Ditto what softballmama said.
gotta say, I don't think any place is busier than the ER (as busy as, in some cases, but not busier)
As a floor nurse, you don't have to care for pts in the hallways that double or even triple your workload. Once your rooms are filled, that's it. If we can't get the pt upstairs, we still get additional pts, only the new ones are treated in the hallways instead of rooms. Last week, I simultaneously took care of 3 vented pts in my rooms, while in my hallway I had a subdural bleed waiting for ICU placement and a sepsis with a pressure of 60 in my other hall.
The ER nurses have no control over when a bed is rec'd. (at least at my hospital) The doc admits, an admission coordinator finds a bed, and then we wait. The beds are invariably given to us to call report on about 1/2 an hour before shift change. It's amazing to us in the ER how all of a sudden at shift change we're flooded with beds. We are pressured to have the pt out of the ER within 15 minutes of receiving the bed to make room for those still waiting in the lobby or rolling in the doors via EMS.
Once a pt gets to your floor, do you need to immediately start a line, draw labs, do an EKG, hook up to monitor, give stat meds/IVF/treatments, assess and determine acuity on EVERY single pt? Well, i do have to do this on every pt that I see. By the time the pt gets to the floor, they are, in general, stabilized with all the aforementioned already done. Even the dreaded 5 page admission assessment is done by admission nurses down in the ER. If the pt waits more than 2 hours for a bed after being admitted, then we call the admitting and get floor orders, so on most pts, that's done too. Yet I still constantly get the run around when I'm trying to call report and get the pt upstairs.
It's not that we want to get the pt out of our face, but when a pt who has been out in the hallway for 24 hours on one of those horrible stretchers, or we've got a MRSA in the same room with someone who doesn't, or when an intubated pt has been in the ER so long that he's been extubated and downgraded from ICU- yeah, we get frustrated-the pt needs to go.
I don't mean to offend any one or make it sound like I think the ER is always right- but this is going to be a sore topic for a lot- and it's something that's always going to be a problem for both sides. I should also add that I rarely ever have problems with the ICUs- they take report quickly and we take the pt right up. The unit nurses are also great when we're holding ICU pts forever and have to start following their unit protocols (another long vent), they'll answer questions and even come down to the ER (gasp! always a shocker to see a non ER nurse in our area) to help.