Monday, November 28, 2011

the blood curdling scream

Ah yes...Its time to give report on your patient. You have a room number. The patient can finally get to a more comfortable bed. If only it were that easy...sometimes it seems the floor nurses have made a science out of how to delay getting an ER patient. So here it is..the top ten strategies employed to delay taking report:

1) Nobody home: No one answers the all.

2) Limbo move: Put you on eternal hold.

3) The switcheroo: Different nurses answer the phone and transfer you to other areas where the nurse taking report supposedly is. You end up back at the desk eventually.

4) The stunner: The HUC "accidentally" hangs up on you.

5) Housekeeping reverse play: Housekeeping has not arrived, just started, cleaning the room.

6) The CTD* defense: One of the patients on the unit is crashing and all of the nurses are involved, no one is available. (* circling the drain)

7) The dodge: The nurse "just transferred a patient", "just got another patient", they will "call you back".

8) The surprise play: As you are giving report, the nurse puts you on hold to talk to the charge nurse about whether this patient is appropriate for their unit.

9) The delay: The nurse is on break, at lunch or dinner and the buddy is way too busy to take report.

10) The shift changer: It is an hour before, or an hour after shift change. The nurses are all in report, they are doing their first assessments, the patient will go to the oncoming nurse after shift change, etc etc.

If you hear a blood curdling scream echoing through the halls of the hospital its probably an ER nurse who can't give report...


rnraquel said...

Absolutely. It ended up being the same situation when I transferred to Recovery as well.

rnraquel said...

LOL today I got the "There's no bed in the room" excuse.

Yvonne said...

I think you must work in my ED. We have been dinged for not getting patients to the floor in a timely manner by our auditing agency and a taskforce has been created to study this.I could tell them in 20 words or less why there are massive delays. Headesk.

midwest woman said...

Faithful blog reader here but these posts drive me nuts.
#1. At 12 patients we have 2 nurses, one tech and no secretary. Yeah that phone might ring.
#5. A room with c diff, MRSA spewed sputum etc. takes awhile to clean. Sorry. We're full and this is the only room we've got.
# 6 and #7. Gotten this one at my end many a times.
#8. No we don't take unstable cardiac patients on drips that aren't allowed on our floor due to monitoring capabilities. That's the sup's fault not ours.
#10. Take report at 4, set room up and have patient arrive at shift change. Room holding you say? No they weren't at radiology either.
I so respect ER nurses and what they do. But making your fellow nurses out to be baldeheaded stepchildren isn't helpful.
It's just more gasoline on the fire.
I know you're venting but we can't can't be all that bad. :)
Just so you know, I've actually gone to the ER to bring folks up and as charge taken report for a co-worker. GASP!

Anonymous said...

What I don't get ... Is with all the "process improvement" and budget clipping hawks in hospital management ... why have they never looked at the antiquated nurse report system??? Everytime we ship a Pt out of our ED I am amazaed at the incredible waste of time spent on this process. Transfer of a Pt from the ED to an in-house floor which has an integrated IT system should be a simple streamed-line process. Not the typical dull repetition of lab values and history that the receiving nurse could easily read on the system. It still boggles the mind with inefficiency! Go figure.

girlvet said...

Anon I agree, why we have to go over what is already in the electronic chart is ridiculous.

Anonymous said...

Another floor nurse here... I can only speak from my four years of (days) experience, but several of the "strategies" are legit.

1. 16 patients. 3 nurses. 1 tech. No ward clerk or we're sharing one with our neighbor unit. So, yeah. No one's home.
2. If a ward clerk or tech happen to answer the phone, they can't take that report. You're on hold until a nurse is able to return to the station.
3. The way our screwy staffing matrix works, we often have to take patients on our neighbor unit. My patients may be spread out over an entire floor. So, yeah. I might not actually be on the unit where you're sending the patient.
4. I have accidentally hung up on people before. It can happen.
5. All often true. The house supervisor rounds to ask about discharges. They practically have each room assigned before they are empty. I can't help that you were given a number before housekeeping even arrived. Go ahead and call them. I already have.
6. Never seen this one used, but if a patient were crashing - the other nurses would be in that room with me. Ward clerk makes all pages and fields calls. Ward clerks can't take report. Sorry.
7. Can't speak to this because my unit doesn't dodge. Someone will always help me out if a ER admit is coming that I'm not really ready for.
8. Same as midwest woman above. Also, we don't like surprise plays either. I've had to call for enough immediate MET codes and ICU transfers on newly arrived ER admits that I won't hesitate to pause report to ask my charge nurse if things don't sound right. This may involve the house supervisor to ensure this is an appropriate placement. I've only done this once, but still...
9. I don't see this happen because our ER doesn't necessarily have to give report to the receiving nurse - just a nurse. Only way you can't is for #1. (And I've been called out of lunch so that someone can talk to ER.)
10. For all the talk of room delays, why is it that my ER admits often arrive around lunchtime or 5:30p - regardless of how long a room has actually been ready?

Our ER faxes some one page of electronic chart sheet and the admission orders. Then someone calls to make sure we received it. That is what usually counts as a report. I need to talk to ER because I need to know more than where an IV is or if the patient has a foley. I don't usually have the luxury of sitting down at a computer to study your fine charting and peruse through all the labs before the patient arrives or the consults start calling.I need a quick snapshot, nurse-to-nurse, so that I have something to help guide my first focused assessment, priorities, and consult calls. And that might include an abnormal lab or two. Since when does a patient report not require nurse-to-nurse communication? And why is the person who calls never someone who is familiar with the patient?

There is a lot of inefficiency when it comes to ER-to-floor transfers, but you don't get to put all the blame on us.

Or you might get a ridiculously long comment from someone who otherwise loves your blog.

Anonymous said...

Or do like I do after waiting 2 hours for a floor nurse to call me back to get report. Take the pt and give report upon arrival. Works like a charm :)