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?
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.
Of course I didn't say anyone was a bunch of "raving morons" but ER is a different breed. Ask anyone who has worked on the floor AND the ER. Everything you thought was an emergency on the floor (aside from imminent airway/code situations) definitely can be put into perspective and re-prioritized. You don't have that luxury in the ER. Pts on the floor have been evaluated, you know they have been on that floor for a while and are not showing signs of decompensation. Again, we don't have that luxury. Most every pt is unknown, all you know is by what you see on the monitor and your instincts. Plus add to that the stress of the traumas/codes that the floor is not "in" on and that creates a new dimension to the ER nurse. Every other floor you have a cap on how many pts you take on, there's a charge nurse who oversees that. In the ER, you have your track (ideally) but you help everyone, hallway pts, ambulance triage, everyone. That amounts to a lot of people. A lot. It's very different, more complex, using every bit of knowledge for every body system quickly, no time to thumb through a book or the internet for information. You're right that nursing is demanding and difficult, but I realized how my perception changed once I went to the ER.
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 agree. I find that ICU nurses like the lines, tubes, and extreme detail. ICU nurses are great nurses. They float to our ED daily.
I just think that whatever specialty you do decide to go and practice at you do so because it is what interests you. That's why there are alot of different specialties. Me personally, I am not cut out to be an ER nurse or Floor nurse, each requires a certain personality trait that I do not have. There are things floor nurses can do and ER nurses can do that I have no clue about...We all have our own special skills. It's just finding the right niche for you.
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!!
I hear you! You summed it up. I would love to arrange flowers, with no people around, no monitors going off, no phones ringing, no pts whining, etc. But I'd want my same pay, just as a person who arranges flowers!
As I stated before, the nurses don't plan things this way. We send patients to the floor/units all day long, not just on shift change. There are times when a certain service may have three patients that ER has consulted them on, and they will put in the bed request for all three patients at the same time. These patients have been waiting for the most part for hours already, and are angry as well as their family members. I can honestly say we NEVER purposely hold patients there. I want that empty room as soon as I can so that I can get the next person back. I also want grandma with a K of 2.0 who is as sweet as she can be to get to the floor where she can get the care she deserves, because for the most part I can't give it to her. Even though she has a problem, the 6 year old having the acute asthma attack sitting in the tripod position with stridor in the wheel chair needs the immediate care and stabilization right now as the triage nurse is wheeling her back from triage whether I am ready for it or not. Get the asthma attack stabilized, come out of that room and get a bed on grandma with the K of 2.0. Record report in the system that we have and call the floor to let them know that report is in and give my name and number where I can be reached in case there are any questions (every nurse in our hospital carries cell phones and we have a universal report system that we dicatate in and listen to report). Charge nurse tells us that we are getting a bus of 50 refugees from hurricaine Katrina and we are already full, the people in the waiting room have already been sitting there for 3 hours, and the ambulances are still roling in. Get a call from the roof and it is an intubated trauma that wasn't even paged stating that they are landing now. No rooms in the ED I hurry up and call upstairs it has been half an hour since report was phoned in on the lady with the K of 2.0 (I don't know what time it is, nor do I care), and try and see if they are ready, the answer I got was, "The nurse that is getting that admission is on lunch and she'll call you as soon as she gets back it should be with in the next five minutes". I didn't have five minutes, had a aid put the lady with K of 2.0 in the hallway, got transferred to the charge nurse and begged for someone to come get this patient. Get the intubated trauma in the room, don't know the patients name, allergies, nothing. All I know about this person is that they hit a telephone pole head on and there was heavy damage to the vehicle and his airway was secure. Get him into the scanner and had to stop the scan twice to bolus fluid because his pressure dropped to 50/30. I can't give him a paralytic because they think he may have had a seizure and neurology can't evaluate him if he is paralyzed. Patient starts to wake up in the scanner, and tries to pull out his ETT, the only drugs that I can give him are versed and fentanyl which is going to drop his pressure even more. Push the drugs slowly, charge nurse calls me and gives me an ICU bed number, call ICU to give a verbal report because the docs want him in the unit ASAP and the ICU nurse asks me if he has an OG tube in. He didn't because I could only get the foley in him and the docs wanted to scan NOW. The reply I got was, "Figures", I apologize for the inconvenience and ask if I can bring up the patient as soon as we are done scanning. I was told yes (thank goodness), so I am bagging the patient as the RT is pushing the vent, and the resident is steering. Patient starts to wake up again and I am pushing drugs, and bagging in the elevator at the same time as my phone is ringing. Get the patient settled in the unit and my phone is stil ringing. I answer it as I am on my way back down stairs and it is the charge nurse again telling me that I got a bed for the acute asthma attack and he can't call reoprt because they are attempting to revive a baby that was brough in through triage that had stopped breathing. Waiting room is now full of survivors (I like that term better than refugees from hurricaine Katrina) as well as other patients. I call report in the system for the little one who had the asthma attack who is now stable and attempt to take care of other patients who are less critical and call after 1/2 hour to see if the nurse is ready for her to be brought up. The response I got was, "She's going to have to call you back because she is hanging an antibiotic". My response was, "I know you are all busy, but we are filled with traumas and hurricaine victims, who have not had their meds in a very long time". The response I got then was, "Well I don't know what to tell you she is in with a patient right now". I asked if I could be transferred to her phone and was told that, "Sorry it's busy, I'll give her the message".
Sorry this is soo long but it feels so good to vent. This was just one day in the ER and it is typical day. For the most part, I don't know what time it is when I am calling report, as I usually loose all track of it. My hint of shift change is when the new shift walks through our doors. We don't really report off to each other in the ER like floors do, it's like, "Hey room 10 is an MI watiing to go to the cath lab, 7 is here for belly pain, labs are drawn, heplock is in and were waiting for results and so on". I guess it is good though that we all carry phones and have the dictation system so that we can be reached. I find the opposite as in it is hard for us to get hold of the floor nurse because we leave our name and extension at the end of our report, but we don't know the nurses name and extension that is getting our patient. I know admission are detailed and time consuming on the floors, but we usually get 15-20 new patients per shift, as well as discharges. I know that at our hospital our floor nurses have 6 patients to take care of. From 7:00am-11:00am our ratio is 13:1. My vented patients are usually my stable patients because they have a secure airway.
I love ER nursing, but it is very disheartening at times. I would love to have follow up on my patients to see if they did Ok or not. I would love to be able to leave work one day thinking that I gave just one person the care that they deserved. I just wish that we as nurses could try to understand each other and stick together a little more. I don't know what the answer is, but discussing it sure does help. Thanks for listening.
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.
Right On! Not to mention that three minutes after getting the call that the room is ready, the charge is calling you, demanding that you move that patient THIS MINUTE to make room for the next of the 30+ folks who are bleeding, crying, puking, yelling or sleeping out in the waiting area, in the hall or rolling up in the ambulance bay. On the other hand, there have been a few slow times (mostly during halftime) when we've gotten all the drugs in, the linen changed and even the admit paperwork done for the floor nurse in advance. Circumstances change. My point is that there are good nurses and lazy ones and some times when good nurses are just getting slammed. There are nice nurses and rude ones and times when a nice one is just getting really stressed out. I'm suggesting that there might be a bit of stereotyping going on in some of these messages. If you've run into a problem, check out the facts. If its a problem, do something to fix it. If you can't fix it, deal with it. If you can't deal with it, move somewhere where you'll be happier. Just don't say that all or even most ER/ICU/Med-Surg nurses are the same. The only thing we do have in common is that we are all trying to get along. Speaking of which - the game's back on - gotta go.
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!!
Well said ERERER!! I have been an ER nurse for 31 years and your observation are right on target. We really do not try to hold patients to transport at shift change. Nursing IS a tough profession no matter where we work and I think the least we can do is be kind to each other.
There are only 2 sorts of Nurses-ER/ED/A&E...call it what you will,people with Type A personalities who treat patients often without knowing whats wrong with them ....who do bizarre interventions on complete strangers... who routinely take more risks and deal with more anguish and pain and loss and hurt....
And then there are all the rest who sit on their ar**s and whinge about the real nurses in ER who know lots abt most everything rather than the "specialist floor nurses" who know more and more abt less and less
There are only 2 sorts of Nurses-ER/ED/A&E...call it what you will,people with Type A personalities who treat patients often without knowing whats wrong with them ....who do bizarre interventions on complete strangers... who routinely take more risks and deal with more anguish and pain and loss and hurt....
And then there are all the rest who sit on their ar**s and whinge about the real nurses in ER who know lots abt most everything rather than the "specialist floor nurses" who know more and more abt less and less
Take heart
The brave and best are always challenged
Tim
See, this is the problem with this profession! Everyone thinks that they are better than everyone else. To have the attitude that only ER nurses do any work is completely disrespectful and just plain wrong!
I have very good friends that work in the ER and they love their job. I respect ER nurses, they are very good at what they do and have to deal with crazy situations that those of us on the floor can never dream of. I work in Tele, I love what I do, I can't imagine working in the ER, it's just not for me. Now does that mean I am not a "Real" nurse? No. It simply means that I am a different nurse.
The main problem that we deal with at my hospital is that some brilliant person came up with the idea of the charge nurse taking report from the ER nurse to make things move faster. Nice idea, except the charge nurse SOMETIMES is nice enough to find you and tell you that you are getting a patient and they never ask the really important questions......is the patient REALLY alert and oriented, can they stand, are they continent, etc. So we can get a little cranky when the surprise patient comes rolling up. But we can't blame the ER nurses because they have no idea that we knew nothing about this patient.
Granted it will probably never happen, but we all need to realize that no one department is trying to sabatoge another department, and we should all respect each other because ultimately we are all in this for the same reason.....the patients.
We aren't allowed to call report for 45 minutes during shift change. Our admissions nurse does her very best to get all the history forms done before they go up. And still, people complain about us. There's just no pleasing everybody.
I worked on an IMC floor, and hated it. at that place report was faxed and most of the time our secretaries wouldn't tell us about it, so we'd find a patient just dumped in the hallway.
No way can we get away with that in the ED where I work. A nurse has to transport the pt to IMC or ICU and get that patient into the bed.
Our hospital is considering having us in ED fax report to all but ICU. I'm against this. Yes, it's really convenient for us, but it sucks for the floor nurses.
Angie, no offense, even if we could go on divert, which is rare, we still can't divert the 30 or so walk-ins that we have hanging around on a typical day. And that's in the summer. I dread flu season. Then we typically have a census of 90 or so at any given time. (this is a hospital with 13 peds ED beds, 21 main beds and 8 minor injury beds.)
Yes, I'd love to give floor nurses a break, especially when they suddenly got bombarded with 2 admissions at once. Some of our charges understand if I hold a patient a few extra minutes. Others don't, and believe me, we pay for it.
The fact is, no nurse in a hospital has an easy job. But once your beds are full, you have time to settle into a routine. We don't. We have to figure out how to get them in and out without killing anybody so the next batch can come in.
MassED, BSN, RN
2,636 Posts
Of course I didn't say anyone was a bunch of "raving morons" but ER is a different breed. Ask anyone who has worked on the floor AND the ER. Everything you thought was an emergency on the floor (aside from imminent airway/code situations) definitely can be put into perspective and re-prioritized. You don't have that luxury in the ER. Pts on the floor have been evaluated, you know they have been on that floor for a while and are not showing signs of decompensation. Again, we don't have that luxury. Most every pt is unknown, all you know is by what you see on the monitor and your instincts. Plus add to that the stress of the traumas/codes that the floor is not "in" on and that creates a new dimension to the ER nurse. Every other floor you have a cap on how many pts you take on, there's a charge nurse who oversees that. In the ER, you have your track (ideally) but you help everyone, hallway pts, ambulance triage, everyone. That amounts to a lot of people. A lot. It's very different, more complex, using every bit of knowledge for every body system quickly, no time to thumb through a book or the internet for information. You're right that nursing is demanding and difficult, but I realized how my perception changed once I went to the ER.