Help Please!!

nrsang97, BSN, RN · Jan 11, 2009

Please don't run off now that you can not back up your comments. I work in a level one trauma ER (100-150 thousand visits a year) 4 12hour shifts per week, I also work at least one extra day in our ICU every week, I know it is different but, I just don't understand your logic. Our ER is always having trouble with staffing because you can not guesstimate how many will come through the door on any given day, so we are always short. However in the ICU we will not give a nurse 3 patients and if they are really high acuity patients(like prismo or something) it is 1:1 so ER holds them until the ICU can take them, and by then they are pretty much stabilized and packaged with a pretty bow- how do you think we can manage them any better when we have sicker pts. (who are not on a diprivan drip yet mind you?
I would also like to add that in my ICU things are always staffed so perfectly that I have never missed a lunch or a break, and the floor never suffered for it-it's going on three weeks now that I haven't had a break in the ER. Just curious-have you ever worked a shift in the ER, sorry if you answered that I may have missed it.
I think that you really should be more of a team player, and I am really glad that the nurses at my place are all working together for the benefit of the patient.

There are many times we have had 3 paitents. Hold the pt till we can take it? Are you joking? That never happens for us. I have had to take a new patient and not really able to. Despite protests.

The packaged with a bow is a joke. Yeah right. I would not expect a GPU nurse to come to me to get their transfer from me so why should you expect me to come and get my pt from you?

TraumaNurseRN · Jan 11, 2009

There are many times we have had 3 paitents. Hold the pt till we can take it? Are you joking? That never happens for us. I have had to take a new patient and not really able to. Despite protests.
The packaged with a bow is a joke. Yeah right. I would not expect a GPU nurse to come to me to get their transfer from me so why should you expect me to come and get my pt from you?

There's no explaining the ER nurse perspective at this point. Unless you have worked ER it's understandable you wouldn't know exactly we do. We aren't able to hold beds, period. Many times the squad is waiting outide the room of the admitted patient and we are treating them right there. Where do you think your patients are coming from? We stabilize them an ship them out, it's our job. We do not have the luxury of holding any bed. They just keep rolling in.

I_LOVE_TRAUMA, RN · Jan 11, 2009

As I said I work ICU once a week, have you ever worked ER? Our level 1 is crazy, chaotic, and never stops, our ICU runs very smoothly all of time, the hospital ensures that. I am just speaking from someone who works both sides, and our regular floor nurses come to get our transfers out all of the time when they can. Souds like the problem is your hospital. I always have coverage when I have to travel with an ICU patient, a lot of times when I in the ER I have to leave many criticals without the proper care, we just have to prioritize the best we can. Also when we have a patient transfer out of our ICU someone is in charge of prepping the room immediately to prepare for a possible admit. Our ICU is 48 beds, we always have 24 nurses on. And whenever an admit comes at least 4-5 other staff member help to get them settled into their room. And I have never (nor have my collegues) sent an patient to the unit who were not clean, with lines done, meds hanging, and at least part of the admission paperwork done. Yes I don't feel like you are being a team player, you have to know both sides and be able to sympathize with what might be going on there, you actually sounded very selfish and I am glad that there are not too many like you on my team. When you says something like-there no way I would do that, it just doesn't sound like you want to be part of the team. Just my :twocents:

nrsang97, BSN, RN · Jan 11, 2009

I have been to our ER to help insert EVD's and caminos. So I see the chaos. How about if you help with the EVD and camino insertions then I'll come and get the patients? Seriously I have recieved so many pt who are filthy from our ER (I ain't talking about filth they come in with, like left in urine and stool).

I have some coverage, but there are others that travel too since all pts get a post op CT or MRI (neuro ICU). So while I am covering their pt till they come back who the heck is watching mine while I am at the ER and they are at CT or MRI?

Never have I ever received a pt with part of the admit paperwork done ever!

If you would have read the previous posts I did say that if there were proper coverage I may feel differnet. I think you need to re read the posts.

So I sound selfish? Ok fine, I don't understand how you get that but whatever. We have a charge who has a assignment and TACT isn't always available for helping with traveling. I am not goin to leave my unit unsafe to go and get my pt. I invited you to check out how the ICU nurses weigh in by checking the MICU/SICU forum.

I believe we won't reach a understanding at this point.

TraumaNurseRN · Jan 11, 2009

I have been to our ER to help insert EVD's and caminos. So I see the chaos. How about if you help with the EVD and camino insertions then I'll come and get the patients? Seriously I have recieved so many pt who are filthy from our ER (I ain't talking about filth they come in with, like left in urine and stool).
I have some coverage, but there are others that travel too since all pts get a post op CT or MRI (neuro ICU). So while I am covering their pt till they come back who the heck is watching mine while I am at the ER and they are at CT or MRI?
Never have I ever received a pt with part of the admit paperwork done ever!
If you would have read the previous posts I did say that if there were proper coverage I may feel differnet. I think you need to re read the posts.
So I sound selfish? Ok fine, I don't understand how you get that but whatever. We have a charge who has a assignment and TACT isn't always available for helping with traveling. I am not goin to leave my unit unsafe to go and get my pt. I invited you to check out how the ICU nurses weigh in by checking the MICU/SICU forum.
I believe we won't reach a understanding at this point.

I read the posts you are referring to.....2 people responded....And yes there will be no understanding at this point, and that's something we can agree on. I thought you were done with this ER nursing thread?

ernursen · Jan 12, 2009

I have been to our ER to help insert EVD's and caminos. So I see the chaos. How about if you help with the EVD and camino insertions then I'll come and get the patients? Seriously I have recieved so many pt who are filthy from our ER (I ain't talking about filth they come in with, like left in urine and stool).
I have some coverage, but there are others that travel too since all pts get a post op CT or MRI (neuro ICU). So while I am covering their pt till they come back who the heck is watching mine while I am at the ER and they are at CT or MRI?
Never have I ever received a pt with part of the admit paperwork done ever!
If you would have read the previous posts I did say that if there were proper coverage I may feel differnet. I think you need to re read the posts.
So I sound selfish? Ok fine, I don't understand how you get that but whatever. We have a charge who has a assignment and TACT isn't always available for helping with traveling. I am not goin to leave my unit unsafe to go and get my pt. I invited you to check out how the ICU nurses weigh in by checking the MICU/SICU forum.
I believe we won't reach a understanding at this point.

Sounds like you are very disgruntled. Seriously, come work with some of us in the ER. We are always looking for good help, but remember you will have to tend to more than 2 pts of all different acuity levels. Just because you get assigned to lower acuity beds doesn't mean you won't get stuck with an acute MI or stroke victim. Our nurse managers and charge nurses will just look at you and say, we need the bed, you are an ER nurse, you can handle it. Many times we have seen nurses (all specialties to include ICU) leave for a break and never return...lol. It's actually both funny and sad at the same time. Like others have said, we have to transport a lot, to admission rooms, CT, etc.... And often times, there is not much staff to watch our other pts while we are gone and we do get pts put into our rooms while we are gone. We are a revolving door. We do not get the luxury of having out pts stay with us awhile. It's always a surprise. I

Also, change is a part of healthcare. If your bosses say you have to do something and it is within your scope of practice, you do it...or you leave. It is very simple. I have worked places where we have actually chosen to work short, our charge nurse asking a disgruntled or lazy employee to leave rather than us having to put up with the negativity. It is so much easier to work and to take of your pts when everyone works as a team. Based on your comments, you are saying you are not a team player. That kind of attitude does not fly at most places...at least it doesn't for long anyhow.

Whatever happened to people's work ethic? I don't know about anyone else, but I LOVE what I do, but I just want to go to work and everyone just loose the drama. We have all graduated from school, so let's just do what it takes to take care of our pts safely and with some compassion. The shift really will go by much smoother with team work.

Larry77, RN · Jan 12, 2009

I don't think our ICU nurses can walk that far...LOL. We take our patients up with RN and tech if available. We are doing one better...the ICU nurses are going to float down to the ED when they have low census...should be interesting.

TraumaNurseRN · Jan 12, 2009

I don't think our ICU nurses can walk that far...LOL. We take our patients up with RN and tech if available. We are doing one better...the ICU nurses are going to float down to the ED when they have low census...should be interesting.

hahahaha....should indeed be interesting....let us know how that goes..... :yeah: looking forward to it

ernursen · Jan 12, 2009

Too funny!!! I wonder how many will say, "I will NOT go down there!" Not many can tolerate the pit like we can.

TraumaNurseRN · Jan 12, 2009

Too funny!!! I wonder how many will say, "I will NOT go down there!" Not many can tolerate the pit like we can.

Yeah...I thought it too funny when one of the fellow ER nurses here told an ICU nurse....we wear big girl panties....omg..mad me laugh out loud....

ernursen · Jan 12, 2009

LOL...that is funny.

jbp0529 · Jan 15, 2009

Very interesting (and heated) thread. I, too, work in an ICU, but would like to weigh in just the same.

I can truly understand both sides of this discussion. The ER needs to move ppl out for other sick patients, and the ICU needs to keep close monitoring and continue treatment of the sick patients. So where does that leave us? Perhaps there is a middle ground of some sort? I guess, at the end of the day, its all about the patient, and patient safety. Perhaps, there are several keys to making such a policy work. 1) there has to be a clear policy set forth by the hospital, laying out the details of pt transport from the ER to the ICU. 2) it has to be uniformly supported by all of the ICU's in that particular hospital (if there are more than one ICU). 3) everyone from the bedside nurse all the way up to hospital administration has to be supportive of such a policy. 4) there has to be a little "give and take" between the ICU and the ER, without either side abusing the system. If the ER has multiple criticals waiting on beds, or lots of traumas rolling in, then the ICU should be understanding of this and make arrangements as quick as possible to help transport up pts waiting on unit beds. Likewise, if the ICU is consumed with a critical patient or a code, or whatever, and isnt able to come bring a patient up, then a reasonable time frame should be set.

I am all in favor of change and for making the system work faster and better. I guess the bottom line comes down to making our patients the priority (whether in the ICU or ER), making sure everyone is on board with whatever transport policy is in place, and keeping the relationship between the ICU and ER a professional and understanding one. We both do hard work, we both have sick patients, we both deal with crap from unruly patients, families, and doctors, and we are all great nurses. Just need to work together and communicate. If nurses are constantly in-fighting and bickering, then its no wonder certain doctors/patients/families dont give us the respect/credit we deserve.

Ok, I'm off my soap box now :wink2: