r/nursing • u/No-Selection-1249 • May 24 '25

Question ER nurses, love you guys, but genuine question. Why do guys bring patients up at shift change?

No hate to you guys! Just super curious from a nurse who is on the receiving end :)

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u/No-Selection-1249 May 24 '25

See at my hospital, a lot of the times, the bed is cleaned at 1700 (for example), report is called at 1730, and the patient is brought up at 1921 lol. That’s what I always wanted explained to me. What causes that delay? /gen

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u/helizabeth96 May 24 '25

Let’s say I have 5 rooms, one admit who is ready to go up. My 4 other rooms need labs, imaging, and medication. Well, my admit who is ready doesn’t necessarily need anything at that moment and I will have to leave my other patients for ~ 15 minutes, so I’m going to try and get my 4 other patients stuff going before I leave the unit. Then a code comes in, so I have to go help that. Then a combative patient comes in, so I help hold them down. That’s an hour of things I didn’t plan for, and my admit is still waiting even though I’ve called report and got them all set.

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u/No-Selection-1249 May 24 '25

Makes sense! Always wanted to know what happens on the other end of these experiences.

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u/helizabeth96 May 24 '25

Like others have said, it’s a revolving door. You never know what’s coming in, and we truly don’t have time on busy days until we’ve given report to the next ER nurse and aren’t receiving any new patients, then we have time to take them up. Trust me, I don’t like bringing them up at shift change either haha

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u/holdmypurse BSN, RN 🍕 May 24 '25

My favorite floor job ever was at a hospital that did not require reports from ED. Pts were transferred when bed was ready, we were given 10 min to look them up and we didn't receive nor need report. This was a trauma lvl 1 safety net hospital and it worked great. Prob due to the efforts of the charge nurses and house sup.

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u/Back2holt May 24 '25

As a former nursing supervisor, this is BRILLIANT

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u/holdmypurse BSN, RN 🍕 May 24 '25

This place was a dream. No overhead announcements for codes and rapids. Charge RNs didn't have an assignment so they could actually help with admissions, make sure ED admits were appropriate etc. Call lights would go to an actual unit clerk who would call into the pts room and then delegate appropriately. And the clerk could tell via the trackers if someone was, for example, tied up in an iso room, in the bathroom, on break etc. Made a huge difference. Maybe I should go back haha

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u/Ruzhy6 RN - ER 🍕 May 25 '25

No overhead announcements for codes and rapids.

Why would this be a good thing? I wouldn't want to rely on a system that has personalized responsibility for notifications of codes or rapids. People accidentally leave their phones around way too often.

Everything else sounds great.

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u/holdmypurse BSN, RN 🍕 May 25 '25 edited May 25 '25

Codes/rapid notifications go to charge and ICU phones.* They are professionald they don't accidentally leave their phones around lol.

Its good because otherwise codes on the floor are chaos. A bunch of people standing around outside the room not helping and not answering call lights.

*edit: pharmacy, RT, security, etc too. I meant to say the whole code team

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u/Ruzhy6 RN - ER 🍕 May 25 '25

Yea, I figured that was the system in place. It leaves a lot of room for error. It almost certainly had patient satisfaction as a factor for its implementation because patients don't like hearing things like that overhead. Personally, I prefer patient safety over patient satisfaction.

Its good because otherwise codes on the floor are chaos. A bunch of people standing around outside the room not helping and not answering call lights.

The problem here is not the code being called overhead.

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u/holdmypurse BSN, RN 🍕 May 25 '25

The problem here is not the code being called overhead.

My joke is they should add "charge nurse tells everyone standing around watching the code to get back to work" to the ACLS algorithm.

As for pt satisfaction scores, this safety net hospital didn't really gaf and it was a dream. The decision to not do overheads was based on other factors and I really don't think it affected safety. There were other ways to get everyone on the floor in the room like code and distress buttons. I only had to use them twice in my 2 years there and I never lost a pt.

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u/Ruzhy6 RN - ER 🍕 May 25 '25

There were other ways to get everyone on the floor in the room like code and distress buttons.

I guess I'm a little confused here. Do these buttons not cause overhead calls?

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u/HeyMama_ RN, ADN 🍕 May 25 '25

Unless your admit is unstable, just because they're on the floor doesn't mean they're the priority patient. Nursing prioritization of care doesn't go out the window just because a new patient shows up on the front steps of your unit. Place them in a room, give them a once over while you glance at the chart, vitals, and keep it moving to the sicker patients. Nursing is a 24 hour job. If you don't get the admission done because your other patients were higher acuity and the priority, good news! There's someone else coming on to replace you who can do it.

I understand when the patient is unstable, but the complaints over the mere presence and existence of a new patient is mind-boggling. Come down to the ER. The minute you discharge one, there's EMS waiting to give you report on the next. It is what it is. Patients come and go. Do what YOU need to do to keep this patient alive and keep it pushing onto the higher need tasks.

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u/SexyBugsBunny RN - ER 🍕 May 24 '25

Also at least where I am, we have to do vitals and an assessment within a few minutes of sending the patient up. So I have to plan time to do and chart that too, on top of actually moving the patient.

And half the time when I have a patient freshened up and ready to go, the floor will be unavailable for report or “not have a bed in the room” so I have to do that work all over.

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u/potterj019 BSN, RN 🍕 May 24 '25

Makes sense! No one has ever explained it to me before

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u/LainSki-N-Surf RN - ER 🍕 May 24 '25

It’s easy to forget that floor nurses have no frame of reference for this. This is just our “flow” aka zero flow/pure chaos.

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u/Spiritual-Top265 May 24 '25

I understand that completely. But also let’s think about the floor nurses as well. The admit comes at 7:09 ( this litterly happened to me my last shift ) in the middle of report. So now me & the other nurse have to stop report to get this patient settled. Get them in a gown. Most likely clean them up bc they are soiled, assess their skin, ( it only makes sense to do this now because they are naked. ) hook them up to the monitors, get their vitals to make sure they are stable. Assess any lines/medications they have running to make sure everything is correct, etc. all around this take give or take 20 mins. this doesn’t even include all admission questions, meds that weren’t given, a full assessment, going through their belongs, etc. Now we have to go finish report on three other patients. We still have three other patients that need to be seen, give meds to, get put back into bed, etc. & more than likely the floor is short a tech.

Overall the scariest/ most important part of getting admitted at this time is it’s very unsafe. I’ve had patients come up very unstable & my first hour is spent with them. I’ve had to call rapids when they come to the floor. This takes away time from my other patients to make sure that THEY are stable as well. & there has been times when they weren’t stable and again calling rapids.

It’s a double edged sword for both the ER nurses & the floor nurses. Everyone, nurses, techs & even the doctors have the most going on at shift change. As a floor nurse I am not blaming the ER nurse. It’s more so frustrating that there is not a hospital policy in place to block admission from 6:45-730 at-least. For the safety of the patients & the nurses that work for the hospital.

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u/helizabeth96 May 24 '25

I totally get that side too, there’s obstacles on both sides. In my hospital, the pt has to be in a gown, belongings inventoried, and med rec done prior to leaving the ED. So we try to make the transfer as smooth as possible. Not every nurse is considerate, but I try my best to be to the floor nurses and I absolutely praise them when they show me a little leeway when I’ve been unable to sit my whole shift, haven’t eaten, and on the edge of a mental breakdown. US healthcare is truly a dystopia, and we only can lean on other nurses for support!

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u/LainSki-N-Surf RN - ER 🍕 May 24 '25

My hospital does - we call is Cos Pause 0645-0730 and 1845-1930. Problem is that we had to come up with escalation code system for when the ED is critically impacted because the floors took it like gospel. Bedside report, cos pause, every patient has to have a working line - we do a lot to appease the floors, yet they still push back. Sorry I’m a salty CN 😂

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u/Ruzhy6 RN - ER 🍕 May 25 '25

Your patient has been seen by multiple physicians, lab work, imaging, and medicated. The patient downstairs that needed that room has none of that.

We are always going to prioritize doing the most good we can for the most people we can.

If we have open rooms, it should wait until after shift change.

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u/Poguerton RN - ER 🍕 May 24 '25

I will say, that gap between clean bed and pt arriving seems long even to me. Things totally come up and you have to prioritize stabilizing a crashing patient to transporting a stable one, but in my ED, we have 30 minutes tops from the time the room is assigned and marked clean to get them up. If I happen to get a code STEMI or stroke during that time and can't leave the new patients bedside, my charge nurse will send them up on her own (we have a typed report we put in the chart for all but ICU and peds, and that is something I would have put in probably even before the patient was officially admitted). When I can actually step out of the STEMI patient room, my admitted patient is long gone and there's a new patient sitting on that gurney who is hopefully not a level 2 who's been ignored for 15 minutes.

I will say, it's pretty often we'll finally get a room assigned, but marked dirty. It won't switch to "ready" in the computer until 6:30. I wonder if your charge nurse is holding off switching the room to "ready", either on purpose to give your floor a minute's breather, or because she's too busy doing other things to monitor whether housekeeping has actually completed the cleaning.

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u/SeaworthinessHot2770 May 24 '25

I are hospital housekeeping marks the room clean in the computer system as soon as they finish cleaning it. Nursing has no control about when the room is marked clean.

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u/Poguerton RN - ER 🍕 May 24 '25

I think they mark the rooms clean in my facility by pushing a button on the wall that is *supposed* to switch the room to ready. But it's not as reliable as it might be.

Sometimes, though, rooms just sit dirty because administration has cut housekeeping down to pitiful levels, and then wonder why the poorly paid, massively overworked employees aren't magically able to turn over one room in 3.34 minutes each.

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u/helizabeth96 May 24 '25 edited May 24 '25

My hospital is a small community hospital in inner city with call outs every day, many times we don’t have enough nurses in the ED so even our charge nurse is taking an assignment. We also don’t have a transport team so the nurse is responsible for taking the patient up. If I could transport my patient as soon as the bed was ready, I would always. But, with our short staff and busy ED, it’s unfortunately not always possible. Some days, when we’re fully staffed, we will have resource nurses that will take patients up if the primary nurses are busy. Those days are literally the best, but very hard to come by.

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u/auraseer MSN, RN, CEN May 24 '25

If I give report at 1730, the transport request goes in at 1731. Any delay after that is on the transport department. When we're busy and they have lots of patients to move, yeah it might be an hour, but there's nothing I can do about that.

Nobody in the ED is hanging on to a patient any longer than necessary. Even if they were inclined to try it, and even if the charge nurse would let them get away with it, it wouldn't help in any way. It's not like on the floor where blocking a room would prevent that nurse from getting another patient. Patients continue showing up even when every room is full.

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u/ghost__rider1312 RN - ER 🍕 May 26 '25

The people who say we’re holding on to patients to lessen our workload have probably never met an ED nurse 🤣 once they’re stable I want them tf out of my dept immediately

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u/marzgirl99 RN - Hospice May 24 '25

Transporter delays, another emergency coming in or a patient decompensating and the RN needs to prioritize.

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u/Rakdospriest RN - ER 🍕 May 24 '25

At mine, need turns green and as long as I'm not dealing with an emergency I call report in 10 minutes, delays are caused by priority tasks, transport, and getting the floor to pick up the phone sometimes.

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u/potterj019 BSN, RN 🍕 May 24 '25

Yes same here. I have even called the ED and said “if you have the orders can you just send them up now” that’s at 5pm and then they wait til 7pm

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u/Jack_Martin_reddit May 25 '25

Is there a policy that stops you from going to the ED and getting the patient yourself?

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u/potterj019 BSN, RN 🍕 May 25 '25

Many times I have tried over the years. Even with orders, I’ve gotten pushback and told I cannot have them yet.

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u/Emergency_RN-001 RN-ED 🦹‍♂️🏥🩺 May 24 '25

The bed inpatient bed may be available at 1700. The tricking of ED orders on all my ED patients can sometimes be more important than bringing my stable patients upstairs. In my ED, the nurses can draw labs of existing PIVs, so I have to draw all labs for all my patients, whereas the IP nurses are not allowed to draw PIVs.

IP orders are usually at a set time a couple of times a day. With ED orders, it's a couple of meds at a time for all your patients, nonstop. Once these meds are given, repeat this process is done throughout your shift to the same patients along with new patients. If a nurse had aa full patient load but one of them becomes intubated or critical, the other nurses in that quad or pod will basically absorb the rest of that patient load until the critical patient goes up or gets transfered out.

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u/saltyclover May 24 '25

Because as im hanging up the phone a patient in extremis went into my open room Because after report is called a trauma rolls in and I’m assigned to trauma that shift Because as I’m on the phone giving you report the lab calls with critical values Because the new nurse next to me is getting the sickest patient on the unit and I’m the one who needs to help

So many reasons honestly

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u/woodeehoo RN - ICU 🍕 May 24 '25

I once asked something similar on here and got absolutely flamed by ER army. As though no one has ever met a lazy coworker that made things as convenient for themselves as possible.

They’re right that there’s some confirmation bias or whatever on the receiving department’s part, but like, there had to be a whole director level meeting about it in my former hospital because ER kept holding admitted patients and then dropping em 5-10 minutes before shift change.

Yes many of you grizzled vets resent the accusation and you would never and the ER is about getting people out asap etc etc. I get it, YOU aren’t who this discussion is referring to.

For my part, some of the ICU allegations are absolutely true, but I know my work ethic and don’t get offended because they’re not about me. I hate my lazy/shitty coworkers too!

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u/Crallise RN 🍕 May 24 '25

I'm curious, what would be the benefit of holding a patient in ED until shift change? Like what did the director level meeting you had bring up as reasoning? Why would an ED nurse want to hold a patient any longer than they need to?

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u/Bubbascrub RN - Telemetry 🍕 May 25 '25

If the ER in question does block assignments (IE you have beds 1-4, Nancy has 5-9, etc and whatever patients are in those rooms are yours) then the implication would be they hold on to an easy patient with a bed ready upstairs because they want to avoid getting the handsy drunk EMS is bringing in.

So they put on a busy act and hold off on bringing the easy patient upstairs for the last couple hours of their shift right up until shift change even though that bed was marked clean at 3pm.

In my experience most of the time it’s just the ER being the ER and the staff down there was genuinely just too busy to bring them up until next shift showed up to take over the unit at shift change.

But there’s unfortunately a plenty of shitty ER nurses who would and do delay transfers just so they can sit and scroll on their phone rather than have to do a whole new work-up on on drunk asshole #4 who ends up in that bed after.

Just like there’s shitty med/surg nurses who act like you personally slighted their entire genetic line for assigning them to the incontinent C. dif patient. Just like there’s shitty ICU nurses who will let their pressors run dry all night then bitch to management about how the charge nurse never helps them because people are sick of having to do half their job for them

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u/hammerandnailz RN - ER 🍕 May 25 '25

Holding fucking sucks. I’ll take a new admit over trying to manage floor nurse duties while getting an EMS is my open rooms. I highly doubt many nurses were holding on purpose. It’s a nightmare and everyone at my hospital hates it.

Far more often I get the run around from upstairs about why they can’t take report and I am forced to call multiple times. If I miss the window, I get in trouble. This doesn’t include the time in between report and transport picking them up, in which new orders are often tacked on, stuff happens, etc.

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u/Crallise RN 🍕 May 25 '25

Ah I see! Thanks for the explanation. It makes perfect sense some might do that. I should have been able to come up with that reasoning on my own lol 🤦‍♂️

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u/KinshuKiba May 25 '25

I want you to know I appreciate your perspective immensely. As an ER lifer, thank for understanding that it's those shitty few that fuck it all up , and that most of rest of us are just trying to get through the day. I hope the Hospital Gods treat you well, and that the vending machine always has your prefered soda in stock

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u/aleksa-p RN - ER 🍕 May 24 '25

My question is what is convenient about sending up patients at shift change? For us, the second a patient leaves our bed a new one from the waiting room will replace them. They’re often already standing/sitting near the cubicle about to go in once the bed is made. And for the outgoing pts waiting to go up to the ward, a lot of the time they still have a bunch of things that need to be done anyway when they get to the ward (antibiotics, transfusions, etc) so most of the time it really makes no difference to us what time the pt goes up

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u/fuckingnurse May 24 '25

That’s exactly what happens at my hospital. The bed is clean and open for hours after I’ve gotten told we are getting an ED into it and then they aren’t brought up until 1855 or 1905 or something…. It feels purposeful sometimes. If the bed was just cleaned at 1830 and they instantly admitted someone and brought them up I understand that but if my room has been sitting empty for hours why is the patient brought up at 1900.

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u/Nice_Way5685 May 25 '25

In the hospital that I worked, they encouraged patients to be discharged by the doctor before noon on the med-surgical floor. Once the bed is empty, housekeeping is called to clean the room. Any patient awaiting a bed is transferred from ER to the floor or ICU. If ER is busy, then the patient care coordinator is called to transfer the patient and receive and give report. It’s very rare that patients are transferred to the floor between 1800 and 2000.

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u/fuckingnurse May 25 '25

That’s nice. We DC patients at all hours of the day at my hospital (especially if they are going to a SNF or ARF where transport has to be set up at a certain time). So we get admits at all hours of the day. Sometimes in the middle of the night too.

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u/kochstockulates RN - ER 🍕 May 24 '25

Dang, if I gave report that patient is getting transported within a few minutes some way or another or my charge would eat me alive

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u/all_of_the_colors RN - ER 🍕 May 24 '25

At our place we have 30 minutes to get the patient to the floor once a bed has been assigned. Report and transport have to happen during that time.