I'm trying my best, but seriously stop putting me down on the phone

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For other ED nurses out there, I don't mean any offense with this post. I'd rather vent here than take it out on someone who isn't even involved. I may have just bumped into a nurse with an awful day or something.

So I'm still in a LTC/SNF dealing with my patients at night we were overstaffed so we actually had a reduced patient load for once 29 instead of 38 to 40. I was so happy so I could catch up on paperwork. However about an hour and a half before my shift ends I have two patients acting up. Using ABC's I had to prioritize what patients had to be attended to first.

One is a patient with respiratory issues with audible crackles when breathing that basically with lower level of consciousness and lethargy. Pulse ox was 82 and even with the rebreather it did not improve so I arranged to get the patient sent out. I gave report to one of the ED nurses and she asked me what the blood sugar was. I said I didn't take a blood sugar because it didn't occur to me since the patient had audible crackles and a non improving pulse ox. She proceeds to go off on me: "It's standard procedure! Are you new or something? We'll be waiting for the patient"

The second one was complaining of chills and had a temp of 101.5, so I gave him the existing order of tylenol for fever orally and told him to call me if he feels worse. An hour later I took his temp and it went up to 103 so I paged the doctor. The doctor asked how his wound packing drainage looked like, I come to see the patient and I see the patient is in the bathroom looking as if trying to vomit. I tell the doctor about the new onset of nausea and attempted vomiting. Doctor orders to be sent to the ER. I have to call yet again to the ED for report. Sadly it's the same charge nurse I explain the situation and this time she decides to blast me again: "What is it with you people? Don't you understand oral tylenol won't work in older patients. Next time do a suppository first before calling, not even worth sending him at this point." *I explain the doctor ordered the patient being sent out* "You should have still done the suppository, still does not change things. You nursing home nurses are something else."

Seriously, I've been working for less than a year and these are the first two patients I ever had to send out. Was I in the wrong in my actions? I wanted to lash out at the nurse for being an ass but I was seriously too busy trying to help my patients out. Giving a suppository to a patient who is alert and oriented as well as able to swallow pills did not occur to me anyway.

If my patients don't get admitted, I'll be happy to take the writeup from administration for wasting time waking up doctors, clocking out 15 minutes late, and ******* of the ED at the affiliated hospital. I thought I made the right choice sending them out. But to be put down by another nurse, I can see why a lot of my classmates have switched careers already.

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Specializes in ED/ICU/TELEMETRY/LTC.

If your patient's don't get admitted, so be it. It's not your job to decide whether or not they get admitted. It's your job to assess your patients and decide if the doctor needs to be called.

It is also not your job to take any heat or rudeness from the ED nurse. I was an ED nurse for 20 years. Now ADON/MDS in a nursing home. Next time, just give your report and if you are treated rudely, call back and ask to speak to the charge nurse. Be sure to name names and report that nurse for her rudeness. If this situation were reported to me by my staff, I would call the charge nurse myself. Whether or not that particular nurse is having a bad day, is not relevant.

I have had patients going bad, called 911, and then called the MD for an order. On hold for 20 minutes, when the doctor came on I said, "I called for an order to ship Mrs. Resident, but since I've been on hold for 20 minutes she's already gone." He had no problem with it. Just write the order, put "Nursing Judgement" on it and be done with it. If they wrote me up for it, I can assure they would not get a cherry. I would still have my job, and my license.

There comes a time when you realize that you are there, the doctor is not. Someone has to be in charge.

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Oh really? I guess I am stupid because I never knew that oral tylenol does not work on older patients.

Remember it is not on you to please that nurse. Yours is to do what you know you need to do.

Sure, next time get a quick BS. But, IMHO sounds like you are more together then that ER nurse, forget her.

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Oh really? I guess I am stupid because I never knew that oral tylenol does not work on older patients.

Me too.

I think she must have just had suppositories on her brain because it sounds like she had a stick up her rectum.

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Specializes in LTC.

Unfortunately I would have gone back off on her and told her look lady, I know what I'm doing, give me your charge nurse....yeah...don'tt ake that crap laying down.

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You will always run into nurses like this. I usually just feel sorry for them. The highlight of their day is ruining yours, so don't let it. I usually say "Wow are you having a bad day?" and tell them I hope it gets better. Arguing with these people doesn't help, they are just sad miserable people who try to spread there misery along. Just hang up and feel better about your job, it could be worse, you could have to work with her all day! Brush it off. I would have told her she can do the suppository herself. But when your new, it takes time to learn to deal with these crabs.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

In nursing school I learned to obtain a finger stick blood sugar reading anytime the patient or resident is declining, even if the person has no diabetic history. You might be surprised by the result on the glucometer machine.

That ER nurse had no right to be rude to you. However, I have a suggestion for the next time that you give report to an ER nurse, paramedic, EMT, doctor, or any healthcare worker. When communicating with other healthcare workers/providers regarding patients, it is best to give report using the SBAR format (Situation - Background - Assessment - Recommendation). Click on the link below to read more about using the SBAR format to give report.

SBAR

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

That ED nurse was rude and condescending and that is probably her personality. I have met a few in nursing from time to time and frankly they aren't worth your time and frustration. They both sound like they needed to be sent.......the only thing I might have added was the glucose. Any altered LOC gets a glucose whether they are diabetic or not....sometimes you are surprised at the result. I also have not heard that PO Tylenol doesn't work.

I'll take getting written up for being too cautious than sued because I delayed treatment.

Consider the source.....good job.:yeah:

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Specializes in Certified Med/Surg tele, and other stuff.

It doesn't matter if your policies state to swing the patient by their earlobes for 30 seconds to see if their Sats improve. It's your policies to do whatever and for your dr to order as he/she sees.

The job of the ED nurse is to get a report SBAR style, ask questions if needed, but not judge your policies.

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I dont think sbar would have changed the attitude of the ED nurse........

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I wouldn't let that ER nurse upset you -- she was probably having a bad night [...or a bad life ;)]. She sounds like the kind of person who likes to belittle others and make them as miserable as she feels. Sounds like you assessed the situation and took the correct actions. As others stated above, the only thing that you could have done differently would have been to check a blood sugar due to the altered mental status / lethargy -- every experience holds a learning opportunity, so it's good to reflect upon situations like this, but then let them go and move on.

Keep up the good work!

Amanda

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Specializes in Certified Med/Surg tele, and other stuff.
I dont think sbar would have changed the attitude of the ED nurse........

No, nothing would change her attitude. Didn't say it would. However, it would keep the exchange short and sweet. The shorter the better with a person like this.

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