ER vs ICU, how did we get there?

RainbowSkye · Mar 1, 2004

I've always considered the change of shift admission to be kind of like the Bemuda Triangle or a black hole of the hospital. In this day of 12 hour shifts it usually starts about 6am (or pm) and isn't completed until 7:30 or so. Woe be to the patient who has been in the ER for several hours already when the doc finally decides to admit him/her at 6 -they're pretty much guaranteed another 90 minutes on that ER stretcher. At least.

And I can tell you that I'm often in a hurry to get an admitted patient to the floor because of pressure from the patient, family, significant other and, yes, the attending. (There's pretty much always another patient waiting for their bed, so it doesn't much matter to me.) All of these folks expect a bed to be immediately available when the doc gives the get-go. So I tell them the bed is "not quite ready".

I do think there could be some answers, maybe. How about having someone assigned to new admissions during shift report (because shift report essentially lasts from the last rounds of the off-going nurse to the first rounds of the on-coming nurse)? I'm not an ICU nurse, but is there one free nurse who could start with the patient at these times? Is it necessary for the admission nurse be the one caring for the patient for the whole 12 hours? I really don't know; I work in an ER where we all kind of jump in together depending on what needs doing.

Thanks. We're all in this together.

RNin92 · Mar 2, 2004

Wow...when I asked the question that started this thread, I knew it would evoke some responses...but this ride has been QUITE eventful!!

I know that ICU nurses work they tooshies off, too.

I know that med/surg work them off as well.

That is NOT the point.

It simply cannot remain "my job is harder than your job" any more.

There are pts.caught in the middle of this battle of wills...someone is going to die.

While we are fighting about shift change (WHICH one exactly?) and who has to wipe more butts-a patient is getting minimal care at best.

THAT is the issue.

teeituptom, BSN, RN · Mar 2, 2004

Ahhh the dreaded Black hole

swallows everything up

but only the pts really suffer

parkernurse · Mar 7, 2004

Apologies are in order..i have to clarify the dork thing. I was speaking about a few er nurses i know personally..not all of them.
And i'm not anti-er nurse either. I suppose the point i was trying to make is that er nurses have alot more (all of it?) control over when report is called. It seems that most of the friction i've experienced w/our er nurses is when we ask them to wait just a few minutes as we're busy (for whatever reasons). The responses we/i SOMETIMES get (huffing and puffing and accusastions and occaisional reporting) are worthy of 'dorkhood'...straight out of 'dorkville'...and as a matter of fact i refuse to apologize for calling these dorks out for what they are....dorks dorks dorks.
I can understand it being busy sometimes when I call to give report but EVERYTIME??? I usually have to call at least three times to give a report or threaten to bring the patient and give a verbal bedside report before I get someone to take report.. It is very frustrating !!! As for no new patients close to shift change--I dont have the option to tell the ambulance to take another lap around the block, because I am getting ready to go home. I am expected to smile receive the patient and punch out when I can.

RNin92 · Mar 7, 2004

i was going thru these posts again...i want to thank everyone for proving my original point...

we ARE at an ER vs ICU place!!

to set the record straight...

we ALL know that there are nurses everywhere who will stall, not do their job, dump a patient, etc...etc...etc...

but that should be the exception not the rule

EVERYONE is busy, overworked and understaffed.

all the more reason to work TOGETHER

and for the floor nurses everywhere that think "well, at least there's a doctor 5 feet away"...forget-about-it

once the patient has benn "admitted"...the ER docs are moving on to the next train wreck that rolls in the door.

they will NOT step in unless someone is coding...and they do that up on your units as well. so we are trying to call the attendings just as you are.

i guess i was hoping that we could get past the BS...and figure out something that works

:uhoh21:

veetach · Mar 8, 2004

i was going thru these posts again...i want to thank everyone for proving my original point...
we ARE at an ER vs ICU place!!
to set the record straight...
we ALL know that there are nurses everywhere who will stall, not do their job, dump a patient, etc...etc...etc...
but that should be the exception not the rule
EVERYONE is busy, overworked and understaffed.
all the more reason to work TOGETHER
and for the floor nurses everywhere that think "well, at least there's a doctor 5 feet away"...forget-about-it
once the patient has benn "admitted"...the ER docs are moving on to the next train wreck that rolls in the door.
they will NOT step in unless someone is coding...and they do that up on your units as well. so we are trying to call the attendings just as you are.
i guess i was hoping that we could get past the BS...and figure out something that works
:uhoh21:

I TOTALLY agree with you, Rn. I wish I had the answer to this problem. I think we all need to take a step back, and think of the patient. For those of you who work in the ICU/CCU please understand that we are not trying to make your life difficult, we just have someone else needing the bed.......

RNin92 · Mar 8, 2004

I TOTALLY agree with you, Rn. I wish I had the answer to this problem. I think we all need to take a step back, and think of the patient. For those of you who work in the ICU/CCU please understand that we are not trying to make your life difficult, we just have someone else needing the bed.......

amen my friend...amen

teeituptom, BSN, RN · Mar 8, 2004

always

we cant get any more back untill we get some up or out

RNin92 · Mar 8, 2004

always
we cant get any more back untill we get some up or out

it's funny isn't it...

we fight so hard to get our patients up to the floor only so we can start all over with other patients...really making our workload much harder.

we should really just sit back and let our friends from the floor take as much time as they need so our jobs can be much more relaxed...

who cares if patients are waiting?

who cares if people may be suffering in the waiting rom?

:crying2:

hmmmmm...

teeituptom, BSN, RN · Mar 8, 2004

For about a year now everytime I take a pt to the unit or the floor I always introduce the nurse to the pt and end it with. "You are lucky, you have the best nurse in the hospital to look after you up here"

RNin92 · Mar 9, 2004

For about a year now everytime I take a pt to the unit or the floor I always introduce the nurse to the pt and end it with. "You are lucky, you have the best nurse in the hospital to look after you up here"

Hey my friend...whatever it takes!!

teeituptom, BSN, RN · Mar 9, 2004

Sometimes I shovel it pretty deep :chuckle :chuckle

Then you have to realize they already had the best nurse in the hosp while in my ER, ME :rotfl: