Floor nurse, please forgive me....

[Anna Flaxis]

....when I send you a patient whose chest tube connections are not taped and banded. Really, I am not an idiot, believe me. You see, the pulmonologist swooped in and switched from the heimlich valve placed by the ED doc to a pleurevac *right* when I was packing up the patient to go upstairs, and we had a trauma arriving who needed the bed. The trauma patient could not wait in the hallway while I taped and banded the chest tube! And no, I didn't even have time to call you and warn you, because the second I sent the patient your way, I was already being pulled into a Stroke Alert.

...when my patient arrives to you cold, hungry, and grumpy as hell. I don't make a practice of ignoring my patients' comfort, and I'm usually pretty good at smoothing things over when we're really busy and people don't get the attention they expect. Many times I've warned them of what to expect when they get to you (that a meal tray won't be waiting for them, that it will take time for them to get tucked in, that lab draws will no longer be pulled from their peripheral IV, that it will take some time for their meds to be ready, etc.) in order to help make things easier for everyone. This time, I just couldn't. I had critical patient after critical patient, and so my stable ones didn't get much attention.

...if my charting stinks. Most of the time my documentation is decent. Not outstanding, but decent (we chart in narrative form on paper documents). But today, I chose bedside care over documentation, and I really hope it doesn't come back to bite me in the butt. Please, if you have any questions, feel free to call me. That's why my phone number is on the piece of paper we fax to the floor for every admit. I really don't mind if you call me. I might be in a hurry to answer your questions as quickly as possible and get off the phone so I can do the other five gazillion things I need to do STAT, but don't take it personally.

This is not satire. I really do feel badly about these things. Does anyone else have any guilty confessions, or is it just me?

[ladside, BSN, MSN, LPN, RN]

I, a coronary care stepdown unit floor nurse, had the pleasure of working on a day that we only had 3 nurses. The ER nurses, please note 'nurses', brought up 4 patients at the same time. Our census was low, that's why there were only 3 nurses, so we had empty rooms. The 4th patient was parked outside of the room where I had just started working on patient #3. The rationale was that there was no one available to accept the patient in the room. So just leave him and his family in the hall??? Really???? If you just cannot keep him in ER until one of us is available, it would be so much nicer to DUMP him in the privacy of a closed door rather than ABANDON him in the hall with the statement "it happens like this sometimes". First time ever that I had witness unprofessionalism to that extreme. 26 years of nursing and I thought it would take a lot to surprise me. Well, that one rendered me speechless! I walked into the hall with my mouth open and in pure shock! I, too, am one of those who would not go to the ER. I know my limitations. But I have encountered quite a few ER nurses who need to recognize the same. There is no shame in admitting that you cannot do a particular job. But to leave a patient in the hall of a floor that has at least 5 empty beds...you have not even learned the concept of fair customer service, let alone 'excellent' customer service. Should you be in the ER? You guys are the first faces that the patients see. Only one chance to make a first impression. Even the deceased are not left in the halls in the morgue. Life as a nurse would be so much better if we all could respect the others' position. This particular ER nurse just blew the patient satisfaction score for his department and ours before WE even had the chance to say "hi, my name is ladside and I'm gonna be your nurse this evening".

[tokmom, BSN, RN]

That is horrible. They should have take the 5 minutes to put the patient in bed!

[tokmom, BSN, RN]

After dealing with ED last night and their true dumping (the day shift wanted to go home, so brought up a pt unannouced and then was snarky to the accepting med/surg nurse.) I'm having trouble being warm and fuzzy at the moment.

To those special ED nurses, even though you are horribly busy but take the time to give a good report and SMILE when you see us waiting to accept both pt and family (who you know are watching us like hawks), Thank you..It makes the process much easier.

[NO50FRANNY]

Ok, so this post really upset me. I will restrain myself. In terms of patients being dumped, come work in ED for just one shift. You had empty beds and four patients arrive, beds to accomodate said patients. This is not usually the case in Emergency, more like 20 arriving and no beds for them. We just get on with it. Patients get put in corridors on their stretchers, mobile patients have treatment in chairs, and still the ambulances line up. The 9 potentially unstable, acutely unwell patients you are caring for are cranky (in the corridor) and sick. I can honestly say that most times, patients would prefer to be in their ward bed or the corridor outside it than stuck in ED when the you know what hits the fan. Psych patients being taken down by 6 security guards, CPR in progress being rushed by, nurses unable to do the nice things because they are prioritising ABC- I think you should acknowledge that sometimes we really do have the patients best interests in mind when we DUMP them on you. I have had patients say "get me out of here", its not that they don't like us, they just don't like whats going on around them. I don't think unprofessional is a fair label. Seriously, we don't deliver unstable patients to wards where I work, they can wait a while to see you. I once delivered four patients at once to one of the wards in our facility, we had to empty the department for a boat crash. The point I am making here is that perhaps the emergency department was the worst place for that patient to be, there may have been a very good reason. It is entirely possible that being abandoned in your corridor was better than being abandoned in theirs, the corridor thing isn't a cardinal sin for us, wouldn't bat an eyelid. Maybe the nurses had to get back ASAP and figured you could handle it. Maybe the nurses didn't put the patient in a bed because they weren't sure where you wanted them. Besides, I have a sneaking suspicion if they did put the patient in a bed without talking to you that would have been totally unprofessional too. I guess the point I am trying to make is try not to attack the ED nurse, if you asked why rather than attack you might be surprised at the answer. Im just getting a little tired of nurses being so awful to each other-Am I unprofessional every day when I sit that patient in a chair because someone who is sicker has just arrived? As far as patient satisfaction goes (according to the latest questionnaires) apparently the best thing I can do is dump them on you. Don't even get me started on professionalism given the atrocious comments and blatant rudeness I encounter daily when I transfer patients. I actually had a patient say to me, after all the staff at the nurses station rolled their eyes and ignored us when we arrived "can I come back downstairs with you?" I said, ït's ok, they will be nice to you, it's me they don't like. As for the comment about whether we should be working in the ED, if we sweated the stuff you are talking about people would die- take it as it comes- In your situation I would have popped out, said hi, put the patient in the bed allocated and said see you in a minute- ooh, and thanks ED nurse, I will take it from here.

[ladside, BSN, MSN, LPN, RN]

How do you pop out to say hi to someone that you are unaware of UNTIL you walk out of the room? As I said in my post, I was completely shocked to see that there was a patient in a hospital bed outside in the hallway with his family. There was no report, no announcement that he was even arriving. This is a patient that was admitted through the ER with SVT. There was no one available to even place the patient on telemetry. When I came out, he was in the care of his family, who informed me that the ER nurse told them that "it happens like that sometimes". That was TOTALLY unprofessional. And whatever room the patient was going to should have been the location where the patient was left. How things are run in the ER is totally different from how things are run on OUR floor. We have policies in place to inform all of the floors if there is mass casualty and to be prepared for an influx. We had no such situation that particular day and I know this because I reported his behavior and there was an investigation. After all, he left the patient to the patient's family, not to the nurse. He had no justification for what he did. There are nurses in every hospital who takes short cuts and this is an actual occurence. And it was unprofessional to stash a patient in the hall on the floors. To be admitted to our floor, there has to be an active cardiac situation in progress, be it acute, chronic, or resolving. What he did was not safe for the patient, his license, my license, or the hospital as a whole. There is no defense for this behavior and you should not take this personally because there are those nurses who put others in jeopardy, patients and staff, and the only way to prevent a tragedy is to call them on it before something tragic happens.

[fiveofpeep]

How do you pop out to say hi to someone that you are unaware of UNTIL you walk out of the room? As I said in my post, I was completely shocked to see that there was a patient in a hospital bed outside in the hallway with his family. There was no report, no announcement that he was even arriving. This is a patient that was admitted through the ER with SVT. There was no one available to even place the patient on telemetry. When I came out, he was in the care of his family, who informed me that the ER nurse told them that "it happens like that sometimes". That was TOTALLY unprofessional. And whatever room the patient was going to should have been the location where the patient was left. How things are run in the ER is totally different from how things are run on OUR floor. We have policies in place to inform all of the floors if there is mass casualty and to be prepared for an influx. We had no such situation that particular day and I know this because I reported his behavior and there was an investigation. After all, he left the patient to the patient's family, not to the nurse. He had no justification for what he did. There are nurses in every hospital who takes short cuts and this is an actual occurence. And it was unprofessional to stash a patient in the hall on the floors. To be admitted to our floor, there has to be an active cardiac situation in progress, be it acute, chronic, or resolving. What he did was not safe for the patient, his license, my license, or the hospital as a whole. There is no defense for this behavior and you should not take this personally because there are those nurses who put others in jeopardy, patients and staff, and the only way to prevent a tragedy is to call them on it before something tragic happens.

That is an isolated incident that really has nothing to do with the positive intentions of the OP. Are you even reading what people are writing and trying to understand what it's like on the other side just as the OP has or are you just here to complain?

Don't take things so personally and don't apply one bad experience to all of emergency nursing.

[FlyingScot, RN]

Nice. Take a thread that was meant to unite and empathize and turn it into a b---ch session. There are plenty of those here on AN. This didn't need to become one.

[ladside, BSN, MSN, LPN, RN]

That is an isolated incident that really has nothing to do with the positive intentions of the OP. Are you even reading what people are writing and trying to understand what it's like on the other side just as the OP has or are you just here to complain?

Don't take things so personally and don't apply one bad experience to all of emergency nursing.

If you read my original response, then you would know that I did not apply this to all of ER. And I am not here to complain. I posted an experience that I have encountered as a floor nurse that could possibly lead the ER nurse to be on the receiving end. It goes both ways. That is what I said. Obviously, you appear to only want to see one side of it. It goes both ways. I gave respect in my first post as I said that I could not go to the ER as I know my limitations. Did you read that? Some people are not cut out to be floor nurses and some are not cut out to be ER nurses and what I said is that "life as a nurse would go so much better if everyone respected the other's position". If you read that, obviously it meant nothing to you, which goes to prove my point in saying respect the other's position.

[FlyingScot, RN]

My post was obviously misunderstood AEB the person/people who "liked" it. I don't think the OP was trying to turn this into an us vs. them thing. Bringing up an anecdotal negative experience does nothing but fuel the fire and is counterproductive. I know as an old ER nurse I wanted to provide the best patient care and not screw the next nurse who had to take care of my patients. Sometimes I couldn't get everything done and make the patient pretty and sweet smelling. When that happened I would go home thinking I was the worst nurse ever. I felt bad for the patient and for my colleague who had to clean up whatever mess was left. We've all had experiences that left bad tastes in our mouths but I would be willing to bet that most of those were based on misunderstanding and mis-communication. Please, don't let this devolve into bashing each other. It serves no purpose and only continues the hard feelings. I really like what the OP had to say and the response from the ICU nurse. It was true collegial dialogue and could go far in mending the riff that often occurs between these two nursing disciplines.

[spencerma2]

It is one thing to have episodes in the ER of 'the sh*t hitting and the flood gates open BUT what the heck is going on here???? Why is the staffing so poor that nurses are having to do the minimum to keep the patient alive and then not enough time to document what was done or even give a decent report to the receiving nurses?

I

[spencerma2]

It is one thing to have episodes in the ER of 'the sh*t hitting and the flood gates open BUT what the heck is going on here???? Why is the staffing so poor that nurses are having to do the minimum to keep the patient alive and then not enough time to document what was done or even give a decent report to the receiving nurses?

NURSES WHAT IS WRONG WITH THIS PICTURE???????????????????????????????????

Has it occurred to anyone that the current staffing levels are poor for the level of care the patients are needing? The situations you are describing used to the exception not the rule.

Has anyone seen any CEOs or managers coming in to help when the unit is overrun with patients? Has anyone done any reality checks about who is earning the big bucks and who is doing all the work??????????

In years gone by, RNs have protested and gone on strike for poor working conditions and unsafe conditions for patient care.

Dang is it any wonder, basic nursing care is not being followed and cross contamination is happening?

What happened to 'charting with a jury in mind'? How would you like to explain what you wrote in your notes to a lawyer? Oh, wait, you did not have time to chart it all???? If you did not chart it, it did not get done even if it was done.

Protect yourself, your license and your patients. Having to defend yourself could cost you everything you ever worked for just to pay the lawyer. Let alone the cost of reinstating your license and the stress of the whole thing.

[fiveofpeep]

This thread is going in so many random and unintended directions methinks.