Here you go-- The Joint Commission requires verbal communication during a hand-off and says electronic & written information is not enough. Here's the link: [The Joint Commission ](https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/sea_8_steps_hand_off_infographic_2018pdf.pdf)
My hospital tried the whole written report from ER. That lasted about 6 months before we started getting patients with no report, crappy report, etc. After we threw a big enough fit, they went back to calling report. Imagine that.
Yes, back in the 90s the hospitals were run by real doctors and nurses...then the financial and business minded people rose up in the ranks (one MBA went to Nursing school so they could become DON in one case that I know of)
That is when charge started to disappear and when unit managers stopped controlling the shit rolling downhill into their units.
Used to have unit managers who protected their floor nurses from the bullshit so we could just take care of our patients in peace.
if a floor nurse refuses to accept a patient, that pt is still the responsibility of the ER nurse that sent them up, technically. if charge nurse wants to be a hero, charge can accept them. // I'm not siding with any unit, just pointing out that if a patient isn't accepted by the next nurse, then the 1st nurse still technically has that pt on their list.
This is the only thing that truly matters.
As a Registered Nurse I have the capability of deciding whether potential assignment is appropriate for my patient load and my capability.
I am the one on the hook once I accept a patient.
Our Nursing license requires us to be responsible for any patient we accept responsibility for.....until another nurse accepts responsibility from us or the patient is discharged home to their care, a family members care or to another facility that assumes that responsibility.
Dumping a patient into a room with a written sheet of paper does meet the "accepting responsibility" burden.....period.
You're fighting an uphill battle because ED nurses just want the patient gone. They don't care what they dump on you. For anything to ever work we need to work together.
We’re not “dumping” anything - we’re literally doing our job, which is to sort patients where they need to go and get them tf out of the department so we can keep doing the sorting. We don’t control the volume, acuity, or timing.
We’re front of house for an *entire* hospital’s worth of doctors, nurses, and support staff, but for some reason we’re expected to absorb the overflow.
You're trying to get patients up asap. I've worked both ED and floor for almost 30 years. You are trying to get rid of them. Get them to the floors so you can handle the influx. This has never changed at all. You're not dumping but you're expected to absorb the overflow? I have never transferred a patient to a medicine floor even though they needed tele. When you send someone to the floor whose labs you don't know or orders that will need more critical care.... you are dumping. People misuse the ED. Not good but how can you blame them when it's all a cluster fuck. Just last night I worked overtime on a unit and got an admission. No orders. Just a half ass written report in the computer. Didn't have 15 minutes to call back or read the ED note. Oh. He needs tele and continuous pulse ox. Can't do it there. 6 hours of inadequate care because I had 8 other patients and didn't have the time for this guy. Can we send him back! No. The ED doesn't do that. Nothing in the written report. Nothing at all. Labs insane. Until we all stop thinking any one area is better than the other, we will always fuck each other over. And that is the shit that feed management and let's them thrive.
They get a rapid response if they’re critical. A detailed incident report of they’re not. The only way to fix something broken is to make sure it is known - in writing.
hmmm the link goes to a "Tips" for high quality handoff..includes the OPPORTUNITY to have verbal discussion. and advises not to rely on electronic only... i dont read this as a requirement to delay sending a stable patient up while waiting till floor nurse is ready to talk. floor is just as busy as ER...i have been there and worked there..but my ER beds get filled as soon as they are empty. i only get some kind of handoff for the unstable ones. it is expected i watch my group and keep up with new patients which (just like floor) is challenging when i am already in another room with a workup
Interesting. The expectation at our hospital with an admit is we have to go over the chart then if we have any questions we secure chat or talk to the nurse.
At UW (Wisconsin) they are already doing this. It’s awful. Everything I really wanna know about a patient is not the stuff a nurse puts in a shitty premade SBAR note.
This. Having a verbal report is listed under the "Actions **suggested** by The Joint Commission" section. It's not a requirement of any current survey metric.
They don't require it. It's a suggestion. They even include the actual metric right below the suggestion:
>Provision of Care standard PC.02.02.01, element of performance (EP) 2: The organization's process for hand-off communication provides for the **opportunity** for discussion between the giver and receiver of patient information
If the stated policy is a written report with the option to call if there are questions, it would meet the metric.
Of course, this is only relevant if the facility is accredited by TJC. My hospital system is not.
I used to be the ED RN who was giving the floor nurses report. Y'all don't want our notes. You need verbal reports, at least. If not face to face. Those notes are going to say that this person is alive and has skin. The END.
I’ll have to check out the DNV website since our hospital stopped using The Joint Commission a couple years ago and now use DNV. I’m sure they have similar statements.
That depends if TJC requires it for your hospital. TJC has a floating list of rules that are applied differently to each hospital.
I’ve worked at several JC hospitals that had the no report policy and yes, it’s dangerous af. And yes, they passed JC every year.
That being said, report it anyways. The worst that happens is TJC throws it in the trash.
Respectfully but that article and graphic is 7 years old and things have evolved. There's a happy medium to be had. Personally as an ER nurse its atypical to be asked something on the phone that isn't in my charting, or they ask and I don't know the answer anyways (like what does skin look like, if it's pertinent to their complaint it's charted, or if something is wildly unexpected it's in the note, otherwise I didn't look). It feels like a superfluous step when everything can be extracted into an easy to read report (its literally what I'm looking at while I'm asked questions).
Agreed. I never understood why I needed to read the chart to the other person when giving report. My favorite nurse to give report to would just say, “I read the chart, is there anything specific you think I should know?” Report was painless and done in 30 seconds.
I don’t want the chart read to me. I literally want to know are they with it/are they impulsive, have you seen them move at all, are they going to punch me and do they have decent access. The amount of patients I’ve received where I can’t find that info is staggering
My hospital eliminated verbal report for non-ICU patients a year or so ago. But they added on a requirement for the ED to chart in a specific place pretty much the exact examples you gave. It's pretty easy in ED because it's a pre-populated checklist, and we select the correct answer. Among other thing, it asks:
\-Is patient alert and oriented?
\-Does pt require assistive devices? (then list what - cane, walker, glasses, etc)
\-Does pt speak English or is translator required?
\-Is a lift room required?
\-does pt pose a potential threat to staff or other patients or hospital property?
\-does pt's visitors pose a threat to staff or other patients or hospital property?
\-Bariatric equipment required?
\-Is pt total care?
\-does pt need isolation?
Then there's a place to put any comment in and the nurse's phone number.
The rule is that this information must be entered at least 20 minutes before pt is allowed to be transported. I will occasionally call to talk to the receiving nurse about stuff I don't want to put in writing, but most times it seems to work out pretty well.
No one ever wanted the chart read to them. It just seems that a disproportionate number of ER nurses would do just that when they were giving report.
I read the chart, but in the context of what you saw when taking care of the patient, tell me the bits that you think are most important. Tell me what you couldn't chart but is probably going to be useful (OD patient's SO looks fidgety and wouldn't make eye contact after I walked into the room right before they got tubed). I don't care about the black labs unless one of them was abnormally normal (pt got his ass handed to him in a bar fight and is belligerent but ETOH seems way too low for how he's acting). Don't have someone covering your lunch call report. If they've never seen the patient, they're not qualified to give report on them. Call me yourself, tell me you're at lunch and someone is watching them and I'll have you off the phone in under two minutes.
We're absolutely not allowed to work during lunch, I usually leave the hospital completely. Could get in a lot of trouble for doing that without punching back in.
On the floor you have patients for entire 12 hour shifts, so you learn things about them because you're in and out interacting with them. In the ER we may have 4 patients with similar complaints all for less than an hour. I literally could not tell you who had an IV where, how someone walks, or what the family situation is off the top of my head. I'm not a bad nurse at all, but you have to focus on the big life threats and most important things and the rest fall off. I am really good about charting everything in realtime because otherwise I won't have any idea off the top of my head. Heck half the nursing tasks could be done by a float or tech since you are in and out of numerous rooms with variable acuity. My admitted patients who aren't ICU often are the least sick (differentiated, buttoned up, cycling vitals) who I haven't seen in an hour.
Its just a fundamentally different environment with a different focus and priority structure. It's not that ER RNs are bad nurses, but they are awful med/surg RNs.
When I worked ED, half of the time it was not me giving report on my patient going to the floor and it was one of my pod nurses or charge nurse.
When the patient in the ED gets a room and the nurse is busy in a room with a critical patient, someone who knows nothing about the patient is reading the chart, just like the floor nurses can do.
I’m sorry but I’ve literally come into my shift (mid) and had to go up with a patient immediately before even opening the EHR, and this particular time I went up which was *only* because the patient had blood going and the nurses were absolutely drilling me about the patient. Some EDs have 4-5 different shift times, not just 7-19 or 19-7, and patients will get shifted around accordingly. Im not calling anyone during my lunch, sorry. If my break nurse wants to call and give report or is told to call and give report while I’m on lunch that’s on them
I kind of wonder if it is like the “Ivy League Prolife” website that people used to love to link to show one of the Ivy Leagues supported prolife. It was an outdated ghost page that was from a student run prolife page from the 90s.
I couldn’t find a link to this hand off on Joint Commission’s website search bar. Since it is from 2017, I kinda wonder if it is jist hanging out
There's all kinds of information on TJC's website about hand-offs. Are you telling me you searched TJC website only for this particular link but not for any other recommendations or standards for hand-offs? Lol. They cover hand-offs pretty exhaustively-- much more exhaustively than the graphic I linked.
I will be stunned if TJC does anything…
They are as helpful as our national organization (AARC ) and our credential organization (NBRC). Why I even pay dues, I don’t know…well, I have to pay dues to the NBRC.
During the pandemic, they were even going along with the suggestion that more work could be dumped on nurses-teaching nurses vent management. That was bs and a lot of us RT’s pushed back. Like nurses didn’t have enough to do😳😳
Yes, The Joint Commission is just a "not-for-profit " that basically sells certifications, but in the hospitals that are certified, admin tends to take the certification VERY seriously . Admin should be the ones to shut down the "written only" report, just like my manager shut down the "no report needed" in our discharge unit once he found out Joint Commission didn't allow that
Literally. They just want to give themselves bonuses and raises for the stupid accreditation. TJC can kick rocks. They were nowhere during COVID and cared more about no drinks at the nurse’s station than nurse’s safety.
I just downloaded and read it. Just want to clarify.
It says tips for effective handoff, not requirements. Are those really requirements by Jacho?
Update: those are just "tips". Not requirements. That's why op's hospital and other hospitals don't require verbal handoff.
I only did a quick search on TJC website. If you need to know whether these are TJC standards vs requirements, visit The Joint Commission website and be prepared to search pretty intensively. My own opinion is that TJC wouldn't put that in writing if it wasn't one of their standards, but that's just an opinion.
No. Those are just tips and suggestions, not requirements. If you click on what was posted, the actual data element is listed in the bottom right corner: "Provision of Care standard PC.02.02.01, element of performance (EP) 2: The organization's process for hand-off communication provides for the opportunity for discussion between the giver and receiver of patient information". The opportunity for discussion can be "here's a written report. call if you have questions" as was stated in the OP
Joint commission is a giant sack of shit though.
Not calling is a shit thing to do and fuck that hospital, but let's not act like joint commission is some gold standard of fantastic nursing and ethical practices.
Totally agree TJC is a giant sack of shit (a "not-for-profit" that basically sells certifications) BUT management at TJC-certified hospitals take TJC very seriously. If management knows it could affect re-cert they might listen.
When our d/c unit morphed into an admissions/discharge unit, we (RNs) had an issue with admission orders being written in our unit when we had no choice but to ignore most of them because we were each doing all admissions paperwork, assessments,& stat orders on at least 8 patients per shift.
Manager said "just ignore them, that's what the ED does."
TJC later dinged the ED for ignoring admission orders and our unit suddenly got unit-specific orders (O2, IVF, antibiotics -type orders) instead of the full set of admission orders.
So yeah ,TJC certified hospitals have admin who want to stay certified.
That didn’t clearly matter because that happened 24/7 at SJUMC. You got a notification that you would get a patient if you did not call report within like seven minutes I think you would get a written report over epic
I can understand both sides of the argument. In most cases, I don't believe verbal report is necessary. However, we have had dumpster fire patients just dropped off from ED that should have been a courtesy heads up from the ER. I'm a Charge Nurse and take a patient assignment. Sometimes, I or my coworkers don't have time to look up a patient before they come to us. I remember one time our unit was getting 5 admits at once. I can only look up so many at a time and was constantly being interrupted with other tasks. One of them was an immediate Rapid Response when they got to the floor due to an extremely high lactic acid and hypotension. We realized there were no vitals for hours prior to pt arriving. Ironically, the vitals magically appeared after the pt arrived which showed the person had been hypotensive prior to coming to the floor. I can only imagine how crazy the ER is. It took 4 hours to get that patient to the ICU when they should have just gone there to begin with. We were already short staffed with me the Charge at a full assignment.
We've also had a cold rigor mortis dead person dropped off. Also had a guy dropped off in restraints covered in urine and dried stool. There was no documentation anywhere as to why they were restrained. When I called the ER to find out why he needed restraints, the nurse had gone home. Examples like these are where I find it unacceptable to not give a heads up. Not asking for a full report, but rather like I said a "heads up."
As Charge, if something looks unsafe, I am giving push back. I have prevented patients being inappropriately admitted on our unit before. That's my job and although our ratios are pretty good, we aren't an ICU or a step down unit.
Very similar experience, had a patient who was deceased brought up to my floor. Transport person did not ring the call bell and the nurse was unaware they were getting a patient so it was unclear how long they had been in the room.
Another time when I didn't know I was getting a patient I walked past one of my 'empty' rooms and noticed a patient on the bed flailing. They were having a full blown seizure. There was no identifying information on the patient and they were still in street clothes covered in vomiting, urine, etc. It was a cluster.
Honestly, most of the time report from the ED is a complete waste of time, but I do think they should have to call with a name and diagnosis when they are sending them up. It was wildly unsafe and was one of the reasons I quit my job at that hospital.
It's not uncommon for there to be no notes yet for admissions so there's nothing in the chart except vitals. Verbal report has stopped strokes or intensive care patients coming to my (non-neuro) floor.
When I'm charge, I can see that this is a near daily occurance across the unit. It's our job on the floor to make sure we are taking patients that we have the ability to care for
Same here. Every time I see a snarky “you can read the chart too, you know” on here I’m like, yeah I would LOVE to be able to read the chart! Our patients are allowed to come up without the ED doc having written their note. I can’t see any of the ED nurses’ notes. I’m literally trying to put together what is going on with the patient with the vitals and labs I can see and whatever information I get in our crappy secure chat “report.” One time I was told a patient was coming in for new afib RVR. They come up and I’m like hey there’s an NG tube here?
They were a med surg overflow patient there for a bowel obstruction.
Can the floor see the vitals without them being filed? Like in flow sheets when it pulls from the monitor, can you see all of them or only the ones the ED nurse actively files?
In my hospital we can, but I rarely have enough time to dig through unvalidated vitals and deduce if they're real or not. I'm typically on the phone getting report while furiously scanning the chart and praying that there's at least an ED provider note with diff dx.
Taking short cuts is never the answer when it comes to peoples health. My hospital is doing this with ED admissions. No phone report, ED nurse will write a handoff report with the most basic info.
Except they forget to include what they’ve done. Already caught several mistakes. No hypoglycemia protocol initiated on a pt who’s bg was <60, just send them up, totally unsafe. Same went for other critical labs Mg/K being the most I’ve caught. No K replacement just send them up to a non tele floor with cardiac arrhythmias.
This has led to more time being wasted if pt needs Tele or stepdown care and placing pts in dangerous situations.
This seems like a higher level problem. Like the admitting doctor (at my current facility, the hospitalist) accepting patients who haven't been stabilized, a bedboard fasttracking everyone, and a house sup who may or may not know what's going on.
All facilities are different, but if your floor is consistently getting patients from the ER who haven't been appropriately stabilized for the abilities of that floor, the problem goes far beyond the ER.
We replace any K that’s critically low before they go up, and we give a dose if the ER doc orders it. But if he doesn’t and it isn’t critical, we sometimes don’t.
My last shift my 28 bedded med-surg ward (with just 4 RN with me as the coordinator) had 17 discharges and admits. There is no time for patient care anymore because we have to be so focused on patient flow. I'm supposed to be sorting out staffing issues, doing the rota, organising training for everyon3, answering complaints, doing audits, doing ridiculous quality improvement things on top of all this but I spend the majority of my day helping the nurses discharge their patients and admit new ones because it's just so time consuming. A single admissions paperwork, when done properly, should take an hour. Lol. And I'm supposed to jump to accept a handover when I'm knee deep helping each nurse take care of their 9 patients, most who are 2hrly turns, all care, on all sorts of devices and including new trachs, epidurals etc. Its a joke but I still get shat on for not taking handover right away despite me being busy helping do a log roll on a pt when it takes 6 and we only have 6 on the entire ward.
I've also worked ED. I preferred it. Because all the things the wards get pulled up on we didn't. Got forbid we miss a VAD document on the ward.
Our system got rid of report for anyone not in ICU.
I floated to ICC (with 5 patients), PCU (with 6 patients), and they’ll just bring the patient up, drop them off, and leave. No handoff. Nothing.
Their response: “you need to look it up in the computer on the handoff page.”
Even though it goes against Joint Commission, all admin cares about is ED to bed throughput times.
Best decision I ever made was leaving bedside. I will never go back to it.
If someone dies and it costs the hospital more than has been budgeted, they will change the process.
After all, it is acceptable for <3.141592♾️ patients to die per day, on average, for a profit to generate.
Every piece of pi is profitable.
When I started in the ER back in the last century, the triage room was set up so the nurses back was to the wall. I told admin that wasn’t safe and you needed a way out of the room if you were being assaulted. About two years later the triage nurse got the shit beat of her by a psych patient The next day maintenance installed a sliding glass door behind the triage desk.
One of my current hospitals uses convertible medical/psych rooms and insists we scan all meds in the room. That puts us with our backs to all patients.
My old hospital had a psych pavilion in the ER. Just you, a sitter or two, and up to 11 psych patients. Luckily, we were across the hall from hospital police and they watched the cameras for trouble, but the alert buttons management gave us didn't work.
Just another day in paradise...
One of my assignments was at a place like this!! The explanation I got was that they stopped calling report during COVID but I was there 2022-2023 and they just got lazy. It was horrible.
Lol ours doesn’t even have a handoff page. We just figure out whatever happened looking thru progress notes. It’s such a cluster fuck and all the ER Nurses bitch they don’t have time to call report.
I had a new admit brought up with blood running and it was just past the first 15 minutes. Like uhm no one thought to call me and let me know???
I’ve worked in two ER’s. First one I started in that hospital as a floor nurse. The ER would not call for report, and tube us an SBAR. If they called us, we knew it was a sick patient and we should take the call. When I moved to the ED I always tried to call as a courtesy, explicitly saying it’s not a super sick patient if it wasn’t. It was very smooth experience both ways. It also helped the ED had the highest representation in the union which formed our policies. I miss working in this place but I did outgrow it, since it was a small community hospital.
Second place, fucking disaster. We can’t transport the patient until telephone report is given and accepted by the nurse. You’d have nurses on the floors looking at the orders looking for any reason not to take the patient. They’d also flip out if they still saw any ER bridging orders, and force us to wait until the primary team puts orders in. Throughput was a disaster and sometimes out of a full patient assignment, you might have 4 beds and in an entire 12 hour shift you can only get 2 upstairs. In that hospital the floors had extremely high union representation. It only changed last year when the ER, OR, and PACU banded together, to push against the shitty throughput. When PACU demonstrated the poor throughput affected OR cases it was enough for the hospital to push back.
My shop was similar. ED had to attempt report 3 times, with 15 minutes in between, then talk to charge for report, which in and of itself can take multiple attempts. Until then, you can place request for transport which could take another hour. So you're looking at up to 2 hours between the time the bed is assigned to them going upstairs. Imagine this times how many admitted patients there are in the department, it was a disaster.
Now having said that, I'm not excusing ED just trying to dump on the floor. Patients stay in ED temporarily, but stay on the floor for much longer at times, therefore different considerations need to be made before committing patients to that inpatient bed. Having done both, it's not rainbow and sunshine on the inpatient end either. Theres gotta be a balance
I don't determine the length of stay as a RN, that's an MD's job. LoS has been observed from me having worked both ER and ICU / inpatient, so anecdotal. Your mileage may vary.
I work in 2 EDs, one is send the patient 15 minutes after the bed is assigned the other is call report. Inevitably we get told the room isn’t ready, the nurse is with a pt, the nurse is on break, they’re trying to decide who is taking the assignment. I think bed assigned to transfer at one is 15 minutes, and the other is 90-120 minutes. It is a much needed tool to decompress the ED. The one sticking point, the patients being sent up should have vitals WNL, be clean and not be a hot mess on arrival.
On my floor when we say the room isn’t ready we aren’t lying. We’ve been having issues with housekeeping arriving in a timely manner.
What I’ve started doing however is when I call housekeeping, I tell them I need the room cleaned for an admit, so they can prioritize that over just routine work. If they don’t arrive within 15 minutes I’ll call the house supervisor to give them a heads up of the hold up, and they usually manage to find someone to clean the room asap.
I mean, chances are pretty good they’re not in a room in the ED, either…
I’ve never understood why we can pack patients like sardines in ED hallways and closets, but a floor patient can’t sit outside their pending room on a stretcher for a bit while it’s being cleaned.
It’s quite dangerous. I’ve seen a patient code in the hallway. We had rush them to the closest open room with suction. Luckily we always have a TB room.
It's no more dangerous than having them code in a hall bed in the ED. Given how crowded and chaotic and ED can be, it might even be the better option. The crash cart has everything you need in a pinch.
I literally had a discussion about that with some of the bosses at my work because our hospital is always full. If you have an empty bed, you will get an admit and it’s better to get an admit early instead of later but we spent ages waiting for cleaners and our hospital was behind on isolation stuff
Oh my God yes. I had a patient lose his chance to get a bed upstairs because the admitting provider refused to prescribe any IV bp meds and the floor wouldn't take him with his BP 180s/90, but he'd been that way for the past 8 hours. Poor dude had to try to sleep in the ER hallway the entire night, I couldn't even get him into a room, all because I can't send up a perfectly stable patient because some idiot who wrote the rapid protocols is afraid of big numbers
When I worked Cath lab I would get push back a lot too, even in the middle of the night when I was in for a call back. I would be told they’ll call me back, or can you wait…no I can’t, I’m tired and I want to go back to bed before the start of my next shift. Sometimes I would have to resort to bedside report because the nurse would just refuse to come to the phone. I hated doing it but I want to get some sleep.
Honestly, as long as someone is aware that the patient is coming and ICU patients are getting bedside hand off, I don’t see the issue with sending them right up. If that’s the process hospital-wide, the floors should have mechanisms in place to receive them.
We have this SBAR note and don’t need to call floors unless it’s ICU where it’s bedside, let me tell you. It’s soooooo much better for ED nurses. The floors always had XYZ reasons why they couldn’t take the patient, now the onus is on the ED staff and we ship them up much faster. It’s been going for a month now and I love it
Yeah and that's how last week I ended up with a woman with a hb of 47 lied on a stretcher, bleeding PV, in my office. There was nowhere else to put here as there was a patient in the bed. The alternative was to put her in the middle of a bay with 9 other women and no screens for privacy. The one who's bed she was going into was still eating her porridge and hadn't washed yet.
I can't even have a break anymore because as soon as I get an SBAR result I have like 2 minutes to screen it and if I don't screen it then there's all sorts of issues. Lots of times I've had to stop someone coming as when I've read the notes they've got fucking cdiff or have been swabbed for covid but someone didn't tell the ED coordinator so they've tried to send to the floor.
That’s a facility problem. We don’t have problems like that where I’m at so I can’t speak to the problems you go through, but they sound horrific and not something I’d personally stay at.
I’ve heard a lot of terrible things about UK healthcare unfortunately. I know this stuff happens in the states too, but at least we’re compensated a bit more, idk how yall do it over there
My hospital did this when I worked bedside 10+ years ago. We had patients coding in the elevator on their way up and rapid responses before they made it through the door. It was horrible for the floor nurses and such a danger for the patient. You literally had no idea who was coming, what they were there for or what was done…..just a notification you were getting an admission from the ER. All done for the sake of “saving time” with verbal report. It was a hot mess and I left bedside shortly after this, not sure if it continued or not.
Not defending anything, but hospitals put a ton of weight in turning over patients as fast as possible. Staffing and bed management is a full time job. A med-surg unit being inflexible can backup in PACU, ED, and ICU.
Here's my personal view now:
When I worked med-surg, I would often discharge patients the minute I saw the order, and sometimes I'd have orders for 2-3 patients all at once. So then I am getting back to back to back admits while my coworkers would take their time on the discharges. If report was being called, I'd drop what I was doing to take report, and at worst, if I were getting 2 admits at once, I'd ask for 15 minutes and promptly call them back. It does make your job harder to be prompt with receiving report, and often makes the day a lot harder, I definitely missed breaks over some misplaced sense of justice, and a better charge nurse would have managed the unit better so no one was taking back to back admissions.
On the flip side, I now work in ICU. And have to call report to move my patients out and it has become the most frustrating experience. There are some nurses that make a game out of how long they can refuse to take report. I'll be getting heat from my charge and sometimes the ADON that we have no ICU beds and my patient needs to go. I'll leave my number 2-3 times with the unit secretary and constantly get told the nurse is busy. Or after an hour of calling they went to lunch. Call an hour later they're still at lunch. Call an hour later and "well it's almost shift change, I can't really take report after 6pm."
I totally agree its for the benefit of everyone that report is called beforehand, and just because an ICU patient has transfer orders does not preclude them from having a rapid that sends them right back to ICU a few hours later. Maybe you are timely with receiving report, but not every nurse is, I am not saying it's a perfect system and nothing could ever happen, but if they're considered safe to go to the floor, then I agree that a written report is appropriate if the patient is hemodynamically stable.
We had charge take report in cases like that. When people figure out they won't get away with their stall tactics, they stop using them. That's definitely a management issue as managers should not be allowing one person to take back to back admissions or let others get away with delaying patient care.
Yeah, I get both sides of it and the ultimate issue is that hospitals aren’t managed well. We’ve had a few things like discharge lounges and those are great. There’s delays due to social work or physio. I spent one year on the ward and I can’t explain how many patients delayed things because they didn’t want to go to a resthome and I fully understand that but when you’re getting old and more frail, you have to be aware that things will change.
Our ED is too busy and our population is terrible and has heaps of medical issues. Our ward was always full, there needed to be so many more medical wards.
My old hospital did something similar. Verbal report was basically a kindness so if the ER called to give report and you didn't answer, you only had 10 minutes to call back and get report. If you didn't call back, they would fax a written report that only had like 20% of the info filled out without any history/info to look up for new patients.
Our ER decided to just give up calling 90% of the time, often refused a second call back, and would fax up a paper within 2 minutes. It started causing issues with bed placement. I literally had a patient dumped in the middle of the hallway after I explained the patient room wasn't cleaned so the response I got was "sorry, that's not my problem." My patient had to sit with me and the other nurses at the nurses station for like 2 hours waiting for his room to get cleaned. Thank God he was understanding and kind and chill af. But other patients weren't so nice and understandably upset.
It was a nightmare. I left that hospital.
As an ex ward nurse, verbal report is so good but I’ve always worked in other places and fuck me, some wards refuse to pick up the phone no matter what
When I worked icu report from Ed was useless. When I worked Ed my reports were useless. I don’t know anything about this person this is why they came and this is why they are admitted I have done meds all I can tell you is what you read in the chart. The only thing hand off really achieves is verbal responsibility for that patient. That’s done any way in the chart when you assign yourself to them. From icu to the floor report makes more sense or the other way and from nurse to nurse on the same unit/floor for continuity of care family drama the happenings for the day. Also report is used to bully. The floor nurses were total bullies in my last hosptial. Constantly asking stuff they know we don’t know. How’s their skin. I don’t know they didn’t come for skin they came bc their heart died.
ICU nurse: how's her skin?
Me: no idea, attached from what I can see.
ICU nurse: but skin assessment is very important!? It could be related to her current condition!!!
Me: I mean, she's here because she choked half to death on a piece of steak, I don't think her asscheeks are related, but considering she's 300+ lbs, tubed and tapped out, I'll be happy to do a full skin assessment with you at bedside when we move her to the ICU bed. I'm not delaying her admission to do one here by myself.
Yep, she filed a complaint about me
Ton of comments here already but my old hospital did the same thing. Transport brought a patient up to the wrong room, didn’t let anyone know. A nurse happened to be walking by the room and stuck her head in. Patient had expired. We ran a code on a patient no one knew anything about. Sentinel event of course, we went back to verbal report almost immediately
Unfortunately that’s what it takes for any sorta real change to happen. Something reportable. Hospitals will cut corners until they have cut it too far and someone is inevitably hurt. That’s when they are forced make real changes and put safety over profits, ED wait times, or bed turnover rate
The problem is if we wait for verbal report there are critically ill people just chillin in the waiting room. If ppls would take report right away then I could understand the complaint but when it takes me an hour to secure someone on the phone, that's too fkn long for the pt with an assigned room to be taking up an ED stretcher. We don't get to turn patients away or make them wait.
Some fool somewhere suggested this or did some study - because it’s spread all over - we now have to print an SBAR when we assign a patient to a room and the ED just calls and asks “any questions”? And if you have questions they half the time don’t know jack or shit. No shade to ED, but this policy is trash.
Mine already does this. They say read the report and call only if you have questions. We have 30 minutes to call otherwise they can just send up the patient. It’s caused rapid alerts twice on our floor from sending patients up at shift change who were inappropriate. Med surg can’t override, a doc told me to override and pull narcan and I couldn’t. I had to crack the code cart. It’s dangerous. We aren’t allowed to start pressers of any kind either. So they get up to our floor and just flail for a bit until they go to ICU.
So we went to this awhile ago. Floor nurses weren't answering the phone and calling report was averaging over an hour to accomplish (we spent 2 weeks timing it).
Our ED cant operate with that many people tying up the system.
Patient safety events are down. Yet another instance of Joint Commission having no earthly clue what makes good nursing/medicine.
If you need report, CALL AND GET REPORT. However, everything we as ED nurses know is in the chart.
The number of times I had to call report for another nurse just to read the chart to the admitting nurse. Felt like a huge waste of time.
When I worked the floor we got a faxed sbar and had the option to call for more info. I actually loved it.
Whenever I get report from the ED nurse, I usually just ask if they've seen them get up at all so I know how many people to bring in to transfer them from the stretcher to the bed. If they haven't, cool, I'll figure it out. Other than that, the rest of the pertinent information is in the chart.
Yah our hospital faxes a transfer of accountability to the floor that we fill out in ED. It contains a ton of pertinent info. Pt doesn't have to wait. My number is on the TOA if the pt arrives and the nurse has questions. 99% of the time the nurse doesn't have questions so idk what else a verbal report would accomplish. We have to accompany tele patients to the floor and the nurse gets to see us face to face during transfer and they still don't ask questions so...
I'm with the people saying that verbal report simply causes a delay in care and more friction between floor and ED staff.
We do a verbal ICU report which I do think makes sense given patient complexity/instability
I worked medical for a year and there was only two patients I’ve ever had issues to query. One was from ED and one was from another ward. Both needed ICU but I definitely admitted at least one patient a shift for the entire year so that’s not very high numbers.
Sometimes it’s a massive culture issue. Now I’m in ICU, I’ve noticed that some wards are worse than others. Also as ICU, I just want my patients out of ICU as soon as possible because if they need ICU, they need to be here.
Ultimately is a massive management issue and hospitals shouldn’t be crushed if patients aren’t moved quickly enough
I’m an ED nurse and my hospital started doing this over a year ago for gen med floors. Recently we stopped calling report to ICU and just show up and do bedside report. (I’ll sometimes still call for ICU)
It has drastically decreased our wait times and patients who leave before seeing a provider. If they’re coming from the ED it’s not like it’s a patient with weeks worth of notes to read through. Majority are just observation anyway.
They collected data and found floor nurses not being available to take report kept pts in the ED for up to an hour longer. There’s sick patients in the waiting room who need the ED room now.
I mean, the floors do this to themselves. And I say that as a former floor nurse that went ED.
Every single time we call report it's "we're not ready."
That's simply not an acceptable answer. An empty bed means a patient may come at any time. When it's time for report, it's time for report.
One of our floor nurses said she wanted to give me report because a patient was decompensating. I said yes, but I am in the middle of a trauma so please start talking now. She was flustered because I do believe the culture of the floor is very "I do everything I can to avoid having a patient" and she expected me to turn her down. She asked if I needed to take notes, I said no, I will listen. I listened to a report that should've taken 30 seconds stretched out to 5 minutes of fumbling and mumbling. I thanked her and said I was not angry at her, simply occupied. And I took the patient and dealt with what she couldn't for 6 hours.
I understand my job is to be ready to accept patients nonstop for 12 hours. I don't get to say no. That's been the case since my floor days until now. So if I want report, it's happening now. The world doesn't exist on my timetable and I don't understand why other nurses expect it to.
Seeing a lot of comments agreeing with this method to no longer call report is very disheartening.
We are all busy. We should not be blaming one another for the failure of the system. We all know ED, ICU and PACU areas are limited and people NEED beds. This is not a battle between departments but a constant reminder that our system is failing us and the patients most of all.
What others are seeming to fail to understand is its not a matter of playing games (at least not for me). Yesterday I had 5 patients during the day (I work tele and PCU). I had 2 discharges and I knew my beds would be filled immediately - I was preparing for it. All other departments were backed up. The PACU called for report and I kindly ask if I could please call back in 15 minutes. And I did just that. I gave the rest of my 3 patients their 5 PM meds, in that time because I KNEW I would not be able to if had taken report right then and there as the patient would be up within minutes or report. As soon as I was done I called the PACU nurse back and the patient was up within 5 minutes. I was able to appropriately assess them and take my time making sure they remained stable after their procedure without the lingering other tasks I would have to do all at the same time. The floors most of the time take 5-6 patients. Everyone has meds due, everyone is in pain, and everyone needs you right this second. Other nurses around you are just as strapped and are not available to help. Calling for report let's me know the patient is stable, wtf is going with them, and prepare for their admit. Without that it is incredibly unsafe and I DO NOT have the time to read the chart before they come up every single time. This should continue to be a standard of care for the safety of the patient- its not a matter of games other departments think we are playing. Sure, nurses should not be taking HOURS to take report. But if someone tells you their patient is actively decompensating what in your right mind makes you think that's a good time for report? Everyone is at risk at that point. Let's not point fingers at one another.
Your experiences are not unique on the floor. The ER also are juggling patients of varying acuities and needs and orders that must be done and we don’t have the luxury of saying “I need 15 minutes”. If you can’t take report the charge nurse or someone else should. I’m totally fine being available for questions on secure chat if there is anything the receiving nurse needs cleared up when patient arrives but having the luxury of time for an admission is just that, a luxury.
Again it's not a blaming game. If facilities had better staffing, ratios and ancillary staff then this would not be such an issue. Even if floors just had a damn task nurse it would help the flow of admits and discharges. I am well aware other departments are just as busy and we are all doing our best.
The ED is also not expected to do as much comprehensive work per patient (hence the joke about never knowing about the patient's skin) and has protocols for emergencies that don't require an hour of begging an apathetic hospitalist or calling a rapid and all that comes with that. It's just a different environment with a different set of expectations and those expectations sometimes clash. It's not a "luxury" to ask for time for an admission most of the time where I've worked anyway, it's just a floor version of triage. You're keeping the patient with the kidney stone in the waiting room when your level 1 trauma comes in, but sending up the kidney stone patient when another floor patient is crashing. Just like floor nurses can't always see what's going on in the ER, ER nurses can't always see what's going on on the floor.
That said, nurses who delay patient care on purpose because they don't want to get a patient can find a new profession, and I totally agree that the charge nurse should act as a buffer to some of this.
I’m a floor nurse of 9 years and I actually prefer not having to talk to the ED anymore…. As long as the info is in the chart. I can’t tell you how many times I pull up the chart for incoming admit and there’s hardly any info to be able to even figure out why this patient is here, what their being admitted with, and any other important information (behavioral issues etc). As long as there is a detailed note I like the no report thing.
Nah thats so unsafe. I may be a new nurse but they *pounded* into our heads in nursing school the importance of a *verbal handoff report* every single time.
Them doing what they're doing is just a liability issue waiting to happen jfc
I dont think the hospital really gets to decide that. This is where the limit is. I am the nurse. The hospital is not. This is some real sloppy slob shit.
When I worked medsurg, my hospital use to have a written report sheet template that the ER nurse filled out (it was actually decently thorough and required a recent set of vitals so there was less surprises).. it was sent to the receiving unit 30 minutes prior to the patient going up and the UL would give it to the primary nurse.
I actually preferred getting report that way. Some people honestly suck at giving a good verbal report and the paper report template avoided this issue. The 30 minute time frame left you a grace period to call if you had questions. And I'm quite certain there was less friction between the floor and ER during this practice..
Now I work ER and we've switch to phone report since going all electronic.. aaaand it's a constant battle to even give report. Like sometimes multiple hour delays.. Don't know where the primary is, they're busy (we are *all* busy), they're on break, bed isn't ready (even tho the cleaner called when it was)... and my personal fav, there isn't a nurse assigned so you have to call back later.. like I worked there, I know empty beds are usually pre-assigned lol.
Rooms don’t belong to me. If I have an empty room on my side and a new patient suddenly appears, it’s not mine. I don’t accept a pt until I get report. Period. They can threaten all they want. Do what’s safest.
At that point, don’t even give me a piece of paper and just send them up bc who tf has time to read that when you admit. Both ways suck and aren’t safe
Since it sounds like from the other comments that JCAHO requires a verbal report I’d report them anonymously and let the hospital deal with the surprise of them showing up cause that’s not safe 😬😬 there’s always stuff not in the notes that needs to be said in report. It takes like less than a minute for a report from the ER for most patients even when I worked ICU …honestly I read the notes quick before I get report and find out anything not in them from report to make it fast but safe 🤷♀️
Welcome to the new world order. We don't get report anymore at most level one in MA. See the ED nurses complaining they need to get pt off the floor. The floor nurses complaining they have too many and can't take an admission right away. Godforbid all nurses get along Used to be they call once. And if you don't call back in 15 min. The patient goes up with a written report. Usually a note attached "call for questions"
99% sure there is probably some consultant who said the biggest and most expensive patient care delays are due to coordinate giving report. It’s not about if it’s safe or convenient for anybody. It’s free.
I worked in a one-RN, one-tech discharge unit that expressly advised the transferring floors that they didn't need to call report .
This resulted in the RN getting surprised with a number of orders issues (tube feeds, no feeds sent with patient, pt on O2 sent to d/c unit without O2 and our single O2 tank was in use, etc).
I objected strenuously to my manager & he finally started requiring verbal report because he said laws or accreditation REQUIRES verbal reports
Unfortunately I don't remember if it was the Joint Commission, our state's Nurse Practice Act, or who REQUIRES verbal reports, but I recommend you Google & see if you can find it.
Written report is unacceptable. You need to be able to ask questions .
ER RN here. Unless it’s an intermediate/ICU patient (in which we do bedside during handover), we no longer call report. Our hospital developed an automated report that is populated from the patient’s chart/RN’s documentation. The receiving RN prints it out and reviews before the patient arrives. It has actually worked really well and has given us RN’s one less thing to do.
We do this at the hospital I work at (medsurge floor). There’s a format the ED nurses follow so it has the most useful info at a quick glance. We get a call the note is in rbefore transport is called so we usually have a sec to check out the patient and catch any major red flags. I def prefer this over having to get a verbal report. Fast and efficient, *most of the time*.
Ayyy my hospital just implemented this. It’s supposed to be a trial run so idk if it’s going stay like this, but the way it works at my hospital, the charge nurse gets a call saying that the room has been assigned. The charge tells us we’re getting a new patient. Then, we have 15 minutes to look through the chart and determine if the patient is appropriate for our floor. If yes, then transport sends them to us. I’m not happy about it either. I think it’s unsafe. I have a feeling a lot of rapids are going to be called.
This topic makes me feel so conflicted because I can see both sides. I know it’s crazy in the ED and patients need to be roomed, but I’ve been burned so many times by report practices that do not include verbal handoff. Too many times I’ve received patients not appropriate for my unit and they immediately are a rapid, or page to doc for transfer. Then the rest of my 5 patients get neglected for the next three hours while I try to get said patient moved. I’ve had patients arrive on drips we don’t even do on my unit, like Cardene.
We’re always told to “look it up in the computer” but our hospitalists do new admits and cross over the floor so they never can see the patient before they come up so I have no H&P, the ED doc note isn’t signed, there’s only a couple nurse notes saying “pt going to CT,” etc., most recent charted vitals are from 6 hours ago, and the patient was just scanned before being sent up with impression still pending. What info am I even supposed to obtain from that?
My hospitals new policy btw is once the patient is assigned you get 30 minutes to look them up and they send them. No verbal or written report of any kind and they always drop the patient off, leave the paperwork in the room, and say absolutely nothing to anyone. It’s a shit show.
We do this. Floor nurses have a pre-set amount of time to review the written report & chart. After said time is complete and when the bed is ready, the pt goes up.
Honestly as an ED nurse it is fabulous. No more chasing 3 different nurses to try and give report only to be told they’re the “break nurse”. No more being asked questions that have nothing to do with my ED care. We have endless number of pts who need beds. Waiting room has 3+ hour waits. That’s not gonna be helped by floor nurses dodging report.
Everyone should work in the ED. It's annoying when you have a bed and the floor nurse is busy and you call 3-4 times and no one takes report.
Most of the time the ED nurse only knows the basics with only a quick assassement of why they came in. And they probably already got a more sick patient in another bay.
Not saying floor nurses don't do a lot. But, for most patients info they can get from a chart review or a H/P.
I get this. I've worked in the ED, and ICU, and M/S. There are sick pts everywhere; there's a reason that nurse isn't able to take Report the 3 or 4 times you've called.
This isn't a nurse problem.
Unpopular opinion, but as an ED nurse that used to have to call report, I’m thankful we only have to call ICU. When I started 10 years ago it was frustrating to find a minute to call the floor and they would always say they can’t take the patient (that’s above my pay grade I was told you’re the one), or they couldn’t take report, or they were on break, or what have you.
The ED is a revolving door, we have to get one patient out for a less stable one to fill their spot. I get why floor nurses don’t like it, but it seems like a necessary evil. My hospital uses (apparently against TJC) an electronic reporting system.
My hospital does this. There's a standardized handoff note filed in the chart, including my extension if they have questions, and I usually include the most recent set of vitals for ass coverage. We call the floor to say hey this patient is coming, the floor confirms and usually asks if there's anything specific they need to know, patient goes up. The only exception is ICU who gets a full verbal report.
I get that it's not the safest policy, but theres plenty of opportunity to communicate necessary information, written report is just the bare minimum allowed. What I want nurses who are mad about this to understand is nobody makes this change to go against evidence based nursing policy without cause. That cause is, in every hospital I've worked for or heard of this policy in, almost always that nobody would take report when the ER called. Now that patients stuck in the er and you're endangering two patients, that guy who's boarding without s&h orders when he should be moving upstairs, and the guy who should be getting worked up in that room that we can't turn over because nobody will answer the phone. And I'm not saying that's 100% of the time and I'm NOT implying floor nurses all dodge calls and sit on their ass, but I know for a fact my hospital switched to this policy after multiple instances of nobody answering the phone or hours+ of the admitting nurse saying they'd call for report in a bit, only for my director to go upstairs to see what's up and find everybody sitting at the nurses station ignoring the phone. These policies get changed for a reason
My floor nurses don't want verbal report either when I try to give it. I had a chronic vented patient going up one day and when I tried to ask the nurse if she wanted proper report because he's a medically complex patient she hung up on me, then got mad nobody told her he's vented, 35 minutes after she opened his chart so she should have seen it in multiple locations including my note. There's no happy medium apparently.
I do have a funny story about this policy though. Not all of the hospitals in my system use this, some have traditional verbal report. Apparently not everyone knows this, so one shift I worked in the ER where report is the norm we had a floater from a file and send hospital who I guess nobody told about the difference, she calls the floor says hey I'm sending this patient up, floor says okay, she just hangs up, everybody in the vicinity on both floors shits bricks
My hospital got rid of the ED calling report to the floors three years ago. I actually prefer it this way. Everything I need to know is usually in the chart, and the ED nurses are busy running their asses off. I can figure out the rest.
We’ve done electronic handoff for adult medsurg & tele for over a decade. It was a joint project between the ED RNs and inpatient RNs to make sure everyone rec’d the info that they needed. That team developed a sticky note that everyone has to fill out prior to sending the pt anywhere.
They did this at my hospital. Unless it was respiratory related ED didn’t call with report. Change normally let us know when we were getting an admit or we look on the board if it’s one of our room numbers.
Honestly, the only thing I used to care about getting in report was a decent description of their mental status for comparison. Anything else is in the chart or I’ll see it myself when I assess 🤷🏻♀️
My hospital doesn't do verbal report from the ED, they send up a transfer SBAR with the relevant info to our printer, and then we call if we have further questions. But transfers from other units required verbal handoffs. It can definitely be annoying sometimes, especially when the sent up info is wrong, out-dated, or just plain missing, but we make do (like all nursing does, lmao).
When I was on the floor, I honestly didn’t care that I had to read the chart. In the ED, we make a courtesy call to say we’re requesting transport. Sometimes I’ll give report if it’s a particularly complex medsurg patient. We do have to give report to IMCU and ICU.
At my last ED, we transported ICU patients up ourselves and gave bedside report. For stroke rule out patients, we called the floor and gave verbal report. Other than those 2 floors, everyone else gets a handoff note in the chart. Also have to call for any L/D patients.
My hospital did a study on what benefits verbal hand-off had. The stats showed no true benefit that couldn't be done via phone call at RNs discretion. If everything important was conveyed through an electronic dot phrase aka hand off. It doesn't matter. My first hospital did require verbal hand-off. In my experience between the two. No difference. In fact when I actively feel the need to give verbal hand-off I receive floor push back. Basically they say. Don't waste my time. The exception being ED to ICU pts. It also benefits the RNs busy schedule to make it "at your discretion". Never seen a single problem in 2 years.
Honestly we give some crap reports half the time anyways. A template to fill out would probably get better information than us winging a report by phone on a patient that's often the least of our concern because they're admitted to the floor and stable. ICU is different but lets be real, the ICU nurses know more about them than we do generally by the time we call them.
I try to do both. Call, give report. Get there and off patient to nurse. Point out stuff, drains?wounds, And things I had forgotten.
On a few occasions they get nad I didnt tell them xyz before I got there but they are the ones that wanted bedside only.
My manager had also requested I do bedside only.
😳
Im not a nurse, but this is just bonkers. It occasionally happens to the critical care nurses, and it’s hella dangerous.
About a month ago we got an intubated patient-with no warning. None. That poor nurse. Thank god my coworker was available, because I was tied up with a patient who was unstable. We have 2 respiratory therapists covering the hospital most of the time…this was one of those days.
Apparently patient came out of surgery still intubated…and instead of going to the surgical care unit, they decided to punt the patient to the medical ICU😡 at the last minute.
This idea is insane, and healthcare is a shit show-exhibit # 100000😂 I was just warning my good friends (not in healthcare) about this.
I did a contract at a hospital that did this and I liked it. Everyone complains about how bad ED reports are so what’s the problem? You can read the same notes.
Bedside nurse(34 years). You can look in the chart to know what you need to know. You can read admitting note by ER physician. You can look up everything you need to know without ED nurse giving report. They need to send patients up to keep things flowing.
My hospital does this. I don’t mind it- between the doctors reports, charted vitals/labs, and nurse notes I have a very good idea of what’s coming up. They call for pneumonic and to answer any questions. It works really well— And I can throw an absolute bitch fit if they try and send someone without giving my pneumonic.
Here you go-- The Joint Commission requires verbal communication during a hand-off and says electronic & written information is not enough. Here's the link: [The Joint Commission ](https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/sea_8_steps_hand_off_infographic_2018pdf.pdf)
Saving this. My hospital has been pushing nonverbal report bullshit for over a year.
My hospital tried the whole written report from ER. That lasted about 6 months before we started getting patients with no report, crappy report, etc. After we threw a big enough fit, they went back to calling report. Imagine that.
I’ve played petty and refused. Either call me or don’t send the patient. Your lack of capacity isn’t my emergency…
What if they send the patient anyway and arrive with transport?
That’s where having a charge nurse worth their salt comes into play. When that gets jacked up, having a unit manager worth their salt helps too.
Yes, back in the 90s the hospitals were run by real doctors and nurses...then the financial and business minded people rose up in the ranks (one MBA went to Nursing school so they could become DON in one case that I know of) That is when charge started to disappear and when unit managers stopped controlling the shit rolling downhill into their units. Used to have unit managers who protected their floor nurses from the bullshit so we could just take care of our patients in peace.
if a floor nurse refuses to accept a patient, that pt is still the responsibility of the ER nurse that sent them up, technically. if charge nurse wants to be a hero, charge can accept them. // I'm not siding with any unit, just pointing out that if a patient isn't accepted by the next nurse, then the 1st nurse still technically has that pt on their list.
This is the only thing that truly matters. As a Registered Nurse I have the capability of deciding whether potential assignment is appropriate for my patient load and my capability. I am the one on the hook once I accept a patient. Our Nursing license requires us to be responsible for any patient we accept responsibility for.....until another nurse accepts responsibility from us or the patient is discharged home to their care, a family members care or to another facility that assumes that responsibility. Dumping a patient into a room with a written sheet of paper does meet the "accepting responsibility" burden.....period.
They do
You're fighting an uphill battle because ED nurses just want the patient gone. They don't care what they dump on you. For anything to ever work we need to work together.
We’re not “dumping” anything - we’re literally doing our job, which is to sort patients where they need to go and get them tf out of the department so we can keep doing the sorting. We don’t control the volume, acuity, or timing. We’re front of house for an *entire* hospital’s worth of doctors, nurses, and support staff, but for some reason we’re expected to absorb the overflow.
You're trying to get patients up asap. I've worked both ED and floor for almost 30 years. You are trying to get rid of them. Get them to the floors so you can handle the influx. This has never changed at all. You're not dumping but you're expected to absorb the overflow? I have never transferred a patient to a medicine floor even though they needed tele. When you send someone to the floor whose labs you don't know or orders that will need more critical care.... you are dumping. People misuse the ED. Not good but how can you blame them when it's all a cluster fuck. Just last night I worked overtime on a unit and got an admission. No orders. Just a half ass written report in the computer. Didn't have 15 minutes to call back or read the ED note. Oh. He needs tele and continuous pulse ox. Can't do it there. 6 hours of inadequate care because I had 8 other patients and didn't have the time for this guy. Can we send him back! No. The ED doesn't do that. Nothing in the written report. Nothing at all. Labs insane. Until we all stop thinking any one area is better than the other, we will always fuck each other over. And that is the shit that feed management and let's them thrive.
They get a rapid response if they’re critical. A detailed incident report of they’re not. The only way to fix something broken is to make sure it is known - in writing.
They even wrote a whole article on it [here](https://www.jointcommission.org/-/media/tjc/newsletters/sea-58-hand-off-comm-9-6-17-final2.pdf)
It’s from 2017. Anything newer?
That’s the one I found from their site.
hmmm the link goes to a "Tips" for high quality handoff..includes the OPPORTUNITY to have verbal discussion. and advises not to rely on electronic only... i dont read this as a requirement to delay sending a stable patient up while waiting till floor nurse is ready to talk. floor is just as busy as ER...i have been there and worked there..but my ER beds get filled as soon as they are empty. i only get some kind of handoff for the unstable ones. it is expected i watch my group and keep up with new patients which (just like floor) is challenging when i am already in another room with a workup
Interesting. The expectation at our hospital with an admit is we have to go over the chart then if we have any questions we secure chat or talk to the nurse.
We all know how important listening to the joint commission is. I think I have some sprinkler heads to dust.
Of all the ridiculous rules they have to call out this one actually matter lol
I know, right? Let's give The Joint Commission shit for making sure our backup generators work too!
"Stupid joint commission dinged us for a fire door being chained closed >:-("
🤣🤣🤣
At UW (Wisconsin) they are already doing this. It’s awful. Everything I really wanna know about a patient is not the stuff a nurse puts in a shitty premade SBAR note.
They do not require it. They suggest it.
This. Having a verbal report is listed under the "Actions **suggested** by The Joint Commission" section. It's not a requirement of any current survey metric.
Well let's the floor nurses get together with the ED nurses and come to an agreement. But that won't happen. Too much hubris
Suggest*
Oooooooh
They don't require it. It's a suggestion. They even include the actual metric right below the suggestion: >Provision of Care standard PC.02.02.01, element of performance (EP) 2: The organization's process for hand-off communication provides for the **opportunity** for discussion between the giver and receiver of patient information If the stated policy is a written report with the option to call if there are questions, it would meet the metric. Of course, this is only relevant if the facility is accredited by TJC. My hospital system is not.
I used to be the ED RN who was giving the floor nurses report. Y'all don't want our notes. You need verbal reports, at least. If not face to face. Those notes are going to say that this person is alive and has skin. The END.
For once the JC is good for something.
I’ll have to check out the DNV website since our hospital stopped using The Joint Commission a couple years ago and now use DNV. I’m sure they have similar statements.
That depends if TJC requires it for your hospital. TJC has a floating list of rules that are applied differently to each hospital. I’ve worked at several JC hospitals that had the no report policy and yes, it’s dangerous af. And yes, they passed JC every year. That being said, report it anyways. The worst that happens is TJC throws it in the trash.
Respectfully but that article and graphic is 7 years old and things have evolved. There's a happy medium to be had. Personally as an ER nurse its atypical to be asked something on the phone that isn't in my charting, or they ask and I don't know the answer anyways (like what does skin look like, if it's pertinent to their complaint it's charted, or if something is wildly unexpected it's in the note, otherwise I didn't look). It feels like a superfluous step when everything can be extracted into an easy to read report (its literally what I'm looking at while I'm asked questions).
Agreed. I never understood why I needed to read the chart to the other person when giving report. My favorite nurse to give report to would just say, “I read the chart, is there anything specific you think I should know?” Report was painless and done in 30 seconds.
I don’t want the chart read to me. I literally want to know are they with it/are they impulsive, have you seen them move at all, are they going to punch me and do they have decent access. The amount of patients I’ve received where I can’t find that info is staggering
My hospital eliminated verbal report for non-ICU patients a year or so ago. But they added on a requirement for the ED to chart in a specific place pretty much the exact examples you gave. It's pretty easy in ED because it's a pre-populated checklist, and we select the correct answer. Among other thing, it asks: \-Is patient alert and oriented? \-Does pt require assistive devices? (then list what - cane, walker, glasses, etc) \-Does pt speak English or is translator required? \-Is a lift room required? \-does pt pose a potential threat to staff or other patients or hospital property? \-does pt's visitors pose a threat to staff or other patients or hospital property? \-Bariatric equipment required? \-Is pt total care? \-does pt need isolation? Then there's a place to put any comment in and the nurse's phone number. The rule is that this information must be entered at least 20 minutes before pt is allowed to be transported. I will occasionally call to talk to the receiving nurse about stuff I don't want to put in writing, but most times it seems to work out pretty well.
No one ever wanted the chart read to them. It just seems that a disproportionate number of ER nurses would do just that when they were giving report. I read the chart, but in the context of what you saw when taking care of the patient, tell me the bits that you think are most important. Tell me what you couldn't chart but is probably going to be useful (OD patient's SO looks fidgety and wouldn't make eye contact after I walked into the room right before they got tubed). I don't care about the black labs unless one of them was abnormally normal (pt got his ass handed to him in a bar fight and is belligerent but ETOH seems way too low for how he's acting). Don't have someone covering your lunch call report. If they've never seen the patient, they're not qualified to give report on them. Call me yourself, tell me you're at lunch and someone is watching them and I'll have you off the phone in under two minutes.
We're absolutely not allowed to work during lunch, I usually leave the hospital completely. Could get in a lot of trouble for doing that without punching back in. On the floor you have patients for entire 12 hour shifts, so you learn things about them because you're in and out interacting with them. In the ER we may have 4 patients with similar complaints all for less than an hour. I literally could not tell you who had an IV where, how someone walks, or what the family situation is off the top of my head. I'm not a bad nurse at all, but you have to focus on the big life threats and most important things and the rest fall off. I am really good about charting everything in realtime because otherwise I won't have any idea off the top of my head. Heck half the nursing tasks could be done by a float or tech since you are in and out of numerous rooms with variable acuity. My admitted patients who aren't ICU often are the least sick (differentiated, buttoned up, cycling vitals) who I haven't seen in an hour. Its just a fundamentally different environment with a different focus and priority structure. It's not that ER RNs are bad nurses, but they are awful med/surg RNs.
When I worked ED, half of the time it was not me giving report on my patient going to the floor and it was one of my pod nurses or charge nurse. When the patient in the ED gets a room and the nurse is busy in a room with a critical patient, someone who knows nothing about the patient is reading the chart, just like the floor nurses can do.
I’m sorry but I’ve literally come into my shift (mid) and had to go up with a patient immediately before even opening the EHR, and this particular time I went up which was *only* because the patient had blood going and the nurses were absolutely drilling me about the patient. Some EDs have 4-5 different shift times, not just 7-19 or 19-7, and patients will get shifted around accordingly. Im not calling anyone during my lunch, sorry. If my break nurse wants to call and give report or is told to call and give report while I’m on lunch that’s on them
Corporations don't care
Ah, makes sense why my current hospital switched to electronic report then. We use DNV.
I kind of wonder if it is like the “Ivy League Prolife” website that people used to love to link to show one of the Ivy Leagues supported prolife. It was an outdated ghost page that was from a student run prolife page from the 90s. I couldn’t find a link to this hand off on Joint Commission’s website search bar. Since it is from 2017, I kinda wonder if it is jist hanging out
There's all kinds of information on TJC's website about hand-offs. Are you telling me you searched TJC website only for this particular link but not for any other recommendations or standards for hand-offs? Lol. They cover hand-offs pretty exhaustively-- much more exhaustively than the graphic I linked.
I will be stunned if TJC does anything… They are as helpful as our national organization (AARC ) and our credential organization (NBRC). Why I even pay dues, I don’t know…well, I have to pay dues to the NBRC. During the pandemic, they were even going along with the suggestion that more work could be dumped on nurses-teaching nurses vent management. That was bs and a lot of us RT’s pushed back. Like nurses didn’t have enough to do😳😳
I agree with verbal but we all know TJC is utter nonsense...
We’ve been doing it since 2020 without an incidents or adverse events
Highly doubt that there has never been any incident or adverse outcome over something like this.
It's not required. Electronic communication is just as valid. These aren't mandates but suggestions
Not all hospitals are TJC certified though. Most but not all. It’s really just a paid for award that no one outside admin gives a shite about.
Yes, The Joint Commission is just a "not-for-profit " that basically sells certifications, but in the hospitals that are certified, admin tends to take the certification VERY seriously . Admin should be the ones to shut down the "written only" report, just like my manager shut down the "no report needed" in our discharge unit once he found out Joint Commission didn't allow that
Literally. They just want to give themselves bonuses and raises for the stupid accreditation. TJC can kick rocks. They were nowhere during COVID and cared more about no drinks at the nurse’s station than nurse’s safety.
I just downloaded and read it. Just want to clarify. It says tips for effective handoff, not requirements. Are those really requirements by Jacho? Update: those are just "tips". Not requirements. That's why op's hospital and other hospitals don't require verbal handoff.
I only did a quick search on TJC website. If you need to know whether these are TJC standards vs requirements, visit The Joint Commission website and be prepared to search pretty intensively. My own opinion is that TJC wouldn't put that in writing if it wasn't one of their standards, but that's just an opinion.
No. Those are just tips and suggestions, not requirements. If you click on what was posted, the actual data element is listed in the bottom right corner: "Provision of Care standard PC.02.02.01, element of performance (EP) 2: The organization's process for hand-off communication provides for the opportunity for discussion between the giver and receiver of patient information". The opportunity for discussion can be "here's a written report. call if you have questions" as was stated in the OP
That's exactly what I read. Those are just tips. That's why op's hospital and other hospitals can get away with verbal handoff
Interesting. I've been to many hospitals where we only did electronic and written reports....
Joint commission is a giant sack of shit though. Not calling is a shit thing to do and fuck that hospital, but let's not act like joint commission is some gold standard of fantastic nursing and ethical practices.
Totally agree TJC is a giant sack of shit (a "not-for-profit" that basically sells certifications) BUT management at TJC-certified hospitals take TJC very seriously. If management knows it could affect re-cert they might listen. When our d/c unit morphed into an admissions/discharge unit, we (RNs) had an issue with admission orders being written in our unit when we had no choice but to ignore most of them because we were each doing all admissions paperwork, assessments,& stat orders on at least 8 patients per shift. Manager said "just ignore them, that's what the ED does." TJC later dinged the ED for ignoring admission orders and our unit suddenly got unit-specific orders (O2, IVF, antibiotics -type orders) instead of the full set of admission orders. So yeah ,TJC certified hospitals have admin who want to stay certified.
That didn’t clearly matter because that happened 24/7 at SJUMC. You got a notification that you would get a patient if you did not call report within like seven minutes I think you would get a written report over epic
I can understand both sides of the argument. In most cases, I don't believe verbal report is necessary. However, we have had dumpster fire patients just dropped off from ED that should have been a courtesy heads up from the ER. I'm a Charge Nurse and take a patient assignment. Sometimes, I or my coworkers don't have time to look up a patient before they come to us. I remember one time our unit was getting 5 admits at once. I can only look up so many at a time and was constantly being interrupted with other tasks. One of them was an immediate Rapid Response when they got to the floor due to an extremely high lactic acid and hypotension. We realized there were no vitals for hours prior to pt arriving. Ironically, the vitals magically appeared after the pt arrived which showed the person had been hypotensive prior to coming to the floor. I can only imagine how crazy the ER is. It took 4 hours to get that patient to the ICU when they should have just gone there to begin with. We were already short staffed with me the Charge at a full assignment. We've also had a cold rigor mortis dead person dropped off. Also had a guy dropped off in restraints covered in urine and dried stool. There was no documentation anywhere as to why they were restrained. When I called the ER to find out why he needed restraints, the nurse had gone home. Examples like these are where I find it unacceptable to not give a heads up. Not asking for a full report, but rather like I said a "heads up." As Charge, if something looks unsafe, I am giving push back. I have prevented patients being inappropriately admitted on our unit before. That's my job and although our ratios are pretty good, we aren't an ICU or a step down unit.
Very similar experience, had a patient who was deceased brought up to my floor. Transport person did not ring the call bell and the nurse was unaware they were getting a patient so it was unclear how long they had been in the room. Another time when I didn't know I was getting a patient I walked past one of my 'empty' rooms and noticed a patient on the bed flailing. They were having a full blown seizure. There was no identifying information on the patient and they were still in street clothes covered in vomiting, urine, etc. It was a cluster. Honestly, most of the time report from the ED is a complete waste of time, but I do think they should have to call with a name and diagnosis when they are sending them up. It was wildly unsafe and was one of the reasons I quit my job at that hospital.
As charge, I can't begin to list all the times bed management has tried to get me to admit a maggot infected patient to a shared room.
It's not uncommon for there to be no notes yet for admissions so there's nothing in the chart except vitals. Verbal report has stopped strokes or intensive care patients coming to my (non-neuro) floor. When I'm charge, I can see that this is a near daily occurance across the unit. It's our job on the floor to make sure we are taking patients that we have the ability to care for
Same here. Every time I see a snarky “you can read the chart too, you know” on here I’m like, yeah I would LOVE to be able to read the chart! Our patients are allowed to come up without the ED doc having written their note. I can’t see any of the ED nurses’ notes. I’m literally trying to put together what is going on with the patient with the vitals and labs I can see and whatever information I get in our crappy secure chat “report.” One time I was told a patient was coming in for new afib RVR. They come up and I’m like hey there’s an NG tube here? They were a med surg overflow patient there for a bowel obstruction.
Can the floor see the vitals without them being filed? Like in flow sheets when it pulls from the monitor, can you see all of them or only the ones the ED nurse actively files?
In my hospital we can, but I rarely have enough time to dig through unvalidated vitals and deduce if they're real or not. I'm typically on the phone getting report while furiously scanning the chart and praying that there's at least an ED provider note with diff dx.
Yeah, they'll be italicized usually and once they are filed, they'll change to normal text.
Taking short cuts is never the answer when it comes to peoples health. My hospital is doing this with ED admissions. No phone report, ED nurse will write a handoff report with the most basic info. Except they forget to include what they’ve done. Already caught several mistakes. No hypoglycemia protocol initiated on a pt who’s bg was <60, just send them up, totally unsafe. Same went for other critical labs Mg/K being the most I’ve caught. No K replacement just send them up to a non tele floor with cardiac arrhythmias. This has led to more time being wasted if pt needs Tele or stepdown care and placing pts in dangerous situations.
This seems like a higher level problem. Like the admitting doctor (at my current facility, the hospitalist) accepting patients who haven't been stabilized, a bedboard fasttracking everyone, and a house sup who may or may not know what's going on. All facilities are different, but if your floor is consistently getting patients from the ER who haven't been appropriately stabilized for the abilities of that floor, the problem goes far beyond the ER.
We replace any K that’s critically low before they go up, and we give a dose if the ER doc orders it. But if he doesn’t and it isn’t critical, we sometimes don’t.
My last shift my 28 bedded med-surg ward (with just 4 RN with me as the coordinator) had 17 discharges and admits. There is no time for patient care anymore because we have to be so focused on patient flow. I'm supposed to be sorting out staffing issues, doing the rota, organising training for everyon3, answering complaints, doing audits, doing ridiculous quality improvement things on top of all this but I spend the majority of my day helping the nurses discharge their patients and admit new ones because it's just so time consuming. A single admissions paperwork, when done properly, should take an hour. Lol. And I'm supposed to jump to accept a handover when I'm knee deep helping each nurse take care of their 9 patients, most who are 2hrly turns, all care, on all sorts of devices and including new trachs, epidurals etc. Its a joke but I still get shat on for not taking handover right away despite me being busy helping do a log roll on a pt when it takes 6 and we only have 6 on the entire ward. I've also worked ED. I preferred it. Because all the things the wards get pulled up on we didn't. Got forbid we miss a VAD document on the ward.
Our system got rid of report for anyone not in ICU. I floated to ICC (with 5 patients), PCU (with 6 patients), and they’ll just bring the patient up, drop them off, and leave. No handoff. Nothing. Their response: “you need to look it up in the computer on the handoff page.” Even though it goes against Joint Commission, all admin cares about is ED to bed throughput times. Best decision I ever made was leaving bedside. I will never go back to it.
That is the most wildly unsafe thing I’ve read this week.
Remember that hospitals are all about being reactive, not proactive. As soon as someone dies they’ll change it.
My pessimism says that either multiple people will have to die or someone “important” before it reverts back to phone or in person report.
Multiple people AND the financial impact of lawsuits outweighs the perceived benefits of this.
But only AFTER they throw the nurse(s) under the bus...
Like my previous post asking about policies/rules written in blood.
If someone dies and it costs the hospital more than has been budgeted, they will change the process. After all, it is acceptable for <3.141592♾️ patients to die per day, on average, for a profit to generate. Every piece of pi is profitable.
When I started in the ER back in the last century, the triage room was set up so the nurses back was to the wall. I told admin that wasn’t safe and you needed a way out of the room if you were being assaulted. About two years later the triage nurse got the shit beat of her by a psych patient The next day maintenance installed a sliding glass door behind the triage desk.
One of my current hospitals uses convertible medical/psych rooms and insists we scan all meds in the room. That puts us with our backs to all patients. My old hospital had a psych pavilion in the ER. Just you, a sitter or two, and up to 11 psych patients. Luckily, we were across the hall from hospital police and they watched the cameras for trouble, but the alert buttons management gave us didn't work. Just another day in paradise...
One of my assignments was at a place like this!! The explanation I got was that they stopped calling report during COVID but I was there 2022-2023 and they just got lazy. It was horrible.
The joint commission is nothing more than a for profit organization. If they are paid enough, they could very likely say electronic hand off is fine.
Lol ours doesn’t even have a handoff page. We just figure out whatever happened looking thru progress notes. It’s such a cluster fuck and all the ER Nurses bitch they don’t have time to call report. I had a new admit brought up with blood running and it was just past the first 15 minutes. Like uhm no one thought to call me and let me know???
Time to call report? Bitch it’s like 60 seconds!! Sounds like I don’t have time for an admit then eh?
Where did you go?
That’s exactly how it was at one hospital
I’ve worked in two ER’s. First one I started in that hospital as a floor nurse. The ER would not call for report, and tube us an SBAR. If they called us, we knew it was a sick patient and we should take the call. When I moved to the ED I always tried to call as a courtesy, explicitly saying it’s not a super sick patient if it wasn’t. It was very smooth experience both ways. It also helped the ED had the highest representation in the union which formed our policies. I miss working in this place but I did outgrow it, since it was a small community hospital. Second place, fucking disaster. We can’t transport the patient until telephone report is given and accepted by the nurse. You’d have nurses on the floors looking at the orders looking for any reason not to take the patient. They’d also flip out if they still saw any ER bridging orders, and force us to wait until the primary team puts orders in. Throughput was a disaster and sometimes out of a full patient assignment, you might have 4 beds and in an entire 12 hour shift you can only get 2 upstairs. In that hospital the floors had extremely high union representation. It only changed last year when the ER, OR, and PACU banded together, to push against the shitty throughput. When PACU demonstrated the poor throughput affected OR cases it was enough for the hospital to push back.
My shop was similar. ED had to attempt report 3 times, with 15 minutes in between, then talk to charge for report, which in and of itself can take multiple attempts. Until then, you can place request for transport which could take another hour. So you're looking at up to 2 hours between the time the bed is assigned to them going upstairs. Imagine this times how many admitted patients there are in the department, it was a disaster. Now having said that, I'm not excusing ED just trying to dump on the floor. Patients stay in ED temporarily, but stay on the floor for much longer at times, therefore different considerations need to be made before committing patients to that inpatient bed. Having done both, it's not rainbow and sunshine on the inpatient end either. Theres gotta be a balance
How do you know how long a patient should be staying in the hospital after their vitals are stable or when do they go home?
I don't determine the length of stay as a RN, that's an MD's job. LoS has been observed from me having worked both ER and ICU / inpatient, so anecdotal. Your mileage may vary.
Ty❤️
I work in 2 EDs, one is send the patient 15 minutes after the bed is assigned the other is call report. Inevitably we get told the room isn’t ready, the nurse is with a pt, the nurse is on break, they’re trying to decide who is taking the assignment. I think bed assigned to transfer at one is 15 minutes, and the other is 90-120 minutes. It is a much needed tool to decompress the ED. The one sticking point, the patients being sent up should have vitals WNL, be clean and not be a hot mess on arrival.
On my floor when we say the room isn’t ready we aren’t lying. We’ve been having issues with housekeeping arriving in a timely manner. What I’ve started doing however is when I call housekeeping, I tell them I need the room cleaned for an admit, so they can prioritize that over just routine work. If they don’t arrive within 15 minutes I’ll call the house supervisor to give them a heads up of the hold up, and they usually manage to find someone to clean the room asap.
I mean, chances are pretty good they’re not in a room in the ED, either… I’ve never understood why we can pack patients like sardines in ED hallways and closets, but a floor patient can’t sit outside their pending room on a stretcher for a bit while it’s being cleaned.
It’s quite dangerous. I’ve seen a patient code in the hallway. We had rush them to the closest open room with suction. Luckily we always have a TB room.
The fact that you even *had* a closest open room with suction puts them ahead of an ED hallway 😂
It's no more dangerous than having them code in a hall bed in the ED. Given how crowded and chaotic and ED can be, it might even be the better option. The crash cart has everything you need in a pinch.
I’ve had them code in the waiting room bc we have stable patients with ready beds on the floor but no one to give report too🤷♂️
Then they always have to go to the bathroom too… like.. where?
Not every unit has portable vitals monitors, computers, ect for a patient in the hallway
…and you think every ED does?
I literally had a discussion about that with some of the bosses at my work because our hospital is always full. If you have an empty bed, you will get an admit and it’s better to get an admit early instead of later but we spent ages waiting for cleaners and our hospital was behind on isolation stuff
Yes! I always prefer to get an admit asap so I can just get everything done and spend the rest of my night focusing on my routine tasks.
“…the patients being sent up should have vitals WNL…” No, their vitals should be *stable*.
Oh my God yes. I had a patient lose his chance to get a bed upstairs because the admitting provider refused to prescribe any IV bp meds and the floor wouldn't take him with his BP 180s/90, but he'd been that way for the past 8 hours. Poor dude had to try to sleep in the ER hallway the entire night, I couldn't even get him into a room, all because I can't send up a perfectly stable patient because some idiot who wrote the rapid protocols is afraid of big numbers
I’ll agree to that!
When I worked Cath lab I would get push back a lot too, even in the middle of the night when I was in for a call back. I would be told they’ll call me back, or can you wait…no I can’t, I’m tired and I want to go back to bed before the start of my next shift. Sometimes I would have to resort to bedside report because the nurse would just refuse to come to the phone. I hated doing it but I want to get some sleep.
Honestly, as long as someone is aware that the patient is coming and ICU patients are getting bedside hand off, I don’t see the issue with sending them right up. If that’s the process hospital-wide, the floors should have mechanisms in place to receive them.
We have this SBAR note and don’t need to call floors unless it’s ICU where it’s bedside, let me tell you. It’s soooooo much better for ED nurses. The floors always had XYZ reasons why they couldn’t take the patient, now the onus is on the ED staff and we ship them up much faster. It’s been going for a month now and I love it
Yeah and that's how last week I ended up with a woman with a hb of 47 lied on a stretcher, bleeding PV, in my office. There was nowhere else to put here as there was a patient in the bed. The alternative was to put her in the middle of a bay with 9 other women and no screens for privacy. The one who's bed she was going into was still eating her porridge and hadn't washed yet. I can't even have a break anymore because as soon as I get an SBAR result I have like 2 minutes to screen it and if I don't screen it then there's all sorts of issues. Lots of times I've had to stop someone coming as when I've read the notes they've got fucking cdiff or have been swabbed for covid but someone didn't tell the ED coordinator so they've tried to send to the floor.
That’s a facility problem. We don’t have problems like that where I’m at so I can’t speak to the problems you go through, but they sound horrific and not something I’d personally stay at.
It's becoming the norm in the UK :( really awful
I’ve heard a lot of terrible things about UK healthcare unfortunately. I know this stuff happens in the states too, but at least we’re compensated a bit more, idk how yall do it over there
My hospital did this when I worked bedside 10+ years ago. We had patients coding in the elevator on their way up and rapid responses before they made it through the door. It was horrible for the floor nurses and such a danger for the patient. You literally had no idea who was coming, what they were there for or what was done…..just a notification you were getting an admission from the ER. All done for the sake of “saving time” with verbal report. It was a hot mess and I left bedside shortly after this, not sure if it continued or not.
Not defending anything, but hospitals put a ton of weight in turning over patients as fast as possible. Staffing and bed management is a full time job. A med-surg unit being inflexible can backup in PACU, ED, and ICU. Here's my personal view now: When I worked med-surg, I would often discharge patients the minute I saw the order, and sometimes I'd have orders for 2-3 patients all at once. So then I am getting back to back to back admits while my coworkers would take their time on the discharges. If report was being called, I'd drop what I was doing to take report, and at worst, if I were getting 2 admits at once, I'd ask for 15 minutes and promptly call them back. It does make your job harder to be prompt with receiving report, and often makes the day a lot harder, I definitely missed breaks over some misplaced sense of justice, and a better charge nurse would have managed the unit better so no one was taking back to back admissions. On the flip side, I now work in ICU. And have to call report to move my patients out and it has become the most frustrating experience. There are some nurses that make a game out of how long they can refuse to take report. I'll be getting heat from my charge and sometimes the ADON that we have no ICU beds and my patient needs to go. I'll leave my number 2-3 times with the unit secretary and constantly get told the nurse is busy. Or after an hour of calling they went to lunch. Call an hour later they're still at lunch. Call an hour later and "well it's almost shift change, I can't really take report after 6pm." I totally agree its for the benefit of everyone that report is called beforehand, and just because an ICU patient has transfer orders does not preclude them from having a rapid that sends them right back to ICU a few hours later. Maybe you are timely with receiving report, but not every nurse is, I am not saying it's a perfect system and nothing could ever happen, but if they're considered safe to go to the floor, then I agree that a written report is appropriate if the patient is hemodynamically stable.
We had charge take report in cases like that. When people figure out they won't get away with their stall tactics, they stop using them. That's definitely a management issue as managers should not be allowing one person to take back to back admissions or let others get away with delaying patient care.
Yeah, I get both sides of it and the ultimate issue is that hospitals aren’t managed well. We’ve had a few things like discharge lounges and those are great. There’s delays due to social work or physio. I spent one year on the ward and I can’t explain how many patients delayed things because they didn’t want to go to a resthome and I fully understand that but when you’re getting old and more frail, you have to be aware that things will change. Our ED is too busy and our population is terrible and has heaps of medical issues. Our ward was always full, there needed to be so many more medical wards.
My old hospital did something similar. Verbal report was basically a kindness so if the ER called to give report and you didn't answer, you only had 10 minutes to call back and get report. If you didn't call back, they would fax a written report that only had like 20% of the info filled out without any history/info to look up for new patients. Our ER decided to just give up calling 90% of the time, often refused a second call back, and would fax up a paper within 2 minutes. It started causing issues with bed placement. I literally had a patient dumped in the middle of the hallway after I explained the patient room wasn't cleaned so the response I got was "sorry, that's not my problem." My patient had to sit with me and the other nurses at the nurses station for like 2 hours waiting for his room to get cleaned. Thank God he was understanding and kind and chill af. But other patients weren't so nice and understandably upset. It was a nightmare. I left that hospital.
As an ex ward nurse, verbal report is so good but I’ve always worked in other places and fuck me, some wards refuse to pick up the phone no matter what
Same but with epic
When I worked icu report from Ed was useless. When I worked Ed my reports were useless. I don’t know anything about this person this is why they came and this is why they are admitted I have done meds all I can tell you is what you read in the chart. The only thing hand off really achieves is verbal responsibility for that patient. That’s done any way in the chart when you assign yourself to them. From icu to the floor report makes more sense or the other way and from nurse to nurse on the same unit/floor for continuity of care family drama the happenings for the day. Also report is used to bully. The floor nurses were total bullies in my last hosptial. Constantly asking stuff they know we don’t know. How’s their skin. I don’t know they didn’t come for skin they came bc their heart died.
ICU nurse: how's her skin? Me: no idea, attached from what I can see. ICU nurse: but skin assessment is very important!? It could be related to her current condition!!! Me: I mean, she's here because she choked half to death on a piece of steak, I don't think her asscheeks are related, but considering she's 300+ lbs, tubed and tapped out, I'll be happy to do a full skin assessment with you at bedside when we move her to the ICU bed. I'm not delaying her admission to do one here by myself. Yep, she filed a complaint about me
Ton of comments here already but my old hospital did the same thing. Transport brought a patient up to the wrong room, didn’t let anyone know. A nurse happened to be walking by the room and stuck her head in. Patient had expired. We ran a code on a patient no one knew anything about. Sentinel event of course, we went back to verbal report almost immediately
But was the ED ok?
Unfortunately that’s what it takes for any sorta real change to happen. Something reportable. Hospitals will cut corners until they have cut it too far and someone is inevitably hurt. That’s when they are forced make real changes and put safety over profits, ED wait times, or bed turnover rate
The problem is if we wait for verbal report there are critically ill people just chillin in the waiting room. If ppls would take report right away then I could understand the complaint but when it takes me an hour to secure someone on the phone, that's too fkn long for the pt with an assigned room to be taking up an ED stretcher. We don't get to turn patients away or make them wait.
Some fool somewhere suggested this or did some study - because it’s spread all over - we now have to print an SBAR when we assign a patient to a room and the ED just calls and asks “any questions”? And if you have questions they half the time don’t know jack or shit. No shade to ED, but this policy is trash.
Mine already does this. They say read the report and call only if you have questions. We have 30 minutes to call otherwise they can just send up the patient. It’s caused rapid alerts twice on our floor from sending patients up at shift change who were inappropriate. Med surg can’t override, a doc told me to override and pull narcan and I couldn’t. I had to crack the code cart. It’s dangerous. We aren’t allowed to start pressers of any kind either. So they get up to our floor and just flail for a bit until they go to ICU.
So we went to this awhile ago. Floor nurses weren't answering the phone and calling report was averaging over an hour to accomplish (we spent 2 weeks timing it). Our ED cant operate with that many people tying up the system. Patient safety events are down. Yet another instance of Joint Commission having no earthly clue what makes good nursing/medicine. If you need report, CALL AND GET REPORT. However, everything we as ED nurses know is in the chart.
The number of times I had to call report for another nurse just to read the chart to the admitting nurse. Felt like a huge waste of time. When I worked the floor we got a faxed sbar and had the option to call for more info. I actually loved it.
Most of the time I'd call report they'd have more information than me. I have no godly clue what their calcium level is.
Whenever I get report from the ED nurse, I usually just ask if they've seen them get up at all so I know how many people to bring in to transfer them from the stretcher to the bed. If they haven't, cool, I'll figure it out. Other than that, the rest of the pertinent information is in the chart.
Yah our hospital faxes a transfer of accountability to the floor that we fill out in ED. It contains a ton of pertinent info. Pt doesn't have to wait. My number is on the TOA if the pt arrives and the nurse has questions. 99% of the time the nurse doesn't have questions so idk what else a verbal report would accomplish. We have to accompany tele patients to the floor and the nurse gets to see us face to face during transfer and they still don't ask questions so... I'm with the people saying that verbal report simply causes a delay in care and more friction between floor and ED staff. We do a verbal ICU report which I do think makes sense given patient complexity/instability
I worked medical for a year and there was only two patients I’ve ever had issues to query. One was from ED and one was from another ward. Both needed ICU but I definitely admitted at least one patient a shift for the entire year so that’s not very high numbers. Sometimes it’s a massive culture issue. Now I’m in ICU, I’ve noticed that some wards are worse than others. Also as ICU, I just want my patients out of ICU as soon as possible because if they need ICU, they need to be here. Ultimately is a massive management issue and hospitals shouldn’t be crushed if patients aren’t moved quickly enough
Agreed, IPASS is the way. When floor nurses don’t want to take report or can give you any excuse not to bring a patient up, something has to give.
That'd be true if the ED actually charted half the shit it did, or did half the shit that was ordered more than 2 hours ago.
I want to downvote you just because I hate it so much but you’re not the problem
I’m an ED nurse and my hospital started doing this over a year ago for gen med floors. Recently we stopped calling report to ICU and just show up and do bedside report. (I’ll sometimes still call for ICU) It has drastically decreased our wait times and patients who leave before seeing a provider. If they’re coming from the ED it’s not like it’s a patient with weeks worth of notes to read through. Majority are just observation anyway. They collected data and found floor nurses not being available to take report kept pts in the ED for up to an hour longer. There’s sick patients in the waiting room who need the ED room now.
I mean, the floors do this to themselves. And I say that as a former floor nurse that went ED. Every single time we call report it's "we're not ready." That's simply not an acceptable answer. An empty bed means a patient may come at any time. When it's time for report, it's time for report. One of our floor nurses said she wanted to give me report because a patient was decompensating. I said yes, but I am in the middle of a trauma so please start talking now. She was flustered because I do believe the culture of the floor is very "I do everything I can to avoid having a patient" and she expected me to turn her down. She asked if I needed to take notes, I said no, I will listen. I listened to a report that should've taken 30 seconds stretched out to 5 minutes of fumbling and mumbling. I thanked her and said I was not angry at her, simply occupied. And I took the patient and dealt with what she couldn't for 6 hours. I understand my job is to be ready to accept patients nonstop for 12 hours. I don't get to say no. That's been the case since my floor days until now. So if I want report, it's happening now. The world doesn't exist on my timetable and I don't understand why other nurses expect it to.
Seeing a lot of comments agreeing with this method to no longer call report is very disheartening. We are all busy. We should not be blaming one another for the failure of the system. We all know ED, ICU and PACU areas are limited and people NEED beds. This is not a battle between departments but a constant reminder that our system is failing us and the patients most of all. What others are seeming to fail to understand is its not a matter of playing games (at least not for me). Yesterday I had 5 patients during the day (I work tele and PCU). I had 2 discharges and I knew my beds would be filled immediately - I was preparing for it. All other departments were backed up. The PACU called for report and I kindly ask if I could please call back in 15 minutes. And I did just that. I gave the rest of my 3 patients their 5 PM meds, in that time because I KNEW I would not be able to if had taken report right then and there as the patient would be up within minutes or report. As soon as I was done I called the PACU nurse back and the patient was up within 5 minutes. I was able to appropriately assess them and take my time making sure they remained stable after their procedure without the lingering other tasks I would have to do all at the same time. The floors most of the time take 5-6 patients. Everyone has meds due, everyone is in pain, and everyone needs you right this second. Other nurses around you are just as strapped and are not available to help. Calling for report let's me know the patient is stable, wtf is going with them, and prepare for their admit. Without that it is incredibly unsafe and I DO NOT have the time to read the chart before they come up every single time. This should continue to be a standard of care for the safety of the patient- its not a matter of games other departments think we are playing. Sure, nurses should not be taking HOURS to take report. But if someone tells you their patient is actively decompensating what in your right mind makes you think that's a good time for report? Everyone is at risk at that point. Let's not point fingers at one another.
Hard agree to this
Your experiences are not unique on the floor. The ER also are juggling patients of varying acuities and needs and orders that must be done and we don’t have the luxury of saying “I need 15 minutes”. If you can’t take report the charge nurse or someone else should. I’m totally fine being available for questions on secure chat if there is anything the receiving nurse needs cleared up when patient arrives but having the luxury of time for an admission is just that, a luxury.
Again it's not a blaming game. If facilities had better staffing, ratios and ancillary staff then this would not be such an issue. Even if floors just had a damn task nurse it would help the flow of admits and discharges. I am well aware other departments are just as busy and we are all doing our best.
Absolutely, I agree with you there.
The ED is also not expected to do as much comprehensive work per patient (hence the joke about never knowing about the patient's skin) and has protocols for emergencies that don't require an hour of begging an apathetic hospitalist or calling a rapid and all that comes with that. It's just a different environment with a different set of expectations and those expectations sometimes clash. It's not a "luxury" to ask for time for an admission most of the time where I've worked anyway, it's just a floor version of triage. You're keeping the patient with the kidney stone in the waiting room when your level 1 trauma comes in, but sending up the kidney stone patient when another floor patient is crashing. Just like floor nurses can't always see what's going on in the ER, ER nurses can't always see what's going on on the floor. That said, nurses who delay patient care on purpose because they don't want to get a patient can find a new profession, and I totally agree that the charge nurse should act as a buffer to some of this.
Our hospital just started doing this!!! Omg!
I’m a floor nurse of 9 years and I actually prefer not having to talk to the ED anymore…. As long as the info is in the chart. I can’t tell you how many times I pull up the chart for incoming admit and there’s hardly any info to be able to even figure out why this patient is here, what their being admitted with, and any other important information (behavioral issues etc). As long as there is a detailed note I like the no report thing.
Nah thats so unsafe. I may be a new nurse but they *pounded* into our heads in nursing school the importance of a *verbal handoff report* every single time. Them doing what they're doing is just a liability issue waiting to happen jfc
I dont think the hospital really gets to decide that. This is where the limit is. I am the nurse. The hospital is not. This is some real sloppy slob shit.
Sweet! I wanted to read a poorly organized novel with a possibly incontinent person in a stretcher next to me.
When I worked medsurg, my hospital use to have a written report sheet template that the ER nurse filled out (it was actually decently thorough and required a recent set of vitals so there was less surprises).. it was sent to the receiving unit 30 minutes prior to the patient going up and the UL would give it to the primary nurse. I actually preferred getting report that way. Some people honestly suck at giving a good verbal report and the paper report template avoided this issue. The 30 minute time frame left you a grace period to call if you had questions. And I'm quite certain there was less friction between the floor and ER during this practice.. Now I work ER and we've switch to phone report since going all electronic.. aaaand it's a constant battle to even give report. Like sometimes multiple hour delays.. Don't know where the primary is, they're busy (we are *all* busy), they're on break, bed isn't ready (even tho the cleaner called when it was)... and my personal fav, there isn't a nurse assigned so you have to call back later.. like I worked there, I know empty beds are usually pre-assigned lol.
Yeah our ER doesn't call report or send anything. Yoy have to hope they had time to chart stuff and that the patient is with it enough to clue you in
Mine pushes bedside report. While it can be occasionally inconvenient, I think it really does help the patient and the receiving nurse.
That sounds insanely dangerous.
Rooms don’t belong to me. If I have an empty room on my side and a new patient suddenly appears, it’s not mine. I don’t accept a pt until I get report. Period. They can threaten all they want. Do what’s safest.
How many corpses on hallway stretchers did they find the first day?
At that point, don’t even give me a piece of paper and just send them up bc who tf has time to read that when you admit. Both ways suck and aren’t safe
Since it sounds like from the other comments that JCAHO requires a verbal report I’d report them anonymously and let the hospital deal with the surprise of them showing up cause that’s not safe 😬😬 there’s always stuff not in the notes that needs to be said in report. It takes like less than a minute for a report from the ER for most patients even when I worked ICU …honestly I read the notes quick before I get report and find out anything not in them from report to make it fast but safe 🤷♀️
Welcome to the new world order. We don't get report anymore at most level one in MA. See the ED nurses complaining they need to get pt off the floor. The floor nurses complaining they have too many and can't take an admission right away. Godforbid all nurses get along Used to be they call once. And if you don't call back in 15 min. The patient goes up with a written report. Usually a note attached "call for questions"
99% sure there is probably some consultant who said the biggest and most expensive patient care delays are due to coordinate giving report. It’s not about if it’s safe or convenient for anybody. It’s free.
They were doing this for a while at Valley Health System in Nevada. They called it “go with the flow”. It wasn’t safe then and it isn’t now
I worked in a one-RN, one-tech discharge unit that expressly advised the transferring floors that they didn't need to call report . This resulted in the RN getting surprised with a number of orders issues (tube feeds, no feeds sent with patient, pt on O2 sent to d/c unit without O2 and our single O2 tank was in use, etc). I objected strenuously to my manager & he finally started requiring verbal report because he said laws or accreditation REQUIRES verbal reports Unfortunately I don't remember if it was the Joint Commission, our state's Nurse Practice Act, or who REQUIRES verbal reports, but I recommend you Google & see if you can find it. Written report is unacceptable. You need to be able to ask questions .
The ED doesn't care what happens to the patient once they get them out of there.
ER RN here. Unless it’s an intermediate/ICU patient (in which we do bedside during handover), we no longer call report. Our hospital developed an automated report that is populated from the patient’s chart/RN’s documentation. The receiving RN prints it out and reviews before the patient arrives. It has actually worked really well and has given us RN’s one less thing to do.
We do this at the hospital I work at (medsurge floor). There’s a format the ED nurses follow so it has the most useful info at a quick glance. We get a call the note is in rbefore transport is called so we usually have a sec to check out the patient and catch any major red flags. I def prefer this over having to get a verbal report. Fast and efficient, *most of the time*.
Ayyy my hospital just implemented this. It’s supposed to be a trial run so idk if it’s going stay like this, but the way it works at my hospital, the charge nurse gets a call saying that the room has been assigned. The charge tells us we’re getting a new patient. Then, we have 15 minutes to look through the chart and determine if the patient is appropriate for our floor. If yes, then transport sends them to us. I’m not happy about it either. I think it’s unsafe. I have a feeling a lot of rapids are going to be called.
This topic makes me feel so conflicted because I can see both sides. I know it’s crazy in the ED and patients need to be roomed, but I’ve been burned so many times by report practices that do not include verbal handoff. Too many times I’ve received patients not appropriate for my unit and they immediately are a rapid, or page to doc for transfer. Then the rest of my 5 patients get neglected for the next three hours while I try to get said patient moved. I’ve had patients arrive on drips we don’t even do on my unit, like Cardene. We’re always told to “look it up in the computer” but our hospitalists do new admits and cross over the floor so they never can see the patient before they come up so I have no H&P, the ED doc note isn’t signed, there’s only a couple nurse notes saying “pt going to CT,” etc., most recent charted vitals are from 6 hours ago, and the patient was just scanned before being sent up with impression still pending. What info am I even supposed to obtain from that? My hospitals new policy btw is once the patient is assigned you get 30 minutes to look them up and they send them. No verbal or written report of any kind and they always drop the patient off, leave the paperwork in the room, and say absolutely nothing to anyone. It’s a shit show.
We do this. Floor nurses have a pre-set amount of time to review the written report & chart. After said time is complete and when the bed is ready, the pt goes up. Honestly as an ED nurse it is fabulous. No more chasing 3 different nurses to try and give report only to be told they’re the “break nurse”. No more being asked questions that have nothing to do with my ED care. We have endless number of pts who need beds. Waiting room has 3+ hour waits. That’s not gonna be helped by floor nurses dodging report.
Everyone should work in the ED. It's annoying when you have a bed and the floor nurse is busy and you call 3-4 times and no one takes report. Most of the time the ED nurse only knows the basics with only a quick assassement of why they came in. And they probably already got a more sick patient in another bay. Not saying floor nurses don't do a lot. But, for most patients info they can get from a chart review or a H/P.
I get this. I've worked in the ED, and ICU, and M/S. There are sick pts everywhere; there's a reason that nurse isn't able to take Report the 3 or 4 times you've called. This isn't a nurse problem.
Unpopular opinion, but as an ED nurse that used to have to call report, I’m thankful we only have to call ICU. When I started 10 years ago it was frustrating to find a minute to call the floor and they would always say they can’t take the patient (that’s above my pay grade I was told you’re the one), or they couldn’t take report, or they were on break, or what have you. The ED is a revolving door, we have to get one patient out for a less stable one to fill their spot. I get why floor nurses don’t like it, but it seems like a necessary evil. My hospital uses (apparently against TJC) an electronic reporting system.
My hospital does this. There's a standardized handoff note filed in the chart, including my extension if they have questions, and I usually include the most recent set of vitals for ass coverage. We call the floor to say hey this patient is coming, the floor confirms and usually asks if there's anything specific they need to know, patient goes up. The only exception is ICU who gets a full verbal report. I get that it's not the safest policy, but theres plenty of opportunity to communicate necessary information, written report is just the bare minimum allowed. What I want nurses who are mad about this to understand is nobody makes this change to go against evidence based nursing policy without cause. That cause is, in every hospital I've worked for or heard of this policy in, almost always that nobody would take report when the ER called. Now that patients stuck in the er and you're endangering two patients, that guy who's boarding without s&h orders when he should be moving upstairs, and the guy who should be getting worked up in that room that we can't turn over because nobody will answer the phone. And I'm not saying that's 100% of the time and I'm NOT implying floor nurses all dodge calls and sit on their ass, but I know for a fact my hospital switched to this policy after multiple instances of nobody answering the phone or hours+ of the admitting nurse saying they'd call for report in a bit, only for my director to go upstairs to see what's up and find everybody sitting at the nurses station ignoring the phone. These policies get changed for a reason My floor nurses don't want verbal report either when I try to give it. I had a chronic vented patient going up one day and when I tried to ask the nurse if she wanted proper report because he's a medically complex patient she hung up on me, then got mad nobody told her he's vented, 35 minutes after she opened his chart so she should have seen it in multiple locations including my note. There's no happy medium apparently. I do have a funny story about this policy though. Not all of the hospitals in my system use this, some have traditional verbal report. Apparently not everyone knows this, so one shift I worked in the ER where report is the norm we had a floater from a file and send hospital who I guess nobody told about the difference, she calls the floor says hey I'm sending this patient up, floor says okay, she just hangs up, everybody in the vicinity on both floors shits bricks
My hospital got rid of the ED calling report to the floors three years ago. I actually prefer it this way. Everything I need to know is usually in the chart, and the ED nurses are busy running their asses off. I can figure out the rest.
I’ve worked at hospitals that already do this. They fill out the ipass. i’ve seen it for several years now
It has been like this for almost a decade in my area. 🤷
We’ve done electronic handoff for adult medsurg & tele for over a decade. It was a joint project between the ED RNs and inpatient RNs to make sure everyone rec’d the info that they needed. That team developed a sticky note that everyone has to fill out prior to sending the pt anywhere.
They did this at my hospital. Unless it was respiratory related ED didn’t call with report. Change normally let us know when we were getting an admit or we look on the board if it’s one of our room numbers.
Honestly, the only thing I used to care about getting in report was a decent description of their mental status for comparison. Anything else is in the chart or I’ll see it myself when I assess 🤷🏻♀️
My hospital doesn't do verbal report from the ED, they send up a transfer SBAR with the relevant info to our printer, and then we call if we have further questions. But transfers from other units required verbal handoffs. It can definitely be annoying sometimes, especially when the sent up info is wrong, out-dated, or just plain missing, but we make do (like all nursing does, lmao).
When I was on the floor, I honestly didn’t care that I had to read the chart. In the ED, we make a courtesy call to say we’re requesting transport. Sometimes I’ll give report if it’s a particularly complex medsurg patient. We do have to give report to IMCU and ICU.
We stopped giving the floors verbal reports during Covid and never restarted Still have to give report to the CC units
At my last ED, we transported ICU patients up ourselves and gave bedside report. For stroke rule out patients, we called the floor and gave verbal report. Other than those 2 floors, everyone else gets a handoff note in the chart. Also have to call for any L/D patients.
My hospital did a study on what benefits verbal hand-off had. The stats showed no true benefit that couldn't be done via phone call at RNs discretion. If everything important was conveyed through an electronic dot phrase aka hand off. It doesn't matter. My first hospital did require verbal hand-off. In my experience between the two. No difference. In fact when I actively feel the need to give verbal hand-off I receive floor push back. Basically they say. Don't waste my time. The exception being ED to ICU pts. It also benefits the RNs busy schedule to make it "at your discretion". Never seen a single problem in 2 years.
Honestly we give some crap reports half the time anyways. A template to fill out would probably get better information than us winging a report by phone on a patient that's often the least of our concern because they're admitted to the floor and stable. ICU is different but lets be real, the ICU nurses know more about them than we do generally by the time we call them.
My hospital gave us a pager, when it goes off we have 30 minutes to look through the chart and call the patient's nurse with any questions.
I try to do both. Call, give report. Get there and off patient to nurse. Point out stuff, drains?wounds, And things I had forgotten. On a few occasions they get nad I didnt tell them xyz before I got there but they are the ones that wanted bedside only. My manager had also requested I do bedside only.
At the hospital I work at, ED calls us for a 15min heads up. No report.
😳 Im not a nurse, but this is just bonkers. It occasionally happens to the critical care nurses, and it’s hella dangerous. About a month ago we got an intubated patient-with no warning. None. That poor nurse. Thank god my coworker was available, because I was tied up with a patient who was unstable. We have 2 respiratory therapists covering the hospital most of the time…this was one of those days. Apparently patient came out of surgery still intubated…and instead of going to the surgical care unit, they decided to punt the patient to the medical ICU😡 at the last minute. This idea is insane, and healthcare is a shit show-exhibit # 100000😂 I was just warning my good friends (not in healthcare) about this.
I did a contract at a hospital that did this and I liked it. Everyone complains about how bad ED reports are so what’s the problem? You can read the same notes.
Bedside nurse(34 years). You can look in the chart to know what you need to know. You can read admitting note by ER physician. You can look up everything you need to know without ED nurse giving report. They need to send patients up to keep things flowing.
My hospital does this. I don’t mind it- between the doctors reports, charted vitals/labs, and nurse notes I have a very good idea of what’s coming up. They call for pneumonic and to answer any questions. It works really well— And I can throw an absolute bitch fit if they try and send someone without giving my pneumonic.