Floor nurse, please forgive me.... - page 4

....when I send you a patient whose chest tube connections are not taped and banded. Really, I am not an idiot, believe me. You see, the pulmonologist swooped in and switched from the heimlich... Read More

  1. Visit  fiveofpeep profile page
    0
    Quote from Medic2RN
    Okay, here's a nice post to show how, under ideal conditions, the through-put for the patient was terrific for the patient, the ER nurse and the floor nurse.

    I thought of this thread after it was over. My patient received his room assignment. It was still early enough where the ER wasn't crazy and oozing with patients.
    I faxed report and called to verify. While waiting for the nurse to get on the phone, another ER nurse told me that he had sent up a patient and another nurse had also recently.

    Once the nurse got on the phone, I asked her about it. She was getting ALL of them. I asked my charge if it was possible to hold the patient for a bit until the floor got caught up. The charge said, "No problem". The floor nurse said she would call as soon as she admitted the other 2 and passed her meds. I told her I would feed the patient his breakfast and make sure the meds were reconciled so she wouldn't have to do that.

    I got an ambulance and another patient in the meantime. She called later, ready for the patient. He was fed, happy, and arrived with people waiting for his admission.

    Now, this is the ideal - something I think all ER nurses and floor nurses would like. Unfortunately, it does not usually happen, but when it does it is enjoyable for us all.

    I think it's not the nurses' fault, but the design of the system. Instead of the constant ER vs. floor scenerio and pointing fingers at each other, we need to step back and try to look at the bigger picture - the process is at fault and the people responsible for designing that system need to know. We are not the designer of that process (unfortunately) and should not be at fault. Nurses are working within that broken framework.
    The question should be: how do we change it to achieve what we need?
    Thank you!!! Good job. You are a wonderful nurse and we appreciate all that you do.

    (It's never said enough)
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  3. Visit  jnetrn profile page
    2
    I have been on the receiving end of the E.R.'s patient admission highway. I remember feeling inconvenienced by the occasional messy patient who arrives to my unit. We would all work as a team to reorganize the patient who was either tangled in a mess of I.V. lines and ecg cables/lines or lying in a mess of bowel incontinence. We would then have to take care of all the immediate pending orders and try to get caught up so that we could get back to our "floor routine." On a bad day, I would have to do it all by myself. I would like to emphasize the word, "occasional" because most of the time the E.R. had the patient clean, stabilized, and organized before arriving to my room. The majority of the time my coworkers were right there with me helping me.

    Now I'm on the other end of the spectrum and have a full appreciation for what the E.R. goes through on a daily basis. The "push back" from the floors we are trying to move patients to when our E.R. is exploding with STEMI patients, screaming psych patients, dementia patients climbling out of bed, and the never-ending influx of patients coming through our doors. We have to prioritize to keep our patients alive. I feel relieved when the patients move on stabilized to their admission bed or on their flight elsewhere. My confession is that sometimes my patients leave a bit unorganized on busy days. I never leave them in their incontinent mess but I have been yelled at by nurses from sending a patient who may have pooped on the way there. So... its not just you.
    Pixie.RN and fiveofpeep like this.
  4. Visit  jnetrn profile page
    0
    And...I could kiss you for that response! It's nice to hear someone who "gets it"!
  5. Visit  edrnbailey profile page
    0
    Quote from ~*Stargazer*~
    Oh man, I really didn't want this to become an ED vs. floor rant/debate!
    The intent is duly noted and appreciated. For some all they can see is the negative. They must justify their own negative thoughts and attitudes by pointing out others. Food for thought.... if the only way to build yourself up is tearing someone else down then who really is torn down in the end?
  6. Visit  edrnbailey profile page
    0
    " I told her I would feed the patient his breakfast and make sure the meds were reconciled so she wouldn't have to do that."


    In actuality most ED nurses would love to have the time to feed their patient. I don't when I've had the opportunity to spend quality time with a patient actually getting to know them or giving 1:1 care without feeling rushed. Those are some of the little moments that remind me why I became a nurse to start with and are occasionally missed. Believe it or not some of those menial tasks and ADL's are envied and not discounted.
  7. Visit  edrnbailey profile page
    0
    Quote from ~*Stargazer*~
    Where I work, last BM is part of the admission assessment. The floor nurse has to ask. If I have a few minutes to kill, I might ask while I still have the patient, so the floor nurse doesn't have to. Knowing what questions are on the admission assessment, I might ask as many of them as I have time to. This makes it easier on the patient to not have to answer yet another barrage of questions on arrival to the floor. But, I don't always have the time.
    Stargazer,

    Never discount the need for last BM even as an ED nurse.. when working up acute Abd pain and or n/v this part of the assessment is important to ED nurses also... We all remember our first acute or significant CONSTIPATION patient and what we and the patient endured to provide relief.....
  8. Visit  edrnbailey profile page
    3
    I worked on a neuro step-down unit for 4 years before transferring to the ED. And I thank God everyday for that experience! Those years and the patient's there taught me to prioritize and good (great I think, but don't want to toot my own horn) assessment skills. I learned that with enough team work you get through anything. (we only had 3 nurses for 28 beds on night shift and no secretary or tech after 11pm) Did I mention it was a neuro unit??? LOL.

    I found that as the ED nurses got to know me and me them that if you took report in a timely manner, whether when they called or you called them back, let them actually give report, and helped with the transfer of the patient to the bed (went in the room and assisted moving patient) or even just were polite with a thank you and you're welcome, they were much more likely to be understanding when you were swamped and needed a few extra minutes to catch up on the code yellow, 3 previous admissions, or the bazillion new orders that the late rounding physician just left you with.

    The same is true if you reverse the roles.... Trying to start the antibiotics on the patient in the ED when you know they don't have them on the floor, giving them that extra 10 minutes (when you can) before rolling up the patient, starting that extra IV site, or God forbid helping clean the patient who was incontinent while you weren't looking or were care for the other 5 patients in the ED that are yours makes it a lot easier to get help when you are busting at the seams and need to move a patient up NOW!. All you have is admission orders and vitals. Your nursing notes are nowhere near complete but you need the bed double STAT.... Those same floor nurses may say sure bring em on, you can give me the details when you get here and just bring up the notes when you can....

    Pay it Forward.... One day you may be the one to reap those rewards....

    We are all nurses. We ALL care for the patients. Different ways, different skills, different areas, same job. When we finally learn that it's not a competition but rather a group effort to provide the best patient care (the reason we are supposed to be here anyway) nursing will truly ultimately finally grow as a profession.
    canoehead, brillohead, and fiveofpeep like this.
  9. Visit  Anna Flaxis profile page
    0
    Quote from edrnbailey
    Stargazer,

    Never discount the need for last BM even as an ED nurse.. when working up acute Abd pain and or n/v this part of the assessment is important to ED nurses also... We all remember our first acute or significant CONSTIPATION patient and what we and the patient endured to provide relief.....
    I think that goes without saying.
  10. Visit  edrnbailey profile page
    0
    All of which is very true. I may not even listen for bowel sounds if chief c/o is unrelated.... This was my humble attempt at making a funny... (obviously not the best) in an attempt to return to board to a lighter more positive tone... but you are right there are some who think this is the most important information of any you may give... but then it takes all kinds... :0

    ps I ask more when i'm the triage nurse cause I'm always thinking are they gonna need the room with a DOOR? (We have some rooms that are simply curtained off and others that have a typical door.) Constipation= door
  11. Visit  ICU_JOSIE profile page
    1
    Quote from fiveofpeep
    Aww what a wonderful thread.From an ICU nurse...Thank you ER for all that you do
    I second that!
    Medic2RN likes this.
  12. Visit  NickiLaughs profile page
    0
    We actually go down to get the patients at the ER at my hospital. The ER manager believes the nurses are too busy to send em up. (And I understand that can happen). But every once in a while we have an ER nurse who is having ok enough of a night and brings me the patient. Which I greatly appreciate because sometimes it's me and a new grad and a registry on my side, and I'm concerned leaving my super sick could code at any minute patient with them to bring up my other one as I'm usually gone a good half hour. I love the teamwork where we all feel like going the extra mile to make things easier for the patients, versus easier for ourselves.
  13. Visit  Perpetual Student profile page
    2
    ED nurses, please forgive us periop types for sometimes swooping in and stealing (or at least pressuring you to hurry up and hand off) the pre-op patients from you during off hours and weekends. We just want to get the ball rolling and get back home so we can get some sleep before coming back. Please don't confuse our blank stares for hostility when it's just that we've been awake for 24+ hours due to getting called back before we can get home, get in bed and fall asleep.

    There's not a single "easy" department in the hospital (I will confess that the PACU can be one of the easiest at times, but that can change in a heartbeat). The staffing is generally based on having just enough people to (usually) get the job done safely. Sure there can be some quiet times in departments like the ED and PACU, but they average out with the times of sheer pandemonium.
    Anna Flaxis and Rose_Queen like this.
  14. Visit  Anna Flaxis profile page
    0
    Quote from Perpetual Student
    ED nurses, please forgive us periop types for sometimes swooping in and stealing (or at least pressuring you to hurry up and hand off) the pre-op patients from you during off hours and weekends.
    LOL, thank you! You know, I'm so glad you're on the ball like that, but it does take me a few minutes to get everything in order so the patient can go, especially when I'm being pulled in ten different directions by my other patients and their needs! I'm just glad you're coming to get them, and I don't have to arrange transport to the OR! Thank you!


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