RN REFUSES to give REPORT.

RanchoEMT

RanchoEMT

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Well as the Title may give away, I was working BLS/IFT the other day picking up out of a Kaiser, in San Bernardino County. Our Patient was originally admitted for CVA a few days prior and was being transported across county lines to a nursing facility approximately 40 miles away. Upon contact with the sending Nurse and after asking for a report, the Nurse states that she has never given a report in her entire time working at this facility and does not feel it necessary to tell the crew(Myself/Partner) now. NOR, does she give our crew any type of face sheet for billing. We are given a paper with her diagnosis (Only) and her prescribed Medications.
-A summarized Version-
I ask her: "How long have u worked here?"
Nurse: “What does that have to do with anything?!”
Myself: “You’ve never given a report or a Face Sheet to any ambulance Crew You’ve ever handed a Pt. too. How Long Have U done this?”
Nurse: “That is not relevant.”
Myself: “ What if my patient goes south on the way to where were going and I have to give a report to an ER Not knowing what her Med HX, Allergies, DOB, Last Blood Sugar, etc. is?!?! What if she has MRSA, or something else and b/c of YOU IM NOW INFECTED?!?! “
Nurse: “We do NOT give out this information here!!!!”
Myself: “ What’s your Name?”

YADA YADA YADA

My partner plays the reasonable middleman and tries to explain why we need what we do. Flustered and red, I call my supervisor and he states this is typical of Kaiser, and that we are to document and transport. Nurse then takes blood sugar after arguing for several minutes, previously stating that she CAN’T take it again for another 2 hours.”

Myself: “ WHY can’t u take a blood sugar now?!”
Nurse: “b/c I can’t.”
Myself: “ WHY?”
Nurse: “B/C I CANT.”
Myself: “ WHY?”
Nurse: “B/C I CANT!” (Crazy Eyes Engaged)
Myself: “ CANT? Or Wont!”


To Summarize RN refuses to give:
Face Sheet(D.O.B., SSN, Insurance, demographics, etc.)
Med Hx
(Contact Pre-Cautions info)
Allergies
Blood Sugar(@ time of Transport)
DNR
Other Pertinent info (will be transported with Foley, hasn’t eaten, Spanish Speaker ONLY, etc.)

WHAT ARE YOUR GUYS’ THOUGHTS AND ADVICE FOR THIS?!?!?! I mean am I just jumping ship?? Is my role as a BLS/IFT that far down the ladder that I am not worthy of the Med Hx or Billing Info (is this ride free?) Mind you I will be the unit firing up the lights, blowing by traffic, giving the report to the receiving ER and giving compressions if something does happen… What really irritates me is, after bickering she caved in on a lot of stuff she said she “JUST CAN’T” do. We got a face sheet and a blood sugar! ANYWAYs, I’d LOVE to hear back.
 
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Did you not have a transfer packet with all that information in it that you could look up yourself without causing a scene and making you both look bad? Did she not have a charge nurse you could go to? Did the pt not have a chart that you could've gone and gotten yourself?

Sometimes they wont do it. Instead of causing a scene that will likely upset your patients/family members and screw you with the rest of that staff, learn to work around it. Quite often if you find the unit secretary, (The chick/dude who sits at the desk and rolls their eyes and goes "Can I help you?" everytime the call buttons beep.) they can print you at least a face sheet. The patient should have an allergy band as well.

Could you not have taken your own blood sugar?

Contact percautions are most often posted on the door, and the paperwork will tell you why.

Does she still have a foley in? She is likely to be transported with it, if not they can D/C it at SNF.

How oriented was your patient? Was there family there? They most often know a hell of a lot more than the nurse will.

If you do not have a DNR in hand, she's not a DNR.

If they handed you a sealed packet, and the nurse is giving you grief, wait until you are away from the nurse or down in the truck to open it.

Getting into shouting matches with nurse is stupid. Just learn to work around it.

PS, not saying you did it, but often the way an EMT/Medic come in and carry themselves with the patients and/or other staff will set the tone of the call. If you come in like "I'm tough poo, I'm an EMT!" attitude or something or another, the RN will probably not be on your side.
 
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RanchoEMT said:
WHAT ARE YOUR GUYS’ THOUGHTS AND ADVICE FOR THIS?!?!?! I mean am I just jumping ship?? Is my role as a BLS/IFT that far down the ladder that I am not worthy of the Med Hx or Billing Info (is this ride free?) Mind you I will be the unit firing up the lights, blowing by traffic, giving the report to the receiving ER and giving compressions if something does happen… What really irritates me is, after bickering she caved in on a lot of stuff she said she “JUST CAN’T” do. We got a face sheet and a blood sugar! ANYWAYs, I’d LOVE to hear back.
Click to expand...

You can never win an argument with an idiot. They are not even smart enough to know when they lost.

In my personal experience certain organizations hire the absolute dregs of the healthcare industry. If your supervisor is informed and cool with it, just load the patient up and take him/her.

If the patient goes south on you, treat them like you would any other unconscious/altered patient you were called to who couldn't answer the same questions.

No matter who is at fault, nothing good ever comes from arguing with nursing facilities, no matter who you are arguing with.

Sounds like the typical day in IFT.

Let it go.
 
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Billing Info (is this ride free?)
Click to expand...

PS, billing info shouldn't matter to you. You're not the biller. They often have that information beforehand, or can call and get it if they dont. I like the face sheet for the name, dob, age, address (Which can also be found on the ID bands with the exception of SSN and address).

Your job is to write the report, let the billing department deal with whether the ride is free or not.
 
Sasha said:
Did you not have a transfer packet with all that information in it that you could look up yourself without causing a scene and making you both look bad? Did she not have a charge nurse you could go to? Did the pt not have a chart that you could've gone and gotten yourself?

Sometimes they wont do it. Instead of causing a scene that will likely upset your patients/family members and screw you with the rest of that staff, learn to work around it. Quite often if you find the unit secretary, (The chick/dude who sits at the desk and rolls their eyes and goes "Can I help you?" everytime the call buttons beep.) they can print you at least a face sheet. The patient should have an allergy band as well.

Could you not have taken your own blood sugar?

Contact percautions are most often posted on the door, and the paperwork will tell you why.

Does she still have a foley in? She is likely to be transported with it, if not they can D/C it at SNF.

How oriented was your patient? Was there family there? They most often know a hell of a lot more than the nurse will.

If you do not have a DNR in hand, she's not a DNR.

If they handed you a sealed packet, and the nurse is giving you grief, wait until you are away from the nurse or down in the truck to open it.

Getting into shouting matches with nurse is stupid. Just learn to work around it.

PS, not saying you did it, but often the way an EMT/Medic come in and carry themselves with the patients and/or other staff will set the tone of the call. If you come in like "I'm tough poo, I'm an EMT!" attitude or something or another, the RN will probably not be on your side.
Click to expand...

-NO PAPER WORK...
-San Bernardino County: EMT's Not allowed to take Blood Sugar
-No Family, Spanish Speaking Only, Not Oriented(Nurse states Normal, after arguing)
-Nurse states she is a DNR, Crew Requests DNR, Nurse states is electronic and she WONT PRINT, Crew states then it doesn't exist outside your hospital.
-Contact Precautions, Non Stated (Still Not going to assume NEthing)
 
-NO PAPER WORK...
Click to expand...

So you transport without any paperwork to bring the recieving facility? They'd kill us if we showed up without a packet even if everything had been "faxed".

Think. If you were doing 911, would you know if the patient was on contact isolation? No? Then pretend it's 911 and you don't know if that wound on their back is festering with MRSA or their poo smells because of Cdiff.

Never never never fight with a nurse. It's unprofessional and makes you look like a monkey. Why did you need a BGL? Was she exhibiting signs of hypoglycemia?

Did you even try to find the charge nurse or to find the chart? What does it matter how long she's been there or what her name was?

Like I said, no DNR in hand then she isn't a DNR.
 
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I would have just found the charge nurse and asked nicely to see the chart. Fighting is never a good idea. It makes you look unprofessional and sometimes as nice as it feels to tell someone they are stupid they just call your boss and complain. I've ran into this problem with a hospital here they freaked when I tried to open the transfer packet. I just said okay im sorry with a smile and opened it when I got in the ambulance
 
jesus H... Ok. Objectively.
Sasha said:
So you transport without any paperwork to bring the recieving facility? They'd kill us if we showed up without a packet even if everything had been "faxed".
Click to expand...
Hello.

Sasha said:
Think. If you were doing 911, would you know if the patient was on contact isolation? No? Then pretend it's 911 and you don't know if that wound on their back is festering with MRSA or their poo smells because of Cdiff.
Click to expand...
Why cant a healthcare proffesional notify another that an extra precaution is to be taken when handling a patient?

Sasha said:
Never never never fight with a nurse. It's unprofessional and makes you look like a monkey. Why did you need a BGL? Was she exhibiting signs of hypoglycemia?
Click to expand...

Never Never fight with anybody. Fighting is bad, mk.
Its required with my company when the Pt. is a diabetic to get a BGL at time of transport. (Note: Patient doesn't speak english) After going back and forth with the nurse we were allowed the privilege of knowing she was a diabetic.

Sasha said:
Did you even try to find the charge nurse or to find the chart? What does it matter how long she's been there or what her name was?
Click to expand...
Charge Nurse Found. Charge Nurse States: "We Don't give out that information." which is Bull. Gotn it before this incident. Gotten it after this incident. questioned other case managers, nurses, etc. its given.

Sasha said:
Like I said, no DNR in hand then she isn't a DNR.
Click to expand...
Then we agree..
 
RanchoEMT said:
Its required with my company when the Pt. is a diabetic to get a BGL at time of transport.
Click to expand...

If you know, under what authority or consent is your company mandating medical procedures?

I am a bit disturbed by this revalation as it looks like an often unindicated procedure I would bet is not done for free.

The other issue is a patient can refuse any or part of medical care, if they accept a ride and are told they "have to have a a glucose check" that doesn't seem like good faith consent to me.

Moreover, a language barrier does not automatically grant consent for treatment.

I am sure you are just following the policy that your employer imposed upon you, but I was really wondering if you had some insight on it you would share?
 
Veneficus, good question(mandating medical Procedures), I don't know. I will find out though. On my end my end its supposed to be something like knowing the most about your patient so you can effectively do the most for your patient. The Real reason i'm sure has a lot of zeros behind it. $$$$
But i like money too, which equates to i like job, which further means i like BGL @ time of transport.
 
First, who or what is this "U" you keep mentioning?

Second, lose the attitude. The nurse may of been inept, but it gives you no right to go act the way you did (If you really even said any of that).

Third, I'm going to quote your OP in a moment and give you my opinion (In BOLD CAPS)



RanchoEMT said:
Well as the Title may give away, I was working BLS/IFT the other day picking up out of a Kaiser, in San Bernardino County. Our Patient was originally admitted for CVA a few days prior and was being transported across county lines to a nursing facility approximately 40 miles away. COOL Upon contact with the sending Nurse and after asking for a report, the Nurse states that she has never given a report in her entire time working at this facility and does not feel it necessary to tell the crew(Myself/Partner) now. BS FLAG GOES OFF. HAVE YOU THOUGHT MAYBE ITS THE WAY YOU APPROACHED HER? NOR, does she give our crew any type of face sheet for billing. DON'T NEED IT FOR BILLING We are given a paper with her diagnosis (Only) and her prescribed Medications.
-A summarized Version-
I ask her: "How long have u worked here?" AS SHE SAID..WHAT DOES THAT HAVE TO DO WITH ANYTHING? YOU COME OFF WITH THAT ATTITUDE AROUND HERE YOU'RE LUCKY TO EVEN HAVE A JOB
Nurse: “What does that have to do with anything?!”
Myself: “You’ve never given a report or a Face Sheet to any ambulance Crew You’ve ever handed a Pt. too. How Long Have U done this?” WHAT IS THIS 'U' YOU SPEAK OF? AGAIN, SEE FIRST QUESTIONS RESPONSE
Nurse: “That is not relevant.” GOOD FOR HER.
Myself: “ What if my patient goes south on the way to where were going and I have to give a report to an ER Not knowing what her Med HX, Allergies, DOB, Last Blood Sugar, etc. is?!?! What if she has MRSA, or something else and b/c of YOU IM NOW INFECTED?!?! “MRSA? IF YOU USE UNIVERSAL PRECAUTIONS ON EVERYBODY, AND WASH YOUR HANDS, YOU SHOULDN'T WORRY SO MUCH ABOUT IT.
Nurse: “We do NOT give out this information here!!!!”
Myself: “ What’s your Name?” YOU ARE SUPPOSED TO BE A PROFESSIONAL, BY ACTING THE WAY YOU DID SHOWS LACK OF MATURITY AND PROFESSIONALISM. AND THIS COMING FROM ME IS SAYING A LOT

YADA YADA YADA FRED FLINSTONE?

My partner plays the reasonable middleman SOUNDS LIKE YOU SHOULD LEARN FROM HIM and tries to explain why we need what we do. EXACTLY WHAT YOU NEED TO DO NEXT TIME Flustered and red, MAYBE YOU SHOULD LEARN TO RELAX BEFORE, BEFORE YOU STROKE OUT FROM STRESS. MAYBE GETTING BURNOUT? I call my supervisor and he states this is typical of Kaiser, and that we are to document and transport. Nurse then takes blood sugar after arguing POOR PATIENT....HAVING TO SEE THISfor several minutes, previously stating that she CAN’T take it again for another 2 hours.” AND WHAT IS ARGUING GOING TO DO ABOUT IT

Myself: “ WHY can’t u take a blood sugar now?!” WHY CAN'T YOU?
Nurse: “b/c I can’t.”
Myself: “ WHY?”
Nurse: “B/C I CANT.”
Myself: “ WHY?” HOW OLD ARE YOU? 12?
Nurse: “B/C I CANT!” (Crazy Eyes Engaged) YOU'RE LUCKY SHE DIDN'T CALL A SUPERVISOR RIGHT AWAY. OR HAUL OFF AND SMACK YOU
Myself: “ CANT? Or Wont!” MAYBE 11? 10? GROW UP


To Summarize RN refuses to give:
Face Sheet(D.O.B., SSN, Insurance, demographics, etc.)
Med Hx
(Contact Pre-Cautions info)
Allergies
Blood Sugar(@ time of Transport)
DNR
Other Pertinent info (will be transported with Foley, hasn’t eaten, Spanish Speaker ONLY, etc.)

WHAT ARE YOUR GUYS’ THOUGHTS AND ADVICE FOR THIS?!?!?! I mean am I just jumping ship?? Is my role as a BLS/IFT that far down the ladder that I am not worthy of the Med Hx or Billing Info (is this ride free OH I'M SORRY, DID YOU FORGET ABOUT THE PART ABOUT PATIENT ADVOCACY? NOT WORRYING ABOUT BILLING INFO?) Mind you I will be the unit firing up the lights, YOU MUST BE NEW TO THIS GAME blowing by traffic, WITH THAT ATTITUDE I HOPE YOU DON'T DRIVEgiving the report to the receiving ER and giving compressions if something does happen… What really irritates me is, I THINK YOU SHOULD RETHINK YOUR ACTIONS after bickering she caved in on a lot of stuff she said she “JUST CAN’T” do. We got a face sheet and a blood sugar! ANYWAYs, I’d LOVE to hear back.
Click to expand...

You need to seriously relax. Sure she may of been incompetent but does that give YOU the RIGHT to act the way you did? Absolutely not. You write it up, move on. If you did not feel comfortable with the transfer of care, you do not transport the patient. Did you ask for a supervisor? Did you even write this incident up? Its not the end of the world. You're LUCKY you aren't out of a job right now. EMT's are a penny a dozen. You need to get thicker skin and learn to be more professional. How many years have you been doing this? This wasn't an advanced ALS transfer. It was a basic transfer
 
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I personally wouldn't have accepted care until getting a full report. I'd file a formal complaint on that, the nurse put you guys in a VERY bad situation there.
 
I definitely understand where the OP is coming from. I'm convinced all nursing staff at nursing facilities across the country are idiots who are totally clueless. If anything its the nurse who thought she was all that and did not feel the need to comply with normal transfer of care procedures. I think legally she had an obligation to properly transfer care. As a healthcare provider you can't just dump a patient on someone else without properly informing them about the patient.

I don't know if an actual argument pursued or not... the tone the OP set doesn't sound like a full fledged argument. I can push buttons and imply much very calmly to make my point with someone. There does come a point where you do need to walk a way. But there is also a point where you serve as a patient advocate and you need to be firm in ascertaining what information you need for your patient transfer. Were not puppets that just do what were told (well, some ppl obviously are).

When a patient is already in a medical facility with known diagnoses and infectious diseases, that info NEEDS to be relayed. It is NOT the same as being at someones home or on a street corner. Again, there is an obligation on behalf of the originating facility to present this to the EMS crew.

I would recommend always asking for the info. If the nurse refuses then ask for her supervisor. If that gets you no where try the unit clerk, call ur supervisor and document the refusal of the nursing facility to comply with your request. Do not raise your voice or allow an actual argument to ensue.
 
I've had a few RNs not want to give report. I politely explain why I need it. This usually works. If not I don't take the pt and call my supervisor. This you did and they told you to document it and take the pt. Now you have a dilemma. Keep your job and take the pt. (This also lets the stupid nurse win and she won't learn anything), or stand your ground and advocate for proper pt care. I can't fault you for whichever decision you take.

Others have already written how to better handle the situation and I'll let that stand.
 
I understand your frustration, but I think your opening remark to the nurse ("How long have U worked here?") was provocative, and not likely to promote cooperation.
 
As ridiculous as that nurse was, it still gives you no right to argue. My advice would be transport, document the crap out of it and report it to your supervisor. 'nuff said! :)
 
When asked "Why", state "Do I bring you a patient without giving you a report?". If they still refuse, ignore them, open the envelope even if they protest, or ask a doc if you can find them. If they have a problem, they are more than welcome to call my supervisor and explain why they don't want there to be proper patient care.


I've done it before. I had a nurse absolutely refuse to tell me anything about the patient claiming an "ongoing criminal investigation" and that I had no right to know anything about the patient, I was just there to transport. I said thanks, took one step to my right and asked the doc, who gave me the whole report than dressed her down.
 
Linuss said:
When asked "Why", state "Do I bring you a patient without giving you a report?". If they still refuse, ignore them, open the envelope even if they protest, or ask a doc if you can find them. If they have a problem, they are more than welcome to call my supervisor and explain why they don't want there to be proper patient care.


I've done it before. I had a nurse absolutely refuse to tell me anything about the patient claiming an "ongoing criminal investigation" and that I had no right to know anything about the patient, I was just there to transport. I said thanks, took one step to my right and asked the doc, who gave me the whole report than dressed her down.
Click to expand...

Lol another affective way to handle the situation. :-)
 
hey Linuss, I've followed a lot of your posts and i regard you as someone with a lot of know-how and experience that I could benefit from. I've summarized alot and i assure you i was not the first to give attitude during the interaction Obviously I had a temper with the nurse, maybe not so much so as everyone is reading into, but how far would you have gone to get patient info if theres no family, no doc in sight, Pt. non-english speaker, and NO Paperwork(including transfer packet)???

I guess what I'm asking is how far can you take the Patient Advocate Road before you have to walk away?
 
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