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
In the ER, you shove an 18 gauge in the AC because, in an emergency situation, it's an easy IV site to access.
Actually, you place a 20g. or greater above the wrist, because the patient is presenting with an unknown diagnosis and may need IV contrast. The vein should be large enough to hold the size of catheter you are using, and to handle the high pressure contrast injection without extravasation. The AC on most people fits the bill.
Traumas require two large bore IVs for rapid administration of blood, fluids, and medications.
For STEMIs, our cath lab specifically requests an 18g. in the right AC because that's the side of the patient the staff in the cath lab is on, and they need to be able to get to the IV site for intraprocedural medication administration and in the event the patient codes on the table.
A lot of our patients come in via EMS with PIVs already in place, usually (but not always) in the AC. It is far kinder to use the access already in place than to poke them again just for the sake of not having a line in the AC.
In the ER, you're not worried about providing comfort for the patient, you're worried about stabilizing and keeping that patient alive. On the floor, I concern myself with making sure my patient is comfortable and healing.
While keeping the patient alive is a top priority in the ED, providing comfort is a huge part of what we do. Nope, it's not on the top of the priority list, but there are many things I do, such as providing warm blankets, extra pillows, repositioning, a snack, antiemetics/analgesics, etc. that are specifically to address comfort. There are limits to what I can do, of course; the stretchers are hard, it's cold, the lights are bright, it's noisy, we don't serve meals, and often you have to wait a while to go to the bathroom because staff is busy with higher priority tasks. But to say we don't concern ourselves with comfort at all is false.
All that being said, despite these being two completely different styles of nursing, these two nurses should not dislike the other. I see it in my hospital and I know it's the same at every hospital. We should work together and appreciate each other for what they do, not consider one better or worse.
I am only a 4-year nurse. My experience was in ICU until I took a 'critical care float' job. I recently( within the last year) changed over to the ER.
My float job gave me nominal experience everywhere but women's services and psych. I often went to stepdown, tele, and general medicine. I feel at least somewhat qualified to say that it is tough everywhere.
ALL nurses work hard. All nurses have bad days. All nurses 'miss' things. All nurses have most likely transported a patient dirty or wet. I think if we spent a bit more time forgiving each other, and less time blaming each other we would be happier.
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.)
I can honestly say that I have never held a patient in the ER so that i wouldn't have to take another patient. Ever.
I want that patient to be in a comfortable, quiet bed. I want them to have proper food, rest, and privacy. I also want that poor patient in the waiting room to have their concerns addressed. If I hold a patient, my charge nurse is finding me to figure out why. Usually, the answer is either a) I have something critical going on and cannot take the patient this moment, or b) the nurse in the receiving unit is so busy that she cannot take the patient yet.
lol ok i'll just reply to the points you've placed out.
understand my background is a full time paediatric nurse. however...if there are staffing issues or no children i float/cover sick leave to all departments. so i feel reasonably comfortable answering as i've experienced all floors and the frustration they have with one another. also to note i work in australia so our scope/rules may differ.
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),
for me the wards eg. med/surg (for me), they can draw bloods stat. however to insert an ivc or draw bloods when it is expected to have been done in emergency. rather makes the ward staff disgruntled as it totally kills the rn's time management it's time they really can't afford to keep the shift running smoothly.
on the emergency side, i know when working there it can be 'crazy!' however acuity/patient load is different and you run by your own time. not like floor nursing where you're drawn over the coals if something isn't done at a set time, under correct procedure. so a ten-twenty minute blood draw/ivc insertion is a pain for the floor nurses. sometimes after all that you can't get the vein and you have to then ring emergency to get their dr to walk to the ward to do the ivc insertion.
don't know how to start iv's due to having an iv team (well that's gone now)
well...we don't have an iv team so moot point for me to comment on. however floor nurses here are competent to do ivc's but i'll admit generally aren't as fast as the nurses in emergency. (they aren't after all putting in an iv every half hour).
can't push any medications (if they do the md must push the first dose)
here we can push pretty much anything. however yes the first dose (antibiotics generally) is meant to be done by emergency. why? so if there's a bad reaction, there's a nice big emergency team with equipment surrounding them. it's the entire rationale of it anyway.
cannot receive patients on any drip (somewhat understanable if it's an icu type drug)
not true in my facility, what medications drips can be received on what floor depends on the medication, example an insulin infusion needing hourly or more monitoring and blood gases generally won't be accepted on med/surg but in high dependency or icu.
i even had one question if the patient could come to the tele floor because the troponin was something like 0.248?????
that sounds odd to me, i'd think a tele floor would accept that.
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
ah....to all the rest i admit emergency is fast paced can be horrifically tiring and stressful and ran off your feet. but floor nursing is heavy and back breaking, from my experience far more understaffed with greater patient loads. morale i've found is lower in med/surg, you can't get help from medical staff quickly, unlike in emergency where i can just walk up to a doctor and tap them on the shoulder and there seems to be less respect given to the med/surg nurses.
one night i was working sick relief on med/surg and a fellow nurse rung up emergency to speak to a doctor due to our wandering dementia patient to see if he could have some risperidone and the emergency nurse answered and said "we're currently saving lives here" and hung up on them. i can say my fellow nurse felt undervalued.
xd all i can say is to see both sides, they both have their hard areas and their good, both should be respected. i've enjoyed working in both, but neither as much as in my paed ward.
emergency nurses are good at thinking fast and on their feet, clinical intervention ivc, bloods etc is easy to them. med/surg nurses are amazing at time management, knowing disease processes, patient interaction and working really hard with sometimes little feedback for it. eg. in my facility in emergency when there, often supervisors will come through and congratulate them on a job well done, this never seems to happen on med/surg.
i think all of us nurses are pretty amazing ^.~ i don't know maybe a little rotation through all wards would be good for all of us. certainly levelled my thinking out.
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!
Anna Flaxis, BSN, RN
1 Article; 2,816 Posts
Actually, you place a 20g. or greater above the wrist, because the patient is presenting with an unknown diagnosis and may need IV contrast. The vein should be large enough to hold the size of catheter you are using, and to handle the high pressure contrast injection without extravasation. The AC on most people fits the bill.
Traumas require two large bore IVs for rapid administration of blood, fluids, and medications.
For STEMIs, our cath lab specifically requests an 18g. in the right AC because that's the side of the patient the staff in the cath lab is on, and they need to be able to get to the IV site for intraprocedural medication administration and in the event the patient codes on the table.
A lot of our patients come in via EMS with PIVs already in place, usually (but not always) in the AC. It is far kinder to use the access already in place than to poke them again just for the sake of not having a line in the AC.
While keeping the patient alive is a top priority in the ED, providing comfort is a huge part of what we do. Nope, it's not on the top of the priority list, but there are many things I do, such as providing warm blankets, extra pillows, repositioning, a snack, antiemetics/analgesics, etc. that are specifically to address comfort. There are limits to what I can do, of course; the stretchers are hard, it's cold, the lights are bright, it's noisy, we don't serve meals, and often you have to wait a while to go to the bathroom because staff is busy with higher priority tasks. But to say we don't concern ourselves with comfort at all is false.Agreed.