Floor nurse, please forgive me....

AICU RN · Jan 7, 2012

I just wanted to say that I really enjoyed the original direction this thread has headed. I'm not sure where a couple of the replies were meant to go but I certainly liked the intended direction.

At the hospital I used to work at, there was a lot of animosity between ER and ICU in particular and it just made everyone miserable. I was a float desk clerk/aide and those were my two favorite places to work. I was constantly subjected to "So and so is such a bad nurse. That patient she brought up here was a mess. How do you work with her when you float down there?" or "I wish you could have heard how rude that unit nurse was to me. She could come work down here." I saw both sides (to an extent) and those attitudes become very contagious really quickly if you're not careful.

Now I am an ICU nurse and my best friend is an ER nurse (different hospitals, same system). After sharing stories about things the other has seen/done, I try to take into consideration all the other crazy things that was happening when this patient came to the ED. The way I look at it, I'm going to get them settled into our equipment and do the big head to toe, in-depth assessment that ICU nurses love so much anyway, straightening up a few things really isn't that big of a deal. That's the way most of the nurses at the hospital I'm at now seem to look at it and everyone seems to be a whole lot happier.

allnurses Guide · Jan 7, 2012

Back to the original theme: I feel bad when I am trying to get someone to the floor close to shift change. No, I absolutely did not hang onto that patient until the last minute; I get more patients whether I have a room open or not. Sometimes my charge pulls that pt into the hall to make room for the ambulance coming in.

We have a new "throughput system". Bed control isn't allowed to give me a room assignment unless the bed is clean (verified by the floor charge nurse). So telling me the bed isn't clean means somebody lied somewhere. I am clocked from the time the room is assigned: 45 minutes to send you the "chat" form, call to see if you have questions, copy the chart, send for the telemetry box and then hope transport shows up. Except that from 0300 to 0700 we no longer have transport, to xray, the floors, anywhere. During that 45 minutes, the floor wants me not only to call report (and it gets really obvious no one bothered to read the chat, asking me for information that I already wrote down gets annoying), but to call that I even sent the chat. I'm glad to clarify stuff, but would you read the stuff first? If I wrote "pleasant , a&o", why do you ask if she is confused and combative? And I still am taking care of the other 3-5 ER pts I have, fitting in those phone calls etc.

If I could give report when I get a minute to stop and call it, then I would get that patient to you long before 6 AM, instead of 0615 during your AM meds. I waited 25 minutes to call a 2nd time the other day, waiting for the call back from the floor nurse who " will call you as soon as they are out of the pt's room". Blew my 45 minute limit all to pieces; but I know what 6A is like on the floor. Did more than 10 years of medsurg, didn't need a lecture on the difficulties of close to shift change. My poor guy needed to get off these lousy ED stretchers, he'd been here for hours. To wait until after shift change would have meant another 1 1/2 to 2 hours on it.

In my perfect little dream world, patients would only get sent to you during the middle of your shift, and ambulances would all come spaced an hour apart. :cheers:

hiddencatRN, BSN, RN · Jan 7, 2012

I liked the original thread too. I really appreciated especially after a particularly annoying incident with a floor I was sending a patient to last night.I try to be pleasant in report, and be detailed. If I'm not, it's because I'm exhausted and having a crap shift but even then I'll try to make a light joke about the craziness so you don't think it has to do with you. If you ask me to repeat something you didn't catch or for clarification I will give that to you. I do feel bad about giving report close to shift change. I know it's not ideal for you but ready room to delivery times are tracked closely and if the patient sits for a while after we have confirmation that the room is ready I better have a good reason for my charge nurse. I have held a patient for 5 or 10 minutes when you ask and we're not too crazy. I try to feed my PO patients so they're not arriving hungry and expecting food from you when the kitchen is closed, but sometimes I simply don't have time to deal with that. When you get pulled to our ER I will smile and welcome you and tell you not to hesitate to ask for help if you need it. When you leave I'll thank you for your help because if you hadn't come down our assignments would have been hellish or we'd have gotten backed up with fewer beds open. I know you probably didn't have a choice in coming down but I appreciate you coming with a positive (if maybe apprehensive) attitude.

brainkandy87 · Jan 7, 2012

I'm finally becoming an ER nurse in three weeks, a dream I've had for a long, long time. I'm transferring from the step down floor I started on after graduation. I'm getting the "we will miss you" and "congrats" comments. In addition, I'm getting the "don't be the ER nurse that....." comments. Sigh.

psu_213, BSN, RN · Jan 7, 2012

To the floor nurses: before working in the ER, I worked on a floor. I could never understand why the ER had to send pt's at shift change? I never understood why they would send a pt when our floor was overwhelmed? How the ER could send up an incontient pt with a wet brief?

Now I see the other end of situation. We have goal times to meet (for length of stay, time from bed assigment to when the pt gets to the floor, etc.). We have had some situations recently that prevent our ER from meeting these times. We get a lot of grief from the higher ups (up to the CNO of the hospital and the VP for patient care) about those times not being met. We hear from the floor, "don't send them up yet, it's shift change" (meanwhile, shifts change at 7am, 11 am, 3pm, 7pm, 11pm--it becomes difficult to avoid shift changes). Well, the same people who oversees your floors (such as the aforementioned CNO) are telling us we HAVE to get the pts. up to the floor. Sorry, we are both stuck in the middle of this race for time, this customer service 'game.' It stinks for both us (believe me, the you-know-what rolls down hill and lands on both of us), and a lot of times we don't have the choice to 'sit on' that pt until you are able to take the admit.

As for putting pts. in the hall: (this is specific to my hospital) our hospital has decided it is better to reduce length of time in the ER and to put admitted pts in the hall on the floor while their inpatient room is being cleaned. Personally, I don't like it, but that is the decision that was made. For us, if the pt is going to a floor (i.e. not an ICU) the pt can go up with transport unless they are on certain gtts. (for example, dilt, NTG, amio, etc.). If transport takes them up and leaves them in the hall, then complain to admistration about the policy that they think is best. If they are on such gtts, the RN will bring them up, and this RN for one will not just leave them in the hall.

(sorry for the rants)

Anna Flaxis, BSN, RN · Jan 8, 2012

Oh man, I really didn't want this to become an ED vs. floor rant/debate!

FlyingScot, RN · Jan 8, 2012

Oh man, I really didn't want this to become an ED vs. floor rant/debate!

I'm disappointed too. Your original intent was terrific and would have gone a long way toward building bridges. It's too bad some people can't just take something at face value and must insert negativity into what by and large was a positive post. It's not like we don't have a hundred "ER vs floor nurses" posts where they could have told their stories and defended their "offended" positions. I'm sorry Stargazer but at least you tried.

psu_213, BSN, RN · Jan 8, 2012

I apologize if my post seemed like ER v. floor. It probably did, but was not meant to be. When I worked on the floor, we got a ton of ER admits through the night, and some of things they (the ER) did (or, many times did not do) aggrevated the heck out of me. Now, working in the ER, those things happen out of necessity...because of the decrees of those is management who work in neither place have decided they know what is best for both places...because both places get incredibly busy and it stinks no matter what happens.

Anyway, I say we unite and turn this threat into the ER and the floor together versus management. OK, not really, but it sounds better than floor vs. ER. :lol2:

Chanda2013 · Jan 9, 2012

I'm an RN student and, after reading this thread, I may never work in a hospital. I don't need all that bitterness in my life.

hiddencatRN, BSN, RN · Jan 9, 2012

I'm an RN student and, after reading this thread, I may never work in a hospital. I don't need all that bitterness in my life.

Might want to read selectively on this website then, or AN could inspire you to change majors. There's a lot of venting on this site that sounds much more bitter than a few of the posts in this thread.

Medic2RN, BSN, RN, EMT-P · Jan 9, 2012

Okay, here's a nice post to show how, under ideal conditions, the through-put for the patient was terrific for the patient, the ER nurse and the floor nurse.

I thought of this thread after it was over. My patient received his room assignment. It was still early enough where the ER wasn't crazy and oozing with patients.

I faxed report and called to verify. While waiting for the nurse to get on the phone, another ER nurse told me that he had sent up a patient and another nurse had also recently.

Once the nurse got on the phone, I asked her about it. She was getting ALL of them. I asked my charge if it was possible to hold the patient for a bit until the floor got caught up. The charge said, "No problem". The floor nurse said she would call as soon as she admitted the other 2 and passed her meds. I told her I would feed the patient his breakfast and make sure the meds were reconciled so she wouldn't have to do that.

I got an ambulance and another patient in the meantime. She called later, ready for the patient. He was fed, happy, and arrived with people waiting for his admission.

Now, this is the ideal - something I think all ER nurses and floor nurses would like. Unfortunately, it does not usually happen, but when it does it is enjoyable for us all.

I think it's not the nurses' fault, but the design of the system. Instead of the constant ER vs. floor scenerio and pointing fingers at each other, we need to step back and try to look at the bigger picture - the process is at fault and the people responsible for designing that system need to know. We are not the designer of that process (unfortunately) and should not be at fault. Nurses are working within that broken framework.

The question should be: how do we change it to achieve what we need?

allnurses Guide · Jan 10, 2012

Stargazer, sorry about that. Seems that I couldn't just say sorry it happened without trying to explain it from the ED side. If we can understand each other's points of view, maybe we can downgrade the disgruntlement some.