Well, once again I've been sent a patient that is just a complete mess and I have no idea what is going on with him. This seems to happen more than a lot lately.
This patient came in because his wife found him on the floor and when he came to he was confused and weak. He had chest pain in the ambulance that was relieved by nitro.
When he got to the ER they did a lumbar puncture, EKG, CT of chest, abd, and head that were all negative except the LP. They were unable to get that because of bone spurs apparently. His vitals were stable, but white count was 23.9 and he had some respiratory acidosis. The man wears oxygen at home due to copd and smoking 3 ppd. He has sleep apnea but will not wear a cpap, so they sent him up on 2L. I ended up having to get him a mask due to him breathing through his mouth and being knocked out cold from morphine he got in the ER.
So anyways, I talk to the wife and she says he has been throwing up every morning and sometimes through out the day for 9 months, also having malaise, fevers, urinary retention, and just not feeling well. Apparently he had been confused more over the last three days. Turns out he had a pretty significant cardiac history with stents and was a recovered alcoholic. There was no mention of this by the ER nurse.
I soike to the MD and she said he was over sedated from meds he takes at home and possibly had gastroenteritis. She said she was going to order a repeat LP for the am.
First of all, I was only told that he came in confused for 3 days and had an elevated white count and unsuccessful LP. The nurse said he had no other tests done, did not mention any of his history other than HTN and COPD, and didn't say anything about fevers or vomiting. Second, he had been in the ED for 12 hours and didn't even have his EMS stick replaced, had no temperatures recorded except right before coming to the floor, and hadn't been given any fluids, just 1 dose of vanc and ceftin.
Im very confused as to how they can get away with not recording vitals. I figured she had only given me his last set because he just got there. She could've given me a range if he'd been there an entire shift already!
I had to call that nurse back when I got the patient to ask why there were orders for fluid boluses and to get the results of tests that she said he had never had. She denied he ever had a fever or that there were orders for a bolus when she had him. She was very rude and acted as if I was overreacting, but the Dr told me the patient needed to be in ICU. There were just no beds. Then the nurse finally said she thought he had meningitis and to just wear a mask. Ugh!
Also, in the doctors h/p it said nothing about any of his symptoms except for chest pain and elevated white count. I'm so confused and probably too exhausted to be thinking about this right now. All I know is this patient is sick and would be better off going somewhere else if the ER doesn't even have a clue what's wrong with him after he's been there for that long.
ICU nurses need to do bedside report in the ED. If they want to whine about interventions, they can do it in a hectic environment. It enables an understanding "of, oh. Your night sucks."
I definitely understand the struggles in the ER but there is still the fact that regardless of how busy it is you must chart, take vitals and give some kind of pertinent report . It does go back to the staffing matrix and admin but while nurses in the ER don't like getting "trashed" likewise the floor nurses don't appreciate it either. Believe me, our eyes are open and assuming we don't understand your struggles is like implying we have a cake walk. It's rough everywhere and most of us have floated everywhere. Bottom line is there are basic nursing tasks that must be completed no matter how busy it is otherwise just skip the ER and send them to the floor.
This is a problem on both sides. At most EDs I work in we have to take our ICU pts up ourselves for bedside report. Great...but who's responsible for my other 4-5 while I'm up there? I usually just ask someone to keep an eye on them but I'm nervous every time I do it.
Specializes in Medsurg/ICU, Mental Health, Home Health.
ICU nurses need to do bedside report in the ED. If they want to whine about interventions, they can do it in a hectic environment. It enables an understanding "of, oh. Your night sucks."
it helps for perspective.
Trust me, it's hectic everywhere...and I think some ED RNs should hang out a bit to see what happens in the ICU after the patient is brought up there. I'm not disagreeing with you, just saying that we all need to see the other side once in a while.
Where I work I was told that all patient information was made inaccessible by anyone except for the ER. Supposedly it used to be available to the floor nurse, so they could look all that up and not have to ask so many questions, but they got mad because we knew certain results already and were asking why certain things hadn't been done.
Specializes in Medsurg/ICU, Mental Health, Home Health.
Where I work I was told that all patient information was made inaccessible by anyone except for the ER. Supposedly it used to be available to the floor nurse, so they could look all that up and not have to ask so many questions, but they got mad because we knew certain results already and were asking why certain things hadn't been done.
It's funny that (with the exception of THAT guy, because he's "that guy") not one ER nurse has returned fire and called the floor nurses names, but the floor nurses have called us just about every name in the book.
What I remember from my EMT days is, to get an IV in ASAP while the veins last, so that the ER nurses do not have to fight depleted veins. I think ER nurses add more PIV's if needed, not change out. Why would you stick a patient unnecessarily to change out a perfectly working IV.
Just an Emergency Department Nurses perspective here…I had a patient come in via EMS and the EMT's were stating they were called for altered mental status with facial droop. No family present. The patient is asphagic, staring straight ahead, able to move the head. The patient is rushed to CT with stroke protocol. Two hours later a family member shows up and states the patient lives in the members home and hasn't spoken or moved purposefully for years. The family member called EMS because the patient wasn't eating or drinking normally for 2 weeks. When the doctor enters the room 30 minutes later the family member states, "oh, my, she couldn't, wasn't breathing quite right this morning". REALLY??? REALLY?? That is the first I'm hearing about that.
This is NOT an isolated case. Stories change all the time from what EMS tells us is the reason they were called to what family tells us to what we tell the doctor is told to us. Then the doctor comes in the room and the patient will tell the doctor a totally different reason(s) for being in the ER. It's very frustrating.
Another thing is, sometimes, we just. don't. know. why. Why are you here? What symptoms are you having right now that made you come in? how long has this really been going on? It's frustrating all around.
I wish we could all view each other as a wholistic team instead of rushing to believe the worst in each other. While I try to give everyone the benefit of the doubt, I have a very hard time with having to attempt to call report three or four times to the floor because the nurse is in a room, off the unit, busy with a patient, at lunch, there is no nurse assigned to the room or whatever.
Having said that, I have been a floor nurse too, and I have taken report on two patients coming from the ER at the same time. I've been promised that they will not come to the floor at the exact same time or within two minutes of each other, only to have that very thing happen, so I feel your frustration.
What you as a floor nurse are not seeing on my end is that while I'm trying to call report for the 2nd or 3rd time, I have three patients, two or all three maybe critically ill, intubated, on diprovan, dopamine, and I have a fourth patient rolling through the ambulance bay in cardiac or respiratory arrest and have no room to put them in because the floor is either legitimately unable to take report or are purposely delaying taking the patient stating the room isn't clean or whatever other reason is given.
We all have very difficult jobs. I CAN NOT be a floor nurse. To say I don't care for floor nursing, would be a gross understatement. I have huge respect for nurses on the floor.
Nine times out of 10, we are not trying to "dump" patients on you, we are making way for the four ambulances coming in and the three already on the wall, while our nurse manager or charge nurse is yelling at us to "move patients now!"
applesxoranges, BSN, RN
2,242 Posts
ICU nurses need to do bedside report in the ED. If they want to whine about interventions, they can do it in a hectic environment. It enables an understanding "of, oh. Your night sucks."
it helps for perspective.