CockyICU,CockyER

Stitchie · Aug 7, 2004

Well, there are previous discussions about similar topics, but one thing that comes to mind as an ER nurse: if you haven't been down there for a shift or two or three, you can't make assumptions that we have any control over what comes in to the ER.

It is impossible for us to plan our workloads because the entire idea of an ER is to expect the worst case scenario at every patient encounter.

So while we don't like the idea of having to send up five patients to a single tele floor, we don't have control over that. We send the patients to where the bed coordinator assigns the patient...and hopefully we receive that bed assignment information in a timely fashion.

We can make things better by working within our own limits of control, and of course by being mature individuals about what we're doing - we're all on the same team. If I can make something work for a floor I will. But if the floor tells me that the room is ready in 1/2 an hour, they are getting a patient in 29 minutes 59 seconds.

Dixielee, BSN, RN · Aug 7, 2004

I had to chuckle at that one. From an ER perspective, let me see if I can make myself clear. When a floor gets full, they can take no more patients, when the ICU gets full they can take no more patients. The ER never gets full. It is the only department in the hospital that seems to have an accordian effect, it just gets more and more full, more and more backed up because you can not stop the flow of patients. We may be able to divert ambulances for a while if things get really bad, but you can do nothing about the walk-ins. Even if we are on ambulance divert, they can over ride and bring us critical patients. One of the hardest things about ER is not being able to get patients to the floor/OR/ICU whatever quickly to make room for the next disaster. We try not to have patients out in the hall, but unfortunately, it happens. I have had to treat an MI patient in a chair on a portable monitor because we were out of stretchers at the time. I can't tell you how many times we will do an EKG, IV and labs in triage and hope it does not show anything major. Many times we treat an allergic reaction, asthma, etc. completely in triage because there is no room in the back. One day a few weeks ago, I was treating an allergic reaction with IV fluids and meds, a hyperemesis gravidum with IV fluids on the sofa in the family room, when an OD/drunk teenager comes in off the street, nearly unconscious and no place to take her. All our rooms were full, so I am starting her IV, drawing blood and suctioning vomit while she sits limply in a wheelchair. Sometimes an ambulance will bring us 4-6 patients at a time in case of a bad MVA. So when we finally get a room number and orders on a patient, we are ready to get them out of the ER as quickly as possible. I can't tell you how frustrating it can be when you work your tail off to stablize a patient, have them intubated, foley, large bore IV's, NG tube and blood hanging only to have the ICU nurse, say, "ohhhh, he needs a bath, he has blood on him". AAAGGGKKKKK. Oh well. We all try to do our best, and I do know that the floor nurses are busy and the ICU nurses are busy, but maybe we all need to walk a mile in the other shoes. After 30 years of nursing, I have walked a lot of miles in a lot of shoes. We all need to understand that the patient is the one we are focused on, and work toward the best outcome for them. So if we seem cocky or in a hurry, sorry. But I get asked questions from the floor that we consider irrelevant. Peds wants to know if the kids parents are married, heck I only want to know if he is breathing! OB wants to make sure the patient has a doctor, med-surg wants to know if the patient has a foley and plenty of pain meds ordered, psych wants to know if the patient has insurance, surgery wants to know if the patient is naked and in a hospital gown, telemetry wants to know what the patients last potassium level was....I want to tell them that they can look on the chart just like I can. Oh well, guess that sounds insensitive, better stop. :rotfl:

bluesky, BSN, RN · Aug 7, 2004

I'm a SICU nurse, and all my pts so far have been transferred down to IMC, not med-surg. Now I'm not going to say that I haven't seen a little arrogance on the part of the ICU nurses sometimes, HOWEVER there has also been plenty of poor attitude on the other side too. For example, once I was taking a pt down with another nurse who still had a Foley (the pt, not the nurse.. :rotfl: ). Well the SIMC nurses had a complete FIT about the foley still being in place. They started to refuse the pt and then my friend said she'd take it out. Then the IMC nurses started whining about how she needed an order for that and blah blah blah. Well, finally my coworker just said she could write the order- because we have done that type of thing before and we are very tight with the teaching staff. So then this whole thing just turned into a huge arguement over a FOLEY. So my point is that there is plenty of guilt to go around on BOTH sides (ICU, ER vs. everybody else) and working like a team means we ALL take it upon ourselves to act like the mutually respectful professionals that we are.

CherieLeighRN · Aug 7, 2004

I've recently had a discussion with a few nurses from the med-surg unit at my place of employment. They were grumbling over the way an ICU nurse handled an emergent transfer from their floor. Apparently, the ICU nurse was disrespectful, arrogant, and pretentious....making the whole transfer a big issue (could've gone a lot smoother if cooler heads were involved). Anyway, i'll spare the details.
So as i'm listening to their complaints, one speaks up and says "...it was worse than dealing with ER..." When i pressed the issue, it came to light that the majority of nurses on this floor have bad/negative things to say about dealing with ER as well..primarily concerning untimely admissions and poor reports.
This apparent lack of comradeiry(sp?)/cohesiveness is obviously detrimental to a healthcare 'team' approach, morale, and of course can impact patient care (insert cuss-word).
Is this an isolated problem, or do you sense similar issues at your place of employment? If so, who comes off as being harder to deal with..ER, or ICU?
(just curious). Any suggestions as to how to remedy the situation?? Or is this something we just have to live with..?

I haven't been working long (I've only been an RN for two months), but I can tell you that there are nasty people like that everywhere. I work at a rather large hospital on a Neurology/Renal/Respiratory floor. We get a lot of ER admits and ICU stepdowns. I haven't had trouble with the ER, and most of the ICU people are nice too. There was one little incident that I found offensive though. We received a patient with a trach from the ICU(not an uncommon thing), and an ICU person had taught the family how to suction the patient, stating that we, the nurses on my floor, might not get there in time. How rude! :angryfire We are perfectly capable of suctioning and caring for the patient in a professional and competent way. Furthermore, the patient's family did not want to have to suction him. They were with him around the clock, but suctioning made them nervous and uncomfortable. And it wasn't their responsibility!! They were willing to do it, but once we gained their trust, they were more than happy to relinquish the task. Don't get me wrong, I have friends in the ER and ICU. Most of the nurses there are nice, respectful, and more than competent. But, once in a while you do have to deal with a nasty attitude. :rolleyes:

fab4fan · Aug 7, 2004

Uhm, pardon me, but I think the ICU nurse was absolutely correct to teach the family how to suction the trach. As short staffed as floors are, it's entirely possible that the nurses would be tied up and not able to get there immediately.

Perhaps it should have been worded differently, but would it be preferable to have the pt become cyanotic?

leslie :-D · Aug 7, 2004

i agree that it was appropriate (not desirable) to teach the family to suction the trach patient given the circumstances at that time.

we teach these things all the time on discharge. family members have to know how to do this whether they want to learn or not.

leslie

RNPATL, DNP, RN · Aug 7, 2004

I think it is perfectly acceptable to teach a family to suction a trach - especially if the patient will eventually go home with the trach and suctioning is going to be a part of their home care. However, I do not think it is appropriate for ICU nurses to tell the family that they may have to suction the patient because the M/S nurses may not get to the room in time. This leaves the family with a great deal of anxiety and stress that they otherwise DO NOT need.

We can all agree that the M/S floors are very busy and in today's health care arena, M/S is the area of the hospital that is most frequently understaffed, but I have worked M/S most of my career as a nurse, and I have never had an incident where my trach patient had to be suctioned by the family because I could not get there. In most, if not all cases, a trach patient is considered a priority patient and when they need care, the NEED care ... regardless of what I am doing.

Now, onto the issue of the ER and ICU nurses. I am very fortunate, in that most, if not all, the ICU and ER nurses I work with are great. However, I did have a situation a couple of days ago that really made me angry. We have a monitor area on our floor for telemetry that is not manned. We call it pulse parameter. Anyway .... our tele patients are monitored in ICU. I am ACLS as well as well versed with my cardiac rhythms .... had a patient go into a rapid ventricular response A. Fib .... patient had been playing cat and mouse with his rhythm all night .... I was waiting to see if he was going to convert before I called the physician .... Vital signs were all stable. I received a call from the ICU RN instructing me to call the patient's physician. This instruction was very rude and matter of fact.

I took a moment to gather myself, explained the situation to the ICU RN, who promptly told me that I would be written up if I did not call the physician. Now, this is at 2:00AM! I was getting ready to page the physician (God forbid, I did not want to get written up by the wonderful and knowledgeable ICU RN) .... as I was getting the number, the patient converted back to a sinus rhythm in the 70's. The patient remained in a nice sinus rhythm throughout the rest of the shift with a nice stable blood pressure also.

I can certainly understand that ICU and ER nurses may have strong experience with critical care patients and many times are a valuable resource. But, I have to say that M/S nurses that are experienced and knowledgeable are JUST as valuable and can critically think as well as an ICU or ER nurse. There is room enough in nursing for all of us, trust me .. more than enough room in fact! :)

sonessrna · Aug 7, 2004

WE all need to stick together...a nurse is a nurse is a nurse. THere are enough forces against us....We need to respect each other and appreciate each other.

fergus51 · Aug 7, 2004

I've never worked either (I'm an NICU/OB nurse, and believe me, we are never "full" either, pregnant women keep on coming!), but I've seen it as a float. One hospital I was in had to institute some guidelines about transfers (they had one nurse in the ER waiting until the porters came on to get rid of her patients, don't ask me why) and they actually did some buddy shifts between units. It worked very well and decreased the amount of inter-unit complaints.

ksfrn66 · Aug 7, 2004

Oh, I just have to chime in on this one. My name is Kathy, and yes, I am an ICU nurse ( there, I admit it). However, I am NOT one of those mean ICU nurses - and you know who you are - We are anal retentive, obsessive-compulsive control freaks. That does NOT give us reason to be rude, arrogant or disrespectful. Unfortunately, nurses who are drawn into ICU (and probably ER) are assertive, aggressive nurses - this is the nature of the beast in ICU. These qualities are also the ones that make us the nurses you want caring for your drunk teenager, your head injured brother in law (if you're from where I am your BIL is probably drunk, + cannabis, and is riding a four wheeler without a helmet...need I say more), and your grandfather who has suffered a hemorrhagic stroke and needs an A-line and an ICP. We do need to work together with other floors. I think in ICU sometimes we get tunnel vision - we aren't caring for 10 pts at a time - only 1 or 2 very sick pts - but is IS different and sometimes we forget what is like in the trenches of the floors. We did leave those behind for a reason though. God Bless the floor nurses - you are a hardy, hard-working group! And, yes, I have been pulled to the ER and walked in those shoes - What a circus! I have always believed that ICU/CCU/ER should all cross-train so everyone has the same perspective. I have worked with ICU nurses who stall an admission from ER becuz they need to take a break, smoke or just becuz they can delay it by saying 'NO". There is no excuse for any of it and as nurses we must do the best we can, be as nice as we can for the 8 or 12 hours we are there for the patients.

Whew....now I am done :

Tweety, BSN, RN · Aug 7, 2004

It's been a while, but I unfortunately have seen the "nursier than thou" attitude of a critical care nurse a time or two. I just blow it off as their ego.

I've also seen from a house supervisor the choas that the ER can be, and the focus on getting patients out and meeting a brick wall "I'm in report" "The room's not ready" "I want to see my other patients first". I've seen someone who hasn't looked at the patient pick up a chart and try to call report with the main focus to get the patient out, without really having an adequate grasp on the patient and basically giving a crappy report.

But 99% of the time things go well, the rapport between departments is good. All departments are stressed and a little cooperation and good spirit goes a long way. I don't let isolated incidences cause me to judge a whole department of nurses.