I don't know if every time I call I end up catching a nurse whose been a having a bad day or is not feeling well, but of the times I've called every time I have called I've gotten the worst kind of attitude. I almost feel as if, perhaps, it is because the nurses that gave me attitude feel as if I'm ruining their day by adding one more patient.
I get it, it sucks. No one enjoys the current state of staffing ratios. I worked the floor and understand. However just as much as I'm going to be an adult and try my best to not take your displaced frustrations personally, also please try to take me sending you a patient not personal.
If it is is any consolation, by the time I return to my unit - my empty room will be clean already and that means time to prepare it for the next train wreck coming my way. I most likely will not go back and have time to relax. Maybe a quick lunch, as my next train wreck is life flighted to me or your next rapid response ends up here.
Just know we are all in the same business. Never anything personal. If my charge nurse ever calls your unit to expedite a transfer, know she's not doing it to be mean. It's because someone out there really needs that ICU bed. What if it was your mom or dad or friend?
When I worked the floor and was busy as can be, of course I would be a little uneasy when I was getting 5 calls because receiving report was delayed 10 minutes because I was doing wound care etc. So yes I get it. This post was intended as a neither side of the grass is greener kinda post. If I have a floor status patient in the ICU with transfer orders and I know there's no one in need of a room or we have other empty rooms, I will call you report and and ask you "Hey floor nurse, have you had lunch? Go eat and then I'll take you the transfer, ok?" Let's be kind and look out for each other!
Specializes in M/S, Pulmonary, Travel, Homecare, Psych..
I used to be one of the nurses who gave you attitudes lol
I honestly didn't know it was as bad as it was. When I received a call for MY admit, it was all fine. Now, if it was for someone else, different story.
I went by a rule regarding admits from ER and ICU: Do right by them and they will return the favor. I never gave them a hard time or made them wait. I wanted them to get to know me, my voice, and remember I was not "one of those nurses". That way if you happened to call during one of those rare bad times I simply needed time............you'd understand.
Problem was when you called, I answered and it was someone else's admit. Ugh
The receiving nurse would always whine and cry, try to avoid getting the admit and everything else. I had no patience for it. I always got caught up in the fight between you and them. And I hated that.
Someone pointed out to me that I was so nice on the phone........until I found out it was an admit and it wasn't for me. This person honestly thought I was mad cause I wanted the admit and was jealous of the other nurse lol
I tried to improve but some of my co-workers I had to go fetch just got on my last nerve. JUST TAKE YOUR ADMIT ALREADY! Not like anyone is gonna hold the patient elsewhere just cause you are not in the mood (never mind that you never are in the mood anyway, regardless of the day being good or bad).
One ER nurse told me she would hang up and call back to a different line if she had someone else's admit and I answered lol
This was ALWAYS an issue when I worked cardio. Most of the problems were because management would assign new patients to a room when your first patient hadn't been discharged yet. So then you get the call from ER or where ever and you have to explain, sure I'll take report, but my patient is still in the bed, so you can't bring this new patient up yet, then everyone is annoyed. Or supervisors would assign an inappropriate transfer (ETOH withdraw to a double room, male to female room, same name to a double room) or my personal favorite, one of our supervisors would only assign transfers after she finished assignments for the next shift, so at 3:10 your phone rings and they have to bring the patient right away because their relief shouldn't have to take over just to transfer.
Basically, nurses got annoyed at nurses, when really it was generally the supervisors fault. Unless you were a nurse telling me that a patient is in new onset rapid afib, seen only by you and on your poorly done EKG because the patient is a jerk and you want him off your floor (and is SR in the 60s when I come to assess and place his monitor) then I'm happy to take your transfer!
Specializes in Stepdown telemetry, vascular nursing..
Different perspective from a floor nurse: the other day I was getting report from an ICU nurse (she's amazing, lots of experience). It was POD 3 and she mentioned Foley...and I blurted out "why is the Foley still in?" I think it came out wrong even though I didn't mean it. Floor nurses know that Foley is out POD 2 in am; the response was that the patient wa son dopamine and to measure I&O and that ICU is different. Another thing is that HgB was 7.4 and I looked back 5-6 days and it was 12, and I had read the surgeon's note that stated "anemia". So I asked an open-ended question..."tell me more about the HgB", to which she replied "how long have you taken care of open-hearts?he just had surgery, oh and yeah I gave him a unit of blood this morning" never mind that the EBL was 200 per note. and he never had the anti-embolic stockings on, leg wounds were open to air.
Worst ever was when patient came with insulin drip on the side not connected, no infusion pump.
I love this post. I've been on both sides and currently a floor nurse. I never ever ever getban attitude getting report on a new admission. Seriously it's part of the job.
Different perspective from a floor nurse: the other day I was getting report from an ICU nurse (she's amazing, lots of experience). It was POD 3 and she mentioned Foley...and I blurted out "why is the Foley still in?" I think it came out wrong even though I didn't mean it. Floor nurses know that Foley is out POD 2 in am; the response was that the patient wa son dopamine and to measure I&O and that ICU is different. Another thing is that HgB was 7.4 and I looked back 5-6 days and it was 12, and I had read the surgeon's note that stated "anemia". So I asked an open-ended question..."tell me more about the HgB", to which she replied "how long have you taken care of open-hearts?he just had surgery, oh and yeah I gave him a unit of blood this morning" never mind that the EBL was 200 per note. and he never had the anti-embolic stockings on, leg wounds were open to air.
Worst ever was when patient came with insulin drip on the side not connected, no infusion pump.
7 to 8 or above is adequate for an open heart depending on the surgeon. All the surgeons I worked always said 7-8 or above.
How do you know the stockings weren't on and maybe were taken off at some point to let the patient to breathe out their legs, and it coincided with the transfer to your unit?
Unless the graft sites are draining, there's no indication for covering them up.
We dont send patients to the floor with an insulin gtt. That's ridiculous. Insulin drips require hourly monitoring of glucose and monitoring the an ion gap and other electrolytes closely, about every 2 to 4 hour BMPs. No floor nurse should have to do all that on top of the already 5 or 6 patients they have. What the heck?
Why does the PACU keep ICU patients? We get them straight from surgery.
Ours go to the PACU first if the plan is for the pt to be extubated. That way anesthesia is there, and the RRTs don't have to dirty a vent that's only going to be used for the short time it takes to get them recovered.
If the plan is to leave intubated, they come directly from the OR.
Ours go to the PACU first if the plan is for the pt to be extubated. That way anesthesia is there, and the RRTs don't have to dirty a vent that's only going to be used for the short time it takes to get them recovered.
If the plan is to leave intubated, they come directly from the OR.
Specializes in Stepdown telemetry, vascular nursing..
7 to 8 or above is adequate for an open heart depending on the surgeon. All the surgeons I worked always said 7-8 or above.
How do you know the stockings weren't on and maybe were taken off at some point to let the patient to breathe out their legs, and it coincided with the transfer to your unit?
Unless the graft sites are draining, there's no indication for covering them up.
We dont send patients to the floor with an insulin gtt. That's ridiculous. Insulin drips require hourly monitoring of glucose and monitoring the an ion gap and other electrolytes closely, about every 2 to 4 hour BMPs. No floor nurse should have to do all that on top of the already 5 or 6 patients they have. What the heck?
Hi, thanks for the reply. As a stepdown unit, we take CABG on insulin pumps, our ratio becomes 3:1, we have an internal protocol for dosing that is quite detailed. The stockings being off was just me venting, it's not a big deal (and you can tell, because the nurse has to order them in the system with a code, long story aaaand patient stated he never had them on, why did I have to put them on). However, we have order sets that state daily cleaning with hibiclens and dressings on graft sites during hospitalization; those and the stockings are an absolute must.
I agree with the HgB being 7-8 and normal, but this guy had hypoperfusion, low urinary output immediately after and SBP 90s. HgB 5 days prior was 12. But in conclusion, do you think the HgB question was stupid?
For the most part I agree! What bugs me is when we get a ICU downgrade who is ONLY being downgraded because they are ready to pass! The put the patient in the room and within a couple of hours the patient die? WTH. We have even had patients die in route in the hallway while being transferred. How on earth is that ok? I know if that happened to my loved one all hell would break loose.
For the most part I agree! What bugs me is when we get a ICU downgrade who is ONLY being downgraded because they are ready to pass! The put the patient in the room and within a couple of hours the patient die? WTH. We have even had patients die in route in the hallway while being transferred. How on earth is that ok? I know if that happened to my loved one all hell would break loose.
We don't usually transfer patients that are ABOUT TO DIE. As in they are hypotensive with a lactic acid of 12 and a PEEP of 15 and FiO2 of 100 with sat in the 70/80s and the family has withdrawn care and we know they'll die within minutes to maybe an hour of disconnecting.
We will tranfer those expected to live a few days or weeks for eventual transfer from the floor to hospice etc.
Hi, thanks for the reply. As a stepdown unit, we take CABG on insulin pumps, our ratio becomes 3:1, we have an internal protocol for dosing that is quite detailed. The stockings being off was just me venting, it's not a big deal (and you can tell, because the nurse has to order them in the system with a code, long story aaaand patient stated he never had them on, why did I have to put them on). However, we have order sets that state daily cleaning with hibiclens and dressings on graft sites during hospitalization; those and the stockings are an absolute must.
I agree with the HgB being 7-8 and normal, but this guy had hypoperfusion, low urinary output immediately after and SBP 90s. HgB 5 days prior was 12. But in conclusion, do you think the HgB question was stupid?
thank you
Your question was well intended, therefore not stupid. You ask what you have to!
Also, I understand you were worried about maybe sounds like hypovolemia, as you're mentioning the HGB and the UOP but maybe the patient needed something else. Without knowing vital signs, SVRI, CI, and pulmonary pressures it's nearly impossible to know.
AutumnApple
491 Posts
I used to be one of the nurses who gave you attitudes lol
I honestly didn't know it was as bad as it was. When I received a call for MY admit, it was all fine. Now, if it was for someone else, different story.
I went by a rule regarding admits from ER and ICU: Do right by them and they will return the favor. I never gave them a hard time or made them wait. I wanted them to get to know me, my voice, and remember I was not "one of those nurses". That way if you happened to call during one of those rare bad times I simply needed time............you'd understand.
Problem was when you called, I answered and it was someone else's admit. Ugh
The receiving nurse would always whine and cry, try to avoid getting the admit and everything else. I had no patience for it. I always got caught up in the fight between you and them. And I hated that.
Someone pointed out to me that I was so nice on the phone........until I found out it was an admit and it wasn't for me. This person honestly thought I was mad cause I wanted the admit and was jealous of the other nurse lol
I tried to improve but some of my co-workers I had to go fetch just got on my last nerve. JUST TAKE YOUR ADMIT ALREADY! Not like anyone is gonna hold the patient elsewhere just cause you are not in the mood (never mind that you never are in the mood anyway, regardless of the day being good or bad).
One ER nurse told me she would hang up and call back to a different line if she had someone else's admit and I answered lol