Floor nurse, please forgive me....

  1. 25 ....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?
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  3. Visit  Anna Flaxis} profile page

    About Anna Flaxis

    Anna Flaxis has '7' year(s) of experience and specializes in 'Emergency'. From 'U.S.'; Joined Oct '10; Posts: 2,207; Likes: 5,755.

    51 Comments so far...

  4. Visit  Anna Flaxis} profile page
    1
    Chuckle, yeah, I thought it was just me!
    MADDOG70 likes this.
  5. Visit  Always_Learning} profile page
    23
    Dear ED nurse,

    ICU nurse here, and I understand. I believe you when you say the patient pooped on the elevator ride up. (No, really, I do. $&%* happens, and it is bound to be after you have the patient all settled, pretty, and ready to go. Ask me how I know. )

    I notice and appreciate what you have done to make my life a little easier, whether it is hanging that antibiotic, starting a second line, whatever. I notice the things that aren't done, but ya know what? I chalk it up to the mad, mad world that is the ED. I don't really expect a super-comprehensive assessment, but a good, focused one. I'll figure out the rest.

    And good Lord, if the patient has an iffy BP, and you go ahead and start dopamine down there before you bring 'em up, I might kiss you. On the face. Without apology.

    I'd be lost if they made me go "down there" (ED). So I guess what I'm trying to say is....thanks! Carry on!
    Last edit by Always_Learning on Jan 6, '12 : Reason: Typo
    bjaeram, MADDOG70, mybrowneyedgirl, and 20 others like this.
  6. Visit  thelema13} profile page
    3
    I always feel bad giving the floor nurses those mean, cold, old ladies that are miserable for the sake of being miserable. I try to feed, gown, wipe and hydrate them with their choice of beverage, not to mention the 30 blankets and pillows.

    Oh, also pts with really bad skin. I truly feel bad about this. I don't always have the time to take a picture and document all of them, nor the time to dress every single one, and I apologize, but sometimes I am tied up. Sorry.
    GrnTea, flyladynurse, and Anna Flaxis like this.
  7. Visit  LaughingRN} profile page
    20
    Quote from Always_Learning
    Dear ED nurse,

    ICU nurse here, and I understand. I believe you when you say the patient pooped on the elevator ride up. (No, really, I do. $&%* happens, and it is bound to be after you have the patient all settled, pretty, and ready to go. Ask me how I know. )

    I notice and appreciate what you have done to make my life a little easier, whether it is hanging that antibiotic, starting a second line, whatever. I notice the things that aren't done, but ya know what? I chalk it up to the mad, mad world that is the ED. I don't really expect a super-comprehensive assessment, but a good, focused one. I'll figure out the rest.

    And good Lord, if the patient has an iffy BP, and you go ahead and start dopamine down there before you bring 'em up, I might kiss you. On the face. Without apology.

    I'd be lost if they made me go "down there" (ED). So I guess what I'm trying to say is....thanks! Carry on!
    Dear ICU Nurse

    thank you so much for your understanding.

    I also understand too. When I call report up and speak to you on the phone, Sometimes I wait on hold for 10 minutes while someone fetches you because you are at a bedside with another patient. When you come, I'm never irritated (we've all been there)

    When I hear the exhaustion in your voice at the end of a very cordial report when you ask
    "How long do you think before you bring the patient up?"

    If the rest of my patients are stable, and census is stable, I reply

    "well, I have to hook them up for transport, find a second nurse it might take me 30-45 minutes..is that okay?"

    I always hear relief on the other end of the phone...because we both know I could have the patient on the floor in 5 minutes.

    IF only ICU and ER could be friends all the time...
    ChristineN, ybq2008, NickiLaughs, and 17 others like this.
  8. Visit  Always_Learning} profile page
    9


    I feel the love.
    TinyRNgrl, MADDOG70, Nascar nurse, and 6 others like this.
  9. Visit  fiveofpeep} profile page
    12
    Aww what a wonderful thread.

    From an ICU nurse...

    Thank you ER for all that you do
  10. Visit  cardiacrocks} profile page
    0
    I have a question for you, have you ever been a floor nurse? I have a lot to say, however i'd like to know your reply first.
  11. Visit  Anna Flaxis} profile page
    1
    Quote from cardiacrocks
    I have a question for you, have you ever been a floor nurse? I have a lot to say, however i'd like to know your reply first.
    Yes, I spent two years on a busy cardiac interventional and medical overflow inpatient unit.
    Esme12 likes this.
  12. Visit  Medic2RN} profile page
    1
    No, stargazer, I have those guilty feelings too at times when there is no way I can 'prep' my patient like I would like to prior to transfer to the floor.

    When I'm lucky enough to have only the set ratio of patients (we can easily go over that during crazy times, as you know) and they are all stable, I'll do a good skin assessment on my nursing home patients, make sure they are clean and wearing a fresh brief. I try to reconcile the med list if I can because I know that is one less thing the floor nurse has to do when they enter the endless admit charting upon the patient's entry to the floor. Anything else I can do to help, I'll do.

    However, the times where I get critical patients all at once, the best I can do is stabilize and hot bed them out - with a yelling charge nurse to send them up, triaging the 3 ambulances that arrive at the same time as to which one I think will die first if I don't see them now, I can't do what I would like to do. I'm not happy about it, but sometimes it's beyond my control.

    In my experience, there has been less floor vs ER lately and I always explain if there is something that needs attention right away and why I couldn't get to it. Normally there's understanding with the few exceptions.
    fiveofpeep likes this.
  13. Visit  Medic2RN} profile page
    1
    Quote from cardiacrocks
    I have a question for you, have you ever been a floor nurse? I have a lot to say, however i'd like to know your reply first.
    Yes, I worked 3 years in IICU and ICU stepdown. I do remember what it was like and how difficult it was. This is why I try to get the patient and family as ready as I can for the floor and what they can expect in the transition.
    LaughingRN likes this.
  14. Visit  Esme12} profile page
    7
    .I think we need to put our selves in the others shoes more often and not always assume that "That ED" is dumping again. These days the biggest impact to a floor nurses day (most of the time) are the ED admissions and ICU transfers. If The ED is busy....EVERYBODY's busy. There are times I think that the abrupt manner of the ED causes hard feelings and the floors take it personal....when it's not personal at all. The ED nurse when delivering that patient already has their mind on the radio report they heard on the way out of the department and the 17 stat things that need to be done when they return.

    ED nurses need to be able to accomplish task after task and don't have time for "emotional investment" until the tasks are done. Patients in the ED are made anxious by the level of noise and activity they witness while they await their bed. Anxiety makes winners out of the best patients so we need to understand why they are so crabby and demanding when they arrive to the floor. There is NO hiding that chaos (controlled but chaos just the same) and patients feel "ignored" ....it is very difficult to explain to most patients that they aren't the sickest because frankly they don't care. Our assesment is focused....on what brought them in......a head to toe on every patient which is the ICU nurses goldern rule(lovingly said), just isn't possible so please forgive.

    But those of us in the ED we ALL know that one or two nurses that the delivery of the message and the message itself leaves much to be desired. There are those who feel it's beneath them to apologize or take the time to say Thank you. We all know those people that as snot to most people and do think themselves "above" others in most things not just the floor. I think it's up to us to try to reign these folk in a bit and soften their blow when possible....because we ALL know how abrasive they are

    I have been both an ICU nurse and an ED nurse and at one time both at the same time and hospital (the perfect job by the way) and I will tell you from all points of veiw.....it's really hard to fluff and buff any ED patient to the ICU nurses standards (lovingly meant) so try to understand. As a supervisor I see how hard the floor works and how stressed they are. They don't have enough help they are under the gun....the whole shift. There are patients comming and going like the ED but just don't have the resources (but who does these days). They have to discharge to get the ED or ICU patient and rearrange everytime they turn around to accomodate the next OR, PACU, cath lab. isolation, detox, confused, 1:1......or request, peacemaking leg saving (for the frequent call light user at the end of the hall) room transfer to get the patient out of the ED.

    But those on the floor you know those nurses that drag their feet, discharges and empty room reports to house keeping until caught so they can delaly that admission sometimes long enough to get their admision tossed to you and your (that's comming later) given to them because you're the prepared one. You need to reign them in and get them to play nice with the rest of you and make them pull their fair share and stop dumping on everyone else.....and we all need to recognize how many patients have come and gone to get those patients out of the ED.

    If we all remember that we are all worked to the bone and maxed out and EMPATHIZE with our peer and acknowledge that we don't really want to work on the floor/unit but they work hard too......to not engage ond argue who's worse off like it's some sort of contest, send the patient the way we would like them recieved and remember to say I'm sorry, please and thank you.....it really does help.
  15. Visit  ladside} profile page
    0
    I, a coronary care stepdown unit floor nurse, had the pleasure of working on a day that we only had 3 nurses. The ER nurses, please note 'nurses', brought up 4 patients at the same time. Our census was low, that's why there were only 3 nurses, so we had empty rooms. The 4th patient was parked outside of the room where I had just started working on patient #3. The rationale was that there was no one available to accept the patient in the room. So just leave him and his family in the hall??? Really???? If you just cannot keep him in ER until one of us is available, it would be so much nicer to DUMP him in the privacy of a closed door rather than ABANDON him in the hall with the statement "it happens like this sometimes". First time ever that I had witness unprofessionalism to that extreme. 26 years of nursing and I thought it would take a lot to surprise me. Well, that one rendered me speechless! I walked into the hall with my mouth open and in pure shock! I, too, am one of those who would not go to the ER. I know my limitations. But I have encountered quite a few ER nurses who need to recognize the same. There is no shame in admitting that you cannot do a particular job. But to leave a patient in the hall of a floor that has at least 5 empty beds...you have not even learned the concept of fair customer service, let alone 'excellent' customer service. Should you be in the ER? You guys are the first faces that the patients see. Only one chance to make a first impression. Even the deceased are not left in the halls in the morgue. Life as a nurse would be so much better if we all could respect the others' position. This particular ER nurse just blew the patient satisfaction score for his department and ours before WE even had the chance to say "hi, my name is ladside and I'm gonna be your nurse this evening".
    Last edit by ladside on Jan 6, '12 : Reason: Typo


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