Your Gettin a Patient - The Doors Open and In Rolls Your Pt.

[CarVsTree]

How does this happen???

Pt. arrives is seen in ED @ 2100 as a trauma alert. Primary/secondary survey, orders entered in CAPOE, plain films, CT scans done, etc.

I get a call from my AP (unit clerk) @ 0230, "you're getting a pt., report's in the computer." I knew there was no bed in the room, as I walk out into hall to get the bed to bring it to 17A, the doors open up and in rolls the pt. Fortunately, the pt. was A&O and could tell me his injuries. I stood there and read report in front of patient.

We won't even begin to talk about the crazy orders the first year put in... But in his defense, he was just hired a few days before to replace a first year that quit.

I don't mind short notice but how about 5 minutes... Hmmmm.... How 'bout 2 minutes.... 10 seconds just don't cut it.

[deeDawntee, RN]

Unstable pt.'s in the ICU? Well I never....

Where did I say that my patient wasn't unstable? If you would read my whole post you would see that I said "stabilized". My post referred to a pt in septic shock who was sent to me without central access or the pressors that were obviously needed. They "masked" the whole issue...

that was my point. And I also learned what to ask when "accepting" a patient...since I don't have MD's on the floor like they do in the ED, it is much harder to get things done that Docs have to do in person (like central access). That was my point.... :uhoh3:

[SarasotaRN2b]

I hate when that happens. It happens to us too. Usually, I assign the patient and two seconds later the ER or admitting is one the phone...."um, can't I tell the nurse first?".

Hi Tweety, this is definitely one of my pet peeves as a unit secretary. Another is when we are beeped that we will get a patient maybe midway during the shift...they don't call report until shift change or the patient rolls in at shift change. The ER is one of the departments that have rotating hours...i.e. not everyone starts at 7a or 7p. Why can't they just wait until 8? Just basic courtesy...

Kris

[UM Review RN, ASN, RN]

the floor and the ER look at things diffferently.

That is why you have different staffing levels, a doc on the unit, stat preference for all tests, proximity to Radiology, transporters, an entirely difffernt Pyxis system in which you do not have to wait for a Tylenol to be profiled before pulling it.

The ER has EMTALA to guide your triage function. Your patient, triage nurse or EMS gives you "report." On the floors, we have something called "continuity of care" and we have no less need to know what has already been done for the patient.

We are certainly not "less than ER" nurses because we are not ER nurses, we too have protocols to follow and a different skill set.

One of them is that we are to get Report before each patient gets to the floor. Our complaint is that we are not getting Report or that we get insufficient Report or that the patients are coming before we even have the room cleaned.

In some cases, the patients may have been stablized and became UNstable on the way to the floor.

You need to stop making this about nurse vs nurse and understand that just like a person doesn't walk in off the street into a Trauma room, we should not be getting patients who have been treated by the ER without getting some form of Report.

[scattycarrot, BSN, RN]

Ok, I am a bit confused here. In the uk we transport our own patients from ED to wherever it is they are going and then give report to the nurse on the new unit. Do you not do that in the US? Or am I reading this wrong!

[UM Review RN, ASN, RN]

Ok, I am a bit confused here. In the uk we transport our own patients from ED to wherever it is they are going and then give report to the nurse on the new unit. Do you not do that in the US? Or am I reading this wrong!

It's done differently here. On our floor, the ER will fax up a report on the patient, verify it with a telephone call (usually to the unit secretary) who is then supposed to notify us that report has arrived.

Our Charge nurse is supposed to have told us that we are getting a patient before that happens so that we can have the room ready.

Sometimes both the Charge nurse and the unit secretary fail to inform the receiving nurse of the pending admission. Therein is the problem and the floor nurse may have just discharged three or four patients and might be in the process of admitting a Direct Admit when a patient suddenly appears out of nowhere and someone says, "Oh, by the way Angie, that's your patient."

Normally I don't care, I can pick up the ball and run with it. But when I've just come on shift and it's chaos, with patients coming and going on stretchers to various tests, and others being discharged and admitted, and I don't know who's who, and suddenly a crashing patient appears on the scene....

well, you get the picture.

Instead of arguing about who has the faster reflexes, we should be helping one another resolve these problems, is all I'm trying to say.

[nuangel1, BSN, RN]

It's done differently here. On our floor, the ER will fax up a report on the patient, verify it with a telephone call (usually to the unit secretary) who is then supposed to notify us that report has arrived.

Our Charge nurse is supposed to have told us that we are getting a patient before that happens so that we can have the room ready.

Sometimes both the Charge nurse and the unit secretary fail to inform the receiving nurse of the pending admission. Therein is the problem and the floor nurse may have just discharged three or four patients and might be in the process of admitting a Direct Admit when a patient suddenly appears out of nowhere and someone says, "Oh, by the way Angie, that's your patient."

Normally I don't care, I can pick up the ball and run with it. But when I've just come on shift and it's chaos, with patients coming and going on stretchers to various tests, and others being discharged and admitted, and I don't know who's who, and suddenly a crashing patient appears on the scene....

well, you get the picture.

Instead of arguing about who has the faster reflexes, we should be helping one another resolve these problems, is all I'm trying to say.

well in the case as you describe above that is the charge nurse and or unit secretaries fault for not telling you about the pt sooner.it is certainly NOT the ers fault.

[scattycarrot, BSN, RN]

Thanks for clearing that up. I can understand the frustration of the floor nurses at not recieving report on a newly arrived patient or turning up unannounced. In the ER we are used to patients rocking up sick as dogs with no notice but its different. The ED is set up for exactly that sort of thing and we are used to working with limited information, whereas on the floors, its an intrusion into an already busy scene (and I don't mean that disrespectivily towards the patient) and floor nurses expect a report and expect time to prepare,as its the way it is supposed to be done. However, this understanding goes both ways and I myself have dropped onto a unit 'unexpectantly' 5/10 minutes early because it was a case of getting the patient out of the ER as quickly as possible because of pressures on the department at that time. Now, I appreciate that each unit has its own pressures but transferring a stable patient to make room for a trauma or a code, makes sense to us in the ED. Unfortantly, that means other units get the shortend of the stick sometimes.

What I still don't get is who transfers the patients to the floor? Is it orderlys? What if the patient goes off on the way?Just curious!

[EmmaG, RN]

What I still don't get is who transfers the patients to the floor? Is it orderlys? What if the patient goes off on the way?Just curious!

In my hospital, we had phone report instead of faxes. The patient wasn't transported until the report was done. They were brought by the ER techs. When transported to ICU/PCU, they were accompanied by an RN.

[Altra, BSN, RN]

The ER is one of the departments that have rotating hours...i.e. not everyone starts at 7a or 7p. Why can't they just wait until 8? Just basic courtesy...

Because it's not very courteous to keep a bed occupied when there are 25 people in the waiting room who are waiting for it, not to mention that 55 year old male coming through the door with active chest pain & a crappy heart rhythm right about now ...

[EmmaG, RN]

Because it's not very courteous to keep a bed occupied when there are 25 people in the waiting room who are waiting for it, not to mention that 55 year old male coming through the door with active chest pain & a crappy heart rhythm right about now ...

I agree. Which is why I wonder why I have to wait hours after being told I'm getting an ER admit... only to have them show up at shift change. (I certainly can't speak for anyone else, but one of my co-workers transferred to our ER and confirmed that many of the nurses there wait til the end of their shift to send patients out to the floor...)

[Miss Mab]

I agree. Which is why I wonder why I have to wait hours after being told I'm getting an ER admit... only to have them show up at shift change. (I certainly can't speak for anyone else, but one of my co-workers transferred to our ER and confirmed that many of the nurses there wait til the end of their shift to send patients out to the floor...)

I think this issue has been discussed ad nauseum.

You are waiting forever and a day for the admitting/holding doc to actually write the orders---otherwise they will go with no orders and I've learned here that floors really don't like that.

Some pt.'s come in, everybody and their mother knows they will be admitted---pt. placement is aware of it early(like syncope w/injury,etc.)but they still need to wait on CT/maybe repeat enzymes, who knows? I was under the mistaken impression that was a courtesy to the floor because that way you're not getting an additional pt. while you wait. It does suck at shift change, though. Talk to the one writing orders.

Finally, a very few lazy nurses DO try to sit on their pt.'s. It's generally not tolerated and I can assure you that ISNT the big problem.

Sorry if some were offended by my tone. I was just making light of an age old issue and yeah, people were making it an 'us against them' thing before I walked in. I have offered suggestions. It is being set up for us to be at odds each other when all we each really care about is the pt.'s safety. Look to the admin. and process changes and quit taking it. They don't care that this issue drives both sides nuts. It's not a 9-5 problem is it?

[EmmaG, RN]

Finally, a very few lazy nurses DO try to sit on their pt.'s. It's generally not tolerated and I can assure you that ISNT the big problem.

Like I said, I can only vouch for what my friend told me of her experience in one ER, however after working in a number of hospitals since I started traveling, I suspect it isn't as rare an occurrence as some would think.