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?
Specializes in cardiac/critical care/ informatics.
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.
Does make you wonder, we have the exact same thing happen to us also, but we aren't allowed to say no admits between a certain time.
Specializes in ER, ICU, Infusion, peds, informatics.
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 just really wish we could all try and respect each other. I am in this for the patient and not silly games, I don't have time for that. I have seen both sides and like I said my boyfriend is a charge nurse on nights on a very busy med surge floor and we have this discussion all the time. I think a lot of it just comes from not understanding what each other goes through like the old saying goes until you have walked a mile in those shoes kind of thing.
I can't imagine anyone holding patients in the ED to wait for shift change on purpose. Our goal is to get them where they need to be as stable as they can be as soon as possible. The second I get that bed I am calling report, not to piss anyone off, but to get the patient that has been laying in an uncomfortable room for 6 hours, with no TV, usually no food, and they are ticked for the long wait and they have every right to be. I want to get them upstairs and more comfortable as soon as I can so that I can take care of the next patient that has been setting in the waiting room for 3 hours, no matter what time it is. I will put report in the system during shift change, and call the nurse and let them know that report is in, but I understand that it is shift change and to call me as soon as they are ready.
Most of our hold up stems on the fact that I work for a large teaching hospital and if it's an interesting case, every med student in the hospital wants to come to the ED to see a procedure before the patient can go upstairs. Also say if it's an ortho case and they are being admitted to orthopedics, it may take ortho 2 hours to come down and see the patient.
Maybe if we can try and discuss our feelings it can give us a better understanding of the red tape. I just feel like I am automatically treated differently as soon as someone finds out where I work. Some days it all becomes too much when you take crap from EMS, ED attending, the admitting service, the patient, the family and then other nurses. I guess that is just being a nurse, but the grass is never greener and I know for sure that I could not work the floor or ICU, it takes a very special person to do it and I make sure I tell my boyfriend constantly that I couldn't so what he does.
In light of agency cuts in our hospital, we've taken a different approach in our ED... we've invited the admission unit staff to work as bank nurses with us.
Traditionally, the admission unit nurses were negative towards us and annoyed when we explained the patient *must* be transferred now when they said they were inundated with admission documents.
Many have now commented that they understand the pressures we are under to stabilise and move patients within the government 4 hour target and that they actually have 24 hours to fill admission documentation... although their superiors don't allow this.
Hopefully this new policy will mean better relations within our hospital, its looking positive so far :)
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.
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Well said Angie O'Plasty, this is the exact reason why I wanted to start this thread and to try and think of some ways to resolve the problems we face when we are all suppose to be there for 1 reason and that is the patient.
I'm sorry if that came off as attitude, but you had just gone off on how ER nurses dump on you and I was trying to point out why it may seem that way. Like I said, I worked on a floor for 2 years and I remember getting multiple admissions per shift and how hard it was to juggle everything. I have a lot of respect for med/surg nurses. You guys have a really hard job and don't get a lot of credit for it. :)
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.
LOL, I may be new, so I haven't had too many experiences with ED nurses (ours often come thru admissions unit, since im day shift-unless they have active chest pain, or from ICU, CCU, etc.
In fact, the only negative ED nurse experience was in ACLS when ms ED nurse acted like she was God and had done and seen it all, and thought she had an in w/ the insructors b/c some of them were paramedics. it was bad. even one of the instructors commented on it.
other than that, ive not had problems. thank goodness! we're all busy and we all work hard.
Maybe if we can try and discuss our feelings it can give us a better understanding of the red tape. I just feel like I am automatically treated differently as soon as someone finds out where I work. Some days it all becomes too much when you take crap from EMS, ED attending, the admitting service, the patient, the family and then other nurses. I guess that is just being a nurse, but the grass is never greener and I know for sure that I could not work the floor or ICU, it takes a very special person to do it and I make sure I tell my boyfriend constantly that I couldn't so what he does.
I agree; I think that would help. If we didn't need all those certifications, I've suggested having a night where a nurse from each unit does a switch so we can see how we can help each other better or where we can compromise to fit both units' needs better. After all, a lot of the problems we have are caused by management, not each other, as someone else said. Nurses tend to help one another, and if we were all part of the process, I sincerely believe we could come up with a better way to do things.
I think I have a pretty good relationship with the ED nurses. But I've worked a unit that is very close to the ER, so I've really had an opportunity to see some of this stuff up close.
Please don't take this personally when floor nurses seem very unhappy to see you bringing a patient.
(Personally, I AM happy to see you because most of our ER patients are brought to us by transporters who have no clue, and they're always trying to walk these folks to the bed, despite our policy. On the other hand, if it's a nurse-to-nurse transfer, it means Patient has some kind of gtt going, which means that we've already found a problem.)
As floor nurses, our major beefs have to do more with patient safety than anything. Here's the main two. And we know that ER nurses don't usually have a lot of control over either, but the fact is that Admissions is down there and bonding with you guys and really gives us an attitude if all hell is breaking loose and we're trying to hold a patient for a FEW MINUTES till we get caught up:
1. Why are we getting admissions at shift change?
Nurses coming on haven't assessed any of their patients and here comes one that could take an hour or more to get assessed, settled, oriented to the unit, and some drugs started.
This freaks us out. In the scenario mentioned in my first post, the patient that I was transporting was only my third assessment out of my 7 patients. Thank God they were all ok, but it's happened where I've had a patient crashing on one hall, and another on another hall, for which the ICU's REALLY got to know and love us. I was forced to give the admit to someone who was already stretched pretty thin.
At one point, our hospital had some program to get patients through the ER faster, and the ER nurses got rewarded for it, so that was a huge contributor to our resentment. Thank goodness they dropped the program. Our inappropriate admissions soared and we were also getting slews of patients who had been in the ED for hours without getting even an aspirin for c/o chest pain for heaven's sake!
2. Why is it that I can never talk to the nurse who took care of my patient?
We send written reports. Sometimes they'll write the meds given on the report sheet. But it's not on the MAR coming up with the patient. Now I'm stuck--did the patient get the med or not? If not, I'm happy to give it, but the report says they did, and the MAR says nothing, and I only have a liter of NS going, so I have no idea.
In some cases I can check the Pyxis to see if a med was drawn for a patient, but the ER's is such an open system that I don't trust it, so sometimes the doc will write for an antibiotic or pain med or something, and if the ER nurse forgets to note it, I have no way to find out if the patient got the med. Then what? Do I take a chance and possibly double-dose? Or not give and chance undermedicating? This is really difficult with patients who need (ahem, trying to be tactful here) larger-than-usual doses of narcotics, or blood cultures or things like that.
I call the ER to ask. It's very rare that I'm able to talk to the same nurse, which means continuity of care to the patient can be disrupted.
That's about it as far as our hospital goes.
I think that the reactions you get, Jen, are either caused by a bit of an inferiority complex in the floor nurses.
I've also met some ER nurses whose attitudes were quite hardened, not just toward us, but toward patients. It's probably one of those things that comes with the territory. I have no envy of ER or ICU nurses in dealing with some of the cases that you have to deal with, and I work nights in order to avoid the dreaded family and visitors.
So your defenses go up. Understandable.
But I've known ER nurses who were convinced that the patient was faking it for drugs, and later it turned out that the patient had a real problem going on. So sometimes it seems like if you don't buy into their mindset of "if we can't find it there's nothing wrong," you're looked down on. When we get a patient like that, I've learned through experience to be as nonjudgmental as possible until all the tests are back. Sometimes I wish that the original ER nurse could see what was found wrong with the patient. It sure humbled me to see a few patients who I thought were faking it for narcotics turn up positive for very painful conditions.
I can't say what the problem is between your floor nurses and ER nurses, but it doesn't hurt to be nice.
AH maybe thats when the beds get assigned. Being doing the ER thing for 17 yrs and this hasnt changed much. We in the ER know there are open beds but generally because of staffing we dont get them. They then get assigned typically right before or just after a shift change. It never fails to holding 7-10 pts at 7 be it AM or PM and the rooms get assigned at 0630 or 1930. We generally surmise that we get the rooms at these times is that the floor is getting additional staffing.
We also dont intentionally hold pts-- we have another pt waiting more often than not for that bed. Like one other poster said tests get ordered Stat or Now that if the pt goes to the floor might get done more as routine because they dont have the staff to go with the pt like we do-- we really dont but thats another issue all together.
Rj
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.
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.
Which is why, despite the anger burning inside me, we waited. It wouldn't be fair to either patient, or that meanie ofa nurse. :)
Does make you wonder, we have the exact same thing happen to us also, but we aren't allowed to say no admits between a certain time.
you know what? it so happens to our unit all the time. it is always at shift change when you are tired and just want to go home, they start filling every empty bed on the unit. i mean, we are not supposed to have shift change admits unless it is a "true emergency" yet we get them constantly, because its always an emergency. for example, last time i worked we had a lady with "emergent hypotension" rushed up to us at 605. we took bets on what the bp would be. i came the closest, it was 120/65 or something like that. it gets ridiculous sometimes.
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jmgrn65, RN
1,344 Posts