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 guess things are different in the UK. Neither the nurses, charge nurse nor the docs have a say on when the patient is to go to the ward/floor... we are governed by a clock!!!
Four hours in the ED and we lose all our funding for the next year and the whole hospital has to start counting gloves (and you think I'm joking, the only exception is CPR, how nice eh!) The last thing I want to do is transfer to the ward five minutes before shift change, but if I don't do it, we might not see a new dinamap for two years.
I can completely understand what was said about shift changes, but the same applies at both ends of the hospital, we all worry about critical patients we have to leave because of transferring or giving handover.
Go easy everyone, we all have it bad, its called nursing and its never routine :)
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?
In our hospital, the ER doc puts a consult in for lets say Orthopedics. Ortho needs to come down and see the patient which may take an hour or two for them to get there. After ortho sees the patient they decide whether or not they will admit the patient. If ortho decides to admit the patient, there is usually a whole new set of STAT orders that the ortho doctor wants done such as another set of x-rays or what ever added to what the ER doc has already ordered. The ortho doc will evaluate these results and use them as a basis for the routine orders for the floor. The ortho doc will then put a bed request in the computer which goes to the bed coordinator. The bed coordinator will assign the patient a bed and call our unit clerk with the bed number, the unit clerk will then give us the bed number and we will call report.
Yes, we may know that the patient is going to be admitted at 2:00pm, but by the time the consulting doctor sees and evaluates the patient, orders additional tests for a basis of routine orders for the floor, the bed request gets put in the system, a bed is assigned and called to the ER, report may not be called until 7:00pm (shift change). There is just so much red tape involved in the whole admitting process.
ie: 11:00am patient comes in through triage s/p hip replacement cc pain/swelling/foul smelling drainage
1:00pm patient gets brought back to an ED bed.
1:30pm ER doc evaluates patient, orders lytes/H&H/cultures/NSR @ KVO/MESO4
2:30pm (Takes usually an hour to get labs back, depending on how busy lab is), ER doc gets labs back, H&H is low, and WBC's are through the roof. ER doc orders ATB, PRBC's and consults orthopedics.
4:30pm Ortho comes down to see the patient. It takes anywhere from one to two hours usually because they are either in surgery, in clinic, or doing rounds.
5:00pm Orhto has evaluated patient, and has decided they want to admit them (Ortho may decide that the patient needs to be admitted to medicine instead of orthopedics which is a whole new ballgame). They first want an x-ray done, and a repeat H&H.
5:30 pm RN draws repeat labs and sends them off and patient goes to x-ray (which usually takes 30-60 minutes depending on how busy x-ray is to get the x-ray done and results back)
6:30pm Ortho reviews these results and puts in a bed request for the patient to be admitted to their unit.
7:00pm Bed coordinator calls the ED with a bed and ED nurse calls report
This is very typical of how it goes. The above patient has already been in the hospital since 11:00am and does not understand that a lot of the wait is getting the results back of tests, consultation, etc. I find that the times we get most walk ins are between 11:00am and 1:00pm, simply because this is the time a lot of people get up and moving around. They will call their PCP's and the PCP's will tell them that they cannot see them today, but if they feel poorly to go to the ER. Since we begin to get tons of walk ins around this time it takes us to report being called between 4:00pm and 7:00pm between all the tests, consults etc.
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.
Well said Angio O'Plasty. These are real issues facing nursing that stems from a lack of understanding and in some cases respect for each other as nurses. I now don't see it as poor me, they are picking on me, rather not understanding what each other does.
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.
Sure hope you are joking Hoop.... some people may take you serious though and it is stuff like that that keeps the "rift" between specialties!
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.
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.
I am sorry that you and your sister had such bad experiences. That definitely shines a bad light on the rest of us! And to be honest, I had no idea that Protonix caused a positive THC! I am now in a position that I do drug screens routinely and have been told that Cocaine and THC are the 2 drugs that have no cross reactants. This is something I will be talking to the drug screen company about. Zantac will however cause a + Meth test. Shocker huh?
Obviously there are good and bad in every department. ER nurses DO get jaded. It is very hard to avoid. I have always said that if you get to that point you really should move on. It is not fair to the patients OR your co-workers.
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.
WOW! Angie I worked as a Floor Nurse before going to ER and I wish I would have been as GREAT as you are describing that I could second guess the ER docs diagnosis. Perhaps, just PERHAPS, the diagnosis was CORRECT and now that they are STABLE, you see a SECONDARY diagnosis? I hate to pick here, but .... We ALL work hard. We ALL have our own problems. But to second guess a diagnosis unless you saw that patient drug through the ER doors and the condition they were in, is to say the least, a little overbearing. This is my humble opinion after a few years of floor nursing and 20 yrs of ER.
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.
Me too Tigger! And to be honest I have always said that I believe that to work in ER or ICU, you should have no less than 2 years Med Surg....gives you a good solid base before specializing.
I try very hard not to appear on a high horse either Tigg, but it sure seems that there are some nurses that will imply that we are regardless. So I guess that is THEIR problem, not ours.
As for the code teams.... I worked Level I trauma centers, Level II, and local small 5 bed ER's. As the ER nurse, I almost always responded to codes. And you are right, most times, there is not a floor nurse there unless it is her patient and then typically she is documenting what the team is doing. Even in the small hosp. the ER nurse and Dr did the code and the floor nurse charted etc. Just the way it was. I hope floor nurses are getting ACLS now and also are able to practice it. Just having it is not good enough.
Its so much easier to blame someone else for the mess we find ourselves in at work, isn't it. Why don't we just admit we aren't really in control?? and try to learn to cope without pointing fingers at 'the other nurse?' I guess cuz I started on medsurg and worked ER prior to ICU, I don't have any 'attitude'...likely because I KNOW what the other nurse is dealing with out there!
All the anger here at ER for all those last minute admissions...my goodness!! it happens!! Ive been fortunate to work with some kindhearted ER staff who will hold a patient for OUR next shift, because we haven't even sat down to do ANY paperwork due to numerous codes, admissions, and procedures, and its shift change. BUT when I encounter this kindness (and I do frequently, but don't abuse it) I reciprocate!! Not only if an ER nurse MUST move a patient from ER to my ICU stat/mid workup... cuz a patient is coding in the lobby and needs that ER bed, but when they are doing numerous procedures and need an extra hand, I will go and assist. I assist with their codes and gopher for them, as an extra hand. IT IS APPRECIATED!! If we did more of this, we would get along better.
Lets be kind to one another out there nurses...as has already been said, its hard enough out there...we shouldn't make it harder on each other. Shame on us.
So...go talk to that nurse in the other unit..respond to a call for help, float to a sister unit, ask to crosstrain... listen and learn and respect that other nurse...and watch how relations improve. When we walk in each others' duty shoes our minds are opened.
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?
First of all let me tell you that everyone cannot be an ER nurse because it is not their nitch so to speak. Coodos for you picKing a job that is hard--unrewarding-and unthankful from your fellow co-workers. That is where the expression comes from nurses eat their own!!!!!!!!!!!!!!!! DON'T LET THEM EAT YOU!!!!!!!!! SPEAK QUIETLY AND DO YOUR JOB AND PEOPLE WILL SEE YOU FOR THE PROFESSIONAL THAT YOU ARE. Those THAT KNOW WILL RECOGNIZE YOUR TALENT. fORGET WHAT YOU HEAR AND WORK ON WHAT YOU ARE AS A CAREGIVER. tALENT COMES IN MANY FORMS--ER IS A GIFT FOR CARING A VERY SPECIAL WAY AND YOU NEED TO RELISH IN THE FACT THAT YOU WILL NOURSIH PEOPLE AS YOU LEARN. gOOD LUCK--I HAVE BEEN AN ER NURSE FOR OVER 15 YEARS AND THERE ARE MEANIES OUT THERE--DON'T BECOME ONE OF THEM!!!!!!!
When you work in a small rural hospital, everybody HAS to get along and help each other. If you don't you have some really long nights. If I get in a bind in th ER after 10pm, one or two nurses will come help me out and in return, we try not to slam them right at shift change. We usually don't keep a patient over 2 hours in our ER because we only heve 4 beds and if there is an admit less than 30 minutes before shift change, the off going RN gets vitals, does a quick assessment and writes an admit note. Then the oncoming RN does the more thorough assessment. If we can we hold them in the ER until someone gets out of report.
Just a quick note--ever notice the one person in the room that is making the most noise? Why do we notice? Because that person is drawing attention to themselves! The quiet spoken-does their work and does it well speaks louder. Keep the faith--nothing goes unrewarded.
ClaireMacl
204 Posts
Hey there,
I guess things are different in the UK. Neither the nurses, charge nurse nor the docs have a say on when the patient is to go to the ward/floor... we are governed by a clock!!!
Four hours in the ED and we lose all our funding for the next year and the whole hospital has to start counting gloves (and you think I'm joking, the only exception is CPR, how nice eh!)
The last thing I want to do is transfer to the ward five minutes before shift change, but if I don't do it, we might not see a new dinamap for two years.
I can completely understand what was said about shift changes, but the same applies at both ends of the hospital, we all worry about critical patients we have to leave because of transferring or giving handover.
Go easy everyone, we all have it bad, its called nursing and its never routine :)