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!
I don't think I've ever given attitude. If anything, I think at times I sound down trodden. The worst has been when I've transferred a patient up to ICU, sometimes as a rapid response, and in that short amount of time the room was cleaned and within 10-15 minutes I'm getting report for a train wreck ED pt or PACU pt. Days like that I tend to apologize and maybe give a brief explanation- i.e. just transferred a rapid up to ICU. It's not the transferring nurse's fault, but it's ridiculous that you aren't given any time to recover. If I've just had a rapid or managed to transfer a patient up to ICU without one, chances are I've spent quite a bit of time with them and haven't seen my other 3-4 patients. I've had this happen twice in the past week and one of those times I got back to my unit to be notified of critical labs for another patient (requiring a split transfusion) then got a PACU ortho patient that had cardiac issues (we get so few ortho patients- not my units speciality- and they are my least favorite transfer. I'll take a pt with a fresh chest tube over an ortho pt any day).
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.
What do you mean, WTH?
Futile cases don't need to be in the ICU to complete their transitions.
Why would you raise hell if your loved one were to transition outside of the ICU? The ICU is the last place (save perhaps the OR) that I would want to be at my transitional event.
I don't mind taking report on the phone but please tell me things that are relevant. I got report today from a floor nurse who was transferring her pt. up to ICU...all I got on the phone was "shortness of breath, can't keep her sats above 80, history of drug use and anemia"...come to find out she was in ARDS from sepsis, on top of having a COPD exacerbation. I'm a new grad so I admit I probably should've asked her a few more questions as to why she was getting sent to ICU for SOB but it was our 3rd patient and I was a bit flustered lol but I also felt like those were pretty big "no brainers". Also when the patient got up to the unit, we were trying to get her situated and the floor nurse had the chart in her hand and was talking to me but I didn't quite hear her so I said "What is it?" (as in "what did you say?") and she shook the chart in my face and said "this is the patients chart!" yikes lol
Yeah, paper charts SUCK.
And now I understand why you were flustered. My first thought at the outset of your post was, "Didn't you look at the chart before or at least during report?"
What I find ironic is when a floor nurse gives me attitude about successive admits we're sending up while I've got a waiting room full of people, multiple ambulances inbound, and patients laying/lying in the halls.
When I'm able, I will do my best to ease the admit by taking off orders, cleaning things up, and even hanging around upstairs to help get the patient settled. Sometimes, though, it's just not in cards.
You are a new grad in the ICU, so I am guessing you've never worked the floor in independent RN capacity. I never once had a patient with ARDS on the floor. I don't see how the floor nurse was suppose relay this diagnosis to you? The floor nurse told you what she or he knew about the patient and let me tell you something, when you have six or seven patients you can only know the minimum and detailed reports of past medical histories and details unfortunately get lost. I worked both ICU and the floor as a side note, I do have a fairly good idea of the expectations.
I also have to add that this RN was probably busy trying to keep this patient from going sour, having even less time to sift through the chart. Cut the floor nurse some slack. You are the ICU Nurse and you are responsible for being a direct clinician in the care critically ill patients, this means speaking constantly with your pulmonary or anesthesia faculty - because diagnoses in the ICU are not static and one dimensional.
They are multi dimensional and dynamic.
You are right, I've not worked the floor. And I can't imagine having 6 or so patients to keep up with. I didn't mean it to sound like they have it easy-because I know they don't. But also...if the patient is hospitalized for sepsis and COPD exacerbation, I just kinda think that's a more important history than 'substance abuse'. Maybe they don't use SBARs on their floor, but we do and that's one of the first things listed,reason for hospitalization. Our pulmonologist was up on the floor, he's the one who sent the patient to ICU. I assumed that he would relay to the floor nurse "hey patient went into ARDS, that's why we're transferring to ICU" but maybe he didn't, and maybe that's why she didn't relay it to me. I wasn't even flustered honestly until she shook the chart in my face while I was trying to move the patient to our bed and get the venti mask on her, I was just thinking I don't care where you set the chart as long as I can keep this pt breathing I'm happy lol.
What I find ironic is when a floor nurse gives me attitude about successive admits we're sending up while I've got a waiting room full of people, multiple ambulances inbound, and patients laying/lying in the halls.
When I'm able, I will do my best to ease the admit by taking off orders, cleaning things up, and even hanging around upstairs to help get the patient settled. Sometimes, though, it's just not in cards.
ER nurses love giving me report, but I'll bite. The "unexpected" is expected in ER. You also get to triage and have an MD available. Our patients come to the floor with no orders and a list of demands. They've already been "waiting forever" in ER and they're beyond irritated with the whole process.
Our seven other patients with scheduled medications and treatments can't be pushed to the side while we deal with the one who just came in.
All I ask is that you give them some dilaudid, ativan and a sandwich before you send them my way. If you'll just do that, I can deal with anything else that comes up. Thanks. :)
I think it is unfortunately the nature of the gig. Hospitalists and ER docs biting each others' heads off - floor nurses and ER nurses biting each others' heads off...its silly really because we're supposed to be on the same team. The process is definitely more fluid in some facilities than others. I do my best to not be the pushy ER nurse and to be understanding but if we're packed out the gills its only a matter of time before the CN is on my case. When you have 40 beds and 40 waiting, its really just riding a sinking ship so I've learned to just ride the wave until quitting time. Also I've learned that humor helps to break the displaced anger ice.
The biggest thing that would probably make the transition more fluid is better communication with bed control. For example, the hospital I did my Capstone at the CN on the unit would put the order of which beds would be filled so there were no surprises. When the ER called, you knew it was yours or your neighbors so you would help accordingly. I've yet to see any other facility do it that way. At my current FT hospital they are also fairly good with taking report for each other if someone is really bogged down. I think that support really really helps. I mean I can definitely equate that to the feeling of my CN dropping another EMS 3 minutes out of my lap while they clearly see I have 2 admissions with ready beds and a full work up on my other patient. Like dude...how about instead of expecting me to be super woman you take report from EMS and let me work on the other 3...but with some CNs that's just wishful thinking lol. But yeah...no matter what your unit we are all fighting the same battle so I try not to take it too personally when the nurse on the other line is CLEARLY not having a good day.
Specializes in Float Pool - A Little Bit of Everything.
I have worked on many sides, ER, ICU, & Floor. There are so many mitigating factors on all sides that can add to the nurse's frustration. In general, like others have mentioned, when I am frustrated it is with the staffing, management, or sup 95% of the time. I try my best to not make the nurse on the other line feel uncomfortable or in the line of fire, so to say.
AceOfHearts<3
916 Posts
I don't think I've ever given attitude. If anything, I think at times I sound down trodden. The worst has been when I've transferred a patient up to ICU, sometimes as a rapid response, and in that short amount of time the room was cleaned and within 10-15 minutes I'm getting report for a train wreck ED pt or PACU pt. Days like that I tend to apologize and maybe give a brief explanation- i.e. just transferred a rapid up to ICU. It's not the transferring nurse's fault, but it's ridiculous that you aren't given any time to recover. If I've just had a rapid or managed to transfer a patient up to ICU without one, chances are I've spent quite a bit of time with them and haven't seen my other 3-4 patients. I've had this happen twice in the past week and one of those times I got back to my unit to be notified of critical labs for another patient (requiring a split transfusion) then got a PACU ortho patient that had cardiac issues (we get so few ortho patients- not my units speciality- and they are my least favorite transfer. I'll take a pt with a fresh chest tube over an ortho pt any day).