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 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?
She might not have transferred a patient wet. That pt might have become wet after leaving the ER. I just hate it when someone assumes guilt.
Someone here, maybe not you, said that one RN license is just as good as another. True. But that's not what the OP was talking about. She thinks the floor nurses are tricking her to avoid accepting a new admit. If we're honest, we know this does happen. how often I don't know, but it does happen, I'm sure. Not everyone is gung ho and thrilled to be working hard or even to carry their fair share.
Wow the tele nurses at your hospital don't draw labs or start IVs?! That's crazy! I feel like I'm constantly doing both, either for my patients or helping out another nurse who can't find a vein in her pt.
In many cases I receive patients from the ED that have cardiac enzymes that are hours overdue or come to the floor with their blood pressure being 210/100 with no intervention. It's all good though, we clean it up because we understand how busy the nurses in the ED can be. It's definitely annoying, but what can you do?
I totally agree with needing more techs. Management is constantly cutting staff and it's not fair to the patients or the nurses. We, on the floor, generally have 1 tech to 20 patients and at any time 10-15 are total care, contact patients needing to be changed every couple hours. There's not enough time in the day.
How much experience have you had in other floors as a "NEW" Rn to come up with all these conclusions? You sound like you are saving the world down there while the other nurses on different places are relaxing and maybe eating popcorn or something.
And by the way, it's so weird that floor nurses are that much restricted in your hospital; assuming you got your facts straight of course.
What sort of place doesn't have RNs who can draw labs, push drugs, or put in an IV???? That just sounds messed up from the get go....no offense to the OP (she didn't make the rules :)).
Specializes in Certified Med/Surg tele, and other stuff.
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
Go work on a med/surg floor and then come back to complain.
As for med/surg floors, not all are like yours, so I hope you are not generalizing.
She thinks the floor nurses are tricking her to avoid accepting a new admit. If we're honest, we know this does happen. how often I don't know, but it does happen, I'm sure. Not everyone is gung ho and thrilled to be working hard or even to carry their fair share.
And we know that some ED nurses sometimes hold patients until shift change so they don't have to take another one from the waiting room. (And don't tell me, "But we don't get to turn down patients, they come back no matter what! Because if that was true, there wouldn't be a waiting room. Emergent patients have to come back. Stable low priority patients get to wait.)
Lazy nurses without a sense of teamwork and understanding of the big picture aren't restricted to the floors.
(Just the dumb ones with no critical thinking skills according to the oh so experienced OP.)
OMG, those ratios are insane, anything > 7 there is NOOOOOOOO way to provide SAFE nursing care I DON'T CARE WHAT FLOOR OR UNIT YOU ARE ON.
I Don't even care if its night shift without discharges and admits, listen, life is tooooo short, and not every hospital has those kind of ratios. YOU ARE PUTTING YOUR SANITY AND YOUR LICENSE AT RISK!!!!!!!!!!!!!!!1
THIS IS NOT AN ATTACK, I PROMISE FROM THE BOTTOM OF MY HEART I FEEL NOTHING BUT PITY FOR A NURSE WITH THOSE RATIOS, BUT DEAR GOD!!!!!!!!
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
I've seen hard-working people fight with each other, each thinking the other must not be doing enough work. "After all, I'm doing all I can; so the problem must be at their end." I can almost aways attribute this to TOO DAMN MUCH WORK, PERIOD. Sounds like your hospital has major staffing and management issues. Do you have a union? You need a united voice to speak up about your third-world working conditions.
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?
, give them a taste of the exhilaration!
Kooky Korky, BSN, RN
5,216 Posts
She might not have transferred a patient wet. That pt might have become wet after leaving the ER. I just hate it when someone assumes guilt.
Someone here, maybe not you, said that one RN license is just as good as another. True. But that's not what the OP was talking about. She thinks the floor nurses are tricking her to avoid accepting a new admit. If we're honest, we know this does happen. how often I don't know, but it does happen, I'm sure. Not everyone is gung ho and thrilled to be working hard or even to carry their fair share.