Lazy Coworkers

[applesxoranges, BSN, RN]

I am really starting to get sick of my particular ER that I am reconsidering taking a job here. The RNs are so lazy! They cannot do EKGs apparently. They cannot take their patient up to the floor. When I am taking their patient up one floor for them, they are unable to triage a patient because it's my job and so the patient will wait 25+ minutes because the floor is complaining to me, not the RN, that something isn't right or that they need more people to transfer the patient. So let's have it reflect poorly on me because the patient is waiting 25+ minutes! Not to mention sometimes I am on lunch and I hear the front desk call for someone to triage (and I am in the cafeteria) only to come back from lunch and have 3 patients waiting.

I am getting sick of it. I am done picking up extra shifts as a paramedic and I'll just do my regular job. Like I became like this before when I was working 48+ hours on top of school, but now I am just aiming for 24 or less plus school. Now it'll even be less.

I think I need to look for a job elsewhere so I do not pick up bad habits.

[funtimes]

I feel your pain. I worked at a hospital where the RNs had like 6 to 8 patients on an inpatient unit, and they still could be relied on to do a fair amount of patient care. Where I work now they have half that many patients, and do far LESS of the patient care, despite having patients with roughly the same acuity. We run ourself ragged all shift taking care of maybe 15 patients, and these are people who are admitted so all of them are pretty sick people. There is massive turnover for techs, and nobody seems to care. The only thing that matters here is keeping the RNs and Physicians happy. Techs are not even a consideration.

The Techs have zero clout or say and its a totally unequal relationship, with the RNs completely ruling the roost. It's a great place to work if you are an RN, but its horrible for "UAP"s. A lot of the techs try to hold on and make it through Nursing school figuring they will have an RN job lined up there when they graduate, but their tech job is so difficult and stressful it results in most of them having to choose between Nursing school or their job.

[ParkerBC,MSN,RN, PhD, RN]

If you don't mind, I would like to chime in with a differing perspective. I have always told nurses that if there was a free moment and they are in the room, they should take care of whatever the patient needs so as long time permits. I have never minded cleaning a patient, completing a linen change, or helping a patient with ADL's. However, if I have six patients and three are Accu checks ACHS along with several med passes within the next 30 minutes, including insulin coverage, I do delegate it out. Even as a nursing student, you cannot completely comprehend everything that needs to be done in a shift. Charting is ridiculous. It is not uncommon for nurses to be double charting their work because it's policy. Often, three assessments are required during day shift. Those not only do they have to be completed, but also charted, which is time consuming. How often do patients press their call lights wanting PRN medications? Doctors continuously change patient's medications and often times, they want the medications discontinued or started stat.

If I did not change the patient's bed or give them a bath during my shift, I would not expect to be fired or reported to the nursing board. However, if I did not get an accu check and provide sliding scale coverage, I would be fired and more than likely turned into the nursing board. We have a scope of practice by which we practice to ensure we are meeting state regulations. Now, I am not saying there aren't lazy nurses because I have met quite a few. But understand that we perform duties based upon priority and sometimes, ambulating the patient to the bathroom isn't priority at that moment. Hanging the next bag of Vanc and drawing a peak and trough are priority.

I hate that you feel that way. There have been many of days that I did not have time to take a lunch.

[Esme12, ASN, BSN, RN]

I am curious....you are allowed to triage patients in the ED? What does this triage consist of?

[rse3]

I am curious....you are allowed to triage patients in the ED? What does this triage consist of?

I was just wondering the same thing. In our ED, only RNs can triage. Even the 1 LPN and the 1 EMT-P there aren't allowed to triage.

[applesxoranges, BSN, RN]

Well, it is because of my role as a paramedic that we're allowed to triage them. It involves getting the true complaint, when it started, allergies, pain/location, things they may have done like taking tylenol, and assigning an ESI level. I am the triage person at night sometimes depending on how many nurses at night. Initially the plan was to have us triage for about 4 hours a night, but usually it is 8-12 hours.

Also, if I am not up front then there is no medical staff up front. If they choose to ignore the radio or they don't hear the radio, then that person could potentially be serious. Sometimes the registration clerks put some crazy initial complaint in the computer because they do not know what to put down.

I emailed the new manager about it to see what they will say. We're all low morale right now due to the lack of staff.

Basically a person is sitting in the waiting room with no contact with medical staff for 25+ minutes because they decide that they can't go out there and fill out a triage form. It takes about 6 minutes to get the information in most cases including putting them in the computer. Sometimes shorter, sometimes longer.

So in the end, they refuse to take their patient up and they refuse to cover triage so the people sit in the waiting room until I can get back.

[funtimes]

If I did not change the patient's bed or give them a bath during my shift, I would not expect to be fired or reported to the nursing board. However, if I did not get an accu check and provide sliding scale coverage, I would be fired and more than likely turned into the nursing board.

The techs where I work do accuchecks, and in the middle of having to do 7 or 8 HS checks we are expected to answer the bulk of the call lights, toilet people, weigh patients, help with admits, do any vitals that are due, and whatever else an RN demands you do RIGHT NOW, like clean up an isolation patient who just messed themselves in the bathroom or whatever. And while doing all that if we miss an accucheck, we just get fired. Forget to empty a drain no one told you about in report? Get hauled into a supervisors office the next shift. Do it more than once and get fired. Have too many RNs complain about you, get fired. Have too many techs from the next shift complain, fired. Patients complain, fired.

Our charting is audited. If an RN does do something you are supposed to do, that counts as a mark against you. I found that out AFTER thinking some RNs were just being super helpful by offering to chart stuff I did all the time. There are a thousand ways to lose your job and potentially end your medical career doing this job, it gets exhausting after awhile.

The other day I saw a call light on and a phlebotomist had just finished up doing a blood draw and informed me that the patient hooked up to numerous lines, tubes and drains would like to go to the bathroom. It suddenly occurred to me why is it they get to just hit the call light and move on to the next patient, while when I'm trying to get through a dozen or more vital signs I'm also expected to toilet people and record I/O and turn patients and get them fresh water and take out their meal tray and record their meal etc.

Imagine if a tech or CNA tells them I'm just here to check your vitals, but I'll hit the call light for you so someone else can do all that because if I don't get these vitals done by a certain time I can get written up? I'd love to see the look on an RNs face when I inform them the patient would like to go to the BR and I got other stuff to do lol.

[Esme12, ASN, BSN, RN]

Well, it is because of my role as a paramedic that we're allowed to triage them. It involves getting the true complaint, when it started, allergies, pain/location, things they may have done like taking tylenol, and assigning an ESI level. I am the triage person at night sometimes depending on how many nurses at night. Initially the plan was to have us triage for about 4 hours a night, but usually it is 8-12 hours.

Also, if I am not up front then there is no medical staff up front. If they choose to ignore the radio or they don't hear the radio, then that person could potentially be serious. Sometimes the registration clerks put some crazy initial complaint in the computer because they do not know what to put down.

I emailed the new manager about it to see what they will say. We're all low morale right now due to the lack of staff.

Basically a person is sitting in the waiting room with no contact with medical staff for 25+ minutes because they decide that they can't go out there and fill out a triage form. It takes about 6 minutes to get the information in most cases including putting them in the computer. Sometimes shorter, sometimes longer.

So in the end, they refuse to take their patient up and they refuse to cover triage so the people sit in the waiting room until I can get back.

I have been an emergency nurse for many many years (35 to be exact) I am aware of the triage process. Your experience as a paramedic make you perfectly capable to perform triage but this does vary state to state in the nurse practice acts.

However....these nurses are just as responsible for they are technically "delegating" this task to you and they remain ultimately responsible....shame on them. They also should not be ignoring the radio and the patients should be triaged before registration.

They can triage........ they are just being obstinate...how many rooms do you run at night? What is your average patients seen? The "it's not my job" ........ never flies with me.

I think you need to have a talk with your manager and ask if this is OK that they allow patients to sit untriaged. If it's "I have a hang nail" yeah they can wait...but at least find out.

If I was the manager I would not allow this behavior....it is always a team effort and we are all there for the patients

[applesxoranges, BSN, RN]

Someone asked what the triage process consisted of. I am assuming to make sure that I was actually triaging and not just registering patients.

Anyway, I don't mind taking the patients up but I would expect them to listen to the radio. I am the one who is chewed out when the patient is made they sat for 25+ minutes in the ER without seeing anyone.

The amount of rooms we run really depends on how many nurses we have and how capable they are. We have about 14 to 17.

The nurses here are spoiled from what I see or else they are just bad at managing tasks. On the flip side, we're all stressed because they are not replacing people in a timely manner.

I am thinking about trying for a L&D position after I graduate just for a change of pace.

Also, it's not really that safe for them to be ignoring the initial triage for any reason. The registration clerks are really bad at their stuff they put in the computer. Sometimes I am like "what the hell" when I see what they put in. It is not at all what the patient wrote down or what the patient tells me. I can see them putting down a "hand injury" for someone who comes in with an entire hand amputation. Or sometimes they make it more serious like someone wanted something change and they just threw in pain in the initial complaint form.