Battle Of The RN's: Emergency Room Vs Floor Nurse!

Double-Helix, BSN, RN · Oct 14, 2011

I'm sorry you had a rough shift. I'm sure you'll learn that, just like the ER has it's own unique problems and stresses, so does every floor and unit.

Nurses really should be more like a community. One RN license is equal to another, no matter what department is stamped on our badge. We need each other. Every one of us is important to the function of the hospital and health care in general. For that reason, I will not participate in any "battle." There have been too many "us vs them" posts here already.

Meriwhen, ASN, BSN, MSN, RN · Oct 14, 2011

I know you're venting and I respect that.

But at the same time, I can't help but think that, as you just said, you are a new nurse...and so you probably know life only in the ER. Perhaps you should float to the floor to see what life is like up there. It is probably not the wine and roses world that you seem to think it is.

Every unit has its own unique challenges that other units may not know or understand. Those differences do not mean any unit's job is more or less important than another unit's. The important thing is to remember that we should all be on the same team--the patients'.

Rodoon, BSN, MSN, RN · Oct 14, 2011

Ugh? This misunderstanding is still going on?

I felt like you once and then I moved to Telemetry. Sorry, but maybe you should float to the floor and see what they deal with. Labs-Ed's are close to labs and you can draw blood and run them over in less than a minute. Floor nurses (RN's) would have to draw blood, label tubes, and take the blood to the lab via elevator (longer time and blood clots). I'm not sure if it's still true or not but ED bloodwork gets priority in labs, not the general floors. If they do draw them they sit too long at the desk because ward secretaries are taking off orders and answering 40 call lights. It's apples and oranges. You drop off one of four patients on a nurse that may have over 10. Floor nurses have to sit on patients that have coded to get them in overcrowded ICU's too. While she sits on this patient her other patients have to wait or get pick upped which is why you wait over 40 minutes to transfer your patient. Newflash--vent patients are on general floors and people in full isolation, both time consuming.

I'm afraid nothing has changed in 30 years so you'll have to get used to it like I did. Nursing work varies, every type has its problems. Venting is fine but put yourself in the patient's shoes--the one you transferred wet. I hope that's a practice you'll change next time. Before you get mad at me-how would you feel if an overworked ED nurse transported one of your parent's like that?

All4NursingRN · Oct 14, 2011

Ugh? This misunderstanding is still going on?
I felt like you once and then I moved to Telemetry. Sorry, but maybe you should float to the floor and see what they deal with. Labs-Ed's are close to labs and you can draw blood and run them over in less than a minute. Floor nurses (RN's) would have to draw blood, label tubes, and take the blood to the lab via elevator (longer time and blood clots). I'm not sure if it's still true or not but ED bloodwork gets priority in labs, not the general floors. If they do draw them they sit too long at the desk because ward secretaries are taking off orders and answering 40 call lights. It's apples and oranges. You drop off one of four patients on a nurse that may have over 10. Floor nurses have to sit on patients that have coded to get them in overcrowded ICU's too. While she sits on this patient her other patients have to wait or get pick upped which is why you wait over 40 minutes to transfer your patient. Newflash--vent patients are on general floors and people in full isolation, both time consuming.
I'm afraid nothing has changed in 30 years so you'll have to get used to it like I did. Nursing work varies, every type has its problems. Venting is fine but put yourself in the patient's shoes--the one you transferred wet. I hope that's a practice you'll change next time. Before you get mad at me-how would you feel if an overworked ED nurse transported one of your parent's like that?

Well to be honest it's a staffing issue, IMO it always is. I cannot care for an ICU patient plus 10 others and be expected to change linens and clean patients, it's physically impossible. DOn't get me wrong, I always try as best I can to make sure I clean the patients, but with up to 14 patients in the ER, new ones screaming in pain, my ETOH stumbling all around I just can't manage. Why they have to take the cna's away?

I've never worked on a med-surg floor, but I've worked in a busy rehab floor and a super busy hospice floor in an LTC before, so yes I know what it feels like to be getting admissions, labs, paperwork, and meds out! the only thing I didn't do there is draw blood.

So yes I'm just ranting :crying2:

ChristineN, BSN, RN · Oct 14, 2011

I'm a float nurse and while my background is med-surg, I do float down to ER to help out sometimes. I think that if you are expected to do more RN work than the floor nurses, you should totally have more ER techs to help out (my ER isn't even a trauma center and they try to keep 2-3 ER techs on at all times). Also, it sounds like the floor nurses have large assignments, I can't imagine taking care of that many pts at once, so I'm sure if they have 7-10 pts under their care they do not have time to be drawing labs and starting IV's on everyone. I have never worked someplace where the floor nurses could not push the first dose of a medication (and I'm assuming we're talking pretty routine meds here).

Ideally the floor nurses should have 4-6 pts and then they would have more time to devote to pt care. Sounds like you ER nurses are being over-stretched too.

DroogieRN · Oct 14, 2011

I think it's an awesome idea to float floor nurses through the ER , give them a taste of the exhilaration!
I'm sorry, I'm a new RN and I've grown to see the huge difference in skill, mindset, and knowledge base of the floor vs critical care/ER nurse.

You are allowed to vent, but your inexperience is manifested in all the finger-pointing throughout the entire post. However, try as I might, I just can't get past this statement. :down:

kakamegamama · Oct 14, 2011

So, it seems to be back to the "us vs. them". Sigh.......no wonder we have so many issues....we can't even support each other. Martyr syndrome seems to be in a lot of places.......

All4NursingRN · Oct 14, 2011

Alright I confess, yes maybe I do have too much of a chip on my shoulder, but there is some truth to what I wrote.

Listen I know we nurses pit ourselves against one another way too often. It seems like alot of our issues come down to poor management, not enough staff, overload etc...

It just breeds this bad mentality... I am guilty as charged.

Still love the ER though *wink* lol

MassED, BSN, RN · Oct 14, 2011

oh the "it's harder where I work" will always prevail.... UNTIL you have truly worked in each and every department, one can never know the other side.

BUT.....

When I hand deliver a tele patient (from my just declared internal disaster status in the ED) to a tele floor and there are 5 nurses sitting and eating... I get a bit miffed. Perhaps if they were told to come help by picking up these patients, instead of our already bogged down ER nurses to come deliver tele patients to their floor.... but it's all about teamwork and management. In order for things to change, management should be on board - and not just ER, but house supervisors should have a plan when it starts in the ER. Just because everyone in house is full and the ER is now holding MANY MANY patients, there should be a plan! Perhaps each and every nurse can take one extra patient, since the ER nurses are all taking one extra patient too? Spread the wealth - if we're all in this, then we're all in this. No woe is me.

I find that not all nurses think this way, but if one person is busting their tail with high acuity patients, then chip in. That's the mentality we should all have - change starts with just one person, after all.

Cheers!

Kooky Korky, BSN, RN · Oct 14, 2011

sorry i was being a bit dramatic with the title! after a long shift i need some comedic relief
so there are some things i don't quite understand about my hospital and their policies regarding floor nurses. whether it's the tele or general med-surg floor.
floor nurses are not allowed to:
draw blood (if it's stat, the md must draw it, if not phlebotomy)
don't know how to start iv's due to having an iv team (well that's gone now)
can't push any medications (if they do the md must push the first dose)
cannot receive patients on any drip (somewhat understanable if it's an icu type drug)
i even had one question if the patient could come to the tele floor because the troponin was something like 0.248?????
so i work nights. now please don't get me wrong, i respect floor nurses, but i think this is incredibly obsurd, what do they do up there? pop meds? my er is extremely busy. while they get a base 6-7 patients, sometimes 10 they tell me, we can get up to 14 patients all with varying acuities. sometimes we have an icu patient with another 7-8 patients because we're bursting at the seams, and this is not occasional, this is pretty much every day.
i've had floor nurses call me and scream because the patient is soaking wet, then she says
were you busy, because if you were busy it's ok" like really? was i busy? this is the er what do you think?. we don't have nurses' aides like they do, they took them out of the er for budget purposes and all we have is one tech per 12-24 patients and they're stuck doing vitals, ekg's and helping out with bedpans etcc...
before the patients go up to their rooms the internal medicine residents beg us to drawn another set of blood, when asked why? oh because the nurses upstairs can't do it!!! really?
i feel like our light days in the er would be consider heavy to them. the other day i had two patients who had beds upstairs. one was a tele, who's hr was in the high 30's low 40's and another was a vent. so i call to give report and the clerk says can you call back because the nurse had to run an rrt and take the patient to the icu. fine i called back 40 min later and she's still unavailable? so then the supervisor calls the er and tells the charge nurse to hold the patients for 3 hours in the er because the floor nurses are overwhelmed and understaffed this is at 4 am in the morning?
well guess what happens? the vent turns into a icu evaluation, i get about 3-4 more patients from triage on top of the 4 i already had, so yes now i'm overwhelmed!!! where's my relief? it's like they throw everything on the er nurses where i work. the residents even tell us that it's easier and faster to get things done down in the er with us.
not to mention they lie to us upstairs. they tell us the rooms are not cleaned and ready when they are. or when we call to give report they complain that they just got a patient or that that bed was just booked. i've even had them threatent to call the supervisor (which the supervisor never addresses it lol)you know i wish i could tell everyone in the waiting room and triage area to go home because i'm overwhelmed .
i think it's an awesome idea to float floor nurses through the er , give them a taste of the exhilaration!
i'm sorry, i'm a new rn and i've grown to see the huge difference in skill, mindset, and knowledge base of the floor vs critical care/er nurse.
excuse the typo's i just got off a rough 12 hour shift

i think all nurses who complain about or lack understanding of areas or shifts other than their own should work a week in said areas or on said shifts. i do understand your frustration, though. having worked both areas on all 3 shifts, i have seen it through both sets of experiences.

the floor nurses don't make the rules any more than you do. it sounds like management needs to figure out some compromises and changes.

why not write out a plan that you can share with management. get doctors and other staff from both areas to join in by sharing their ideas of how both areas could function better, for the benefit of the hospital, not your benefit. they don't care about nurses, they do care what the public and docs think and about $$$$.