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I used to work as an ER nurse and now a house supervisor. Two things about the job that baffles me are the floor nurse and on call staff. What is with the attitude of some floor nurses and not... Read More

  1. by   4XNURSE
    Originally posted by Susy K
    My only complaint with the ER is when they get involved with obstetrics - which they clearly shouldn't!!!

    You get NO quarrel from me there. YOU get em soon as we can get em to ya!
  2. by   4XNURSE
    Originally posted by RoaminHankRN
    4X... Could you paste that article.. Link requires you to be a member.
    Let's try this.

    Sep. 1, 2001

    Why ED nurses have that attitude
    VALERIE LYTTLE is an ED nurse at Auburn (Wash.) Regional Medical Center.
    ED nurses have the reputation of being loud, demanding, and bossy. And while that may be true, this ED veteran explains why.

    The challenge of being a jack-of-all-tradesThe added stresses of emergency careWhy we are the way we are

    Before I moved to the emergency department in 1995, I'd worked on a variety of different units over the course of my nearly 16-year career. So to me, this latest move wasn't especially noteworthy. A colleague of mine, however, viewed things a bit differently.

    "I suppose you'll develop that ED attitude," she remarked on my last night in my old unit.

    "That ED attitude," I have come to learn, means having a reputation for being aggressive, assertive, loud, demanding, tenacious, and bossy. ED nurses are frequently called chronic complainers and are also accused of not understanding the floors, the patients, or the families.

    At times, ED nurses certainly are guilty of all of those things. While I don't excuse offensive behavior, I would like to share with you some very good reasons why those of us who work in the ED behave the way we do.

    The challenge of being a jack-of-all-trades
    If on some days we seem to have an attitude, try to understand how many different nursing tasks we're called upon to do. Although we're best known for our ability to treat emergency trauma, we also have to be part labor/delivery nurse, part pediatric nurse, and part geriatric nurse. We must move among all of our duties quickly and easily, turning from a critically injured child to a patient with a sprained ankle to a cardiac patient without skipping a beat.

    We take on the role of clinic nurse, caring for patients who return for daily antibiotics and staying up-to-date on those diseases that are reportable to public health agencies. We are oncology nurses who have to help cancer patients through an oncological emergency or support them as they exit this world.

    But it doesn't stop there. For some patients, we are renal nurses; for others, we are orthopedic nurses, applying all kinds of splints--and sometimes even making our own.

    We are pulmonary nurses, helping asthmatics and patients with COPD, and we are neuro nurses, rushing a stroke patient to the radiology department for a CT scan to determine which treatment protocol he'll need.

    We are cardiac nurses when we must work feverishly to get enough IVs in place to administer thrombolytics to a patient suffering an MI. We are intensive care nurses when we're looking after a patient who's septic and going into multisystem organ failure.

    Then we may have to turn to a burn patient and know the priorities of care for someone with severe burns to 70% or more of his body. In addition, we must know what to do for a patient involved in a hazardous material incident.

    We are forensic nurses when we assist with the exam of a sexual assault victim, or attempt to collect and preserve evidence on gunshot victims. We dabble in psychiatry when we keep a patient experiencing an acute manic or paranoid episode from harming himself, or encourage a severely depressed woman to hang on.

    We are also educators, teaching patients how to walk with crutches or manage their asthma at home, or explaining to a new mother what to do when her baby develops a fever. We promote safety by reminding patients about the correct use of seat belts and helmets. We're also the "SWAT team," responding to codes and crises throughout the hospital.

    The added stresses of emergency care
    In the ED, we have to be able to respond at a moment's notice, no matter what else is going on. The ED doesn't have the luxury of closing, can't turn away patients, and always has to make room. When a sick patient comes in, we can't say, "Sorry, we're full," or "Sorry, that nurse is on break."

    We have to put our feelings aside--in fact, we're too good at negating our own feelings, and as a result, we're at high risk for post-traumatic stress disorder, an occupational hazard for all emergency care providers.

    In the ED, we also see humanity's worst. We deal with murderers and rapists. We look after victims of abuse. We care for innocent victims of alcohol-related car crashes.

    We see people during the worst times of their lives. We are there when a critically injured patient pleads with us to not let him die. We are there when a family tries to achieve a sense of purpose for the loss of someone they loved as we explain organ donation.

    Why we are the way we are
    If we seem aggressive, perhaps it's because drunk or distraught individuals verbally abuse us. We try not to take it personally, but it's hard to duck every arrow when you're in the line of fire. We also face the risk of physical assault and threats to our safety as part of the job.

    If we seem too assertive, it's because assertiveness is an essential quality in any nurse--especially those in the ED. We have to speak up for patients and their families in situations that are often chaotic.

    In addition, assertiveness is essential when we triage patients. We need this quality when explaining to the patient who feels miserable with the flu why she must wait for hours while another patient gets treated immediately.

    If we seem loud, it's because we sometimes have to shout to make our findings heard in a busy trauma or resuscitation situation.

    If we appear demanding, it's often because we need to get admitted patients to their rooms to free up beds for another who's waiting--and there's always someone waiting. We're also demanding when we have a full unit, plus six or eight patients in the halls on monitors, and we're running out of both beds and equipment.

    If we are tenacious, it's because we know that sometimes you have to prove your point with attending physicians or residents who may want to discharge a patient you believe should be admitted. Sometimes tenacity is required for airway management, to do everything possible to avoid having to intubate someone in an acute asthmatic episode.

    Are we bossy at times? Absolutely. But that's because we have to be able to respond appropriately when a major trauma rolls in--whether or not a physician is available at that moment.

    So if at times we seem curt or irritable, please bear with us. We realize that these qualities can be exasperating. While it's true that we chose to work in the ED--and most of the time we love it--this nursing specialty can be physically, mentally, and spiritually draining. Please try to understand us when we get that ED attitude.

    Emil Vernarec, ed. Valerie Lyttle. Why ED nurses have that attitude. RN 2001;9:49.

    Published in RN Magazine. Copyright 2001 Medical Economics Company at Montvale, NJ 07645-1742. All rights reserved.

    hope I'm not violating any copyright stuff!

    Last edit by 4XNURSE on Feb 26, '02
  3. by   RoaminHankRN

    I will not disagree with you on your story or anyone else with similar accounts.

    So do floor nurses have an attitude because the ER nurses have one?

    And you are correct, no one is better than another.

    But there needs to be better teamwork and understanding between the two.

    Like you said, you remember being a patient at one time. Try to keep that in mind all the time.
  4. by   RoaminHankRN
    Thanks RX...

    As I mentioned..we need understanding.
  5. by   4XNURSE
    Originally posted by RoaminHankRN

    I will not disagree with you on your story or anyone else with similar accounts.

    So do floor nurses have an attitude because the ER nurses have one?

    And you are correct, no one is better than another.

    But there needs to be better teamwork and understanding between the two.

    Like you said, you remember being a patient at one time. Try to keep that in mind all the time.

    You got that right!

  6. by   Cindi_B
    Having worked both sides of the fence-ER and floor nursing, I found a problem that may or may not have been specific in our hospital. A significant percentage of the ER nurses were relatively new and had not worked on a med/surg floor for any length of time. Therefore the new nurses in their inflated sense of being an "ER" nurse would dump patient care on the receiving nurse. Likewise, the floor nurses, knowing that the odds are that they will receive a patient who needs a lot of the "basic" patient care would not be able to free up a bed until about 30 minutes before the change of shift. It was a bad situation all around but especially for the patient. Where's management????? At another meeting?........It takes all sides to mend a fence...Hey, let's just tear it down!!!!!!
  7. by   askater11
    That's funny regarding patients arriving 20 minutes before shift change. That happens all the time on our floor. Not just from E.R. but also from "certain" hospitals. Occasionally we do get patients from E.R./transfers during mid-shift but in the most part no.

    One hospital I'll call for report at the beginning of shift. The patient arrives 8 hours later. It always happens.

    I always wonder why nurses are rude to one another. Gosh I wish it could stop!!!!!!!!!!!!
  8. by   P_RN
    When my father in law had his fatal heart attack, the ER was awesome. When my daughter broke 3 vertebrae the ER was awesome...that's 2 hospitals.....THEN when I had to go to the ER back in Sept. the ER was AWFUL! 3 different hospital and probably 30 different health care workers. Apples and Oranges for sure.

    EVERY instance is different. I have gotten report at 830AM and the patient not be brought to the empty bed until 645 PM with IV not started, ordered abx not started and the patient not fed. There was no interval call, even when I called there was no explanation.

    I have had patients brought without report and had a transporter LEAVE them in the hall because the former patient had not left yet. Do you want to discover a patient in that circumstance? I even had a transporter bring someone who had DIED on the way up, then wanted to know if she could use the phone in the room before she went back down. Are these typical. No they are not. Are these the ones that stick in my memory? You bet your sweet tukkus they are.

    I have had ER nurses call me and ASK if it is OK...to come now....the answer is usually yes. If I ask you to wait ten minutes, you usually do. I won't have an attitude if you won't.
    I guess that paperwork is paperwork and nurses are nurses, but they are NOT the same.

    To admit a patient through ER or from home to the floor required approximately 45 minutes of documentation. That's before you begin any treatment, but any comfort measures are of course done .First there are also the other 13-14 patients calling on you for care too. Sometimes I had a tech for my team, sometimes there was only one for the whole floor.

    If I get two new ones, then there is 90 minutes of paperwork.

    We don't need to gnaw each other. Attitude usually reflect back with the same attitude. Make yours a good one.
  9. by   Brownms46
    Bravo P_RN ...,

    Very well said! :
  10. by   dawngloves
    Try this shoe on:
    Spend half the day trying to get tele monitors DC'd because ER is full with R/O MIs. Super tells you you have an admission, you wait and wait for ER to call report. You are ready to take VS on your 6 pts. so you call them. RN can't come to the phone. OK, tell them to call when they're ready.
    Do your VS, nothing. Set up for the admission, go into computer and get admissions lab results, still no report. Call super to make sure pt didn't expire. Nope, still coming.
    Well, 1830 rolls around and guess who's calling report and quess what else, the pt is on the way with transport on a monitor!!! No RN! Hello!
    Why is this? Because the ER is busy? I don't doubt it. Just remember that, because it gets busy in the floor too.
    This happened to me almost every weekend I was on. And then I got over it.
  11. by   dawngloves
    I even had a transporter bring someone who had DIED on the way up,
    LOL PRN!!! :chuckle I had transport bring me a dead guy from an MRI! I don't know when the poor guy expired, but he was pretty cold.

    Sorry to divert from the topic.
  12. by   jimminy
    I think all nurses should rotate to all the different areas during orientation and again once a year. This way we would see alll sides of the coin and know that every specialty has it's problems, concerns, and frustrations. I know from experience that yes, we may find out a patient is going to be admitted, but that patient may not go up for another 8 hours. However, if we would all rotate, everyone would know that the admit docs decide to hold the admit orders until another ct is run, neuro consults are done, more labs, c-spine is cleared, and then more xrays are done (because, according to the docs, it takes too long upstairs). This is after all the initial workup has been done. We end up stabilizing the patient, doing all the initial workup and then the admit docs orders that he wants done in the EC first! This is not just Trauma, it occurs with all the types of patients. I have seen the docs finally pull the orders out of their pockets that are dated 6 hours ago, so it looks like we were lazy and "sat" on the patient for six hours. I write on the orders "received orders at ___ time". We have started to take a patient up and the doctor changes his mind and wants ANOTHER test!!

    Yes it is frustrating for everyone. Trust EC nurses when they say they are not sitting on patients on purpose. We don't want them any longer than necessary because we've got 4 nurses, fifty acute patients, and more EMS rolling in constantly, and this does not include getting pulled to the different areas when the trauma rooms get swamped. This is the holding area! If we went upstairs and worked with ya'll, we would see your frustrations.

    Why can't everyone just get along? :kiss
  13. by   pebbles
    I know the ER is busy, and I do try to cut them some slack and take admissions when I can. But sometimes it is apparent that consideration does not go both ways all the time.

    In our ER, they commonly try to "clean house", and get all the admits out of the ED before *their* change of shift. So that means we floor nurses are expected to take admits at OUR change of shift - making us late, etc. Also, sometimes we think it is less safe to admit a patient at change of shift, cuz what if he isn't perfectly stable... So we try to refuse admits within 1/2 hour of change of shift time, as a matter of "unwritten" policy (and some of the ER nurses respect our "rule", out of courtesy).

    I co-ordinate with the Nursing Supervisor (who is in cahrge of the whole hospital) as to how busy they are down in ER. If they were NOT busy, and a patient arrives in ER at 2300, there is NO reason WHATSOEVER that this patient *has* to have been moved to the ward at 0700. Get him to me before 0600, or after the next shift has arrived. As a matter of courtesy. ER nurses have been know to be lazy and avoid work from time to time also...

    The article about ER nurses having attitude should NOT be used as an excuse for (un)professional rudeness.