Floor nurse, please forgive me....

[Anna Flaxis]

....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 valve placed by the ED doc to a pleurevac *right* when I was packing up the patient to go upstairs, and we had a trauma arriving who needed the bed. The trauma patient could not wait in the hallway while I taped and banded the chest tube! And no, I didn't even have time to call you and warn you, because the second I sent the patient your way, I was already being pulled into a Stroke Alert.

...when my patient arrives to you cold, hungry, and grumpy as hell. I don't make a practice of ignoring my patients' comfort, and I'm usually pretty good at smoothing things over when we're really busy and people don't get the attention they expect. Many times I've warned them of what to expect when they get to you (that a meal tray won't be waiting for them, that it will take time for them to get tucked in, that lab draws will no longer be pulled from their peripheral IV, that it will take some time for their meds to be ready, etc.) in order to help make things easier for everyone. This time, I just couldn't. I had critical patient after critical patient, and so my stable ones didn't get much attention.

...if my charting stinks. Most of the time my documentation is decent. Not outstanding, but decent (we chart in narrative form on paper documents). But today, I chose bedside care over documentation, and I really hope it doesn't come back to bite me in the butt. Please, if you have any questions, feel free to call me. That's why my phone number is on the piece of paper we fax to the floor for every admit. I really don't mind if you call me. I might be in a hurry to answer your questions as quickly as possible and get off the phone so I can do the other five gazillion things I need to do STAT, but don't take it personally.

This is not satire. I really do feel badly about these things. Does anyone else have any guilty confessions, or is it just me?

[MADDOG70, BSN]

also, we dont care when the last time they ate was or what they had unless they are going for surgery. So dont ask.

[psu_213, BSN, RN]

also, we dont care when the last time they ate was or what they had unless they are going for surgery. So dont ask.

What about last BM? I've knows some floor nurses obsessed with this.

[Anna Flaxis, BSN, RN]

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.

[fiveofpeep]

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?

:redbeathe Thank you!!! Good job. You are a wonderful nurse and we appreciate all that you do.

(It's never said enough)

[jnetrn]

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.

[jnetrn]

And...I could kiss you for that response! :hug:It's nice to hear someone who "gets it"!

[edrnbailey]

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?

[edrnbailey]

" 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.

[edrnbailey]

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..... :w00t:

[edrnbailey]

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.

[Anna Flaxis, BSN, RN]

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..... :w00t:

I think that goes without saying.

[edrnbailey]

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