ER Nurses Treated Different in my Hospital!

UM Review RN, ASN, RN · Sep 4, 2005

Any tips or suggestions from those of you that have been doing this for a long time on how to keep the peace between departments?

Actually, I have found quite the opposite treatment. I find that the ER nurses tend to treat floor nurses like medical wimps because we cannot do what the ER does (nor do we want to). We get treated like we're stupid or we're not fast enough, or that we're slackers who don't want to work.

The truth is, floor nurses do not have the resources to deal with patients crashing all over the place. We don't have the staff. We don't have a doc to give stat orders. We don't have the best access to medications and tests, compared to the ER. For instance, many ER patients are prescribed a stat dose of Rocephin. Guess what, I can't pull that from the Pyxis, only ER can.

As a floor nurse, I can tell you that it's very scary and dangerous to have a patient crashing and in the midst of that drama, Admissions calls for another room. It's like they're oblivious to the situation. This happened to me the other night. I was in a situation in which I had just gotten instructions to transport a patient to ICU, and the phone call that came as we were pushing that patient's bed up the hallway was for the next admission. I was the only ACLS nurse on the floor and I was the only nurse who could safely transport that patient.

Only one thing truly bugs the heck out of us:

We don't like it that the ER will hold onto patients until their staffing is assured, then ship them almost simultaneously to the floor at shift change. So we get 3, 4, 5 patients in a row who were sitting in the ED for 9, 10, 12 hours.

This is in addition to having a full load of patients.

We have to ask why those patients couldn't have come up in such a way that we would actually be able to finish one patient's admit paperwork before going onto the next.

In the ER, you have a triage nurse who will only let patients in when you are ready for them. Too many patients, not enough staff, and the ER goes to diversion. But we on the floors have no such thing. If we're backed up to the hilt, if every nurse has already taken an admit or two and we're scrambling to get stat meds out and get patients admitted, it doesn't matter--our arguments about safety fall on deaf ears. Our licenses and our patients' lives are in jeopardy at that point and instead of solving the problem, we're treated like we are the problem.

So please don't take it personally; we know you don't make the rules. But please do try to understand that floor nurses have a very different modus operandi than the ER.

Cali Nurse · Sep 4, 2005

OK, you obviously have some misconceptions about how the ER works. First of all, we do not sit on pts and ship them all up to the floor at once just to piss off the floor. We cannot send the pts up until we have admit orders, and sometimes the consulting physicans are the ones who decide to hold on to all the pts and dump off all the admit orders for 3 or 4 pts at once. So then we scramble to get the pts out, and yes some of them have been there for hours, and that is because we have been doing all the stat orders that you cannot do upstairs. We've been taking the pt's to CT, xray, giving meds, rushing around to get all that stuff done. I think you are envisioning the ER as a place where we have the TIME to sit around. No, we are trying to get the pts to the appropriate care areas so we can take care of the next EMERGENCY in the waiting room.

The traige nurse does not "wait" until we are "ready" for the next pt. Most of the time I'm coming back from the floor or just finished cleaning the empty room and it's already filled.

I really have to wonder at the lack of understanding that is out there. I started out on med/surg for 2 years and I don't remember thinking that the nurses in the ER were in any way responsible for the amount of admissions that we got on the floor. If you are not adequately staffed, that is not the ER's fault. Everyone has staffing issues, and the ER is not excluded from that. We need to work together here. I know that if a nurse on the floor asks for an extra amount of time and I am able to help them out, I do. But that is not always possible and should be appreciated when it is.

Actually, I have found quite the opposite treatment. I find that the ER nurses tend to treat floor nurses like medical wimps because we cannot do what the ER does (nor do we want to). We get treated like we're stupid or we're not fast enough, or that we're slackers who don't want to work.
The truth is, floor nurses do not have the resources to deal with patients crashing all over the place. We don't have the staff. We don't have a doc to give stat orders. We don't have the best access to medications and tests, compared to the ER. For instance, many ER patients are prescribed a stat dose of Rocephin. Guess what, I can't pull that from the Pyxis, only ER can.
As a floor nurse, I can tell you that it's very scary and dangerous to have a patient crashing and in the midst of that drama, Admissions calls for another room. It's like they're oblivious to the situation. This happened to me the other night. I was in a situation in which I had just gotten instructions to transport a patient to ICU, and the phone call that came as we were pushing that patient's bed up the hallway was for the next admission. I was the only ACLS nurse on the floor and I was the only nurse who could safely transport that patient.
Only one thing truly bugs the heck out of us:
We don't like it that the ER will hold onto patients until their staffing is assured, then ship them almost simultaneously to the floor at shift change. So we get 3, 4, 5 patients in a row who were sitting in the ED for 9, 10, 12 hours.
This is in addition to having a full load of patients.
We have to ask why those patients couldn't have come up in such a way that we would actually be able to finish one patient's admit paperwork before going onto the next.
In the ER, you have a triage nurse who will only let patients in when you are ready for them. Too many patients, not enough staff, and the ER goes to diversion. But we on the floors have no such thing. If we're backed up to the hilt, if every nurse has already taken an admit or two and we're scrambling to get stat meds out and get patients admitted, it doesn't matter--our arguments about safety fall on deaf ears. Our licenses and our patients' lives are in jeopardy at that point and instead of solving the problem, we're treated like we are the problem.
So please don't take it personally; we know you don't make the rules. But please do try to understand that floor nurses have a very different modus operandi than the ER.

Luv2BAnurse · Sep 4, 2005

OK, you obviously have some misconceptions about how the ER works. First of all, we do not sit on pts and ship them all up to the floor at once just to piss off the floor. We cannot send the pts up until we have admit orders, and sometimes the consulting physicans are the ones who decide to hold on to all the pts and dump off all the admit orders for 3 or 4 pts at once. So then we scramble to get the pts out, and yes some of them have been there for hours, and that is because we have been doing all the stat orders that you cannot do upstairs. We've been taking the pt's to CT, xray, giving meds, rushing around to get all that stuff done. I think you are envisioning the ER as a place where we have the TIME to sit around. No, we are trying to get the pts to the appropriate care areas so we can take care of the next EMERGENCY in the waiting room.
The traige nurse does not "wait" until we are "ready" for the next pt. Most of the time I'm coming back from the floor or just finished cleaning the empty room and it's already filled.
I really have to wonder at the lack of understanding that is out there. I started out on med/surg for 2 years and I don't remember thinking that the nurses in the ER were in any way responsible for the amount of admissions that we got on the floor. If you are not adequately staffed, that is not the ER's fault. Everyone has staffing issues, and the ER is not excluded from that. We need to work together here. I know that if a nurse on the floor asks for an extra amount of time and I am able to help them out, I do. But that is not always possible and should be appreciated when it is.

I've been on both sides of that coin. But this [argument] can be compared to the nurse/cna argument. Who does more work? Neither. It all seems to boil down to money, imho. More work is expected of everyone so that we all feel we are over worked, therefore thinking that the other floor, ER, OR, or whomever....has the easier load, because how on Earth can they possibly be working harder than we? I mean, goodness gracious, we can't even take a break! Thing is, we all work hard and simply may have different tasks to do. Just be courteous to different departments, and do your best.

Jen2 · Sep 4, 2005

Actually, I have found quite the opposite treatment. I find that the ER nurses tend to treat floor nurses like medical wimps because we cannot do what the ER does (nor do we want to). We get treated like we're stupid or we're not fast enough, or that we're slackers who don't want to work.
The truth is, floor nurses do not have the resources to deal with patients crashing all over the place. We don't have the staff. We don't have a doc to give stat orders. We don't have the best access to medications and tests, compared to the ER. For instance, many ER patients are prescribed a stat dose of Rocephin. Guess what, I can't pull that from the Pyxis, only ER can.
As a floor nurse, I can tell you that it's very scary and dangerous to have a patient crashing and in the midst of that drama, Admissions calls for another room. It's like they're oblivious to the situation. This happened to me the other night. I was in a situation in which I had just gotten instructions to transport a patient to ICU, and the phone call that came as we were pushing that patient's bed up the hallway was for the next admission. I was the only ACLS nurse on the floor and I was the only nurse who could safely transport that patient.
Only one thing truly bugs the heck out of us:
We don't like it that the ER will hold onto patients until their staffing is assured, then ship them almost simultaneously to the floor at shift change. So we get 3, 4, 5 patients in a row who were sitting in the ED for 9, 10, 12 hours.
This is in addition to having a full load of patients.
We have to ask why those patients couldn't have come up in such a way that we would actually be able to finish one patient's admit paperwork before going onto the next.
In the ER, you have a triage nurse who will only let patients in when you are ready for them. Too many patients, not enough staff, and the ER goes to diversion. But we on the floors have no such thing. If we're backed up to the hilt, if every nurse has already taken an admit or two and we're scrambling to get stat meds out and get patients admitted, it doesn't matter--our arguments about safety fall on deaf ears. Our licenses and our patients' lives are in jeopardy at that point and instead of solving the problem, we're treated like we are the problem.
So please don't take it personally; we know you don't make the rules. But please do try to understand that floor nurses have a very different modus operandi than the ER.
__________________

I did not start this thread to be a debate. I was just wondered why different specialty areas are treated so differently sometimes and I came to the conclusion that it is ignorance. I can't send a patient upstairs until I get a bed. I cannot get a bed until the doctor puts in a request. I don't have a doctor just giving me stat orders all the time, but I do have protocall orders that I must follow before the doctor even sees the patient. The other day I had a chest pain and the EKG, CXR, and first set of isos were on that patients chart before the doctor even got into the room. No our triage nurse does not hold onto patients until I am ready. Guess what? I don't have rooms or beds that are full and can deny patients because the bed is full or the room needs cleaned, i have cleaned many rooms my self in order to get a patient seen quicker. I have the hallway, the waiting room, as well as the ambulances that keep on rolling in. I know that it is and can be an inconvenience, but I cannot just say I'll take the intubated trauma comming in 30 minutes when they have a 10 minute ETA. I don't mean to debate or argue, I just feel that the whole reason for all of theis is ignorance and not actually understanding what each other does.

hrtprncss · Sep 4, 2005

Only one thing truly bugs the heck out of us:
We don't like it that the ER will hold onto patients until their staffing is assured, then ship them almost simultaneously to the floor at shift change. So we get 3, 4, 5 patients in a row who were sitting in the ED for 9, 10, 12 hours.
mmmhhmm i second that and i'm a unit nurse. for some reason admits flux in around 630 to 700pm that's why we have instituted a rule not to take er admits between sixthirty and seven thirty, and for some reason they do come, where only responsible for monitoring the patient and not doing the full admit.

Aneroo, LPN · Sep 4, 2005

I was just pondering this a bit ago.

I've been fussed out by some nurses in the ER (my co-workers!) because I am "nice" and don't want to take a patient upstairs at 1905. I realize they are in shift change. I have been guilty of calling report during shift change. I'm usually slammed, can't fill out my fax report sheet, and my charge nurse will come ride my ass until report is called. At least after I call report, I can say "I'm tying up loose ends" if she tries to ride my butt then.

I TRY and get some of the orders completed before going upstairs. If we're waiting on a bed, and have faxed down the pharmacy orders sheet and get the meds, we'll give them. I TRY and get my blood cultures or labs that need to be finished, but sometimes it's just not realistic. We're not all out to screw floor nurses over.

However, when I get upstairs and need to move my patient to the bed, this is when I get irritated. The floor nurses catch an attitude with me sometimes for no obvious reason. I'm pregnant for goodness sakes, I'm not gonna pull this 300 pound lady by myself! My preceptor and I moved a patient to her bed, changed her into a gown, and got the dirty linens out from under her- we didn't even receive a thank you. That shoots our "nice" spirit down, and we were very tempted to go ahead and send this floor nurse her next patient right away (we didn't, we're too "nice").

I think some of it stems from some of the nurses in both departments who just aren't NICE! Personalities rub the wrong way, people talk about other people during free time, and judgements (unfair ones) are made. I remember nursing school and being on those floors- I hated it, wouldn't care to do that job. Major props to those who do!

The only thing we can do about it is to TRY and understand what that other nurse might be going thru, appreciate the fact they're probably working just as hard as you, and smile through it. -Andrea

UM Review RN, ASN, RN · Sep 4, 2005

That shoots our "nice" spirit down, and we were very tempted to go ahead and send this floor nurse her next patient right away (we didn't, we're too "nice").

See, to me it has a lot to do with safety to the patients involved. Those lil head games might seem OK to you but to me they're not safe. Has nothing to do with "nice."

Thanks for unwittingly supporting my view, by the way.

hrtprncss · Sep 4, 2005

this thread can go on forever....icu/floor nurses vs er nurses...and you'll hear arguments from both sides but being an icu nurse, i agree on all the points that was said by angie they're pretty much true on most cases

UM Review RN, ASN, RN · Sep 4, 2005

No, we are trying to get the pts to the appropriate care areas so we can take care of the next EMERGENCY in the waiting room.

Perfect example of the disrespectful attitude we floor nurses get, Cali nurse. The way you say this, it sounds like only ER nurses have emergencies.

Once again, it sounds an awful lot to us floor nurses like you neither understand nor appreciate what we do, nor do you understand how the various floors work.

I am all for having an exchange program to see how different units work, and please let it be known, I DO respect ER nurses. But we have some issues that we could be working out.

It's too universal a problem to pretend it's not there.

UM Review RN, ASN, RN · Sep 4, 2005

I have taken many classes at this facility and on several instances have had the instructor say things like, "Oh we have an ER nurse in here I'll have to watch what I say." When I took my PALS class it was taught by the PICU nurses and when I went in for my megacode the instructor said, "OK Mrs. ER nurse lets see how you deal with this one." He made me run the megacode for at least 35-40 minutes and tried everything in his power to stump me, and didn't stop until he did.

And Jen, this was a really rotten thing to do. It's happened to me to in classrooms at times. I finally decided that those kinds of instructors really don't know their stuff after all, otherwise they'd get that big chip off their shoulders and teach the class.

William_SRNA · Sep 4, 2005

When I worked ER we tried to get all the patients up as quickly as possible. Mainly because the pizza was getting cold, beer was getting hot and the football game was on TV.