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ER dropping the ball?

Nurses   (51,244 Views 265 Comments)
by Birdy2 Birdy2 (Member) Member

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You are reading page 18 of ER dropping the ball?. If you want to start from the beginning Go to First Page.

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I get needing to vent after a crappy day but it's probably not going to earn you much sympathy to make a provocatively titled post about emerg nurses. As others have said, context is critical and you don't know what exactly was going on in the ED (or in the ICU) at this time. If this patient was really better suited to be in the ICU, call a rapid response, talk with your manager, and advocate for a timely transfer. Then write up an incident report if you felt important information was being help from you or pertinent care not provided in the ED.

However, in order for patients to qualify for the ICU now (at least where I work) they generally have to be intubated, in need of invasive monitoring, on multiple pressors, etc. This patient sounded unstable for sure. But was he so unstable that he necessitated a critical care bed?

Have I ever had an inappropriate patient sent up to my floor from the ED? Yep! Does it suck? Yep! But I know that we have "dropped the ball" at times too. At the end of the day, we are human and will make mistakes. We are all doing the best that we can and can only do so much. If there is a repeated pattern of things being missed or inappropriate patients being sent up to the floor, talk to your manager. If there are workload issues and your patient load is too heavy, talk to your manager. Hopefully your patient had a good outcome!

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Birdy2,

Something tells me that this thread has been a bit of an eye opener for you. I hope that you have been able to glean something of value from this. We could all stand to be more empathetic in our attitudes and speech concerning our fellow brothers and sisters in nursing. In so many posts describing our differences, maybe we can focus on some things that are true across the board. We all worked very, very hard to get through nursing school, to pass our boards and to become certified in our specialties (as applicable). Our jobs can be thankless at times and then you come across a patient or family that touches your heart and reminds you why you are here. Amidst all the demands and stress you are under please know that you are not alone. Though we are in different departments and under different circumstances we are ultimately here for the same reason, the patient. Because without the patient we would have no one to care for and be out of a job. I am so grateful to have my job as a nurse, it teaches me a lot about people and a lot about myself. Keep your head up Birdy2 because I understand your frustration. I worked the floors and then I went to the ER and had a lot more understanding. We are not all out to get you or to trip you up. Case in point, I had a hypertensive patient in the 230's systolic who we gave three or four rounds of medication which did bring the pressure down but would climb back up. After speaking with the emergency room physician several times and he to the admitting physician, I was told to place a patch and give po meds and send upstairs. I already knew the med surg nurse's response would be one of panic. Even after explaining the situation to my charge nurse so she would be aware of any potential fallout, I called the floor and gave report. As expected a small shrill of panic filled the other end of the line. I ensured the nurse that all parties were aware, the ER doctor, my charge nurse and most importantly the admitting doctor. In this instance it could be construed as an ER dump, but taken in context I have advocated for our patient. But I highlighted this information to the receiving nurse more than once. I documented well and sent a patient with a pressure of 200 systolic upstairs. I am sure some will have something to say about that, but it was done with all parties involved being made aware of the situation. So again I encorage you and you never know after all this you might float down to the ER and fall in love like I did. Happy nursing!

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bgxyrnf has 10 years experience as a MSN, RN and specializes in Med-Tele; ED; ICU.

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If they don't follow commands then they don't score a 6 on the motor section of GCS, but they would fall between 1 and 5. If they have absolutely no response, for instance if they still under paralytics, then they still get a score of 1. There is no patient that can't be given a GCS score.
The GCS doesn't apply to a patient under the effects of paralytics... it's simply not valid. The patient isn't in any stage of a "coma," they're medically paralyzed.

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The GCS doesn't apply to a patient under the effects of paralytics... it's simply not valid. The patient isn't in any stage of a "coma," they're medically paralyzed.

Yeah, I'm in the camp of thinking making a big deal out this in report is ridiculous. One of the FIRST things we're going to do after we get the patient in the ICU is our own assessment. We know if they are freshly intubated, they are potentially paralyzed and snowed completely. Ask the question if you like, but what's the point of trying to insinuate the ER nurse is an idiot for having different priorities?

This just sounds like a pissing contest to me.

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emtb2rn has 21 years experience as a BSN, RN, EMT-B and specializes in Emergency.

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Umm... I feel the need to point out that as ICU nurses we get coding patients as admissions ALL THE TIME...

What the heck are you talking about?

Quite often a coding pt will arrive in the ed with a io as the only access, difficult airway so not tubed, and the pt's hx is "witnessed collapse, that's all we know".

And that's with medics. We also get the call, "cpr in progress, 5 minutes out, no medics".

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Libby liberal - perhaps you are the one who needs to venture iutside your department. I have been a nurse for 20 years. I have worked Med Surg, Step down, SICU, CVICU and CathLab. However, I have called the ED home for over 15 years. I have witnessed crappy nurses in all of those departments. But for the most part, luckily, I have met amazing nurses and techs who do amazing work with tight resources. just as on your floor, Nurses in the ED do not make the rules but must work within the confines of them. We cannot go on divert. That call comes from above. We can suggest it until we are blue in the face, but ultimately admin will decide what level of unsafe they are willing to take us to. Additionally, we cannot 'send' patients 'somewhere else'. That's called an EMTALA violation. Look it up. It costs the hospital $50,000/event to 'send them somewhere else'. If you are referring to transfer after stabilization, we must get an accepting MD first. Chances are that if our hospital is tight with beds other hospitals in the area are too and cannot accept a transfer. As far as ED holds - never a good idea - having holds decreases further the ability of the ED to take in new pts. Those hold frequently get shifted to hallways because of critical pts that are continuing to come in and need stabilization. Nursing has it hard enough without people like you who are all to quick to point a finger and put someone else down in a attempt to elevate themselves. I suggest you either find a new career of find a way to be a team player and realize that nursing is a 24 hour job.

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Birdy - do you think the pt antics you describe only happen on your floor? Is it perhaps within your mental capacity to think that all of that also happens in the ED? Or on other units? The reason we will sit on hold is because 9 times outta 10 we have a charge nurse breathing down our necks to get the pt up to the floor, where they belong, so that the medic that is waiting can off load the next pt and get back in service.

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BellionRN has 7 years experience and specializes in Critical Care.

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Tired & read a post incorrectly! Apologies.

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All comes down to focused assessment vs. head to toe. ER is focused on chief complaint. Did you go to nursing school? Good, then you can replace your own IV per hospital policy. If an order is missed, then that is on that nurse, not ALL ER nurses!

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Emergency RN has 30 years experience and specializes in ED, CTSurg, IVTeam, Oncology.

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To make a long story short:

ED = confusion, down and dirty, stabilize and get 'em up alive, move on to the next victim.

ICU = figure out what's REALLY going on, fine tune, start the road to recovery

MED-SURG = heal, educate, rehabilitate, release.

It's a nursing continuum and one needs to remember that. After 30 years of hospital service in both Emergency and Intensive Care arenas, I won't belabor the point. But IMHO, I think that all ICU nurses should have an annual mandatory rotation in the ED and vice versa. The lack of appreciation for the clinical needs and differences of each setting is what drives this perpetual misunderstanding and my personal belief is that management seriously needs to look into providing a solution. However, one final note. If the confusion in the ED rises to the point that patient contacts are so haphazard that it OVERLY impacts patient care, then staffing is generally at issue.

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You seem extremely jaded- there is no I or you in nursing, we are a TEAM. I am sorry you aren't a team player and feel the need to be hateful to others. I make every effort to correct issues that I believe are harmful to my hospital and my department- not every issue is the end of the world and not every issue needs to be addressed. I work with a team though- not against other nurses. Perhaps you should try that and maybe you won't have so many issues.

Dumbness coming at you; slaphappy, overly tired here or something; There is an I and a U in Nursing, But there is no TEAM!!!!! ROFLMBO!!!!!!

OK, now we've all had a good laugh, I hope.

What I see is that nurses are simply expected to take care of too many patients in both ER and M/S, probably all units.

Things will never get better if we don't stand up, united, and force needed change re: staffing.

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