Did I overreact? Please help me stop obsessing! *warning: long post alert*

  1. Scenario: pt dumped from ER to our unit at change of shift. we're in report. no one knows when pt arrived. no one has looked at pt. pt has no tele monitor on. so, ok, a full admit and big assignment, what else is new? no prob. *sigh*

    then.... it turns out that last shift was made aware of possible admission 2 hours prior, and the pt's orders were entered fifteen minutes before report started. Given that orders are passed from the pt's in-transit bed to the unit sec to enter them, and orders were put into the computer (completely!) before report was started, leads me to believe that the pt was on the floor at least a full 20 minutes before report was started....and therefore, that SOMETHING coulda been done for the pt. by the prior shift. vitals, tele box, water pitcher....anything.

    i sorta felt like I was had. And I said so to the Charge.

    Well, frankly, pts appearing on the floor as if by osmosis happens all the time and I usually don't get upset about it, and I've never made a complaint about it, except then, because I'd still feel better about doing my own assessment, etc.

    I came home wondering WTF happened, was I PMS'ing or what?

    OK, so it turns out that I do have the flu, but still, in addition to feeling like yukstuff over having the flu, I still feel like crap over this, because, as you all know, I really DO love my job. (99.99% of the time....)

    But I can't think straight at this point. I have actually found myself going to websites looking at those flashing blue lights that KMart uses for specials to see if I could buy a bunch of them to use for ER transporters to stick to the wall of the admit's room, to alert us to admits,

    or to require the ER folks to place the monitors onto new pts as they pass the desk where the Unit Sec gives out the monitors in the first place, which would at least alert the monitor tech to the new admit, who would then alert us--

    sounds a tad obsessive? rambling? yes, I admit it. I need help.

    And yes, I realize that the root problem is lack of interdepartmental communication and "something" needs to be done about it.

    But what? What are your thoughts on the matter?
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  2. 14 Comments

  3. by   MissdonditaBsn
    I'm curious, does your Er staff give report to the receiving nurse prior to transporting the patient? In the hospital where I work, no patient is transferred to the unit from ER unless a Nurse to Nurse report having been called first. This helps to eliminate the problem of patients arriving on the floor unknown.

    If your facility does that then I think you were had by the previous shift. I think that you have every right to be angry. I am sorry that you had such a bad evening. It seems to me that this is a situation that has probably rolled off your back in the past, but you weren't able to let go because you don't feel well. I don't believe that you are obsessing (ok, maybe a little, haha). I do think that there are larger issues to be delt with here, mainly patient saftey. If the patient had been there at least 20 minutes without having been seen, there is a safety issue here, IMHO.

    I do like the idea of blue lights on the stretchers.
  4. by   ERNurse752
    When I take up a pt, I always make sure someone knows we're there with the pt.

    If someone doesn't come into the room to help me transfer the pt over to the bed etc, and I can't seem to find a single soul, I hit the call light on the way out. That doesn't happen often though. Usually they're ready for me, because I call first to make sure they know we're coming.

    Of course, this situation sounds like your co-workers knew about the pt since the orders were put in...No breakdown in communication here; sounds like they were rarin' to go home and didn't feel like doing anything else.
  5. by   Sleepyeyes
    actually, we get a fax'd report....i like it except for the aforementioned problem of not knowing when a pt actually gets here.
  6. by   passing thru
    Your manager talks to ER manager.
    I'm assuming a nurse on your unit took report from the ER nurse.
    And that report was passed on in shift change report.

    The ER manager is the key. The day shift ER people are under pressure by the night shift ER charge to get ALL patients out of ER before shift change. So, the ER nurse -once he/she had a bed assignment for that patient, has called your unit & said, "The patient has been assigned to room # ___, he's not ready to come up yet, BUT , ""CAN I GIVE YOU REPORT NOW?"" "It will be a while before he is ready to come up as I am real busy right now."
    This is where the two hour wait comes in. Your nurse is assuming the patient will be up in the next hour and accepts report.
    In our hospital, -- once the nurse on the floor accepts report, the patient can go up at any time.
    All our managers have made it clear to the ER director that NO patients will be admitted to the units between 1815 and 1915.
    These directors respect the importance of shift change communication .
    Our ER Director and ALL ER nurses know the policy & are written up if they disregard it. No patient transfers during shift change.
    NONE- NONE NO Patients from ER.
    So , it goes back to policy and policy enforcement.
    Ask yourself, what is so riveting that you do on your unit for the patient that the patient has to be hustled to your unit at that time? If the patient is unstable, ER is a good place for him.
    Your ER is just '' Cleaning out the ER for the night shift."

    Put your grievance where it will do some good. Complaining about the previous shift-no benefit.
  7. by   Sleepyeyes
    and ERNurse, some of our transporters do that--but some just dump the chart on the desk and keep walking.... (I've seen them, so I'm not making it up)
  8. by   nursedawn67
    Originally posted by Sleepyeyes
    Scenario: pt dumped from ER to our unit at change of shift. we're in report. no one knows when pt arrived. no one has looked at pt. pt has no tele monitor on. so, ok, a full admit and big assignment, what else is new? no prob. *sigh*

    then.... it turns out that last shift was made aware of possible admission 2 hours prior, and the pt's orders were entered fifteen minutes before report started. Given that orders are passed from the pt's in-transit bed to the unit sec to enter them, and orders were put into the computer (completely!) before report was started, leads me to believe that the pt was on the floor at least a full 20 minutes before report was started....and therefore, that SOMETHING coulda been done for the pt. by the prior shift. vitals, tele box, water pitcher....anything.

    i sorta felt like I was had. And I said so to the Charge.

    Well, frankly, pts appearing on the floor as if by osmosis happens all the time and I usually don't get upset about it, and I've never made a complaint about it, except then, because I'd still feel better about doing my own assessment, etc.

    I came home wondering WTF happened, was I PMS'ing or what?

    OK, so it turns out that I do have the flu, but still, in addition to feeling like yukstuff over having the flu, I still feel like crap over this, because, as you all know, I really DO love my job. (99.99% of the time....)

    But I can't think straight at this point. I have actually found myself going to websites looking at those flashing blue lights that KMart uses for specials to see if I could buy a bunch of them to use for ER transporters to stick to the wall of the admit's room, to alert us to admits,

    or to require the ER folks to place the monitors onto new pts as they pass the desk where the Unit Sec gives out the monitors in the first place, which would at least alert the monitor tech to the new admit, who would then alert us--

    sounds a tad obsessive? rambling? yes, I admit it. I need help.

    And yes, I realize that the root problem is lack of interdepartmental communication and "something" needs to be done about it.

    But what? What are your thoughts on the matter?
    I don't think you overeacted, they could have been honest and at least said "hey we just got this admit, I haven't had time to do anything for him yet...think you can deal with it" At least you would have known the patient was there and not "SURPRISE!!!"
    Hope your felling better....take care
  9. by   oldgirl
    At our place, if patients are monitored, RN goes along to the floor on a tranfer from ER to tele. That RN makes sure that monitor is on before she leaves the floor. Most of the time, the telemetry nurses are there to do it, or at least have the monitor and leads in the room ready to go.
  10. by   webbiedebbie
    Wow, can't believe something like this is still happening today! About 20 years ago, we had a similar incident on one of the floors in our hospital. Only, this was a direct admit that came through ER and went straignt to the floor. No one supposedly knew of this admission. The patient crashed and died. What a mess that was. It's a shame that something bad has to happen before something gets changed or done. Why doesn't administration listen to us?!
  11. by   l.rae
    shift change is tricky.....as ER nurse, if l take a pt up, l feel responsible until i see the whites of the floor nurses eyes....even if l have to go to desk and hunt chg nurse and say...blah blah...
    we never take a pt up w/o report...personally, l think the floor nurse should have to sign that they accepted the pt when the transfer takes place.....we do this in ER when we accept pts from squad.....if no sig is on the receiving facility area and the medic just leaves the pt....that medic is legally responsible for that pt until that release is signed!....works real well....and nurses wont' sign unless they know the pt has been triaged by another nurse.

    also, we try to be sensative about change of shifts on the floor, but when it's balls to the walls in the ER...they go to the floor anytime we send them, thankfully with the supervisors blessing....
  12. by   kaycee
    Originally posted by l.rae
    [B

    also, we try to be sensative about change of shifts on the floor, but when it's balls to the walls in the ER...they go to the floor anytime we send them, thankfully with the supervisors blessing.... [/B]
    Agree, here we try not to send up at shift change but if there is no more room in the ER they go up. We call report to an RN then if it's a tele pt they are accompanied by a nurse and monitor and attached to one in the room. The chart is handed to the receiving nurse sometimes in the room , more often hunting them down. Even on med surg we let everyone know the pt in room such and such is here.
    Sounds like in your case Sleepyeyes it may have been the fault of both the ER and the previous shift. I would have been angry too!
  13. by   nursegoodguy
    I don't like it when people dump stuff off on you at shift change. I've had it happen many times also as if you are not busy enough when you come on duty. Sometimes you have to say something about it...
  14. by   passing thru
    AMEN !! and DITTO ! to all of the above !

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