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.
I also wanted to add, in defense of the ED nurses -- they have NO control over when a patient is admitted or a bed is booked. If a patient has been held in the ED and all of a sudden at shift change, there is an admission order, they can't help that. That is all on the physicians. Perhaps they are the ones who hold the patients all shift so they don't get more admissions to write orders on?!
So...that argument needs to just go away. We are all doing the best we can!
Ack! I'm clinic, going from McKesson to Cerner. It's a nightmare. Were too big for McKesson to support anymore and Cerner has never written a program for such a large clinic with so many specialties. No one was allowed to take vacation from May until July when we were supposed to go live. Now that's been pushed back another two months!!
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.
Ack! I'm clinic, going from McKesson to Cerner. It's a nightmare. Were too big for McKesson to support anymore and Cerner has never written a program for such a large clinic with so many specialties. No one was allowed to take vacation from May until July when we were supposed to go live. Now that's been pushed back another two months!!
I feel your pain. McKesson is a little simpler than Cerner. I like Cerner better, but that's because I've used it for years. I hope the nursing staff is being consulted on the setup.
We are being consulted NOW, as they realize that they have no idea what we actually need. I'm in the busiest, most profitable specialty in the entire clinic. Cerner's prior experience in writing for our area was a small, 2 MD clinic with no sub-specialties to it. Yeah.
I feel your pain. McKesson is a little simpler than Cerner. I like Cerner better, but that's because I've used it for years. I hope the nursing staff is being consulted on the setup.
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.
I am not picking on thenightnurse (or any specific nurse)...I have found that the ICU nurses are much more likely to look at the charts that floor nurses; however, the ICU nurses often play it off like they haven't. For example, they will ask me about something that is clearly charted in my assessment..."Is the alert and oriented? Does he follow commands? Any nystagmus? Does he have normal bowel sounds?" etc. Then comes the "well, I see he had a Potassium of 3.1 and that you notified Dr. SoAndSo about it, but did you do anything to treat that? What is being done about XYZ abnormality on his chest X-ray? Is this new?" I appreciate when they look at the chart, but don't try and spring a trap with it.
I think FlyingScot offered some very germane questions. Do you work in the ED? Do you know the process at your hospital for bed assignments and how this relates to when the ED physician authorizes the pt. to be transported to the floor? Do you realize that sometimes you are already to give report and sent the patient to the floor (well before shift change) and one of the admitting docs demands the pt goes to MRI before going to floor? Would you rather us sent that patient upstairs for you to arrange getting the patient to MRI or some other testing? What about if they are on cardizem or some other treatment where the RN would have to accompany the pt. off the floor to this test?
Really though.....why so serious? Getting so angry over a tongue in cheek comment.
And no, I don't work in the ED. And I'd be willing to bet you don't work in my facility. So you don't know what gets said to us on the phone for report or how things get handled.
Report yesterday from ED solidified why verbal report is important. It was a very screwed up medical and nursing plan of care due to the family. The ED nurse and I didn't talk about IV site, interventions, etc. We just spoke about plan of care--or lack of it. Different docs with different ideas on how to handle it, family dynamics, decision-making (or lack of). It was VERY important for me to know these things.
In this situation, it helped me prioritize the conversations I wanted to facilitate on the floor. I (or, more importantly, the patient and family) NEEDED to have the attending/PCP talk directly to the family to figure out how to proceed. When the resident came in to accept the patient, I insisted that he get the attending in the room before he did anything else. Frankly, he seemed relieved by this, and the conversation did happen, and the plan of care was clarified and acted upon.
I also wanted to add, in defense of the ED nurses -- they have NO control over when a patient is admitted or a bed is booked. If a patient has been held in the ED and all of a sudden at shift change, there is an admission order, they can't help that. That is all on the physicians. Perhaps they are the ones who hold the patients all shift so they don't get more admissions to write orders on?!
So...that argument needs to just go away. We are all doing the best we can!
Something about the timing of our hospitalists gets us a lot of admissions at around shift change. Despite the belief expressed here that we like keeping our patients, we don't. We really like when they leave. The shift change timing sucks, but is out of our control.
Our floors are under no mandated time constraints, so they generally just don't take patients after 1800. If I end up with a pt at shift change, I will usually call toward shift change and suggest if the oncoming nurse call me before the rest of report to get report directly from me. Otherwise they will be getting report from the next ER nurse. That nurse will not know the details the floor nurse wants. He/she will only know the critical information. That's how we work in the ER.
The report on oncoming ER nurse might get for an admitted pt might be "The guy in 16 is being admitted for exacerbation CHF, He came in looking crappy with sat's in the 80's. Looks pretty good now, and shouldn't need anything before he goes up".
Really, I don't want any more than that form another ER nurse. If I need more, I can check the chart. It's not that the the timing of the Lasix and and UO isn't important. It is. It's just that I am not going to store that information in my head, or on a "brain sheet" when it is already easily stored in the EHR.
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.
We call report when the bed is ready. If that's shift change, so be it. Ambulances and walk-ins to the er don't stop because we have shift change.
Lol, I only want to know the details that are subjective, and anything that I need to take care of once they get to the floor.
I think it is sad that many nurses don't check the chart before moving forward in treating their patient. They are being transferred from a critical care setting to an acute setting when going to the floor. Now ED to ICU I know the ED nurse is coming up with them so I can drill them personally because that's when it is important.
To me anything else is just petty to complain about. Maybe because I have worked the ED and know what truly is important to know.
And I think floor nurses don't realize that an ED nurse can be on their 20th pt for the day, not the same 5-6 the floor nurse has had all day that are all stable (most of the time).
Lol, I only want to know the details that are subjective, and anything that I need to take care of once they get to the floor.
I think it is sad that many nurses don't check the chart before moving forward in treating their patient. They are being transferred from a critical care setting to an acute setting when going to the floor. Now ED to ICU I know the ED nurse is coming up with them so I can drill them personally because that's when it is important.
To me anything else is just petty to complain about. Maybe because I have worked the ED and know what truly is important to know.
Your last sentence really should be qualified with "based on the setting." I give and get report from a variety of settings--ICU, ER, PACU, GI lab, cath lab, IR, SNF, rehab, medical, surgical., telemetry. Every one of those nurses gives report differently and expects report differently. Maybe I'm the odd one who tries to give report based on the setting the patient is going to. I also ask questions of reporting nurses that are a priority to start my care of the patient, wherever I may be. If I'm working SNF that day getting a patient from acute floors, I will ask about bowel movements, any pain management problems, and if there are wound care orders. I will not ask that of ER nurses, however, when I'm working acute floors.
The settings we work in dictate what we need and want to know and what's important.
:rolleyes:
FineAgain
372 Posts
I also wanted to add, in defense of the ED nurses -- they have NO control over when a patient is admitted or a bed is booked. If a patient has been held in the ED and all of a sudden at shift change, there is an admission order, they can't help that. That is all on the physicians. Perhaps they are the ones who hold the patients all shift so they don't get more admissions to write orders on?!
So...that argument needs to just go away. We are all doing the best we can!