How do you all feel about nurses writing DISPO on the tracking board next to your patients?

[Guest ERCat]

How do you all feel about nurses writing DISPO on the tracking board next to your patients? 

It drives me nuts but the nurses do this ALL the time at my ER even though we have asked the nursing director to have the charge nurses stop doing this. We can clearly see little check marks when all of the labs and imaging studies are back on our patients so THAT should be enough to tell us the patient may be ready for "dispo." I don't need a nurse writing "DISPO PLZ" in the comments.

However maybe I am hypocritical because when my patient has been sitting in the room with no lab draw for an hour, I will write "labs please" in the comments. Maybe it IS different though, because it is OBVIOUS that the labs need to get done but it isn't obvious when a patient is actually ready for "dispo" even when all the tests are back (i.e. the patient's pain may still not be under control, I may be trying to get ahold of their PCP before discharge, I may be arranging follow up with a specialist, etc.)

Thoughts on this?

[karakent]

At our ancillary hospital ER it was possible for the nurses to do this (they can't at our main hospital ER because we use a different EMR which won't let you do this, why there's two different EMRs  I have no idea). I actually used to change their comments to "waiting to discuss w/ attending." I hated it when they did it because I was literally just starting out and thought it was just me but then I overheard my attending discussing it with the head of the ancillary ER (she was super frustrated about it too). That ER was way less volume than the main ER and the nurses that worked there would get very antsy when times started approaching 3 hours (the EMR changes the color of TID to red once they reach 3 hours, yellow when it hits 1 hour). 

But in short--I thought it was really rude when they would type it in all caps. Luckily we don't go to the ancillary ER anymore--they hired all new staff to cover that since the main ER started getting more busy. 

[Eastcoast PA-C]

It doesn’t bother me unless they do it before the patient can actually be dispo’d (i.e. the troponin isn’t back). Our EMR tracking board is terrible for knowing when stuff is actually completed, so it’s sometimes a helpful reminder. But if the tracker makes it obvious that they are ready for dispo, I can see where it would come off a little passive aggressive.


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[cc56]

Doesn't bother me when they tell me, my system the comments are more helpful than demanding.  "CT then DC", "Admit 234", things like that.  I could see the way you describe it as turning into a pissing match.  It would have the potential to bother me. 

[gbrothers98]

If you are using a tracking board where comments can be entered, likely you can enter the same comment field and erase the DISPO comment. But that is counter passive aggressive. Avoiding jousting matches such as this enables career longevity.

My personal practice is to stay on the move and update nurses on what I am doing for the patients, what my plans are, get their feedback, what I am waiting for, etc. Verbal communication beats the trackerboard every time.

This kind of behavior also invites reflection. While the nursing staff may be passive aggressive, there is also the potential that you are not as organized nor as attentive as you think you may be. Or you may just be over sensitive in a fast paced environment that emphasizes action higher than contemplation? 

There is much in the ED that we can let bother. The staff member we may not like working with much, the attending that pimps you like you were on your first clinical rotation, the chronic ED patient who you see more than their own PCP. To make the ED a marathon rather than a sprint, best to pay attention to what really matters vs the minutiae and mundane.

Good luck.

George

[IveyD]

I reply with what Im waiting for (md review or reexam) but I do look constantly at resulted diagnostics to ensure no prolonged dispo d/t poor time management. But, if they put double question marks, I erase it.  Its annoying bc I don’t  put “meds or labs?” 
 

its like texting, intonation and meaning are lacking. We tend  to get annoyed bc its pushing us when we clearly havent forgotten we have pts that need to go/stay and we are pushed enough as it is.  They want me to understand why they havent started an IV or delivered meds, then they really cant expect to be able to DISPO the dispo.