RN REFUSES to give REPORT.

[WTEngel]

Everyone has bad days. In this case I am more frustrated with the nurse's lack of professionalism than your own. Would she have transferred the patient to the oncoming nurse and refused to give report? Would she have transferred the patient to another floor without report? Nursing claims to be so professional (and in 99% of cases they are EXTREMELY professional) and in this case I see a flake who for whatever reason had a chip on her shoulder.

It could have been the attitude you approached her with, it could have been she was having a bad day, it could be that she has a poor opinion of EMS professionals (which you probably didn't help,) or it could be that the nurse was just a complete loser.

I have run into issues similar to this with referral facilities on a few rare occasions, and in most cases immediately when you see that the referring staff is being standoffish, it is because they themselves have a lack of knowledge on the patient. At that point, put the principal of the issue aside (the fact that they are refusing to give you info or doing it defiantly) and keep your eye on the prize. Seek alternate ways of getting your patient info such as other healthcare workers, physicians, unit clerks, family, etc.

It also helps that I always roll with a nurse (that's just the way I roll...) and in the rare instance the referral staff is being obstinate, I can usually just say, "OK, no problem..." step inside the patient room and allow my nurse partner to have a try at speaking with the referral nurse.

The bottom line is, everyone deserves to be treated as a professional, even if they may not be acting like a professional. Do your best not to escalate the situation, discuss the matter with the charge nurse, your supervisor, and medical director if necessary. Document well, and as always, be as flexible as you can.

 

[rescue99]

Sheesh....

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.

No information, no transport. If ya can't bill, ya can't transport. This is not an accident, nor is it an acute illness.....this was a planned scam IMHO. The sad thing is the supervisor actually agreed with the so-called nurse? Not acceptable and explains the sub-par wages we receive in EMS. Not to mention the the nurse was simply incompetent. No wonder so many EMS professionals get the impression that "highly educated" nurses are such idiots!

 

[rescue99]

I agree

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.

You are the most correct so far. The situation happens all too often to crews no matter how they approach staff. Fact is, it should never happen, period.

 

[rescue99]

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

Sounds like a typical day at the DMC Sometimes there isn't much else to do but play the game.

 

[DrParasite]

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.

BINGO!!

If you don't get a report, don't get any paperwork, then don't transport the patient. don't get into a screaming match. ask for their supervisor. maybe you will get someone who has a clue, maybe not. either way, be professional. contact your supervisor. advise them of the situation. let the boss give you guidance.

For those that say "just transport the patient and deal with the idiot later" well, that's a HUGE liability on your end. you know you don't have the proper information, you have no paperwork, and you are still going to be "good company men" and transport the patient to wherever he is supposed to go? those who say to do it are more retarded than the nurse. If you ever want to be respected in this field, you need to know when to stand up to other providers when they are in the wrong, and not be pushovers and do what the nurse says just because she's the nurse.

 

[njff/emt]

i agree with parasite, i too have had the misfortune of incountering with those types of "nurses"., granted everyone has a bad day but since you are the healthcare professional recieving the pt you have every right to know what's goin on with them., i've also had some ask me why i needed the information because they've never been asked for it before, i simply say that i needed it just in case the pt crashes we have info for the hospital., if they still refused i called my dispatch and told them the situation., plus some facilities have contracts with other companies so they may already have all the info., all in all you just got to let certain things go and not let it bug you., trust me there are worse things than a nurse with a nasty attitude

 

[johnrsemt]

No one has mentioned the one thing that would help out alot, and that I have had to do in the past: Call the receiving facility and get a report from them; if asked state that the paperwork given was mangled due to copier issues or something else that doesn't assign blame. and the sending nurse is new to this patient and can't give a report

the receiving facility has gotten a report from the sending facility before your arrival; so make use of it.

 

[Sandog]

All the while, amongst all the bicker, one must do what is best for the patient. Poor sick guy has nothing to do with your argument de poids...

 

[MusicMedic]

Unfortunately this scenario is all too common in southern CA SNF's Transports....

although i havnt been in the situation with not having any paperwork... ive been in plenty of situations were the Nurse refused or did not give me an proper report.. luckily i had the paperwork and so i would look that..
and most of the time i just tell the Nurse in the ER/Urgent care that the Nurse at the SNF didnt give me a proper report and they usually call the Facility and have a stern talking to.
Ive had a Nurse not tell me that they had any Iso Contact/Infection Control and ive read the paperwork and found out they had Hep-C (or in another situation the patient told me they had HIV)...

In regards to your situation i would have called the supervisor (like you did) and also refused transport until i got all proper paperwork...

 

[Veneficus]

Unfortunately this scenario is all too common in southern CA SNF's Transports....

although i havnt been in the situation with not having any paperwork... ive been in plenty of situations were the Nurse refused or did not give me an proper report.. luckily i had the paperwork and so i would look that..
and most of the time i just tell the Nurse in the ER/Urgent care that the Nurse at the SNF didnt give me a proper report and they usually call the Facility and have a stern talking to.
Ive had a Nurse not tell me that they had any Iso Contact/Infection Control and ive read the paperwork and found out they had Hep-C (or in another situation the patient told me they had HIV)...

In regards to your situation i would have called the supervisor (like you did) and also refused transport until i got all proper paperwork...

This happens all over, not just in CA. It is a fairly common in my experience.

It is best to try and work around it. Eventually I got to the point where I didn't want a report from the facility, just give me the packet and I will figure it out on my own, it'll be quicker and more accurate.

The best is when you ask to speak with the nurse and the LPN tells you she is a nurse, but cannot tell you the history, meds, or allergies on the patient.

"Can I please speak to the real nurse now?"

Who usually relates she just came on shift" and doesn't know anything about the patient because she has not got around to them yet because of all the billing paperwork she is obligated to do before seeing patients.

The winning trifecta is when it is a temp agency nurse who has never been there before and likely will never be there again.

I could go on for years about nursing home stories.

Don't get worked up. It's not worth it.

 

[JPINFV]

On the general topic of reports, I think it all revolves around having a realistic idea of how much report to expect. Transport paperwork is, normally, a gold mine of information, and yea, I can understand being expected to look at the paperwork for a lot of the history/allergies/meds. Yes, I can understand a nurse seeing little need to cover a 5 page med list, especially when the provider has a good chance of not understanding the difference between an ARB and a ACEI.

Similarly, when it comes to a communicable diseases, as Dr. ExMedic once put on JEMS Connect, there are two types of concerns. There are the diseases that are major. This is your HIV, Heps, etc, and then there's the diseases you might actually catch, such as MRSA, the flu, TB. Yea, HIV is bad and communicable, but unless you feel like playing with blood or having sex with the patient, your actual risk of HIV is pretty low. Same with Hep C. You aren't going to catch Hep C by shaking the patient's hand without gloves. However, look at the paperwork. All of those communicable diseases should be listed and anything acutely respiratory should have you taking precautions regardless of what the nurse tells you. Why would a patient with a productive cough at a nursing home need additional precautions than the patient coming from home? Shouldn't they both have respiratory precautions taken? Pull on the big EMT pants, perform an assessment, and decide on precautions as indicated.

Sometimes you just need to take a step back, examine what information you have, including the ability of the patient to act as their own historian, breath, and be the bigger person at the pissing match. Sometimes it's not worth the argument, and it's never worth the argument just to prove yourself right. If you need to submit an official complaint, do it through the official channels after the transport instead of trying to hash it out on scene. However the OP's issue of neither proper report nor proper paperwork makes it a difficult situation than it normally is.

 

[RanchoEMT]

Hey guys, thanks to all so far for the input. Of course Hindsight is 20/20 and its real easy to say you should have just did this or done that, but i guess learning comes from failures sometimes.. Maybe i'll be a bit more careful and level headed about things next time now that I've been there/done that(Argued with a Nurse), i'm sure i'll have plenty of opportunities to practice! I'm very appreciative of the opportunity to vent and seek advice from you guys and this website. We Are all here to seek consultation, Learn and improve ourselves/help improve others... Anywho, this is getting too fluffy.
Thanks.

....Seriously Tho, give me a *&%@ Blood Sugar!

 

[RanchoEMT]

...and for the Purpose of further discussion, perhaps i was too vague,
the only thing we got from the nurse was a paper that stated the patient's current diagnosis(admitted for CVA), and a list of prescribed medication's coming from this facility only... Not a Med Hx nor Medication Hx.

Lets be perfectly clear, because i can tell by the previous posts that i have not yet been. There is NO PACKET of information. NO PAPER that has the information the crew was asking for. And NO OTHER physical thing* with which to refer to the patients medical Hx or any other type of info for that matter. This lack of info....This COMPLETE lack of info is the topic of discussion. Just to be Clear.

 

[usalsfyre]

If you learn a little about pharmacology you'll fine you can't figure out a fairly good medical hx.

 

[rescue99]

No one has mentioned the one thing that would help out alot, and that I have had to do in the past: Call the receiving facility and get a report from them; if asked state that the paperwork given was mangled due to copier issues or something else that doesn't assign blame. and the sending nurse is new to this patient and can't give a report

the receiving facility has gotten a report from the sending facility before your arrival; so make use of it.

The nurse is still required to transfer care, which includes a report. I do hope the OP had common sense enough to do his talking out of ear shot of anyone, most especially a patient.

 

[Veneficus]

The nurse is still required to transfer care, which includes a report.

While I fully agree with you, I will bet dollars to doughnuts the nurse didn't see it that way.

One of the things that always struck a nerve with me is that many nurses are told something along the lines that techs are not licensed providers and as such are only around to carry out orders and cannot have care transfered to them.

Also when you think about it, while a nurse can delegate to a tech, what would happen to a paramedic who transfered care to a lower capable provider?

A nursing home patient needs nursing care.

So I can see where many feel that the actual report and transfer of care is not between facility and IFT, but facility and facility, with the IFT being techs who drive the patient in a similar form of pushing the bed from one section of a hosital to another.

In the event of a decline in the patient's status, those same providers would have the responsibility to see the appropriate care is given. It is easy for EMS providers to think that care is the ED, because that is what is drilled into them.

The fact remains the ED is not definitive care. Nor was it ever meant to be. Many chronic medical problems cannot be served by the ED, and as such direct transfer of the nursing home patient to the most appropriate healthcare is superior than a trip to the ED so that the ED has to run all kinds of tests and do what the NH could have. (Disclaimer that sometimes the ED is the proper destination)

Patients who are being transfered between facilities with the exception of an ED are not likely to just code out and die. (Sorry to take that away from all the IFT folks who were probably hoping for that in order to use something taught in EMT or medic school)

Trouble breathing, Low or high BP, large masses in the neck or abdomen, etc, etc. are conditions these people live with everyday and probably have for sometime. They are not emergent as EMS providers are taught because they are not acute and they are being properly managed.

Now if I take you out of your home suddenly and you don't understand why, you might have a little bit of stress response. Rapid breathing, heartrate, etc. But it certainly isn't an emergency.

The patients most likely to code on IFT are already DNR patients. In which case there isn't much going to be done anyway.

Most providers outside of EMS have no idea about EMS, or EMS trained IFT providers. They don't see it as transferring care, they don't understand what the providers do or are expected to. What EMTs/paramedics are or do was given absolutely no time in my medical school despite the facts the school teaches paramedics and medical students ride with paramedics as mandatory clinical time. You must realize in a majority of both medical and nursing schools if EMT/paramedics are even mentioned that is probably special.

I don't agree with it, but it is what it is.

 

[Journey]

We give enough report for what we believe is appropriate for a BLS level of care just like we do our CNAs, transporters and ED technicians. EMT students do at least one clinical in the hospital and we know they are very limited in what they can do or their medical education. We also know they will only be doing the basic vitals and not pushing any medications.

Some RNs have given a complete report just as they would and probably already had to the RN at the other facilty. But, the problem then comes when the RN from the other facility calls back wanting a clarification because the EMT to RN report was passed on as the patient go 200 mg of Lasik and was in V-fib prior to departure instead of 20.0 mg of Lasix and hx of A-fib. The EMTs may try to grasp more than they are prepared for which can result in a report that might not be accurate. We also had EMTs refuse transport because of something in the history 30 years ago and has not been an issue since that time. TB is an example. Even after several attempts to convince them it is no longer a problem since PPDs and CXRs are done, it doesn't matter. PPD screens are now required in many LTC facilites. MRSA is another one that scares EMTs as mentioned but it does give the RNs staff and indication of how little might be known about patient care and infections. Unfortunately the RNs do not have alot of time to spend going over what should have been included in the curriculum for EMS as it is for our technicians and CNAs. Please recognize standard patient precautions. You should notice if there a sign on the door and isolation stuff by the room. C-diff, influenza and TB are the big ones now which do require special consideration. Others like HIV would be a concern if you are going to play in their blood or have sex with them in your truck as often seen on TV shows. Neither are advisable.

More often than not, the RN or LVN at the other facility has received a full report along with a case manager file. If the patient is diverted to an ED, either the sendng or rec'g facility may be contacted for the appropriate paperwork and information to prevent any miscommunication of condition, hx and meds.

However, I do agree that the code status paperwork should accompany the patient on BLS transfers along with just the essentials of care similar to what is required for intrahospital transport.

If it is a higher level of care such as an ALS with a Paramedic or an RN, a more thorough report will be given since treatment is being continued throughout the transport.

Also, for billing, the Case Manager will often do the arrangements for transport with a pre-approval from the insurance before the ambulance will even be dispatched. There have been times where the ambulance has been delayed or canceled because of the lack of approval for payment has been denied sometimes due to missing information or a clerical error. So until your ambulance service sees the money, some patients don't get transported. This can also be part of the arrangements when ambulance services get contracts with various hospitals and LTC facilities.

One more point, just because a patient is a DNR, we still treat up until they code if we feel it is a reversible problem unless there is also a "do not escalate care" order along with the DNR. However, EMS may only be able to take the DNR order and do what their protocol states. We have ran into that situation also from the point of not doing anything including providing oxygen for someone who is a DNR (not comfort care) to doing everything because the order was not exactly how their protocols stated a DNR order should be.

 

[Akulahawk]

To make life easier for RNs so that they don't have to think about what an EMT needs or a Paramedic needs (because many times the RN doesn't know the difference) I just ask the RN to give report as if to another RN on another floor, unit, or shift. I'll also ask for a transfer packet. I'm going to be able to keep up and then some. Then again, I have a broader education than most medics. It probably comes as a surprise to them when it becomes obvious that I know what they're talking about...

Now why do I want to know stuff? Simple. I'm protecting my own license. I need to know that the level of care that I can provide is appropriate for the patient. There have been times where I've had to advise the sending facility that I can't accept the patient over something as simple as the patient having an IV fluid that is out of my authorized scope of practice. When that happens, they're also advised of what fluids I can monitor during transport, and if changing to a different fluid during transport is not possible, then I have to advise that the patient needs to go by CCT... Most of the time, the fluid is changed to something within my scope of practice.

Stuff can be that simple...

 

[medicRob]

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.

I haven't read anything more than this first original post. However, as an RN I will say that this nurse was in the wrong.. While you cannot expect her to give you every little detail you want, it seems that everything you asked for was reasonable. Take this up with her charge nurse. Explain to the charge nurse what kind of information you requested, why the information is important for you in transport, and the nurse's actions in a matter of fact way, not in a "Well I hated the way she did this" kind of way.

While there are RN's who go to nursing school to specialize in palliative care and gerontology who are quite competent, there are some nurses who are working at nursing homes simply because they could not cut it in a medical center. However, the same is true of any profession really.

 

[rescue99]

While I fully agree with you, I will bet dollars to doughnuts the nurse didn't see it that way.

Yeah, yeah.....ain't it always the way!