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Nurses General Nursing

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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 wanting to take patients. When I call to place patients, oh the attitudes and excuses I hear.

Sure, ER should help out where they can and when they can. But when the waiting room is full and the hall beds are taken, cut 'em some slack. Do floor nurses understand the ER has an "open door policy." How many floor nurses have worked ER? It's a different world down there.

Remember most patients are admitted through the ER and it is their first impression of the hospital. Do you know what the biggest complaint on patient surveys are?

Second... on call staff. Two things to say about that. Save the whining for your spouse and if you don't like on call... Taco Bell is hiring.

Hank

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

Specializes in Trauma acute surgery, surgical ICU, PACU.

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.

Specializes in Everything except surgery.
Originally posted by pebbles

[b

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).

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

WOOOHOOOOO,

I'm glad someone else said exactly what I was thinking! I have worked a lot of different areas including ER, and "I" have SEEN "clean house" done up front and in person.

I have also seen exactly what jimminy has described. I also know for a fact, that working in the ER is a whole different animal.

But that still doesn't excuse the attitudes I have seen in all too many ER nurses.

A couple of months ago I and another nurse, transfered a pt back to the ER after having a procedure in the GI specialty area. We ran into the most arrogrant, nastiest nurse ever! All we ask for was some assistance in transferring this person to a bed. And NO...there were was no WWIII going on in the ER. We put on the call light...even though they had received report prior to transfer, and KNEW we were on our way....no one came to assist. Upon going to look for someone...we found several ppl. standing around...who tried to get an attitude also. The non busy ppl had the nerve to ask us what did WE want! Just a little help getting this pt. in bed will do...thank you very much!

I do agree with jimminy, that everyone should pull a shift in another area, to refresh their memories about the other side of the fence.:cool:

I think we all have had problems with each and every other unit. We get focused in on what we are doing and get really frustrated when the other person can't or won't see that you are dancing as fast as you can.

It's also not always the fault of another unit for delays in beds.

One situation I was in.... ER had a patient they wanted to send to me. I work in a very small, 3 bed Advanced Neuro Care Unit. All 3 of my beds were full and ER wanted to send me a patient and were insistant that I take him. There was no way! .... yet....

I told them that I had one patient who was going to be transfered out to the regular floor but they didn't have any beds yet because the patient mine was going to replace hadn't been picked up by the ambulance yet because they had an emergency and the regular floor had been waiting all day to get the guy over to the rehab hospital but the patient who was supposed to leave there was also late in leaving.... and so the story went.

Unfortunately, ER got tired of waiting and had patient transport bring the patient up to my unit.... errr..... we don't haved bunk beds... bed is very obviously currently occupied as is the one still out on the floor... so the Fresh hemorrhagic CVA had to stay on the stretcher sitting out in the hall.... along with his huge family getting madder and madder because the bed was still occupied and everyone knows how uncomfortable the ER stretchers are!... me included.

Yes, I had taken report and had primised to call ER immediately when all the patient movings and bed cleanings had been done so they could send the patient up to me. When I called ER and asked why they sent the patient without my calling, they just said, "It had been so long, we just figured you had forgotten to call us." Needless to say, I wasn't happy, the family was furious, the patient who was supposed to be transfered out offered to sit in a chair while the bed was cleaned for the new patient... the supervisor was royally pissed that she was going to have to straighten out the mess......

All round, it was a mess and there was no specific person or division at fault. We were full and discharging people and transfering them as fast as possible... and we were all very frustrated.

I honestly can say that I have worked all areas so I have seen it from both sides... as well as that of being a patient waiting for a bed in ER while being sick as a dog in the waiting room but, on a whole, I have found more ER nurses being rude and trying to be assertive to get their patient up to the floor than the floor nurses being too lazy to accept the patient in a timely manner. Trying to be assertive toward me doesn't work. I admit that it makes me bow my neck but I will never NOT take a patient immediately when I am capable of doing so. The rude nurses just get reported to their supervisor in writing and verbally (face to face), with full documentation about the situation and what was said. The ER nurse might only get a slap on the wrist but their boss as well as mine will know that the incident happened and that I will not back down.

I also have experienced the ER end of shift clean out. It's not just the nurses but the ER Dr who doesn't want to have to report off on a patient to the oncoming shift.... Heck, it happens in the recovery room, too.

We all get frustrated but there is no call for the over all and generally rude, assertive attitude I have run into many times from ER nurses. They do a hard job but so do the rest of us. Keep a civil tongue and so will I.

Heck, I just heard that night shift at WalMart pays $22/hour!!!! (after about 2 years of working there) Where do I go to sign up????

Kat

I really don't mind an admission 20 minutes before my shift is over, how about 5 minutes. I will be told i'm getting an admission at 5 am, no big deal so my patient load is already pass the point of safety. It never fails at 725 am my patient arrives with the er nurse, with her coat on. I don't like patients to wait, it is unfair to them to wait for the oncoming shift, but when my patient tells me they were told there were no beds available and they have been waiting since 5 am to come upstairs it ticks me off.

I never understand why is it okay for nights to take an admission 15 minutes before 3-11 ends and 7-3 can't take an admission til

they come out of report. IT's no wonder nightshift has more overtime than any other shift. Didn't mean to offend anybody just an observation.

Originally posted by Katana

I think we all have had problems with each and every other unit. We get focused in on what we are doing and get really frustrated when the other person can't or won't see that you are dancing as fast as you can....

...All round, it was a mess and there was no specific person or division at fault. We were full and discharging people and transfering them as fast as possible... and we were all very frustrated.....

I also have experienced the ER end of shift clean out. It's not just the nurses but the ER Dr who doesn't want to have to report off on a patient to the oncoming shift.... Heck, it happens in the recovery room, too.

We all get frustrated but there is no call for the over all and generally rude, assertive attitude I have run into many times from ER nurses. They do a hard job but so do the rest of us. Keep a civil tongue and so will I.

Heck, I just heard that night shift at WalMart pays $22/hour!!!! (after about 2 years of working there) Where do I go to sign up????

Kat

Kat your problem is that you're more perceptive than the average Joe. (or Suzi or Clyde) You seem to have an excellent handle on the whole scope of the problem.

Now how do we get the message out?

ken :confused: :devil:

Specializes in Trauma acute surgery, surgical ICU, PACU.

Hmmm. Kat's post made me think of something.

Those of you who get angry/outraged family members over things that are not your fault, things that are caused by faults in "the system", or the way other units (including ER) do things: Do you ever encourage the family to complain and tell them where to go with their complaints?

I'm just thinking management is more likely to listen to their complaints than the word of a nurse - cuz they are the customer in the business, after all.

Originally posted by pebbles

Hmmm.....

tell them where to go with their complaints?......

LOL ! Tell them to stick it Where ?

LOL

ken :chuckle :devil:

PS, I'm trying to be sorry, I couldn't help myself.

:chuckle :chuckle :chuckle

horsecrazy, the unit I work in has no secretary. What we try to do for the shift change patient is the off going nurse will do all the orders while the on coming nurse does the admission and assessment. It works well. Yes, the offgoing nurse does a little overtime but the good will is worth it and our nurse manager approves it.

4xNurse, Thanks. Dunno how we can get the attitude out but it sure would be nice. I've been an RN for 26 years and have worked pretty much everywhere but OR. hehehe I like my patients zipped up, thankyouverymuch. :)

Pebbles, we have a Patient Liasion and we refer the family to her. It's her job to find out what happend and to smooth over ruffled feathers. I wouldn't have her job for all the tea in China!!!

Kat

Specializes in ED, House Supervisor, IT.

Floor nurses are bringing up some points. What do ER nurses have to say?

Floor nurses... what are some remedies you would offer... I sure there a lots of stories to go around. But if I am the patient, I want to know what you (ER, floors, surgery, etc) would do to fix things so I don't wait any longer.

Another point to remember.. there are two sides two every story..and in our business there is a third...

Pebbles said...

"I'm just thinking management is more likely to listen to their complaints than the word of a nurse - cuz they are the customer in the business, after all."

Because we need the business of the patient.. If one decided to complain.. Who do you think management will side with?

The ER nurse with her coat on?

The floor nurse whose shift ended in 5 minutes?

The patient?

Specializes in Med/Surg, Geriatrics.
Originally posted by RoaminHankRN

Wendy,

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

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

Well Hank, you know that goes both ways. Why don't you try a little understanding and teamwork? When is the last time you worked the floor? When is the last time you had 9 patients, all of them bad, some of them in restraints(and getting out), docs on the floor writing stat orders, docs doing procedures and another one unstable but there's no bed in the unit just yet and ER calls and demands to give report right now as if you are standing around doing nothing? Oh yeah and where do you think the families go once they hit the floor? Hint: it's not home.

I got news for you. There are times that I don't take another patient because I don't think it would be safe for me to do so. I am not going to risk someone else's life (and here's the selfish part) or my conscience and license just because I don't want to rock the boat or be labelled as uncooperative. And it's unfortunate that the patient is suffering(and yes I've been a patient several times myself), but that's not my fault. That is a system fault and I refuse to accept the blame for things out of my control and I refuse to blame my fellow nurses.

But Hank, heres' the thing. I don't pass judgement on ER when they roll a patient to the floor with 2 pages of orders and who hasn't had a thing done for him since he got to the ER 12 hours before and I don't pass judgement on the units when they roll down a transfer 15 minutes before shift change when they've had the bed assignment for 6 hours. In fact, I am usually working too hard to worry about what the other departments are doing, I just assume they are working as hard as I am, not less.

What is about nurses that they constantly feel the need to put down each other and assume that the other one is "lazy" or just "incompetent" because he or she isn't ready to do things your way when you want it? Can somebody, anybody answer that one for me?

If it's so frustrating for you Roamin', then maybe you ought to look into that Taco Bell thing.

Specializes in Med/Surg, Geriatrics.
Originally posted by P_RN

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.

Excellent points!

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