floor nurse spent a week in the ER, they would know why I have no earthly idea when my fx hip last moved his bowels.
Last but not least, I'd like to thank you for concern with my emotional well being. I am not burnt out. What spurred my OP was actually a query from the mucky mucks about how to improve through put. From a nursing end of things, what slows through put in my hospital is the process of verbal report. The process we use now is identical to the process we used prior to computerized charting. I think if we could use the technology more efficiently, it would benefit our patients.
"Take a few days off. Sleep, rest, relax. Then come back refreshed and ok to do the very basic thing you need to do. "
I am pretty sure I have been doing the basics. Maybe even more. Pretty sure my peers- including other units- would agree. Nonetheless, you will be happy to know that I am at my sister's, looking over the lake. Gonna launch the boat shortly, and I noticed some shish kebobs marinating in the fridge. I'll probably mountain bike, water ski and kayak today. My next scheduled day is in late July.
The EHR software in the ED is different then the EHR software on the floor so we can't see what you see.
Well, that answers my question.
I need report from you because at my hospital, about 90% of the time we get patients when the ED nurses are about to leave their shift. They like to hold onto the patients so they don't get more. Last week I got a patient up to the floor, situated, etc and then my charge nurse decided to move him to another section of the unit and I lost them. If I didn't have report, I would have been at a lost.
This claim fascinates me. I have worked 8 ERs and never seen this as any kind of regular thing. I really don't like having admitted patients, for a number of reasons, try and get them up to the floor. Even if I was self centered and cared nothing about the PT, I would sill want them out of the ER.
Maybe you could expound on this a bit.
I had an ED nurse, who actually worked on my floor for like ten years up until January, start out the report by saying, "why can't you just look this up?". This was the admission diagnosis for Pete's sake, not the IV site or anything like this. I told her to just send me the patient and I hung up on her. I don't have time for that nonsense.
Oddly, in order for me to know the admitting diagnosis, I have to look it up in the admission orders intended for the floor nurse. Obviously, I know the chief complaint. But I would have no idea if the doc went with dehydration, weakness, near syncope, etc. It is absolutely irrelevant to me as an ER nurse, but I look it up on the admission orders so I can tell the floor nurse who will write on their brain sheet.
I also scan the orders to see if there is anything that really should be done in the ER, even though they are floor orders. If there is an XR or CT, I get it done. If IV access is inappropriate for the plan of care, I try to resolve it.
2 days ago I had an admitted pt who had admission orders that included tylenol prn pain. After giving report, and before going up to the floor, I rechecked rectal temp. (pt had a full degree difference between po and rectal temps .) I gave the tylenol then called the hospitalist and suggested that he change the order as some nurses would not have given it without a correct order.
Luckily we have EHR easily accessible to all nurses. It is no harder or time consuming for a floor nurse to check an ER record than it is for me to scan the admission orders.
I suppose I wouldn't have ruffled so many feathers had my OP been "What are the barriers and challenges you, as a floor nurse, face in accessing the EHR".
On the other hand, all these responses, including some anger and frustration at ER nurses, are enlightening, and helpful to me as I look at how to get pt's to the floor more efficiently.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I suppose I wouldn't have ruffled so many feathers had my OP been "What are the barriers and challenges you, as a floor nurse, face in accessing the EHR".
On the other hand, all these responses, including some anger and frustration at ER nurses, are enlightening, and helpful to me as I look at how to get pt's to the floor more efficiently.
You probably also wouldn't have gotten so many responses. I wouldn't have even looked at a thread entitled "What are the Barriers You Face in Accessing the EHR."
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?
I firmly believe that communication and report is a crucial time to share ideas and thoughts. In that brief moment when two minds are connected on that one patient - magic AND safety can happen. I've had many eureka moments during report.
Communication skills are essential to being a professional. If I wanted to read off lists and orders ONLY then I'd apply at the local Jack in the Box.
Sure, I've read the chart if you give me more than 5 seconds between the admit being paged, and you calling to see if I've looked at the chart.
^^^THIS^^^
I would love to find a way to work better and more efficiently with my coworkers in the ED. But this happens every. single. time. I want to get report from you and I don't ask frivolous questions. I need to know if you handled the 200 BP because that's not "floor safe". I need to know what happened with the 6.0 K+ because you didn't chart any interventions. Or scan any meds.
Please don't think your job is more important than mine. It cheapens our profession. You are busy...yes, I get that. You have people pushing you to get patients out...I get that too. But we are busy too. Just acknowledge that and we will get along fine. We need to find a way to work together, not tear each other apart.
:rolleyes:
Oh'Ello, BSN, RN
226 Posts
The thing is you shouldn't have to guess at this. As an ER nurse, you perform focused assessments on patients all the time. You just need to better know your audience. I've been a nurse for a year on the floor, but when I have to transfer patients to other units/levels of care I focus my report toward the parts of the assessment that are relevant.
If my heme onc patient goes into rapid uncontrolled A-fib... I'm not going to report to the CTICU nurse what day they are of their chemo and all the details of their FISH study and leukemia subtype. That nurse probably doesn't know what any of that means, and thusly doesn't care. Similarly, I'm not going to give report to dialysis about the patient's premed requirements for blood products and that they take Roxy instead of dilaudid before their bone marrow biopsies.... because its irrelevant. I'm going to tell them: Recent pressures, urine output, edema, relevant labs and what meds I gave and held.
Focused report of focused assessment.
I made a thread so maybe we can share our wants and needs from inter-unit reports here. Hopefully we all can learn something.