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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 phone...at 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...
As a nurse who ran the floors for 30 years...my perspective is different. ER nurse holding on to her pts till the end of the shift so they can't be given another pt, then suddenly its a mad rush to empty ER at THE WORST possible time. Or the report from the ER nurse not telling you the whole story, and the new pt takes up WAY more time they should-adding to my already way to heavy pt load. I enjoy your blog a lot, it gives me a view of nursing from the ER side. But i think you should spend a year or two working the med/surg floor side of things. You might have some sympathy for us. At least you can send your bad pts out. We have to deal with them day after day.
ReplyDeleteI worked med surg.
ReplyDeleteI worked med surg.
ReplyDeleteFor us, it's not a matter of holding the pts until shift change because we don't want another...it's because they don't get the bed assignment until the new floor shift is coming on because they didn't have enough staffing on the previous shift. It makes no sense for me to give report to the new ED nurse and then have her give report to the floor five minutes after I've left. I have NEVER deliberately hung on to a patient just to avoid getting a new one! If this is such a common problem, why don't they have a nurse start a half hour early to help transition these patients?
ReplyDeleteED RNs do hold patients til the end of their shift- I've seen it many times. Room assigned 1230, report called 2:45. No. Why does the ED do this? I dunno, maybe the ED RN was too busy, or getting lunch... Sound familiar? Should ED breaks/needs automatically trump floor breaks/needs? I say no.
ReplyDeleteIt doesn't make sense for day ED RN to report to night ED RN, then transfer? What do you think will happen upstairs if report is called to day RN? Day RN will say "haven't seen the patient, but here's what ED said." Ideally, off going ED RN calls report to incoming floor RN, patient moves 30 min later.
Floors do play games. But EDs do, too. If BOTH sides respected the other, things would go more smoothly for both.
Why doesn't an ED nurse stay late to facilitate the transfers?
I agree there is a problem- but you're defining it as floor-based. It's ED AND floor based. Gotta fix the real problem.
I work in Canada. ER x 15 years. Seems the problems transferring patients from ER to the floor are universal. We get the same BS from upstairs...patient hasn't gone home yet, bed's not cleaned yet, call back later please we're too busy to take report now, the nurse accepting the patient is on break or busy, it's shift change call back in an hour...blah, blah, blah. I read the comment above about RN's from ER not giving a proper report so that the floor RN's can predict their new and heavier work load...maybe that's true..some patients I transfer require a lot of nursing care...but here's the kicker...there's not a god damn thing I can do about that. The guy has to get out of the ER. And here's the big BIG difference between YOU and US. Your workload eventually caps. Your beds are full. You can't accept anymore patients. You're done. In the ER the patients keep coming and coming and coming and COMING!! They never, ever stop. I take a patient upstairs and yes, he's gone for me. BUT when I get back to the ER 15 minutes later there are 10 other patients waiting to take his place. We try hard to do all that we can for the floor prior to transferring... like starting all the lines, giving all the current nebs, starting all the antibiotics, changing dressings etc.... so that your workload is at least less during the admission process. And hey, wanna tell you that when you tell me the nurses can't accept the patient right now as they are on coffee break I have to say I haven't had a f'n coffee break for 15 years. I'm lucky if I get a pee, never mind lunch. Just saying.
ReplyDeleteThe admission process is ridiculous. It's a lot of paperwork stuff, but it affects patient safety. It's not as dramatic as that first neb or ETT, but the nurse gets written up if it doesn't get done. It cant be ignored so neither can the time it sucks up. There's lazy on both sides. Inexcusable on both sides. But the problem isn't JUST "upstairs doesn't meet the ED's needs." EVERYBODY has too much to do way too often. That is what we need to fix, not fight amongst ourselves about which unit has it rougher.
ReplyDeleteI agree, the process needs to change. But all the wards need to understand the ER department cannot hold patients and once the DOC decides to admit the patient, our job is to get him out of the ER asap to make room for the thirty patients sitting in the waiting room. We cannot hold patients to accommodate ward issues. Otherwise WE are admonished.
ReplyDeleteAnd the ED has to understand that, just as you can't hold people and meet standards, the floors can't take admits instantly with indequate staffing and meet standards. I make no excuses for the lazy. Look at it this way- if I NEED a car but don't have the money, does the dealer have to give it to me? No. Floor nurses don't get what they need any more than the ED does. Both can want/need all kinds of completely reasonable things. Making adequate resources available is an admin decision. Is there a reason you getting written up is not ok but the floor being written up is? No. Reverse is also true, but the floor accepts the admit and can not say "there were 30 people here"- the same admin that forces unsafe staffing will then throw the floor RN under the bus and say "then you had no business accepting the admission."
ReplyDelete