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?
Indeed, I must disagree c the beleagured ED RNs; in the hospital in which I work they came up (again) c their experiment of expediting the ED admits by calling the floor to give report (invariably during the last hour of our shift when we are least likely to have time to take the call) if they cannot retrieve the floor RN w/n 1 call they fax a report & ship up the "surprise" Pt.
I've had some interesting faxed reports that state "Pt a/o /4 c the other box checked confused; basically pts who almost knew their name."
Oh, & the pts c BPs of 60 over palp but "stable"...I have just enough spare "hour or so" to get them to ICU a they code. This is safe? These Pts are brought up by a transporter. This floor on which I work is Oncology, HIV, Medical (i.e. everyone c blood sugars of 600, attemted suicides, Oncologic emergencies ad infinitum.)
I've been @ this Hospital a number of years yet, if I do encounter a live RN from whom I get report it is often someone who transferred FROM being a floor nurse. As ED is so arduous why do I never encounter RNs who transferred FROM ED to floor nursing. Essentially, my impression is that if the Pt is in full arrest they die in ED or end up on a vent to ICU. The rest get shovelled out stable or not. As far as the MDs go I think I'll ask some of them if it is their desire to ship Pts up @ shift change; I beleive this falls under the category of "blame game"...seen it happen too many years & too many Hospitals to buy that one.
Sometimes the docs come from office hours knowing they've got someone to see and admit in the ER. They grab the two charts, see the patients and then hole up in the dictation room for an hour writing orders and notes. Then they bring out both charts, having said as they left the bedside " we'll get you right up to the floor " but that was an hour ago.
So now the RN has two patients that need to be transported to the same floor, it's getting darn close to shift change, and the families are saying "when will he go up, the doctor said soon, but that was an hour ago!" There is just no way to win. Unfortunately it happened almost every day at an ER I worked at. One day I was bringing a patient up to the floor and the receiving nurse complained that they had gotten 5 (FIVE!) admissions in the last hour, and it was 1830. She was much calmer than I would have been. Apparently many docs did the same thing that day and they were just lucky enough to have been tagged with all the admits.
I don't know what the solution is. I think we can all understand that the docs won't be changing. Luckily since then I have switched to a smaller hospital and if the floor is slammed we can ask someone to send down a regular bed so the patient is more comfortable and there is a little less pressure on staff to take admits they are not ready for. Sometimes observation bed patients are able to be discharged from the ER in the morning. They return the favor to me too, if the ER is drowning they will make every effort to get here without delay, and forgive me some paperwork that by rights should be done here.
this is a problem everywhere (i was a traveller for quite a while). Speaking as an ER nurse, one of the main reasons for shift change admissions: our ER docs. They hate turning over a pending admission to the next ER doc coming on (7a & 7p too), so they rush around toward the end of their shift to get everyone admitted. Pt's holding in ER are a problem everywhere. Visitors hang out until their family member "goes upstairs", and bug us every few minutes for that promised bed, or stare at you from behind the curtain. The nurses "upstairs" in our hospital have a maximum # of pts that they are assigned. when that is reached, we hold in the ER. ER nurses have no maximum # of pts. they just keep coming, and we have no extra nurse stashed somewhere to take them. Last night I had 2 admitted ICU, 2 admitted PCU patients, and the ER patients coming in the door. Little johnny with his broken arm sat in a w/c in the hall, next to granny from nursing home messing her pants. Also, having worked ER for many years, i have lost all concept of time: routine med times, meal times, bath times, poop times, accucheck times. these patients are losing out because there is no routine in ER, and we are not programmed for it. add in that there are no TV's, phones, or bathrooms in their cubicles, makes for very unhappy pts/families. had one visitor stick his head in a room with a code going on, to ask (again) when mom's room would be ready.
Nursing is a tough profession. I thought i had found my home in the ER, but maybe it is time to get out of it all together. I grow pretty good tomatoes!!
At my hospital, we usually don't get a location for a patient until just before shift change. We hold admissions for up to 6 hours because our nursing supervisor is placing cath lab patients, open heart cases, direct admissions, and any other patient. Emergency patients come last.
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.
It's infuriating when I get an admit like that that I HAVE to take, no matter how busy I am with a patient ratio of 8 pt's per nurse, but I can get written up for wanting to wait on the admit. Of course then my pt with HGB of 6.8 has to wait on that blood transfusion while I'm putting the new admit to bed because I can get written up for letting the new admit wait in the hall on the stretcher(if he fills out the questionnaire on discharge) , and I can't send for the blood because the 30 minute expiration on the blood will run out before the new admit is in bed. And the LVN is pestering me "I need an order for insulin for a blood sugar of 560" And the NA comes screaming down the hall, "mr. so and so is desatting to 70%, and that's on the 100% NRB. He's purple and his respers are 48+". And the other LVN comes over and states very calmly, "Room 107 just pulled out his foley and has lost approximately 250ml of blood, I think you need to call the doc."
But I HAVE to take the admit, because ER is threatening me with a write up, I told them go ahead, so instead of writing me up, they sent the pt up anyways, when I said I wasn't ready.
The admit, was a hemodynamically stable patient admitted for pain control r/t a herniated lumbar disk. A,A&Ox4, VSS, given pain meds in ER, he waited on the stretcher inside his room but he was out of the hallway.
Needless to say, yes, elthia had a very frustrating night the other day with regards to the ER and ER nurses. After everything calmed down, the threats of being written up by the ER disappeared after I told my side of the story to the house supervisor.
I can say, I do have two ER nurses, that if I blurt out, I have a pt crashing, they'll say call me back. Bless them. I know from a dear friend who is an ER nurse that it can be a crazy and frustrating job, but most hospital positions are crazy and frustrating it's just different types of emergencies.
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?
I get that too, as do my cohorts in the ED. I hate to say this, but I find that ED nurses are disliked because they're good at what they do. Before I transferred to the ER, everyone I worked with said "oh you'll hate it, the ER nurses are such bitches." Of course there are lots of "those" in this field, but I find that in the ER, nurses have to be more to the point, are very specific about their needs and definitely voice their opinions. The ER demands that of a good nurse. Once I have spent time in the ER, I know now that those nurses I worked with were jealous, afraid to try another area of nursing that is DEFINITELY intimidating, I don't care how good you think you are. You know your true skills and quality during a trauma/code. That's what seperates the floor RN from the ED RN. That's my opinion.
I'm an SICU nurse, open heart/trauma ICU....personally I wouldn't wanna be an ER nurse....It's not jealousy because ICU nurses are not jealous of ER nurses because if they are they would be down there working because they're competent. It's just personality differences.
I get that too, as do my cohorts in the ED. I hate to say this, but I find that ED nurses are disliked because they're good at what they do. Before I transferred to the ER, everyone I worked with said "oh you'll hate it, the ER nurses are such bitches." Of course there are lots of "those" in this field, but I find that in the ER, nurses have to be more to the point, are very specific about their needs and definitely voice their opinions. The ER demands that of a good nurse. Once I have spent time in the ER, I know now that those nurses I worked with were jealous, afraid to try another area of nursing that is DEFINITELY intimidating, I don't care how good you think you are. You know your true skills and quality during a trauma/code. That's what seperates the floor RN from the ED RN. That's my opinion.
Now that sounds a lot like you're saying that the best nurses are ER nurses, which I'm quite sure you're not saying.
Or like floor nurses don't run codes or (worse) don't know how to run a code, which can't be what you're saying because it is sooooo not true.
I respect ER nurses because their skills are so multifunctional and their work is very fast-paced and very demanding, but at the same time, I wouldn't imply that the ER is any more difficult to work than any other area. Each area has its own challenges. It's really a matter of finding which one is right for you.
Apparently you have.
That's great, but the rest of us aren't a bunch of raving morons either.
It's infuriating when I get an admit like that that I HAVE to take, no matter how busy I am with a patient ratio of 8 pt's per nurse, but I can get written up for wanting to wait on the admit. Of course then my pt with HGB of 6.8 has to wait on that blood transfusion while I'm putting the new admit to bed because I can get written up for letting the new admit wait in the hall on the stretcher(if he fills out the questionnaire on discharge) , and I can't send for the blood because the 30 minute expiration on the blood will run out before the new admit is in bed. And the LVN is pestering me "I need an order for insulin for a blood sugar of 560" And the NA comes screaming down the hall, "mr. so and so is desatting to 70%, and that's on the 100% NRB. He's purple and his respers are 48+". And the other LVN comes over and states very calmly, "Room 107 just pulled out his foley and has lost approximately 250ml of blood, I think you need to call the doc."
But I HAVE to take the admit, because ER is threatening me with a write up, I told them go ahead, so instead of writing me up, they sent the pt up anyways, when I said I wasn't ready.
The admit, was a hemodynamically stable patient admitted for pain control r/t a herniated lumbar disk. A,A&Ox4, VSS, given pain meds in ER, he waited on the stretcher inside his room but he was out of the hallway.
Needless to say, yes, elthia had a very frustrating night the other day with regards to the ER and ER nurses. After everything calmed down, the threats of being written up by the ER disappeared after I told my side of the story to the house supervisor.
I can say, I do have two ER nurses, that if I blurt out, I have a pt crashing, they'll say call me back. Bless them. I know from a dear friend who is an ER nurse that it can be a crazy and frustrating job, but most hospital positions are crazy and frustrating it's just different types of emergencies.
from your post, I would say, "come to the ED and see what a regular shift is like." You'll see our side of it. When there are no beds on the floor, then the hospital sup miraculously "finds" 3 or so around "your" shift change. We have no such thing, the pts keep coming in, even as our shift changes. When we have pts in the hall, ambulances continuously arriving, no one to triage those pts, people screaming in the waiting room, pts asking "how long until the doc gets in here, I've been her for xx amount of time." And to keep bringing pts back, placing them in the hallway, even though there are not more nurses around to take on these extra pts. We all deal with it. Pts with the high priority are those with airway probs, then circulatory probs, etc. Everyone complains, no ones happy, it goes with the territory. I know on the floor it's a pain to take an admit on shift change, but that's not an excuse to keep a pt in the ER when there's a room assignment, and that pt might have been waiting for HOURS for a bed. I used to start on an admission (that is never long and arduous anyway, since all of the information is in the EMR or Meditech from when they came through the ED), and the next shift could pick up where you left off. It's a 24 hour facility, things continue to go and people will need things, even as your shift ends. Teamwork, people! I realized how easy floor nursing is, once I moved to the ER. Though I will never go back to the floor, the ER is difficult most days, I never eat or socialize as much as I had time for on the floor. I learn way more each and every day. I hate the fact that some people use "write ups" as a means to control a persons behavior. What are we, high school? Go for it, is what I say. I think write ups should be used for variances and serious problems, not social conflicts. Anyhoo, again, that's just my opinion. No wonder we can't get enough men into this field, women can be so petty!!
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twin#2
36 Posts
Indeed, I must disagree c the beleagured ED RNs; in the hospital in which I work they came up (again) c their experiment of expediting the ED admits by calling the floor to give report (invariably during the last hour of our shift when we are least likely to have time to take the call) if they cannot retrieve the floor RN w/n 1 call they fax a report & ship up the "surprise" Pt.
I've had some interesting faxed reports that state "Pt a/o /4 c the other box checked confused; basically pts who almost knew their name."
Oh, & the pts c BPs of 60 over palp but "stable"...I have just enough spare "hour or so" to get them to ICU a they code. This is safe? These Pts are brought up by a transporter. This floor on which I work is Oncology, HIV, Medical (i.e. everyone c blood sugars of 600, attemted suicides, Oncologic emergencies ad infinitum.)
I've been @ this Hospital a number of years yet, if I do encounter a live RN from whom I get report it is often someone who transferred FROM being a floor nurse. As ED is so arduous why do I never encounter RNs who transferred FROM ED to floor nursing. Essentially, my impression is that if the Pt is in full arrest they die in ED or end up on a vent to ICU. The rest get shovelled out stable or not. As far as the MDs go I think I'll ask some of them if it is their desire to ship Pts up @ shift change; I beleive this falls under the category of "blame game"...seen it happen too many years & too many Hospitals to buy that one.