ER nurses bringing pts to the floor soiled

imintrouble, BSN, RN · Dec 31, 2013

I find myself on both sides of this issue. I'm frequently annoyed when my pt arrives from the ER soiled. But I know all the nurses who work my shift in ER, and I know none of them are uncaring or lazy.

I find myself "liking" the floor nurse posts, and also "liking" the ER posters.

Now about those AC sites. I really don't like those. Where I work they're simply used for expediency. No other reason. The quick fix for the ER, makes alot more work for me, and I'm not as understanding about that.

BSNbeauty, BSN, RN · Dec 31, 2013

I worked as an ER nurse for a short time and I have witnessed this. I personally tried my very best to make sure my patients' were clean before going to the floor. However, there were times when I had to send a soiled patient up to the floor due to higher acuity or more emergent patients coming into my rooms. I always apologized to the patient and nurse to whom I gave report. I understand the plight of both ER nurse and floor nurses.

msjellybean · Dec 31, 2013

I'm an ED nurse now, but worked on the floor for 3.5 years, frequently with a 6:1 ratio and one tech.

If the IV site became problematic, I'd would start a new line and move on with my day. I don't understand why it's such a big issue for so many people.

All4NursingRN · Dec 31, 2013

This reminds me of the time a floor nurse called me to yell my ears off because the patient came up soiled. She then said...were you busy? because if you were it's ok. I politely (admist the chaos ensuing around me) explained that I had 11 patients and a new patient from the waiting room every 20 minutes. I felt so bad....

you see I never intentionally send pt's up soiled, in fact I clean all my bed bound patients myself if I have to! Our ED got rid of all the CNA's and only kept the techs who are also swamped with EKGs/Vitals. Even if all I do is clean the patient and place a clean chuck and send them up I never send them soiled. But yes some ED nurses, tech, NAs can be lazy, I know.

But my oh my it can get so rough and chaotic in the ED, chaotic like trying to reason with your combative AMS/psych/overdose patient, take care of the ICU eval, calm and medicate the screaming patient in pain, answer phones from internal medicine, tele monitor, and transporters..... and clean little old lady in bed 6??? YES THIS GOES DOWN...ALL AT THE SAME TIME.... so yes I at times (rarely) knowingly sent patients up soiled. Im sorry :--(

bebbercorn · Dec 31, 2013

Have been on both sides. On the floor, rarely got a soiled (e.g. caked poo, on an incontinent pt, I can give the benefit of the doubt) pt from ED. And I have never intentionally sent a patient up soiled, as I would expect of my peers (except if unstable, but by then all orifices are probably plugged). I'm sorry for your run of luck, but simply calling the nurse in the ED or asking them to stay with you and help clean the pt can stop that problem. In the ED it's incredibly frustrating when you are seeing, discharging, transferring, coding sometimes dozens of pts in a night and someone griping with their 6 stable patients because you forgot to give a pair of socks.

That being said, thanks for advocating for patients. Keeping skin clean and intact is incredibly important, but not as important as a patients dignity.

canadianhungarian · Dec 31, 2013

I'm an ED nurse now, but worked on the floor for 3.5 years, frequently with a 6:1 ratio and one tech.
If the IV site became problematic, I'd would start a new line and move on with my day. I don't understand why it's such a big issue for so many people.

I completely agree! Resite and move on....

I used to be a floor nurse for 2.5 years before I started recently floating down to our ED permanently. And we used to get soiled patients sometimes...it happens. Clean them and move on. Sometimes the EMS will even drop off patients that are soiled because it happened in transport. 100% of the time one of the EMS will help me change the pt quickly and help them get undressed....if I ask nicely

In the field of healthcare everyone should work together as a team - not department by department or unit by unit. At least that is maybe wishful thinking lol?!

Racer15, BSN, RN · Jan 1, 2014

You also cannot be sure what that ER a nurse is dealing with. I had a pt roll in the door, horrific elder abuse case. Stage 4 pressure ulcers ALL OVER her body. The smell whe. You walked in the room was horrific . I spent three hours cleaning the pt, assessing her wounds, taking pictures, documenting, calling social services, the police, talking with each of them, starting her IVs, giving meds...I have no idea what was happening with my other patients at that time, they may have gone to the floor covered in poop. That patient I was talking about went to the floor with no wound care because I wanted the floor nurses to be able to see them for themselves, but I did offer to stay and help dress the wounds, and brought all the supplies they would need. I always offer to stay and help clean up, it isn't a big deal to me and I am more than happy to help. I get irritated when the floor nurses try to imply we ER folks are lazy, I never purposely leave my patients soiled and I am always more than happy to stay on the floor to help with whatever they need. We are a team, we should all be willing to help each other.

sistrmoon, BSN, RN · Jan 1, 2014

... You know I was a floor nurse who went to emergency and like most emergency nurses, have been on both sides. I had this very long list of logical and completely appropriate reaons for some of the angst written here. Then I realized that this isn't a "let's be intelligent and mature" thread, but another specialties war where everyone just wants to attack like piranhas. Ok then, I'm thinking it must be ok to start a topic on how floor nurses try to pawn new admissions onto the next shift so that I get crapped on by cranky floor nurses during shift change. I'm constantly being told by charge nurses "Bring them at 1100" or "Bring them at 0700". Or the complaining floor nurses who loudly swear about getting the incontinent pt who I've cleaned 4 times an hour saying "It's ok, you do what you have to do and we'll keep up with you." The patient gets to hear the nurses talk about why they don't belong on their unit and how unfair it is to have a new admission. I've seen patients cry at being left on the floor with sarcastic nurses after I told them how much nicer it would be to get to where things are less intense than the E.R.[/quote']
This is so not how it goes at my hospital. We'll have a bed booked all shift, will call numerous times wondering when the patient is going to come up, and the ED inevitably calls report at shift change. We *never* want change of shift admissions because we have to give report to the same cranky next shift nurses who give us attitude about it not getting done all shift.

sistrmoon, BSN, RN · Jan 1, 2014

And I do understand the ED is slammed but when a patient gets to the floor at 0230 and had an antibiotic due at 2200 that wasn't hung, has an unstageable pressure ulcer and Gtube not mentioned in report and is a new quadriplegic(also not included in report), it's a bit disconcerting. I also get a lot of "well, I didn't actually care for this patient but am giving report for my coworker" from the ED which if it happens once in awhile is fine but seems to happen a lot, which has an effect on care and decent report.

Anna Flaxis, BSN, RN · Jan 1, 2014

This is so not how it goes at my hospital. We'll have a bed booked all shift, will call numerous times wondering when the patient is going to come up, and the ED inevitably calls report at shift change. We *never* want change of shift admissions because we have to give report to the same cranky next shift nurses who give us attitude about it not getting done all shift.

Sometimes what happens where I work is that the patient comes in, and because of their condition we already know they're going to be an admit, so we give the house supervisor a heads up so he or she can get us a bed. But the ED workup still hasn't been done yet, so that needs to happen first, and takes a couple of hours. Then the ED MD contacts the hospitalist, who may take an hour or so to come down and see the patient. Then the hospitalist spends another hour in the patient's room (and it's frustrating because they have the chart, so I can't start on the med rec or do the admission assessment in the computer), and then they come out and spend another hour writing orders. So then we get the chart back and have to update the meds in the computer and put in the admission assessment, do any stat orders, one more set of vitals, print off the vitals, make sure the patient is not soiled, all while caring for our other patients as well, and by that time several hours have passed between when the patient was first identified as a potential admit and the house supervisor notified, and when the patient is actually ready to be moved. And often, it happens right at shift change, not because ED RNs have it out for the floor nurses, but because that's just how it worked out. Or, it's also OUR shift change, and it's not fair to the oncoming RN to leave it to them, especially when they have a full lobby, people waiting to be triaged, and an ambulance on its way. If the patient is ready to go, they need to go, shift change or not.

I really liked the process at my old place. We faxed report up to the floor, so there was no telephone interaction, and we took the patient up whenever they were ready, regardless of shift change. If the hospitalist wasn't there and the patient was ready, the ED MD would write quick admit orders so we could get the patient rolling. It made the process so much smoother and more efficient.

Anna Flaxis, BSN, RN · Jan 1, 2014

And I do understand the ED is slammed but when a patient gets to the floor at 0230 and had an antibiotic due at 2200 that wasn't hung, has an unstageable pressure ulcer and Gtube not mentioned in report and is a new quadriplegic(also not included in report), it's a bit disconcerting. I also get a lot of "well, I didn't actually care for this patient but am giving report for my coworker" from the ED which if it happens once in awhile is fine but seems to happen a lot, which has an effect on care and decent report.

Sometimes, the hospitalist comes in, writes the time on their order sheet, then goes to see the patient and spends an hour in there. Then they come out and spend another hour writing orders, so at least 2 hours have passed between the time on the order sheet and the time the ED RN actually sees the orders. At my hospital, staffing goes down to one RN at midnight, so if that one RN has an admit, and that admit is stable, then they are lower on the priority list, as the RN needs to focus on new/unknown/potentially unstable patients, get their workups going, etc.

At my current place of employment, we try to have the primary RN call report on their own admits, but sometimes it doesn't work out that way. At my old place, it was really common to call report on others' patients (when we did telephone report; once we changed to faxed report, it became a moot issue).

Anna Flaxis, BSN, RN · Jan 1, 2014

The point is that it's not just a matter of the ED being a busy place; it generally is, and this is a big contributing factor. But the other factor that makes a big difference are the processes involved in getting a patient admitted. At my old place, the process was very streamlined and there was really no excuse for not having stat orders done or transporting a soiled patient, unless it was just one of "those shifts" that happen in every ED (and the floor nurses were generally very forgiving because stuff like that didn't happen a lot). At my current place, the admission process is cumbersome and inefficient, and this contributes to stat orders being missed, other RNs besides the primary calling report, transferring at shift change, and soiled patients arriving on the floor. I am advocating for change, but meeting a lot of resistance, mainly from the other RNs who haven't worked any place else and so they don't understand how much better things could be.