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?
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
For shame, Tim, you really don't believe that do you? See previous post.
I have been on both sides as a floor nurse, a critical care nurse for 5 years and an er nurse for 2 years, and I think there is a misunderstanding between all. One we have no control in the er for when we get bed assignments or the patients orders. Second, we get patients ongoing-not only do we have the patients to send up but we could also turn over 5-6 other beds 3 or 4 times before the floor gets the patients. As far as critical care nurses, usually you have 2 patients and you know them and what is going on- we get them at the door and have no idea what we may be dealing with and we also have the potential to have 4 to 5 critical care patients that need immediate help now and we don't always have the staff we need either, so you may be stuck taking care of these patients by yourself. I never understood ED nursing until I did it myself and then I realized why things are so different. I know as a critical care nurse I did full assessments of my patients but as an ER nurse we usually only do a focused assessment based on the patients complant because we don't have time to do everything else. I give my respect to all nurses in all areas because we all work very hard to help our patients and I thank every nurse who does their best
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.
:angryfire Oh my Gosh... Just sat here and read all of this remarks. Just shaking my head. I have been an ER nurse for over 15 years and I started out on a tele unit fresh out of nursing school, I do remember what it is like, but it seems that the nurses that are putting down us ER nurses don't have a clue as to what happens in the ER. YES YOU HAVE EMERGENCYS TOO. But WHO is it that responds to your codes. THE ER NURSES!!!! HELLOOOO.. We have to leave our patients to go to the floor to work the codes, because most of the time the floor nurses don't have a clue as what to do. Because they don't need to? How many floor nurses have their ACLS?? So we might be working a chest pain or two or three and have ambulances coming in and still have to respond to the floor emergencys. And to whom ever said that when we get busy we go on diversion. NOT TRUE.....Can't divert an unstable pt if your the closest hospital... Most ER nurses can multi-task and can do 3-4 chest pains and set up a suture tray at the same time. Get a grip. We dont get lunches or breaks most of the time and there is nothing more irriating than to call report to the floor, any of them, only to hear that the nurse can't take report because she/he is at lunch. AN ACTUAL SIT DOWN LUNCH????? Maybe all the floor nurses who think that the ER nurses have it so easy should really spend at least 12 hours just observing in the ER. It takes a special kind of person and personality to work in the ER and not everyone is cut out to be an ER nurse, just as it takes a special kind of person to work the floors, icu, or, ob,....ect. Thank god that there is alot of diversity in nursing so we all can fit in. The old saying....walk a mile in my shoes.....
But WHO is it that responds to your codes. THE ER NURSES!!!! HELLOOOO.. We have to leave our patients to go to the floor to work the codes, because most of the time the floor nurses don't have a clue as what to do.
We have a Code Team who responds to our Codes. It's made up of the AOD, an ER doc, the designated Respiratory Therapist and one nurse from each unit. The 2 ICU nurses who respond usually do the IVPs. I don't think ER nurses themselves have to respond to Codes on the floor and in turn, we don't have to respond to Codes in the ER.
And to whom ever said that when we get busy we go on diversion. NOT TRUE.....Can't divert an unstable pt if your the closest hospital...
Well, we do. Of course unstable patients are cared for, regardless.
Most ER nurses can multi-task and can do 3-4 chest pains and set up a suture tray at the same time.
Just like most floor nurses routinely handle a few patients in active CP with a couple of destabilizing COPDers, all while doing an admission.
We dont get lunches or breaks most of the time and there is nothing more irriating than to call report to the floor, any of them, only to hear that the nurse can't take report because she/he is at lunch.
....walk a mile in my shoes.....
We don't get lunches because the admissions keep coming, and much as you would like to believe that you're the greatest nurses in the world, we then not only have to deal with the admission process, but in the course of it, realize that the patient needed to go to ICU. Or that they've had a DDimer of >1000 and didn't get a stat CT angio, or that they've come in for stroke symptoms 10 hours ago and nobody did the NIHSS. Or that they're still having significant CP and have gotten no ASA. Or that they're being eval'd for syncope, had 2 boluses of NS, and now the little mini-me transporter wants to walk them to the bed.
You people are supposed to stabilize patients. It's your job to be fast-paced. It comes with the territory.
Floor nurses are supposed to dig deeper. We HAVE to do a complete head-to-toe assessment on the patient. The ER got the patient alive and now the floor's whole reason for being is to keep it that way. Your ER dx may be waaaaaaaaaaaaaay off of what is actually wrong with that patient, and it's OUR job to not only figure that out, but to actually KEEP the patient from crashing AGAIN.
So get down off'n that horse, mister. We're all busy saving lives here.
Get a grip.
I echo the sentiment.
Maybe all the floor nurses who think that the ER nurses have it so easy should really spend at least 12 hours just observing in the ER.
Maybe you need to come up and walk a mile in our shoes for just a couple of shifts. Believe me, you'd come away with a little more respect than this particular post is showing.
Maybe at this point I'll amend my previous statement: I do have a lot of respect for ER nurses, but I'm not your dang doormat either, bub.
With this much bickering, whining, and fussing, it's amazing patients get taken care of at all. When it comes down to it, it doesn't really matter if a floor nurse thinks the ER should have sent a patient up sooner or that the ER nurses don't respect the floor nurses or vice versa. EVERYONE is different. Every single person has a different personality and different values. All this negativity comes from people generalizing and making snap judgements based on which department someone works in. Shouldn't you be concentrating more on the skills the person possesses??
As I told one of our ER nurses, if I can take the patient as soon as I assign them a bed, I will, I know they're busy. But if I ask for a few extra minutes because a staff member didn't show up and we're having to shuffle assignments, or because at the moment I'm just plain too busy to take the patient, can't they give me the same consideration? I'm not asking for extra time because I'm waxing my legs. Just because it's happening in the "emergency room" doesn't make it a bigger "emergency" than what we've got going on. While you don't have the luxury of stopping them coming in, we don't have the luxury of merely stabilizing, we've got to go beyond the stabilization to getting them well, and that takes a bit more time per patient. We're not floor nurses because we "can't cut it" in the ER, we're floor nurses because that's where our talent and interest lies.
We have a Code Team who responds to our Codes. It's made up of the AOD, an ER doc, the designated Respiratory Therapist and one nurse from each unit. The 2 ICU nurses who respond usually do the IVPs. I don't think ER nurses themselves have to respond to Codes on the floor and in turn, we don't have to respond to Codes in the ER.
Well, we do. Of course unstable patients are cared for, regardless.
Just like most floor nurses routinely handle a few patients in active CP with a couple of destabilizing COPDers, all while doing an admission.
We don't get lunches because the admissions keep coming, and much as you would like to believe that you're the greatest nurses in the world, we then not only have to deal with the admission process, but in the course of it, realize that the patient needed to go to ICU. Or that they've had a DDimer of >1000 and didn't get a stat CT angio, or that they've come in for stroke symptoms 10 hours ago and nobody did the NIHSS. Or that they're still having significant CP and have gotten no ASA. Or that they're being eval'd for syncope, had 2 boluses of NS, and now the little mini-me transporter wants to walk them to the bed.
You people are supposed to stabilize patients. It's your job to be fast-paced. It comes with the territory.
Floor nurses are supposed to dig deeper. We HAVE to do a complete head-to-toe assessment on the patient. The ER got the patient alive and now the floor's whole reason for being is to keep it that way. Your ER dx may be waaaaaaaaaaaaaay off of what is actually wrong with that patient, and it's OUR job to not only figure that out, but to actually KEEP the patient from crashing AGAIN.
So get down off'n that horse, mister. We're all busy saving lives here.
I echo the sentiment.
Maybe you need to come up and walk a mile in our shoes for just a couple of shifts. Believe me, you'd come away with a little more respect than this particular post is showing.
Maybe at this point I'll amend my previous statement: I do have a lot of respect for ER nurses, but I'm not your dang doormat either, bub.
Always willing to discuss in a respectful way,
~Angie O.
I guess you didn't read all of my message. I DID walk a mile in your shoes, I was a floor nurse before going to the ER. Can you say the same?
Our code team is made up of the ER Doc, ER Nurse, ICU Nurse and RT. Not all hospitals have code teams and those people on the code team are still doing their regular nursing and still have to leave to respond to the code. In all my years I have never seen a floor nurse respond to a code in the ER. We don't call them over head cause we're already there. Each nursing speciality has their own unique way and there is a need for all of us. As I stated eariler. It takes a special person to be a nurse and each nurse in their specialites. Nobody asked anyone to be a doormat, just understand where we're coming from too. Maybe the ER nurses at your hospital stack pt's. I don't know, don't work with you or in your ER. At my hospital we try not to send them all at once and don't call report or take pt's to the floor during shift change. It's called respect, but I can say that there has been times when we have tried to call report and the nurse was busy or the room not cleaned or some other excuse only to find that when taking a walk to that floor all the nurses are in the nurses station gabbing away about nothing. Kinda puts an attitude right out there. So since I'm not on a High Horse, I can't get off. Been there, done that.
re ed RNs responding to codes on the floor; I have never seen an ER Nurse repond to a code; R.T.s respond, MDs on floor respond (day shift when we have a slew of MDs around) & we have nsg supervisors from ICU respond (not ICU RNs who have Pts). Additionally, where does one come up c the assumption that those who work as floor Nurses do not also have ACLS? Twin di
I DID walk a mile in your shoes, I was a floor nurse before going to the ER. Can you say the same?
With all due respect, and I hope this doesn't sound rude, because it's not meant to, that was 15 years ago, and a lot has changed with our Telemetry units since then. We get more complicated patients, insulin drips, all kinds of things that even 5 or 10 years ago would've been turfed to an Intensive Care Unit.
All that without any appreciable difference in staffing ratios.
I have learned from this thread, however, a few things:
1. Not all ERs can divert. Didn't know that. I believe we have to according to state law or something equally fearsome to TPTB.
2. As with staffing levels in any of our units, the admissions are pretty much given at the mercy of TPTB and not decided by nurses. I truly didn't know that, either. It seems to us like we get more admissions during shift change.
The other night three of us came to work at 11 pm and each of us had an admission assigned to us. It might be upsetting to some until you realize that our unit handled about 14 other admissions (not counting D/C's here, they don't take very long) throughout evening shift. So when that happens, we just go over the charts and orders as carefully as possible, and if we find errors, we just fix them unless they're life-threatening.
3. If you truly read all my posts, you would see that I did not ever say I disrespected ER nurses, but that they had a tendency to disrespect us floor nurses. This attitude is further borne out on this thread by a few posters' rude comments. I also explained to the OP that what happened to her in that class was completely unfair and almost smacked of the teacher trying to get her to teach the class instead of doing the job he was paid to do. If there's a next time, I'd politely say, "Wait a sec. I'm not at work here, so I'm gonna sit back and let you do your thing, teach."
4. As I said before, if we can discuss death, dying, politics and religion on these pages without dissing one another and creating hurt feelings, why not this topic? Surely if there are problems between nurses, we can begin to look at sources and solutions, can't we?
5. Almost universally, the floor nurses have expressed fear for all of their patients' safety when they get admissions at shift change. We KNOW those patients are sick. Even if they look like easy walkie-talkies, anything can and does happen. Got one patient the other day 45 minutes before I was to go off shift. Well, as the patient is transferring from stretcher to bed, the patient starts chest pains up again. Probably angina, resolved with a couple of nitros, but I probably didn't help much because I was completing paperwork in between repeating BP and asking, "OK, how's it now?"
Not an optimal experience for that poor patient, I'm sure, but I'd get my butt in a sling if I have to stay overtime. Again, no one's at fault, it's just the way the cookie crumbles.
6. Floor nurses don't see the majority of the ER patients because they're taken care of and discharged either home or to a floor unit. But lest you forget:
Once a patient is sent to the floor, that patient doesn't come back to be treated at the ER, no matter how critical that patient's situation gets. Which does (and should) scare us floor nurses because we don't have the resources as readily as the ER has to deal with it. I'm stressing that phrase because yes, we can, but we have more delays because the floors are not generally well set up to deal with emergent situations. Doesn't mean we're lacking in talent or skills, but we are probably lacking in manpower, if nothing else.
Think about it. I'm probably the only ACLS-trained nurse on my unit at night. Would your ER staff with only one ACLS-trained nurse? Or does it work better if you have a couple?
As a result, most of our floor nurses are trying to keep an eye on all of them at once. In this way, patients don't get far enough to Code before we're intervening, so that's why it looks like what we're doing is easy.
But still, if you haven't actually accepted a patient, it's different than if you already know you have 8 really ill patients. There's only so much that can be done in a shift and we're all overwhelmed all the time nowadays.
7. I think that the real problem here is that there's simply no way floor nurses can make things easier on the ER nurses, so we don't have the usual exchange that we'd have between floor nurses. We can only ask that we not get admissions at shift change, and since the ER nurses say they have no power over that, it profits them nothing to advocate for us (and in reality, the patients) to ask whoever IS in charge (I know there must be someone in charge of all this stuff down there somewhere.....) to withhold sending that patient until it's safe to do so. Not because the patient is tired of lying on the stretcher or the family's irritated with being without their favorite sitcom.
I'm feeling like we've reached a little better understanding of what we each do, even if some were rude and others were bickering. I agree, we need a meeting of the minds with the patient safety issues really being addressed.
So I must say that I'm glad the OP started this thread and we had an opportunity to lay out some of the things we face on a daily basis.
PS I'm still trying to figure out: who exactly IS the person who decides when a patient goes to the floor? The ER doc? Or the patient's attending? If not the nurse, then would it be the ER Charge?
Maybe the solution is when hiring a bed coordinator, or training a bed coordinator, that nurse should spend a few weeks on the floor/er/icu, so that they would be more well versed when it comes to bed allocation and the time constraints each unit faces. Sometimes it's just ''fill in the hole'', not taking into account the acuity of the patients, and the specific unit's staffing. This leads to chaos and aggravation not only to the patient and their families, but also to the staff. Admitting should also be inserviced by nurses on the particular unit they come from so that they can work efficiently on placing the patients but at the same time create a balance where everyone could work together.
I wouldn't say there is a specific person who says "now is the time the pt can go to the floor". It's more like a process. The ER doc is ready for them to go as soon as the consulting physician says they are accepting the pt. In our hospital, the admitting doc calls the bed manager/admissions office and they assign the bed. So at that point you could technically call report, but there may be some stat orders added on that have to be done prior to admission which need to be included in report. So basically, the biggest factor is the bed manager because without that you don't know who to call report to. The primary nurse is the the one making sure all of this stuff gets done, so as soon as all the admit paperwork and orders are done the pt is ready to be transferred. The charge nurse is usually coming around and checking on how much longer the pt will be there, and sometimes will call report and help get everything done so the pt can get out of the ER, because they want that bed for another pt.
PS I'm still trying to figure out: who exactly IS the person who decides when a patient goes to the floor? The ER doc? Or the patient's attending? If not the nurse, then would it be the ER Charge?
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kadokin, ASN, RN
550 Posts
For shame, Tim, you really don't believe that do you? See previous post.