Floors VS ER

mhull · Mar 24, 2006

Does anyone else have a rivalry with the floors in the hospital? It just seems that when the ER sends patients upstairs, they always have a problem with something!

We must work the same place. I see the same problem. I just kill them with kindness. Gosh, half the time they don't come to the room to help move the patient over to their bed, I have to call out for help if needed.

We also have a hard time getting the nurses to take report on out patients. We don't get to stall a patient when they're coming in by ambulance, why do they play this game with us? Is it just my hospital that has this problem?? Sorry, I'm venting, any responders? :angryfire

If I run into this problem, I call and ask for the charge nurse. If that doesn't work, I take the patient up and give report there. But I also take into consideration if they are coding someone, up to their eyes with stuff, etc. I'm really not a mean person.

I do not wish to offend anyone with my statements. I am just making observations at my place of employment. And, no, not all the nurses are like that. My best friend for example works in the Cardiac Step Down unit, and I am good friends with several of the ICU nurses. Please don't get upset or take offense to my statements, I am sure the floor nurses at times feel the ER nurses are the same way. I am sure this is an age old battle that is not going to die.

Now I am going back to my :chair:

smackRN · Mar 24, 2006

I've never worked anywhere but ER, and I could write a list about all the things I find frustrating about the floor. I often say I wish every floor nurse would just come work one day in the ER, so they would get it.

I bet you do. In our small facility, floor nurses are regularly pulled to ER -myself included. BTW you will almost NEVER find an ER nurse pulled to the floor here. Maybe that's why it doesn't seem to bother them to send multiple patients at shift change.

Now having said that I'll tell you that I love our ER nite crew.They do all they can to go with the floor flow and make you feel at home when you do get pulled to work with them.

DusktilDawn · Mar 24, 2006

I have been a ER nurse for 12 years and worked dozens of hospital as a travel nurse all over the country. It is the same all over the country. The only suggestion I have is if there was a float nurse on each floor to take report and accept the patient. We understand that nurses are over worked, no matter where they work in a hospital. I now work as a charge nurse in ER and yes I am guility as ever other ER nurse that think everyone should drop everything and take my patient. We are going to try the fax report, but it still concerns me that a patient is brought up and the nurse may be busy and not realize the patient is there.

This is exactly my problem with faxing reports at my facility. We receive no notification PERIOD that we are receiving a patient. Other nurses from other units have told me that patients have been admitted when the unit was extremely busy and patients were not assigned or taken care of because no one knew they were there. This has not happened on the unit I work on that I am aware of. How reports are faxed at my facility is a safety issue as far as I'm concerned. Bear in mind that because a report has been faxed, that does not mean anyone has accepted responsibility for this patient. Often times these reports arrive after the patient if they arrive at all.

This is a letter written to Nursing Spectrum about the issue I have with faxed reports: http://www.nursingspectrum.com/CareerManagement/AskTheExperts/Law/detail.cfm?ID=598

I do like the idea of an admission team or something along that line. Adequate staffing would also help.

jillyk*rn · Mar 24, 2006

gotta chime in on this one:lol2: !

personally, if i can't get to the phone for report, it is not because i am just passing meds. i have floated to the er, and i get a little sense of what is going on down there.

10pm - maybe she wasn't passing meds. that's time for hs blood sugars. maybe there was a problem. it is also the time for night dressing changes, etc. there are lots of things going on:bugeyes: :bugeyes:.

i know that maybe the er patient has been there for 8 hours (not waiting to get to the floor, but being taken care of), but that doesn't make him more important than those 5 i already have on the floor.

i am one of those who is also gonna kill with kindness .

er to the floor will be one of those age old problems with no good solutions!

neneRN, BSN, RN · Mar 24, 2006

I bet you do. In our small facility, floor nurses are regularly pulled to ER -myself included. BTW you will almost NEVER find an ER nurse pulled to the floor here. Maybe that's why it doesn't seem to bother them to send multiple patients at shift change.
Now having said that I'll tell you that I love our ER nite crew.They do all they can to go with the floor flow and make you feel at home when you do get pulled to work with them.

Please don't disregard the sentence I wrote after saying I wish the floor nurses could come down to ER so they would get it; I also said they probably feel the same way, that we don't get what its like for them. My whole point is that both sides have valid frustrations.

Marie_LPN, RN, LPN, RN · Mar 24, 2006

There was several times on the floor i'd worked on where we found out we were getting a new admit from the ER when the pt. was getting wheeled by the desk. 5 minutes later, the report's coming out of the fax machine.

Raevyn · Mar 24, 2006

I have worked both the ER and the floor, and didn't really have an appreciation for the ER until I worked there.. God bless you ER nurses... because.. I just do not have the stomach for it.. I am a ICU nurse.. Love it there... but it is quite frustrating.. the days I spent there.. ambulances running in and out.. people flowing through the doors like running water, helicopters flying in we only have 25 beds... they are in the halls and with 6 nurses and 2 docs... its a mad house.... It's tough on the floor sometimes.. but not nearly that tough.. no way..... Not sure if you guys are doing the Admin RX yet.. but thankfully in ER.. they are not.. and that is a good thing... it would be a nightmare if they did... its a nightmare in ICU/CCU with it now.. but we shall see..... but everyone needs to realize.. ER isn't down there.. trying to say.. HEY... lets see if we can piss the floor nurses off.. because believe me... they are just praying for the hell to end..LOL

ImaERtraumaRN · Mar 24, 2006

This is an age-old problem. At our hospital we tried using faxed written reports but it seemed that something was lost in not giving a verbal report. Also, sometimes the paperwork was lost and that was a problem too. We recently went back to verbal reports and now deal with the "I'm not ready" issue. It would be nice if there was a rotating "admissions RN" that could be on call to take report in shifts, maybe a two hour block. This way the pt. could be accepted, admitted with a history done and then handed off to the recieving RN with all the info gathered by the admissions RN. Of course, that would be in a perfect world where there was plenty of staffing.

My biggest issue is when there are beds closed up on the units but we are not allowed to close beds in the ER due to staffing. We are holding with pts in the hallways and EMS rolling in, but due to staffing issues we have beds closed upstairs. Oh well, what are you going to do???

TRAMA1RN · Mar 25, 2006

I work in the ER we get a bed assignment fax report call and confirm report recieved and put accepting persons name on fax cover sheet for the record and wait ten minutes before transporting. 90% of the time I will weigh the patient put the patient on the floors monitor and write the weight on the white board and get the first I & O for the floor nurse. The bed is not lowered the sheets are not folded back and all the furniture is in the way, at least have the courtesy to have the room cleared out. Also when I send my techs with unmonitored patients they should be treated with the respect that they deserve since they are my right and left hand when I need them. Floor nursing is difficult I understand, I have done it, but I love the chaos of the ER and would not trade it for the world.

madore57 · Mar 25, 2006

Although I work in the Cath Lab now (and have the same problem) - I worked in the ER for years. It seems half the staff on the floors seem to go to break at the same time. I must tell you however, my favourite memory of the ER vs the floors. I was working in Dallas at a major hospital ER and I had called report and was transporting the patient upstairs myself. This was a big guy. I pushed the stretcher off the elevator with great effort and found 6 Nurses sitting at the desk doing their charting. I placed my chart on the desk and asked "can I speak to the Nurse for room xxx please?" Nobody responded or even looked up. This time I said "could one of you please help me get this patient to room xxx?" Still no response - not even a peak. The CEO was standing behind them and nobody saw him, including me. He asked me in a quiet voice "can I help you with that stretcher?" I said "yes please - thank you so much". He grabbed the end of the stretcher and I've never seen Nurses jump so high so fast in all my life! I had lots of help then!

Eilleen.

Justhere, BSN, RN · Mar 25, 2006

Our hospital has a policy no transfers between 6:30am/pm to 730 am/pm, but we still have some that try to transfer between that time. The nurse that receives the patient is suppose to fill out the H&P, which takes about an hour because we are computerized charting now. But when we get them so late in the shift they pass the buck to the next shift which tends to make us upset. I try and get my patients that I am recieving to the floor as soon as possible because I have also been that patient waiting on the bed (seven surgeries). If it is between 730 and 830 it is hard because at 730 we hopefully got out of report and if I get a patient right then it is 900 before I get to see my other 6 patients which isn't good either. I don't know if there is any good solution because everyone is going to have a complaint about something. To bad we can't schedule emergencies around the nurses schedules but it just doesn't happen that away.

madore57 · Mar 25, 2006

One of the things that happens is that the Docs usually change shift at about 6pm and at that point they're moving all their patients. The new Docs coming in want the rooms cleared so they can see patients (most still get paid per patient seen). We do a lot of waiting for Docs to sign off their charts so we can move patients upstairs before change of shift. I always loved the Nurses like "LPNtoRN Student" who called me for report! And I loved it more when the Doc was actually ready to release the patient!

Eilleen.