I Have several questions to ask everyone who's been around a lot longer than myself. I just started my nursing career in a level 1 trauma center in a large teaching hospital and as an ER nurse I find a lot of attitiude coming from everyone.
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.
My boyfriend is a floor nurse at the same hospital and we often get into discussions about how much the floor nurses complain about us. I try my best to give the best report I can with the focus assessment that I do. I rarely send up a naked patient after a trauma, and always put the patient in bed, get their tele pack on them, and if the patient is soiled, I clean them up before I take them upstairs, or I'll stay to help that nurse clean them if it happened in the elevator (yes it does happen in the elevator and we can't clean it then).
I try the best I can to establish a good repor with nurses from other units, because I believe that communication is key to patient care between departments. I find that I am always courteouse to nurses from other units. We have a 15 minute rule for getting a patient upstairs after report is called. I find that to be very unrealistic and in most cases if I don't need that room right this second, for a major trauma/MI etc I always tell the nurse to just call me when you are ready for them and I'll bring them up. There has been a few times where I had to enforce the 15 minute rule when we had patients in the hallway, and even then I explained the situation and apologized that I would have to bring them up ASAP due to the MI that was lying in the hallway.
I guess what I am asking is, has anyone else encounterd this? I just feel as soon as someone finds out that I am an ER nurse I am automatically disliked and treated differently. We are all nurses and I just wish we could all try and understand each other and work well together. 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?
WOW. As a former floor nurse, float pool nurse, and now ER i can honestly say that even on a BAD day i never felt like the ER was sitting down there laughing hysterically deviantly planning on how to piss me off by bringing up a patient at shift change. My thoughts are this. If the ER calls report on the patient, and you take it, then that's fair game to bring the patient up. PERIOD. We don't have to wait "our turn" til you get thru with your previous admission, or maybe you are getting another admission so could we hurry up?
I've done the floor thing. And i was the "red headed step child" aka float pool nurse as well. Sometimes i'd get ALL the admissions that day because "i made better $$$ than the regular staff, so i should get all the hard work." Yes that's what they'd say to my face. Did it suck? yes. Was it hard? sometimes. But there were PLENTY of times when i'd get 2 admissions within 10 minutes of each other, and have a patient come back from surgery, etc..etc...
NOW that i'm in ER, i honestly don't look at the clock. I call report when i'm ready to give up my patient. By giving up my patient, that means i've done all the work and here they come. I try to get them up within 15 minutes of report call, most of the time works, but sometimes it doesn't. I do not transfer patients to the bed by myself, regardless of how busy people are. Why? because ITS NOT SAFE and no one is expected to do a one person transfer, so why should i? i only have 1 back and i plan to make mine last. I try to bring up my patients in clean repair, linens clean, clean gown, with a glass of water if possible. Sometimes it doesn't happen. Sometimes things just don't go as planned, and nothing anyone can say will change that. But i know in my ER we don't "sit around" and plan on ways to screw the floor staff. we could care less what the floor staff thinks of us. I honestly think now that i've been on BOTH sides that sometimes the floor staff or unit nurses need to come spend a day with me in my ER. Try to juggle 6 patients, 3 unstable, 1 psychotic, 1 detox and 2 peds that may or may not have parents available. And draw their labs, start their lines, asses and document, trouble shoot, liason for the doc, assist with procedures. Do i think my job is harder? HEAVENS NO. I think each and every aspect of nursing whether its floor nursing, ICU, or ER has its hard days and stressful times. Who are WE as colleagues to second guess each other and point the finger? I can only assume when i call you that you are just as busy as me, and i try to keep the conversation light. I ALWAYS say "hi Jane, this is Dawn in the ER. I'm calling report on Mr. Smith, are you ready" i usually get a heavy sigh and they say "its now or never" and i say "how's it going down there? you guys keepin busy" then they tell me oh yeah or whatever. Then we ease on into report. It usually calms them down just enough to FOCUS on their new patient coming, and usually are so nice afterwards. They say "thanks Dawn, they are going to 308-1. can you wait about 15 minutes tho? i just got another admit and i need just a little more time." if i can i say sure. if not i tell them i can't and why. COMMUNICATION.
But the fact that people still think that ER just sits around waiting to ruin everyone elses day is just BEYOND me.
Sorry, but you misread what I wrote and now you're putting words in my mouth. Maybe you need to go back and read the OP's first post? Or the entire thread?
Because I (and other floor nurses who responded after me) never claimed that you weren't busy; we said we had a problem with sending patients up to the floor at change of shift. I explained why we had a problem with that and what emerged after that was the usual pi**ing contest, instead of enlightenment, understanding, and a possible solution to the problem.
I stand by what I said, politely, firmly, and respectfully:
Sending a bunch of patients up from the ER at change of shift is dangerous, and I don't really care whose "fault" it is, we should all be working together to resolve the issue so that patient well-being is not compromised by overloading all the nurses on a particular unit.
I just got through reading this entire thread from the beginning to the end, and I really feel like crying, or screaming. People, all areas of nursing are difficult, and thankfully we all can find an area that works for us. I have worked med-surg, icu and now work er-7years in er. I usually find when I tell people I work in ER I get nothing but respect, (I choose to forget those that don't react that way, well after I finish sticking pins in their voodoo doll :chuckle I didn't spend over 30 years living in Louisiana for nothing.) I work ER now because I don't want to work the floor, I will wash dishes for a living before I will work the floor again. I am so thankful that some nurses choose to work there, and greatly admire the hard work you do at a very hard job. Of course ER nurses work extremely hard also, but it fits my personality better, so I am able to tolerate the stress I feel there easier than the stress I received on the floor. You know when you walk in the ER doors that most of the patients you see you will only have to dealy with for a limited amount of time. Sometimes that is a good thing, and sometimes disappointing - it sometimes seems the difficult patient never leaves quickly.
At our facility we only have 12 hour shifts and a rule that report cannot be called after 0600, or 1800. Of course there can be exceptions. I have had an icu nurse call at 1830 and say, I can take report on that patient, just have the next shift bring them after 1900. I've also called to give report and had a nurse ask for more time, and I will give it to her if at all possible. Of course some people abuse things, but they eventually get theirs. It's a matter of working together for the benifit of the patient.
TO the OP: The comments you had made during pals weren't hateful, thats just the instructor trying to "bond" with you a little. Each time I do one of those recerts, they always say- OK, so you're the ED nurse- you see the patient in the parking garage...." Let's see how you do outside of the department....Usually I see it that ED and ICU are treated as elite nurses, and Med/Surg sort of as an area for those who couldn't hack ED or ICU...
It's strange.
As far as sending a patient at shift change. I agree it is dangerous. I dislike calling report ot 10:00pm and hearing in the background the nurse saying, "Well, I guess that ED nurse doesn't want me to eat dinner tonight" But I refuse to send a patient up at 6:30 or 7. There is too much going on and the patient might not be assessed by the nurse quickly. And yes, Med/Surg patients are also sick- and could possibly do something strange on the transport and need something else. I've been surprised to read that it isn't policy everywhere.
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
i understand the controversy. in another lifetime i was crrn, a rehab nurse. at that time we were lowest level of the totem pole in the hospital according to some speciality areas. in this lifetime i am the don in a ltc facility, so i can only imagine where my nurses and myself would fit in the hierarchy now...
i think that nursing is just an inconvenient profession.
many nurses are "planners," they want to know what they are doing when they get to work, they make their plan when the get there, and get upset if that plan for the night (or day) changes. it is tough to be flexible when you have such important things to do (meaning taking care of sick people).
planning is so reinforced in nursing school. we do care plans. then we make our "plan for the day" when we get to clinical. and then we have to answer to our instructor why our bath wasn't done by 10 am, like we had planned (pt got in the way).......and the process of getting inconvenienced (and perhaps irritated) when our plans don't work out begins.
unfortunatly, sick people do not always adhere to our plans :) . and it is really difficult to blame them. it is much easier to blame each other.
i have worked both er and icu, and i see both sides of the issue. and the fact is, if facility staffing was better, the er might not be in such a hurry to get those patients out of there, and it might be easier for the nursing units to accept the patient.
it is really tough, when you are in the er, to have patients stacked up in the hall, a packed waiting room, and ambulances lining up outside.
and it is really tough, when you are in the icu, to have two (or three) crashing or unstable patients and the er (or pacu) on the phone telling you they are bringing you another one.
nursing is tough.
we can't take it out on our patients (lets hope), so we take it out on each other. i know that i am guilty of being less-than-friendly to that er nurse that brings me my thrid patient of the night. is it her fault? of course not. but how can i smile and thank her?
jen, the pals instructor was just plain wrong (as angie said). that was inappropriate, and i hope you mentioned it on your eval of the class.
as for the attitude that you get throughout the hospital, all i can say is that you have got to do the "kill them with kindness" thing. it is hard, it really is, to put a big smile on your face and ignore the crappy attitudes. but i think that you will find if you do that, and are as plesant as can be despite the attitude you are getting, you will slowly thaw them out.
i am in a job right now where i am fairly independent. my predecessor had a bit of an elitest attitude -- she expected the chart when she got there, she expected the nurse to drop what she was doing and help her -- and i got a bit of a chilly reception when i first started. but i have worked hard to deveolp a good relationship with the floor nurses and icu nurses, and it has made things much easier for me. it takes time, but it can be done.
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i think that nursing is just an inconvenient profession.
many nurses are "planners," they want to know what they are doing when they get to work, they make their plan when the get there, and get upset if that plan for the night (or day) changes. it is tough to be flexible when you have such important things to do (meaning taking care of sick people).
planning is so reinforced in nursing school. we do care plans. then we make our "plan for the day" when we get to clinical. and then we have to answer to our instructor why our bath wasn't done by 10 am, like we had planned (pt got in the way).......and the process of getting inconvenienced (and perhaps irritated) when our plans don't work out begins.
unfortunatly, sick people do not always adhere to our plans :) . and it is really difficult to blame them. it is much easier to blame each other.
i have worked both er and icu, and i see both sides of the issue. and the fact is, if facility staffing was better, the er might not be in such a hurry to get those patients out of there, and it might be easier for the nursing units to accept the patient.
it is really tough, when you are in the er, to have patients stacked up in the hall, a packed waiting room, and ambulances lining up outside.
and it is really tough, when you are in the icu, to have two (or three) crashing or unstable patients and the er (or pacu) on the phone telling you they are bringing you another one.
nursing is tough.
we can't take it out on our patients (lets hope), so we take it out on each other. i know that i am guilty of being less-than-friendly to that er nurse that brings me my thrid patient of the night. is it her fault? of course not. but how can i smile and thank her?
jen, the pals instructor was just plain wrong (as angie said). that was inappropriate, and i hope you mentioned it on your eval of the class.
as for the attitude that you get throughout the hospital, all i can say is that you have got to do the "kill them with kindness" thing. it is hard, it really is, to put a big smile on your face and ignore the crappy attitudes. but i think that you will find if you do that, and are as plesant as can be despite the attitude you are getting, you will slowly thaw them out.
i am in a job right now where i am fairly independent. my predecessor had a bit of an elitest attitude -- she expected the chart when she got there, she expected the nurse to drop what she was doing and help her -- and i got a bit of a chilly reception when i first started. but i have worked hard to deveolp a good relationship with the floor nurses and icu nurses, and it has made things much easier for me. it takes time, but it can be done.
I worked in a float pool, primarily telemetry, before moving to the ED. My memory of working upstairs is that it required a different skill set than I utilize in the ED, not necessarily a better one, just one more appropriate to that work setting.
In returning to school to pursue a BSN, I ended up making acquaintance with many nurses who work upstairs and voice some of the same frustrations with the ED as Angie O' Plasty and others on this thread have. I don't take offense at this at all (for one thing, I am an ED nurse with the requisite thick skin). Rather, I've had an opportunity to build bridges with some of the folks upstairs. I've been able to listen to their reasons for their frustration and gained a new perspective on how what I do impacts my patient's hospitalization. Likewise, I've had a chance to explain what we're faced with in the ED. And it's made for better experiences for us all when we return to work--it's a lot easier when there's a face to the name you give report to. I've even officially suggested that we implement a kind of "exchange" program where ED nurses and floor nurses can observe the work on each other's unit for a shift to gain an appreciation for the unique challenges presented in each setting. Informally, I go out, not just with my ED co-workers and paramedics, but also with some of the floor and ICU nurses. And beer unites us all.
I don't think there's anything qualitatively different about ED nurses vs. floor nurses vs. ICU nurses that's really worth talking about, except as it applies to an individual who's making a decision about what area best suits their expertise and personality. The "ED nurses are the best/floor nurses suck" stuff just bores and embarrasses me. I'm a more complete and informed nurse for having worked upstairs in the past, and can anticipate some of the things that will make the patient's admission, and consequently their hospitalization, go more smoothly.
As an ER nurse, I think ER nurses are definitely treated differently by other nurses. Many of the skills that ER nurses are required to have are not required for floor nurses. Add to that the capability of an ER nurse in an emergency situation. ER nurses see codes all of the time, so someone going into V tach is just another day at work. Maybe there is an inferiority complex. Are we snobby? Probably a little. But I think it's because of the skills that we have to learn and the wide variety of patients we have to see. We see ALL of the patients going up to every floor, and need to learn to assess and treat everything. I think all nurses should be required to have the same set of skills.
I find it outrageous that some floor nurses cannot put in
IVs or NG tubes or draw labs. Regardless of whether you use the skills, you should know them.
I think that you floor nurses are forgetting a crucial point. Most of the ER nurses were floor nurses before going into the ER. So your categorization is invalid.
Your point about shift change is the pot calling the kettle black. With ER nurses, shift change takes 5 minutes. Then the new nurse takes over where the last nurse left off. If the patient is to go to the floor, the new nurse on usually takes them right away. The name of the game in the ER is to get the room free as soon as possible. It doesn't behoove us to wait around. Our patients are going up to the floor at the time time, regardless of shift change. It's the floors that have the prolonged shift changes with the taped 20 minute reports and dinner breaks at precisely 7 pm. I especially love how the nurses on my tele floor go on break just as they know I'm bringing my patient up.
I firmly believe that people should be cross trained. We are required to be on med surg floors in school. I think we should be required to be in ERs and ICUs as well.
"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."
I'm sorry that you had this experience. I remember from the old days of ACLS having this same problem when I was an ICU nurse. PALS/ACLS/NRP is geared to be a learning experience, with de-emphasis on the 'testing' of the skills learned. Please say something to the coordinator for the program about this instructor - they need remedial education in adult learning concepts...Keep you chin up and glorify that you are in an area of the hospital that has to keep up to date in EVERYTHING - ICU hold + 3 other patients, NO PROBLEM. (Ask an ICU nurse to do what we do and they would crumple...:chuckle
as of leaving my shift tonight in a level 1 trauma, when the trucks would not stop coming through the door, there was a pt who has been down there for 42 hrs., that was 2.5 hr ago when i left. we dont sit on pts. and we dont go on diversion. thats a mythical word where i work.
As an ER nurse, I think ER nurses are definitely treated differently by other nurses. Many of the skills that ER nurses are required to have are not required for floor nurses. Add to that the capability of an ER nurse in an emergency situation. ER nurses see codes all of the time, so someone going into V tach is just another day at work. Maybe there is an inferiority complex. Are we snobby? Probably a little. But I think it's because of the skills that we have to learn and the wide variety of patients we have to see. We see ALL of the patients going up to every floor, and need to learn to assess and treat everything. I think all nurses should be required to have the same set of skills.
I find it outrageous that some floor nurses cannot put in
IVs or NG tubes or draw labs. Regardless of whether you use the skills, you should know them.
I think that you floor nurses are forgetting a crucial point. Most of the ER nurses were floor nurses before going into the ER. So your categorization is invalid.
Your point about shift change is the pot calling the kettle black. With ER nurses, shift change takes 5 minutes. Then the new nurse takes over where the last nurse left off. If the patient is to go to the floor, the new nurse on usually takes them right away. The name of the game in the ER is to get the room free as soon as possible. It doesn't behoove us to wait around. Our patients are going up to the floor at the time time, regardless of shift change. It's the floors that have the prolonged shift changes with the taped 20 minute reports and dinner breaks at precisely 7 pm. I especially love how the nurses on my tele floor go on break just as they know I'm bringing my patient up.
I firmly believe that people should be cross trained. We are required to be on med surg floors in school. I think we should be required to be in ERs and ICUs as well.
iused to speak Spanish fluently. but theni had no one to talk to and i lost the skill. u cant expect a nurse who experiences a code once every year to be able to run it flawless. use it it lose it. how many chemo drugs did u learn about in nursing school? do u know them now? ease up some.
It has been awhile since I replied to this thread (computer problems). The day I posted this thread was a bad day and there has been many good ones since. I still believe the problem stems from staffing and not understanding each other. I think it would be excellent if all hospitals had an exchange program where you did at least one shift on each unit so that we could better understand and help each other, but until then we have this board for discussion.
I have had quite a few floor nurses tell me that they appreciated me getting the patient into bed and applying their tele pack on them or thank me for giving the an extra 30 minutes before bringing the patient up so that they could go to the cafeteria before it closed. I have built a good relationship with many of the floor nurses and we respect each other. There are still the ones that will write up incident reports because I brought a patient up without a gown on them (waaay too much time on their hands), but they are the same ones that think I sit around and do nothing all day so I don't let it bother me.
As far as the PALS instructor goes I saw him in the cafeteria the other day and he asked me how it was going. I told him just fine as long as I didn't have to take his class for another two years. He just laughed and apologozed for the hard time he gave me and stated that he just wanted to make sure that the "people that are seeing the coding kids " know what they are doing. I politely told him that I could understand his point but there are better tactics to use.
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Sorry, but you misread what I wrote and now you're putting words in my mouth. Maybe you need to go back and read the OP's first post? Or the entire thread?
Because I (and other floor nurses who responded after me) never claimed that you weren't busy; we said we had a problem with sending patients up to the floor at change of shift. I explained why we had a problem with that and what emerged after that was the usual pi**ing contest, instead of enlightenment, understanding, and a possible solution to the problem.
I stand by what I said, politely, firmly, and respectfully:
Sending a bunch of patients up from the ER at change of shift is dangerous, and I don't really care whose "fault" it is, we should all be working together to resolve the issue so that patient well-being is not compromised by overloading all the nurses on a particular unit.