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!
With burn patients I seem to have a talent for catching the floor nurse in the middle of a shower or dressing change. I just take it in stride and work with them. If they ask for 10 minutes I wait 15 or 20 before I call back. I try to fluff and buff the pt as much as I can; clean gown, drains emptied and charted, labs sent, CT or X-RAY completed, OR fluid removed or put on pump tubing. I'm pretty sure they notice and reward me by usually taking report or the charge sometimes takes it for them. Rarely do I get pushed back a second time and sometimes the nurse calls us for report.
As someone else said, we are all in this together. Everything I can do to help the floor or unit nurse pays off in goodwill. Btw, I love some of the ICU nurses at my work. When I call they have already read the chart and know my patient almost as well as I do.
It really adds a whole other level of stress, when you have to give report to Icu and they decide to question you on everything, including doctor's orders. I understand you have to know everything that's going on with the pt, but unlike ICU, I don't have 15/20 minutes to report on 1 patient. And then when you bring the patient up to ICU, once again they're questioning "why this wasn't done, why did we do this?" Blah blah. I guess everyone needs someone to take their frustrations out on. I just wanna say "here's Doctor So n So, they can answer why they ordered this "
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
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?
I did insulin drips all the time on the floor. One time I floated and a brand new relief charge assigned me 2 insulin drips and a chest tube. Luckily people were nice and helped me. Especially when Mr. Chest Tube got out of bed without calling and tipped his thing over. Two other nurses changed it out for me while I was adjusting one of the insulin pumps. Thank goodness for teamwork.
The other night, three of my six patients were on bed alarms. One was able to use the call light appropriately (kinda), one was not and the third...well, she would just rip out her IV when she needed help.
The charge that night is one who pays more attention to "geography" (i.e. making sure your assigned patients are on the same hall) rather than acuity when preparing the assignment. So at least all of my bed alarm peeps were one-two-three right in a row...?
The ICU nurse who called report to give me a transfer may not have gotten the warm fuzzies from me now that I think about it. To the ICU nurse: I'm sorry!
Jumping out of bed, pulling out IV lines, NGTs etc., is the usual/norm for Pediatric patients. Welcome to our world! I do admit, we often have a parent at the bedside...but when we don't or when the parent is asleep or sometimes refuses to help because they think we nurses are responsible and they (the parent) shouldn't have to do anything to help with their child when they are in the hospital, it is a whole different ballgame! Some parents whose children are chronically ill consider the hospitalizations respite for themselves. Most hospitals Ive worked, only provide sitters in Pedi for suicide watch, or potentially violent patients. Just sayin'!
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.
I have always appreciated ER nurses like you! Thank you for trying to help...You have your own side to deal with and I get how frustrating it can be to be met with "attitude" when you are simply just trying to do your job. This all gets back to lack of adequate staffing, once again!
The only situation that bugs me when getting a transfer is when it is right at change of shift, orders haven't even been written yet, (which isn't supposed to happen, but sometimes does) or the report is one of those..."I don't really know this patient. I am just reading the notes from the nurse who had him/her." As an ER nurse, I understand that the latter often is out of your control...
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. :)
How would you like your family member to die in the hallway
The probability of transitioning during transport is pretty low. Of course, *low* probability doesn't mean *no* probability but that's no reason to occupy an ICU bed with a patient who will derive no benefit whatsoever from it.
Having seen quite a number of people transition during my career and personal life, it's pretty difficult to say with any accuracy when they're in their last hour or two. And even if we could, there's still no reason to keep them in the ICU... they do not need *intensive* care and, in many hospitals, those critical-care beds are critically needed by patients waiting in PACU or the ED.
For me personally, I wouldn't want my family member to transition in the hall, I would want them to transition at home, in their own bed, with the sights, sounds, and smells of a lifetime surrounding them.
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 won't do the sandwich but I will administer PRN meds if I have them because I know that it may be awhile before the floor nurses get to it.
I'm not sure what you mean by we "also get to triage."
Yes, we have an MD but once the patient becomes an admit, I have no more access to an MD than do you because the ED doc is no longer the patient's attending physician.
The only situation that bugs me when getting a transfer is when it is right at change of shift, orders haven't even been written yet, (which isn't supposed to happen, but sometimes does) or the report is one of those..."I don't really know this patient. I am just reading the notes from the nurse who had him/her." As an ER nurse, I understand that the latter often is out of your control...
Just as I don't like taking an assignment in which I'm about to send one patient upstairs (saying, "I don't really know this patient") and discharging one and hearing, "that one just got here and I haven't even been able to get started."
We don't like those situations but neither do we create them.
Why does the PACU keep ICU patients? We get them straight from surgery.
Our PACU can take ICU acuity patients. Whenever possible we send ICU acuity patients straight from the OR to ICU (less hand offs, less potential for error). Sometimes, hospital census, ICU census and the needs of other patients preclude us from holding an ICU transfer in the OR waiting on an ICU bed. Generally we are only willing to hold for 30 minutes or so - if they're cleaning a room we'll hold instead of send to PACU. I've had situations where we couldn't hold in the OR because there was a life threateningly emergent procedure that needed to go and we had to accommodate the emergency case, our room, which would be waiting on an ICU bed was the only room projected to be out in the next hour.
Nurses are pushed too far for the most part. An attitude with another nurse may be the only way the offending nurse can release a little steam. We need to be perfect with the patients, families and medical staff. Being mean or rude to one another won't solve the problems, but sometimes you just need to blow off a little steam. Just my thoughts,
Just as I don't like taking an assignment in which I'm about to send one patient upstairs (saying, "I don't really know this patient") and discharging one and hearing, "that one just got here and I haven't even been able to get started."
We don't like those situations but neither do we create them.
I understand. That is why I said that I realize it is out of your control.
This is another conversation that brings up how pressured we all are are working in hospitals. Too much on all sides. Doctor's too!
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azhiker96, BSN, RN
1,130 Posts
With burn patients I seem to have a talent for catching the floor nurse in the middle of a shower or dressing change. I just take it in stride and work with them. If they ask for 10 minutes I wait 15 or 20 before I call back. I try to fluff and buff the pt as much as I can; clean gown, drains emptied and charted, labs sent, CT or X-RAY completed, OR fluid removed or put on pump tubing. I'm pretty sure they notice and reward me by usually taking report or the charge sometimes takes it for them. Rarely do I get pushed back a second time and sometimes the nurse calls us for report.
As someone else said, we are all in this together. Everything I can do to help the floor or unit nurse pays off in goodwill. Btw, I love some of the ICU nurses at my work. When I call they have already read the chart and know my patient almost as well as I do.