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?
Once a patient is seen and sorted, has a bed allocated it is in their best interest to go to a ward
Especially when the patient is a five year old setting right next to a raging alcoholic swearing and swinging at everyone. Can't understand why I would want either of these patients going upstairs quickly (being sarcastic).
So many nurses carry a chip on their shoulders! Did they miss the day in nursing school when they said you had to get admits or you wont have a job? Most admits come through ER's. Why would an ER nurse hang on to a patient and make more work for themselves? Grow up.
ER nurses ARE differant. Most nurses immediately look at a patients diagnosis before caring for them. In the ER, a diagnosis is the last thing a patient gets just before he leaves. But he still gets nursing care.
I've spent the last 20 years in emergency care, both pre hospital and in the ER. In my chosen setting few nurses could match my experience and skill. At the same time I admire the ICU, OR, School, Nursing Home, etc nurses for their abilities to do what I could never tolerate. I treat them as proffesional equals.
Keep your bickering to your immature selves. If you want to feel like victims, more power to me! While you gripe, whine and argue, I'll be giving the best possible nursing care, because the patient is what it's about. If you're having bad days because you think you're being picked on, I pity your poor patients.
Each area requires a certain expertise. Some nurses are better than others, regardless of their specialty. I admire my fellow nurses, because, let's face it, it can be a tough profession. It is demanding physically, mentally and emotionally. But, in my experience, SOME er nurses do have inflated opinions of themselves and that is their problem. What bothers me is when it affects patients.
I have seen and heard nurses criticize patients and treat them as drug-seekers and/or crazy. I have even been on the receiving end of it. With a long history of migraines and recent dx of Fibromyalgia, I have been treated as a drug seeker by both the ER doc and the staff. Toradol will not get rid of a migraine! I wish it would!!!!!!!!
I have a disabled sister that was in the ER once with mental status changes due to medications that were prescribed for her. In the process of the work-up, an RDS was done and came back + for marijuana. No one ever doubted the drug screen regardless of what I told them. Both the doc and the nurses treated her like she was a druggie. It was an obvious attitude change. With a little research of mine, the truth came out. She was taking Protonix and this caused the + test result. Of course, no apologies were given.
IMHO, most (not all) ER nurses are very judgmental. I realize that they deal with all kinds of people. A lot of them do not go to the doctor like they should and, yes, a lot are drug-seekers and users. Just, please, do not assume that all are. Some nurses don't even try to cover it!
I would also like to see some of the ER nurses work some shifts on the floor/ICU and coordinate all they do and answer call lights and deal with families, etc. Many ER nurses like ER because they do not keep their patients for days and deal with the same issues on a daily basis.
The only problem that I have is that the ER tends to send the patients up 30 minutes before shift change. Many time, I have been told that I would be recieving a patient at 1000 but the report is not called to me until 1415, only 15 minutes before report and the patient is brought to the floor during report.
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?
Just keep doing what you are doing. It sounds like you are making a tremendous effort. Try to keep that newbie enthusiam, discipline and courtesy. Some people are ar**holes. Forget about them and their efforts to run you down. They are seeing things from a place in the past where they have felt mistreated/disrespected/whatever. As much as you are able, show them how wrong they are. It's a high pressure environment in every aspect of healthcare. Keep that in mind and you will do fine. God bless you!
Never an ER nurse, but trying to keep perspective,
I've often called our admission unit very early, thinking that the ED stuff is finished, since the medics seem to have finished documenting.... only to have them say either that the registrar MUST review the patient prior to going to the ward due to concerns or further tests, such as a lumbar puncture/drains inserted, which is easier to do in the ED and should be performed asap... or a secondary consult is needed... the patient may be too unstable for transfer, they may need a CT prior to transfer... or even that the nurse looking after the patient has three new patients just as the ward is ready.... all are potentially unstable and therefore the nurse cannot leave the new patients to transfer since it could potentially take 30 minutes. So many things happen that mean we can't admit when the bed manager calls the ward, sorry!
I can't stand going onto a ward during handover. First off, it is usually the end of a 12 hour shift for myself and the admissions ward, so we all end up being late. If the patient isn't mobile, you have to wait 15 minutes for the "hands" to transfer. I could go on and on. Just remember that your ED/ER collegues have just as much pressure on them as you do, we don't want to be transferring late either!!!!!
Claire
The only problem that I have is that the ER tends to send the patients up 30 minutes before shift change. Many time, I have been told that I would be recieving a patient at 1000 but the report is not called to me until 1415, only 15 minutes before report and the patient is brought to the floor during report.
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.
Amen, sister, or brother, as the case may be. I believe the op has good intentions and is a fine nurse, however, everything you said is true. I work on a psych unit and have a lot of interchange w/ER. Of course, they try to get our pt's to the floor first. Understandable, too much disruption in an already volatile unit(ER). I do my best to empty out beds ASAP, but they(ER), sometimes don't seem to understand that we have a ltd. number of staff and our pt's have to be searched for safety and not left alone on admit. God bless the ER nurses and all the floor nurses. We are doing the best that we can do, let's all try to remember and pray for each other! :)
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.
Sometimes, pts on the floor can decompensate, very quickly, and we have to work to FIND a doc that will give orders/take charge. They are not always easily available and we are not as efficient as ER nurses at "taking hold" of the situation, whether through lack of experience or equipment. Please keep this in mind when you evaluate your peers. thanks
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.
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.
Yes, discussing it does help. And now, my perspective as floor nurse: On a busy psych unit, with nursing home transplants trying to code and actual psych pts runnning naked in the hall and/or trying to harm themselves or someone else and family members needing an expalanation for why grpa has not been moved to a more appropriate environment and dr's wanting report and treatment planning, NO, I can't take 4 psych admits from ER all at once who need to be reassured, checked for safety, and oriented to their surroundings(and sometimes, sorry er nurses, medically assessed), when I only have 3 staff (not rn's, TOTAL staff) to take care of all of this. So now you know (at least a glimpse) of how the other half lives.
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.
Yes, discussing it does help. And now, my perspective as a floor nurse: On a busy psych unit, with nursing home transplants trying to code and actual psych pts runnning naked in the hall and/or trying to harm themselves or someone else and family members needing an explanation for why grpa has not been moved to a more appropriate environment and dr's wanting report and treatment planning, NO, I can't take 4 psych admits from ER all at once who need to be reassured, checked for safety, and oriented to their surroundings(and sometimes, sorry er nurses, medically assessed), when I only have 3 staff (not rn's, TOTAL staff) to take care of all of this. So now you know (at least a glimpse) of how the other half lives.
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.
Jen2
931 Posts
Especially when the patient is a five year old setting right next to a raging alcoholic swearing and swinging at everyone. Can't understand why I would want either of these patients going upstairs quickly (being sarcastic).