Trust and Transfers

24 Sep

After reading this posthere by Braden, I realized the missing link between the ED nurse and the floor nurse is trust. It seems the floor nurse in this post was unprofessional and flighty by description and this post is not about that particular situation but my own experiences.  How many times have I had that sinking feeling of what condition will my patient be in this time? I work on a telemetry floor and usually have anywhere from 4-6 patients at a time. The ED nurse calls and gives report to the nurse and the the ED technician will transport the patient to the floor.  I never have a problem with receiving patients and I always take report as soon as I am called, I know it is busy.  What I can not stand though is when I hear that a patient has a SPB hovering in the low 90s after multiple fluid bolus, no admitting orders, no work up done by the attending, and when the patient does get to the floor you find the patient lethargic, no urine output, no orders for fluids, the blood pressure dropping and your patient is probably septic has not been worked up yet after hours in the ED. So now my 5 other patients have to wait on me while I attend to this obvious septic patient getting urine cultures, blood cultures, lactate level etc…If that was worked in the ED the patient would of went to ICU for a lactate level > 4 if the patient were to have been worked up.  Then when you get the results back from the lab you have to work on getting the patient off the floor and into an ICU bed transfer the patient etc…

Or the ED nurse tells you in report the patient is in respiratory distress with a rate of 44- the patient is cool and pale and diaphoretic. You ask the ED nurse, ” should this patient really transfer to telemetry?” The ED nurse tells you that the ED doc is sure the patient is ok to transfer to tele.  The patient gets to the floor and a rapid response has to be called because the patient is in  obvious resp distress, and ABGs are obtained, Stat portable chest x ray is obtained and the patient has severe CO2 retention and needs to be intubated. Again another delay in care for a patient that should of been admitted to ICU instead of telemetry.

This is not the usual but it does happen alot. I also know that patients are sick or they would not be in the hospital to begin with, but sometimes I see inapproptiate admissions to the floor; then I just have to work a little bit harder to get them the bed where they belong for the best care for that situation.


One Response to “Trust and Transfers”

  1. Wanderer September 26, 2008 at 04:45 #

    I’m right there with you. Been there, played that game. Luckily enough I have a collection of great charge nurses who freakishly guard their territory and don’t stand for this kind of irresponsible patient placement. Hell hath no fury like a good charge nurse fighting an incorrect placement…I swear I’ve heard poor residents’ drawers burst into flames as they get laid into, after the patient has been sent to the Unit.

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