CockyICU,CockyER

military girl · Aug 7, 2004

I have been a RN for three years. My first year I did ER, Stepdown and Med/Surg. I felt that I needed a taste of all three areas.

Having worked 5 years as a LPN and 8 months as a RN in the ER, I totally have sympathy for the floors. When I was a new RN and working in the ER, the floors were swamped and sometimes asked if we could sit on a patient for 1/2 hour(if they were in report). That was fine as long as we had beds available in the ER, but most times, I had to call back to the floor and tell them they neede to take the patient. The ER is never empty, and we don't have control who comes in the back door. I did try to make things easier for the floors such as starting blood or IVs if I had time to do it. And yes, some of the med/surg nurses asked questions that didn't need to be answered. If I didn't have orders from the admitting doctor, sometimes that was a problem for them, but hey,if the doc wants to call orders to the floor, that's their decision.

As far as ICU nurses, the ones that I worked with were very high speed. But they never complained about dirty patients or having to do something beneath them. You have to remember, they are taking care of high acuity patients, so if they seem a little rude, don't hold it against them.

As nurses, we need to stick together. People are getting sicker and sicker and we need nurses more than ever. Stop fighting and come together for the sake of the profession.

I've recently had a discussion with a few nurses from the med-surg unit at my place of employment. They were grumbling over the way an ICU nurse handled an emergent transfer from their floor. Apparently, the ICU nurse was disrespectful, arrogant, and pretentious....making the whole transfer a big issue (could've gone a lot smoother if cooler heads were involved). Anyway, i'll spare the details.
So as i'm listening to their complaints, one speaks up and says "...it was worse than dealing with ER..." When i pressed the issue, it came to light that the majority of nurses on this floor have bad/negative things to say about dealing with ER as well..primarily concerning untimely admissions and poor reports.
This apparent lack of comradeiry(sp?)/cohesiveness is obviously detrimental to a healthcare 'team' approach, morale, and of course can impact patient care (insert cuss-word).
Is this an isolated problem, or do you sense similar issues at your place of employment? If so, who comes off as being harder to deal with..ER, or ICU?
(just curious). Any suggestions as to how to remedy the situation?? Or is this something we just have to live with..?

trauma dog · Aug 8, 2004

I couldn't help but to reply to this one, as an ER nurse who tries to especially nice to staff of other floors (trying to convince them that they really should come cross-train with us) because of a mass casualty that nurses hospital wide responded to on and off shift and really saved several lives.

OK, that said, first, not to bash RNPATL because I don't know the whole story, BUT, why would you not want to contact the physician for new-onset a fib, even if it is only paroxysmal. Wouldn't this patient need to be started on blood thinners and possibly diltiazem. It would be nice to know a big ol' blood clot isn't sitting there in the atria waiting to go on a fatal journey. oh, say to the lungs or brain.

Secondly, here is a soap box of mine. I really really really hate when I call report to M/S floor, the nurse accepts report, and when we transport the patient to the floor, guess what, not only is the room not ready, there isn't even a bed in the room for the patient. When I approach the nurse about it I am told, "there may be a bed down the hall in 343b, but you"ll have to move it", now not only are we taking up extra time to do what I feel should have been already done, 2 staff members, a nurse and tech, are tied up doing a floor job when an ER full of patients are waiting and my patient is spending way too much time in a busy hallway often off the monitor. If the nurse had just said, "that room isn't ready just yet, if you'll wait till I call you back when it is, I get right to getting it ready", is that asking too much for my patients?

RNPATL, DNP, RN · Aug 8, 2004

OK, that said, first, not to bash RNPATL because I don't know the whole story, BUT, why would you not want to contact the physician for new-onset a fib, even if it is only paroxysmal. Wouldn't this patient need to be started on blood thinners and possibly diltiazem. It would be nice to know a big ol' blood clot isn't sitting there in the atria waiting to go on a fatal journey. oh, say to the lungs or brain.

He was already on blood thinners, but your point is certainly well accepted and I would have agreed.

moia · Aug 8, 2004

I am a CVICU nurse and thank god I work nights because I remember when I had my orientation transferring patients to the floor. Every time I couldn't find a nurse, we had NO help getting the patient from our bed to the new bed...when the nurse finally showed up all I got was attitude . Nothing in the room was ready..no suction for chest tubes no IV pump...they got report but obviously made no effort to listen to it.

They were always deeply resentful on each new admission and it made me crazy.

The floor we use is a specialized stepdown used only for our unit...what did they expect when they took the job?

I worked trauma and ER made us crazy...I cannot tell you how many times a patient just showed up with no phone call at all.....this was the residents fault though not the nursing staff...the residents would freak out and say they could do more in the ICU and bam..there they were rolling in the door yelling for a central line and an art line...we scrambled...the Er nurses would never apologize though...I still think someone could have called that they were on the way...lack of communication is what makes me crazy.

Transferring a patient to an empty room with no nurse is just about the worse thing that can happen...it freaks the patient out...more than once I have had patients ask to go back to the ICU. It's also really disrespectful...I have another patient and a new OR on the way..I can't waste my time looking for a nurse and suction and a bed and a proper oxygen connecter and then repeating the report I just gave over the phone.

I work nights now and the floor actively lies there a** off when I call to see how many beds they have for morning transfers...I have to call the supervisor to find out they have 10 open beds..then they start with the understaffing...well..they have new grads and agency....tons of nurses but they are too inexperienced to handle normal transfers...most of these people are self care patients for goodness sake...it's excuse after excuse...they never think that they are preventing someone from having open heart surgery...if there are no beds available surgeries get cancelled...and how do you tell a patient who has been waiting 2 months they have to go home because the floor nurses are feeling a little too inexperienced today to look after anyone?

We have addressed it with their manager and their educator and their 2 nurse practitioners...four extra nurses on shift everyday but still they can't take any transfers.

But ofcourse in the middle of the night when one of their patients needs a little extra care....like having to check their sugar every hour after someone gave way too much insulin..get them to the ICU!!!! and we have to scramble doubling and tripling patients and crossing our fingers no one crashes..and the fight to get this patient back to the floor? epic...

The floor is staffed for a patient ratio of 1:4, resource has no assignment..80% of the patients are self care ..they have 4 support RNs on dayswith no patient assignments for all chest tubes and resp issues and they have an assigned physiotherapist for only their floor every day...physio gets everyone up and walking.......

This is paradise when I see how illused and overworked the regular med floor is treated..the surgical floor is a little better but not much...they work like dogs...sometimes I wish I could haul our stepdown nurses into the unit for alittle tour of terror close up and then hand them off to the medsurg floor nurses for a little lesson on team building,organization and a sense of humour.

I have seen this attitude in two of the three of hospitals I have worked at...the third was great because they had to come to the unit for orientation for 3 weeks they worked beside us and knew why they had to hold up their end..we were all a giant team..alot like a little factory..and if the line stopped moving anywhere it was a disaster.

I have seen arrogance everywhere..I don't mind it at all...these people are really good at what they do..it's attitude I can't stand .

bluesky, BSN, RN · Aug 8, 2004

Listen, teamwork is about all parties thinking about what they can do to improve a relationship- it takes two to tango, as they say. But if you look at even the title of this thread..."cockyICU, cockyER", you are clearly pointing the finger at critical care nurses in just the same bashing way as you are accusing them of behaving in the first place. My rule in life has always been to treat people with respect and concern until they've been mean to me 3 times. After that, I definitely need therapeutic interventions! :rotfl:

zenman · Aug 8, 2004

1. Have a pool of nurses (that are paid extra) rotate though Med/Surg, ED, ICU, telly...at least a month per year in each unit. A knowledge of what the others do helps...sometimes.

2. If the floor is not ready after they have accepted the patient, providing no emergency has happened, park the patient in front of the nurses station and explain to the patient that "these nice nurses will be taking care of you now."

3. Document everything. Nothing can be done if it is not written up. Hopefully, it becomes a part of the nurses evaluation and can affect their pay raise.

4. Hopefully, the supervisor helps, particularly when the floor is stalling. I even help bring patients up from the ED sometimes so I can get a taste of how the floor receives the patient. But, I also have no trouble documenting that a particular ED nurse has had too many patients arrive on the floor soaked with urine from shoulders to toes. Unit managers also have a responsibility for their staff. Any documentation I do goes to the DON and the unit manager. There are always checks and balances; the unit managers are evalulated on their performance also.

5. As a supervisor, I try to keep the peace between units and I do like to remind people that they should have picked up a clue during nursing school as to what it was going to be like. :roll

6. An admissions nurse has worked out well at the places that have had one...at least where I've been.

And remember...all this crap was going on 30 years ago when I started...how's that for some hope!! :uhoh3:

angel337, MSN, RN · Aug 8, 2004

I had to chuckle at that one. From an ER perspective, let me see if I can make myself clear. When a floor gets full, they can take no more patients, when the ICU gets full they can take no more patients. The ER never gets full. It is the only department in the hospital that seems to have an accordian effect, it just gets more and more full, more and more backed up because you can not stop the flow of patients. We may be able to divert ambulances for a while if things get really bad, but you can do nothing about the walk-ins. Even if we are on ambulance divert, they can over ride and bring us critical patients. One of the hardest things about ER is not being able to get patients to the floor/OR/ICU whatever quickly to make room for the next disaster. We try not to have patients out in the hall, but unfortunately, it happens. I have had to treat an MI patient in a chair on a portable monitor because we were out of stretchers at the time. I can't tell you how many times we will do an EKG, IV and labs in triage and hope it does not show anything major. Many times we treat an allergic reaction, asthma, etc. completely in triage because there is no room in the back. One day a few weeks ago, I was treating an allergic reaction with IV fluids and meds, a hyperemesis gravidum with IV fluids on the sofa in the family room, when an OD/drunk teenager comes in off the street, nearly unconscious and no place to take her. All our rooms were full, so I am starting her IV, drawing blood and suctioning vomit while she sits limply in a wheelchair. Sometimes an ambulance will bring us 4-6 patients at a time in case of a bad MVA. So when we finally get a room number and orders on a patient, we are ready to get them out of the ER as quickly as possible. I can't tell you how frustrating it can be when you work your tail off to stablize a patient, have them intubated, foley, large bore IV's, NG tube and blood hanging only to have the ICU nurse, say, "ohhhh, he needs a bath, he has blood on him". AAAGGGKKKKK. Oh well. We all try to do our best, and I do know that the floor nurses are busy and the ICU nurses are busy, but maybe we all need to walk a mile in the other shoes. After 30 years of nursing, I have walked a lot of miles in a lot of shoes. We all need to understand that the patient is the one we are focused on, and work toward the best outcome for them. So if we seem cocky or in a hurry, sorry. But I get asked questions from the floor that we consider irrelevant. Peds wants to know if the kids parents are married, heck I only want to know if he is breathing! OB wants to make sure the patient has a doctor, med-surg wants to know if the patient has a foley and plenty of pain meds ordered, psych wants to know if the patient has insurance, surgery wants to know if the patient is naked and in a hospital gown, telemetry wants to know what the patients last potassium level was....I want to tell them that they can look on the chart just like I can. Oh well, guess that sounds insensitive, better stop. :rotfl:

dixie, you are definitely an ER nurse. i had a day like you described just yesterday. our charge nurse was literally in tears because we had no where to put the numerous codes and possible MI's rolling through the door. i challenge any nurse to work in the ER. i guarantee they will have a different opinion. you could not have summed it up any better.

Ruby Vee, BSN · Aug 8, 2004

ICUs vary and ERs vary. Some ICUs are great and others aren't. Some ERs are great and others aren't. For that matter, some floors work hard and others infuriate you with their lack of interest in patient care! It's unwise to generalize. However . . . .

In my last job, the ER was staffed mostly with nurses who either couldn't hack it in the ICU or didn't want to work as hard as we have to in the ICU. (In some ERs, you get plenty of down time. I know that's not the case for every ER. I've worked in places with great ERs, and I know I couldn't do what their nurses do on a daily basis!) Their shifts changed at 7 and 7 (as did ours) and it's amazing how many patients you heard of at 6:30 that HAD to transfer before 7. They'd been there for hours and hours, and the first you hear of it is at 6:30.

I've been in ICU for over 20 years. I have never, ever asked if a patient had a bath before transfer. I ask if the blood has been drawn (and when) if the chest X ray has been done -- not because I won't take the patient if it hasn't, but so I know whether I need to do it. I ask what service so I know who to call for orders. But if my bed is ready in 30 minutes, I'm looking for that ER patient in 29 minutes and 59 seconds. Even if it's a bogus admit.

In the ICU, we're squeezed between the ER and the step-down. I may not be able to take your ER patient until the step-down unit takes my transfer. And when ER is clamoring for a bed, I'm afraid I'm not very patient with a step-down nurse who tells me that "we can't take that patient until the nurse has had her lunch." (I'd like lunch, too -- but I'm not likely to get it until that ER patient is admitted and settled.) It's funny how that never seems to happen if we have to transfer a patient out in order to get a bounce back from the step-down unit. Lunch isn't as much of an issue for THEM, then, although I still won't get mine.

Thank you for allowing me this opportunity to vent!

mattsmom81 · Aug 8, 2004

Some days in our hectic workload its hard to see things from the other unit's perspective. One big plus to working in lots of areas is I can relate to the other nurses...I've done medsurg and I've done ER so I know where they are coming from.

When another nurse seems a bit short or rude to me, I assume they are having a bad day...and voice this. Often this gets a smile and a sorry, and our conversation goes better. I try hard to be pleasant with coworkers...nurses have things rough the way it is without putting up with rudeness from each other.

Altho at times I too have been amazed how little the ER and/or medsurg nurses know about their patient, (other times I've been impressed how MUCH they have ascertained in a short timeframe) I realize they don't have 2 or 3:1 ratio like I do in ICU... so they and have different priorities in patient care (by necessity).

If there is a blatant negligence issue, or anything majorly amiss....the time of transfer is really not when to discuss it...we must do the best we can then for the patient THEN and sort any problem out later, IMO.

Rude coworkers will be found everywhere unfortunately...just do the best YOU can and don't get sucked in to their problem. I know easier said than done sometimes.

pricklypear · Aug 9, 2004

When I worked on a tele floor, I constantly had problems with ccu nurses being rude and uppity. MICU nurses were always polite and helpful. Don't ask me what was different, except ccu thought they were the most important unit in the hospital, with the most intelligent nurses in the state! When the patient being transferred is one of 12, it's hard to know every single thing about that patient. Most times all I knew was the patient had no BP, having chest pain, resp distress etc... I tried hard to cover as much as I could, but it usually wasn't enough for ccu. They seemed to relish the floor nurse's anxiety. Anyway, when I started working in ICU (different hospital) I swore I would never act that way when receiving a patient from some overworked floor nurse. The only time I get irritated is when I get report that the patient has a BP of 60/20, sats of 70 on a 100% O2 and I get a patient with 120/70, sats 99 on a NC with the O2 at 4 L. I've heard "oh I never checked the BP on THAT arm." :nono: I've also gotten a patient with real sats of 70% who had a NRB mask with the O2 set at 4L. "We aren't allowed to titrate above 4 L without an order" :angryfire I don't see this very often, but unfortunately I do see it. Sometimes information is gathered from CNAs but never followed up on by the nurse. I've even heard of a nurse turning OFF a full face mask bipap (left the mask on the patient) "it was alarming all the time" then panicing when she couldn't figure out why the patient had sats in the 60s! I guess it's all just a matter of give and take. ICU needs to remember that the floor nurses are trying to take care of tons of patients, and the floor nurses need to make sure they have covered all the bases before calling the doc. I have noticed that the nurses in ICU who started there as a new grad have much less patience and empathy for the nurses on the floor than those who have been there, done that.

Farkinott, RN · Aug 9, 2004

Unfortunately the same things happen in the land of Oz. The discussion just goes around and around in circles. This thread is a microcosm of the nursing world! Until people actually start putting their money where their mouth is then the same crap will still pile up!

Rapheal · Aug 9, 2004

There are only about 2 nasty ICU nurses where I work. They have that holier than thou attitude. The rest are great. Some even will start IV meds off the transfer order for you, or make sure the patient is bathed before transfer. :)