Why don't the big boys understand??

GardenDove · Feb 9, 2007

They live in their own, insular world, and are not aware enough to realize it?

nursebrandie28, BSN, RN · Feb 9, 2007

:rollDear Tazzi,

I see both sides. My part time job, I work in a trauma center in st louis ( the designated one for 3 states) and my PRN job I work at a rural 4 bed ER.

I agree with you, when I try to transfer at my 4 bed ER, it is a mess. They treat me ( and half the time, I know the nurse I am calling report too) like an idiot, our doctor is an idiot and so on. One time, this nurse said, "don't bother sending xrays, we will do our own, our machine is better" It is a mess, they need to understand that we are a small hospital.

On the other hand, when I work at the trauma center, we are ALWAYS short staffed, and get transfers in from EVERYWHERE!!! Sometimes, trauma patients will be sent with NO IV's, bladder patients sent with no foleys, and even patients sent with no paper work. It does get very crazy at times, like all ER get!! I, myself, know how it is working in a small town hospital, so I am always nice, but you're right some of my co-workers can be very bitchy!!! And the reason, they have never worked in a rural hospital before!!

So, keep your head up!!! Do the best you can and if they do not like it, invite them to walk a mile in your shoes!!!

RNsRWe, ASN, RN · Feb 9, 2007

I work in a rural hospital. 6 beds in the ER and the town has one stop light. If you blink while driving you're through town without realizing it. We send most of our transfer pts up the road to the next hospital, but sometimes (like today) every hospital within a 90-mile radius is full. Then we try the cities up north. Almost always the doc there will get snooty and ask "Why can't you keep him? Aren't you a hospital?"
I understand they're used to having all resources at their fingertips, but how come they can't understand that not all hospitals do?? After spending over an hour calling facility after facility, I finally found one with an open bed and then spent I-don't-know-how-long explaining to them, "No, we don't have neurology or cardiology here. No, we can't do an MRI in the middle of the night because the MRI trailer only comes once a week in the daytime", etc. etc.
Sometimes I feel like banging the phone on the desk!

They don't understand because they don't want to. They are quite comfortable being holier-than-thou, or at least better-than-thou.

My facility and others in the region are small-to-midsized, I'd say. We are located in small cities and therefore are not as endowed with resources as the big trauma/teaching hospitals are, but we are in no way rural like you described. We get transfers in from a couple of small outlying hospitals that are probably alot like yours; not even sure if one of them has as many ED beds!

At any rate, our docs sniff at the rural ones, and the bigger centers sniff at our docs. Bigger fish in smaller ponds, and so on up the food chain.

If there's any consolation, the same docs that are sneering at your lowly little medical stop are THEMSELVES sneered at by someone else at a more prestigious joint....and they know it.

Shamira Aizza · Feb 9, 2007

It's interesting that they wouldn't make that comment when their hospital has a revenue-generating bed available.

This referral issue is a problem; if there were a bit of competition for your referrals, I suspect this wouldn't be a problem, because the tert centers would make it suddenly more convenient to receive your patients.

One of the big boys at your facility should take this issue to a couple of the popular receiving centers and tell them that the facility that makes the transfer process most convenient will be the hospital that gets all your business from now on.

hope3456, ASN, RN · Feb 9, 2007

I work at a 'medium' sized hospital in a suburban community, but, location wise, we are surrounded by rural communities in 3 states. We have a very smart CEO who figured out that catering to these areas and bringing their pts to our facility was a huge money maker - our hosp is doing very well financially. They have even made 'business arrangements' w/some of these rural hosps. I used to work on the tele floor, and sometimes we had more pts from out of town (and state) than locals.

TazziRN, RN · Feb 9, 2007

"Bigger fish" theory sounds good to me, except the biggest fish of all don't have this attitude! We transfer a lot of criticals and peds to Stanford and UCSF and they are absolutely wonderful. No big-headed attitude at all. Too bad the guys in the middle don't think the same way.

RNsRWe: we're so small that we have a helipad, but to have a pt flown in to us means the pt is in extremis and won't make it any farther.

prmenrs, RN · Feb 9, 2007

Shamira and Hope have hit the nail on the head. This is business we're talking.

Our small Level 2 NICU transfers babies to tertiary care. One is a dedicated Children's Hospital, if they don't transfer babies in, they don't have any pts. The other has a high risk L&D--they get nearly all of their pts "in-born". Sometimes moms are transported to that facility ante-natum. (@ least that would be preferable) Guess which hospital makes it their business to run a kick-rear transport service?

By the same token, we rely on the tertiary care units to transfer babies back before discharge. That way, we get a few $$$ out of the deal, too, the baby is closer to his/her parents, and the referring peds gets the baby back after d/c.

We also get neonatologist coverage from a group that goes to all the outlying hospitals every day.

I think the problem needs to be tackled from the business perspective. You need the tertiary facility, and they need you. Altho, they don't seem to realize it. They need to understand that the "attitude" of the person (doc, nurse, whatever) on the other end of the phone makes a difference to their bottom line and that message should come from their managers.

PANurseRN1 · Feb 9, 2007

"Bigger fish" theory sounds good to me, except the biggest fish of all don't have this attitude! We transfer a lot of criticals and peds to Stanford and UCSF and they are absolutely wonderful. No big-headed attitude at all. Too bad the guys in the middle don't think the same way.
RNsRWe: we're so small that we have a helipad, but to have a pt flown in to us means the pt is in extremis and won't make it any farther.

I understand what you mean. I work at a small community hospital. There are three other hospitals in the county, and one is the largest. You would think they're the daggone Mayo Clinic, the way they act. Bottom line is, they are the biggest fish in a small pond, but they are not necessarily better. I've had plenty of pts tell me that they prefer our care; it's more personal and wait times are shorter.

rjflyn, ASN, RN · Feb 9, 2007

It gets real fun when one has to call 8 or 9 hospitals to transfer a neuortrauma or head bleed pt as there is no neurosurgeon or no neuro icu beds avalible.

It is a funny feeling though going from a year and a half ago flying out AMI pts to the hospital 30 ground miles away for emergency caths. To now having those same AMI's being flown into us for emergent caths and our door to ballon time being in the top 10% in the nation. Oh yeah that reminds me I need to change my count down- March first that goal goes to 60 mins.

Rj

TazziRN, RN · Feb 9, 2007

Rj, we're so far away that we have to thrombolyze our MIs before transport.

allnurses Guide · Feb 9, 2007

Hmmmm . . . 3 bed ER here.

We do things differently - what I thought was the legal way to transfer pts from ER's.

Our ER doc is responsible for finding a doc to accept the patient needing transfer. Then THAT doc is responsible for finding a bed - he calls his hospital's nursing supervisor. Then that person calls our nursing supervisor with a bed #. Then we transfer. We can't call a helicopter until we have a bed #. We do have a helicopter pad. Fixed-wing have to land at the airport and we take the patient over in our ambulance.

steph