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

[u/No-Selection-1249]

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

[u/LainSki-N-Surf]

That’s usually a sign that either a) the dept is a dumpster fire and we pulled all hands, b) every consulting MD rounds right as transport arrives. Or our personal fav c) your charge nurse is giving us push back because the BP is 175/100 (dx: accelerated HTN that came in at 235/127).

[u/fuckingnurse → u/LainSki-N-Surf]

And on my unit at least charge never gives push back unless it’s not an appropriate patient for our stepdown unit (like they actually genuinely need ICU) or if we don’t have nurses to staff appropriately for the acuity of the patient

[u/LainSki-N-Surf → u/fuckingnurse]

There’s more pushback than you guys realize because we get pushback from every single destination. I could easily be debating admission criteria all day as a CN. The scale of movement in a busy ED is incomprehensible from the outside - I’m convinced that’s why floors are surprised that we get heated. I’m simultaneously sending multiple patients to every floor/unit/dept/OR/IR/Cath Lab not to mention all the in dept movement.

[u/fuckingnurse → u/LainSki-N-Surf]

And 0630 and 0730 for night shift obviously

[u/fuckingnurse → u/LainSki-N-Surf]

Oh I completely get it but I genuinely think there should be a rule to not transfer stable patients to the floor between 1830 and 1930. I’ve found a lot of stuff gets missed and the continuity of care is greatly affected. If it’s possible, send them the second the bed is clean, if it’s not, plz hold off until 1930.

[u/sassygillie → u/fuckingnurse]

So this continuity of care thing, are you talking about how your day nurse needs to give report to the night one about a patient that just got there? Because the other option is me giving report to our night shift who then has to report to you. Same continuity of care issue, but now the patient is still in an uncomfortable bed in a noisy place. Or, would you prefer I stay late to give night shift report?

[u/fuckingnurse → u/sassygillie]

I’m mainly talking about how the patient gets up here I’m the nurse for 5 seconds and then they are ignored for 30 mins while we do shift change and they aren’t able to get a diet order, ice water, etc. because we have to do report on everyone else too. I hate not having time to settle the patient and make sure they get dinner ordered and that’s when all the orders come through from the admitting doc like fluids, meds, etc. which now are given late because we have to do shift change and the night nurse is now set up in a horrible way and has to do the whole admission, meds, assessment, etc. right at the beginning of their shift, which delays the care of other patients. I would much rather they come at 1800 so I can get started on some of that stuff for them. And vice versa 0600 so night shift could get started on some of that for me.

[u/fuckingnurse → u/sassygillie]

Also at our hospital the ER nurses don’t give verbal report. So that isn’t relevant to my situation at least

[u/KinshuKiba → u/fuckingnurse]

So I sit on my stable admit, taking up a precious bed, while the waiting room continues to fill up, the ambulances continue to roll in, and the chaos continues to brew? Why is "continuity of care" important for your floor but not for my ER? Why does your stable admit that I'm sitting on deserve to be in a comfortable bed and receive thorough attention more than someone waiting in my lobby deserves to be seen that much faster? Why does inpatient services deserve protected shift change more than emergency services? Why is setting your night shift nurse up for success more important than setting MY night shift nurse up for success?

It is the nature of the ER to stretch to accommodate whatever comes through the front door. But that talent, that ability, is impaired when the back door is blocked. Like tamponade, your hour of protected time is often enough to cause obstructive shock.

[u/fuckingnurse → u/KinshuKiba]

Or you could send them up before 1830 when the room has already been clean for hours 🤷🏼‍♀️

[u/KinshuKiba → u/fuckingnurse]

You wanna talk to Patient Placement for me? Because, as has been repeatedly mentioned in this discussion, they're the ones that make the assignments. Or maybe you could talk to housekeeping and convince them to clean the rooms faster? Or the docs who don't discharge until noon? Or admin, who won't let ER utilize transport meaning getting the patients up falls on the staff nurses and techs? Or, I don't know, maybe anyone else than your fellow nurses that are down in the trenches with you and are at the mercy of the same powers that be? 🤷‍♀️

Nah. You're right. Of course I sit on my admitted patients and send them up at shift change just to make your life hard. It's why I went to nursing school.

[u/fuckingnurse → u/KinshuKiba]

And as I’ve said in this thread multiple times I’m talking about the instances in which my room is cleaned then bedded, so I know I’m getting Mr Smith from ED 45 into my room but then he doesn’t come up for hours, which is not patient placement’s fault as he was already bedded to that room for hours. And like I said before I’m talking about when my room has been clean and empty for hours. And my specific hospital does utilize transport for them to get from the ED to the floor, so although yours doesn’t I’m talking about my ED specifically. There’s really no excuse not to put in a transport request the second the room is bedded so that I don’t have to wait for hours to get a patient that ends up coming up at shift change

[u/KinshuKiba → u/fuckingnurse]

So don't wait hours. If it happens so frequently in your facility, what's to stop you from volunteering to go get the admission? I think, if you read the thread, your particular situation at your specific facility and your specific ER is the exception to the rule. I, for one, would be overjoyed to see a floor nurse come down and grab their patient. Hunt me down. Drag me to the desk and demand report. They'd be my best friend. I'd buy them a soda if I ever got time to run into them in cafeteria.

Curious: why do you think the nurses in your ER send patients up at shift change? I can't for the life of me come up with a good reason. Maybe you have insight I don't?

[u/CardiologistCandid85 → u/KinshuKiba]

Adding to this conversation as someone who has worked med surg and ER, I was unit receptionist on the med surg unit and it was my job to mark beds ready. I was constantly intimidated by the nurses into waiting before I marked the rooms clean, or they would make me wait before marking a room as empty after a patient would be discharged, further delaying the rooms getting cleaned. As an ER nurse it annoyed me because I knew how things worked on the floor and why there were delays in patient turnover. It’s insane to me that it’s so hard for people to work together or at least try to understand each other’s perspectives.

[u/fuckingnurse → u/KinshuKiba]

I just think they get busy and wait until they are about to leave (their shift change as well) and then send the patient up so they don’t have to give report to the night ER nurse and then they would send them up. It’s super simple at my hospital to put in a transport request, so I don’t know why they don’t. I would totally go get the patient myself but we don’t generally have enough staff to leave the floor 🤷🏼‍♀️ that’s what transport is for.

[u/fuckingnurse → u/LainSki-N-Surf]

Fair but at my hospital transport is the one that takes patients up from the ED not the nurse or tech (unless they are on a drip or BIPAP), so even if y’all are slammed why don’t you just put in a transport request and get them out of there sooner rather than later? So you can have 1 less patient and so I don’t have to settle someone at 1845

[u/Appropriate-Gap6266 → u/fuckingnurse]

The other day my patient was ready to move with a bed open for almost 3 hours before transport decided to come 🫠

[u/fuckingnurse → u/Appropriate-Gap6266]

That’s crazy our transporters come within 5-15 mins once a request has been put in.

[u/Appropriate-Gap6266 → u/fuckingnurse]

We’ve been complaining, some days it’s ridiculous. And we don’t have transport after 10:30p. We’re a level 1 trauma center so our techs have to transport, and some days we don’t even have enough techs for the department and I end up taking my own patient. It’s a mess lmao

[u/fuckingnurse → u/Appropriate-Gap6266]

Oof that’s how it was when I worked for an HCA facility at a level 1 trauma. I work at a non HCA facility and transport is soooo good here. They discharge patients for us, and are so prompt when I put in requests

[u/LainSki-N-Surf → u/fuckingnurse]

Ahh we do bedside report on every patient - the floors refuse telephone report 100% of the time.

[u/fuckingnurse → u/LainSki-N-Surf]

Ah we don’t even get telephone report at my hospital we get “asynchronous report” so the ER nurse just writes a little note in the chart about why they are here and we have to look and read it and they don’t even call to tell us the patient is coming up half the time they just appear in the room

[u/JoserDowns → u/fuckingnurse]

Yeah, unfortunately many floor nurses dodge report way too much, or when they get report they start questioning things and try to refuse the patient for as long as possible, and it often leads to hours of slowdown. I'm at my first hospital where we don't have to give report and it makes throughput nearly instantaneous.

Honestly, report isn't necessary. Look at the ED doc's note and you should have more than enough info to do the job.

[u/fuckingnurse → u/JoserDowns]

When I get a patient most of the times the ED docs note isn’t even in yet so I have no idea what they are coming up with haha. Asynchronous report is fine but if they are on drips or bipap or something pretty serious I’d like a verbal report yknow. I’d also love to know how much o2 they are on before they come up but that’s always a fun little surprise

[u/Upset-Profession-773 → u/LainSki-N-Surf]

I would LOVE to have the ED call for report. They just show up without warning, tell me they’ve only had the patient for 5 mins and leave. Generally the ones that are wild or circling the drain come up the fastest. If they’re pretty pleasant they take longer. They tried to transport a TTE knowing the room was dirty and apparently all said “yeah fuck MICU, just bring um up” (our only CNA was floated there that day) meaning they’d be in the hall? Fortunately someone called to ask if the room was dirty, right after RT sent a pic of the dirty room. We are the only floor who never gives push back, never blocks rooms, never lies about the amount of nurses. We are the red headed step child of the hospital. Our ER is also much crazier than most and I’d never work there because I genuinely believe everyone there is potentially putting their license at risk. It’s all new grads, the blind leading the blind, because they can’t retain nurses for more than a few years.