MedSurg/ICU nurse here. (okay, not in acute care anymore but my heart is still there).
When I found out I was getting an admission, as soon as I could, I looked up the patient - read a recent H&P if possible, wrote down all of the lab results and meds given, that sort of thing. And I have honed my assessment skills.
So when I would get report from the ED all I needed to know was the stuff NOT in the computer. Is this patient a jerk, have a crazy daughter who is hovering, that kind of thing.
I've got labs, vitals, and history. I'll do the assessment. If throughout my research I find something off (like when I was a MedSurg nurse and saw a positive troponin in a patient complaining of left shoulder pain - I'll probably ask why this patient is coming to me), I'm going to ask you about it. Otherwise, just let me know when the patient is coming. I know you have tons of crap to do and have no clue what's coming to you next.
In the ICU, I did a bath as I did the initial assessment (vitals willing) so I don't care if the patient's a mess. Just warn me that the daughter's cousin's best friend is a lawyer who's best friends with Joe Biden or if the patient speaks only Cantonese or is a kangaroo. Whatever I can't get from the computer.
But that time the ED sent us a corpse (yes it happened and no I don't really remember WHAT was going on, it was a long time ago) that was a bit different. But no different than if the nurse I was following on the floor left me with a corpse, really. I've gotten a LOT more pissed off at nurses working with the same resources I have because I KNOW what is going on with them and I have to follow them again and again.
So I think there are ED nurses who drop the ball but there are ICU nurses who drop the ball and MedSurg nurses who drop the ball, so on and so forth and everyone have a great day....
Wow this is becoming a heated debate. But I'm a Tele nurse in a crazy city hospital and I've shadowed down in my Ed while in school and I'll admit it's crazy down there. Sometimes the Ed does drop the ball but it's usually nothing crazy that affects the patient and I try to be understanding of that environment. Once in awhile I don't even get reported (technically they don't have to in my hospital, the pt is just sent up and I have a surprise admission) or they are on some form of isolation that I didn't know about until I had already come in contact with my pt, or they're on 1:1 pt watch and the pt is sent up alone.
But we all need to work together (every dept) to do what's best for the pt and like others have stated... Stop tearing each other down. If the staff is just lazy that's one thing but if the problem is truly out of the nurses' hands let's stop all the blaming.
I totally agree, in the ER, you don't have to start another line if the pt has a working line. You are expecting to much from the ED. We don't have time to give you a long & involved report, we may have had that pt for a brief time no matter how long they had been in the ED. I don't particularly care if he has had a BM unless he came in with Primary diagnosis of constipation. You really need to get some prospective. Also it wouldn't hurt you to come and orient a week in the ER & learn what is important & what in not,& what order you should do something as you juggle your multiple pt's & needs. As of today NO care tech on my unit, so I am doing it all by myself. Please get a grip!
Get a grip! I have been an R.N. for twenty years. I have worked MED SURG, E.R. I.C.U., O.R., PACU., HYPERBARICS They all are hard in different ways. Respect one another and stop putting on a another down! Everyone drops the ball. E.R. is there to stabilize and determine what the best ave. Is for treatment they don't fix them!
Incompetent or lazy nurses work in all different areas of the hospital. Everyone is overworked and understaffed. We're all busting our butts to provide the best care while having more and more expectations/requirements added to our workload. I agree we all work better as a team when a little forgiveness for small errors/mistakes is given, and we actually acknowledge that each department is doing their best. Every area has their own skill set and goals, along with their unique struggles.
I would say I've seen a nurse from just about every department "drop the ball" before. Heck, I've dropped the ball myself. ED gets the bad rep because they are the initial triage point, and most patients who are admitted come from the ED. Unless it's truly critical or particularly offensive (it rarely is) then I don't make a fuss.
The need for droplet precautions was not
conveyed in report. The need for a tele bed or a private room is apparently of little concern for some ER staff. Awesome teamwork.
The last few times that I had a patient who needed any sort of precautions, I didn't find that out until I was on the floor or calling report and I saw what the doctors were using for an admit diagnosis. The couple times that I did find out about all that before calling report, I'd already been in and out of their room, for several hours. At some level, all ED nurses are waiting to get sick with something really nasty - minor things like influenza are part of the job. And yes, I do call influenza minor. TB, meningitis...not so minor.
I have advocated time and time again that this patient needs an ICU bed, this one needs telemetry...do the doctors listen? Nope. I've sent up patients who have needed telemetry but their rooms weren't wired for it. How is that my fault? Am I supposed to keep a patient in the ED because I disagree with what unit they've been admitted to?
And on that same note, I've sent patients to the ICU who only needed a med/surg bed. Usually that's because of staffing issues, but there have been other times that the doctor has seen something that I didn't and they didn't tell me about it.
Look, it's obvious that you are upset. But automatically blaming the nurses for the decisions of physicians doesn't get anybody anything. I can talk at my docs until I pass out and they won't change their minds. Teamwork? We have it coming out of our ears, but when the doctor is in the middle of telling you something about your patient and a crashing patient comes in, you're suddenly the last thing on their mind. Your patients are considered stable, they've got a nurse to keep an eye on things and have been admitted.
I agree with the posters who talk about the importance of teamwork and each department understanding that we all have different areas of practice and different roles in caring for patients.
I have worked in the Med/Surg setting before and now I work in the ED, I have transported patients with Chest Pain R/O ACS on telemetry to the Med/Surg floors and got them settled into a bed only to have the Med/Surg receiving nurse say "This patient has been here since 1 PM and it's 5:30 PM now and you haven't fed them dinner!". I will remain calm and realize that in their role this is a very important task that must be done as a part of the daily routine. My response is calmly and respectfully, "I apologize but the ED is busy and we weren't able to do that for this patient. He has had IV access established, fluids replenished, EKG completed/labs were drawn and I have gotten his chest pain, dyspnea, and GI upset under control. I know that he will continue to receive good care."
I have also transported patients up to the Med/Surg floor and had the admitting nurse ask why I didn't administer the patient's home medications from the admitting orders sheet. Again, I know this is an important task in this setting but not the priority in the ED. I take a breath and calmly explain that I have only just received the admitting orders prior to transport and most of the patient's home medications are not stocked on formulary in the ED as they are on the floors. I also explain that when I speak with the admitting physician/hospitalist I ask if there are any medications/treatments that need to be administered STAT in the ED and will do so prior to admitting to the floor which means that the other medications/treatments can wait until the patient has been admitted.
With that being said, I understand that each setting is different and it takes a special kind of nurse to work in that environment. We need to respect each other and remain focused on the task at hand which is the delivery of high-quality patient care and the safe transition of patients from one practice area/level of care to another.
The night before last, I walked into the Ed for work and took report from the of going nurse "good news and bad news, I'm discharging the last pt in this pod (of 4) but you have an ambulance coming with a shortness of breath". OK, I think, I can start stocking the rooms until she gets here. Go to the stockroom and come back and the charge nurse puts a young woman in my pod with a hx of vomiting x 2days and diabetes and unable to take her meds. Is in DKA Sugar in the 700's. Has done this so many times, she has no veins left. I'm frantically trying over and over to get a line on her while she's vomiting away when the ambulance comes in with a 70 yr old with stage 3 lung cancer, O2 80% on a non-rebreather, pt is on chemo and has a fever of 103 at this time. Thankfully, EMS has started the line for me and drew labs, but she still needs blood cultures drawn. She has a port, so I go ahead and access this real quick and draw the cultures and grab some fluids and tylenol, take off the 42 blankets she has on and run back and keep attempting the iv on my DKA pt. I'm in the room and charge comes in to tell me she put a frequent flyer in one of my other rooms complaining of abdominal pain. I ask if she can try the iv on this pt as I haven't been able to and leave her to it while I go assess the new pt. I walk in the room to see this pt is white as a sheet with a trach and she tells me she has abdominal pain AND shortness of breath and she needs a breathing treatment as I assess, she has crackles and wheezes all throughout her lungs and guess what, she's diabetic too with a sugar in the 400's. Get her iv started labs drawn and radiology comes to take her for a chest x-ray. As I'm walking out of her room, the other radiology tech comes and tells me my other pt's port won't flush for the CT. OK, deaccess and reaccess port real quick and send that pt off to CT. Charge is still trying the iv on my DKA pt when the triage nurse puts a 70 something F with a fever and "shaking" in my last room. Start the iv, draw the labs tell her we need a urine sample, she sits up and starts vomiting. Grab her some zofran and fluids, come back and she's ripped out her iv. By this time, the iv is started in the DKA room and there are orders for 3 boluses, 2 k riders, an insulin drip, zofran, morphine and Ativan. I start all this, and the lab calls with more criticals. The cancer pt has a white count of 1.6 her temp has come down and her o2 has come up to 96% so I titration her down to a high flow nc at 6lpm, put her on reverse precautions. Lab is on the phone again, the 3rd pt has an h&h of 6.4 and 23 so, redraw for blood bank and there's now orders for bicarb insulin, d50 lactulose and calcium and bolus. Now, remember I still have to go back and restart the iv on the 4th pt (who has family members that are so bad no one else will go in the room, so no help delegating) wait, the DKA pt now has hourly fingersticks and q2 hour bmp so I redraw those and send them off. Charge comes and tells me we are transferring DKA and lung pt, transport is on the way will be here in 10 minutes. Hurry up and chart what I've done and try to call report, the floor nurse at the first place is busy and "will call me back" call report to the second place, transport is here for the second one and I send them off. Flight crew is now here and say they will listen while I give report. Call report and the floor nurse now can't be found. I state I will wait on hold while they find. 5 minutes later they find her and I give report, send the pt off. Go to restart iv on the 4th pt and still no urine, so I straight cath pt also. My other two rooms are now empty and 2 more pt's are on the way. Now, tell me again about getting two admits back to back on the floor or Call me to complain about an iv site or a bolus not given on a stable pt. We spend the whole shift putting out fires and stabilizing patients quickly with no information
One third of the nurses in the US are over 50. There is going to be a huge shortage as these nurses leave the workforce and there aren't enough replacements.
Well then it's back to hitting the books again tonight for this little nursing student...I refuse & will NEVER ever let a patient suffer & not be able to receive the right kind of care, that they deserve; just because some bonehead bigwigs want to keep making cuts & unsafe changes. This coming from a person who is in fact a certified MA & a current Nursing Student (going for my LPN right now, & then God-willing a little further down the line RN.)
I can tell you for a FACT that going to school to be an MA (I didn't attend a 6-month program, I did a full yr.) However, even in that full year, I PROMISE you that it didn't even begin to scratch the surface in regards to what an actual Nurse has to know.
Yes, anyone (like a monkey/puppet) can just pump out meds, and stick an arm with a needle or two, and maybe even hang an IV bag. HOWEVER Nurses are trained to do so much more then that. Nurses are not only trained for the physical actions of performing tasks, but to know the "Why" and the Reason behind the specific task they are performing, & furthermore the reason why they are performing the specific task for the specific pt in question. There is a reason why we have our own license, there is a reason why a Nurse can be sued for Malpractice (rare, but can happen), there is a reason why NURSES have to know many things on the same level that a Doctor does.
MA's aren't trained to be pt advocates (Nurses are!) MA's are Doctor advocates! Biggest difference right there! An MA will listen to the Doctor's order's without batting an eye each & every time!! (Lord, I cringe to think of how many future pt's who have a potassium level of 3.5, will be given a diuretic at the hands of an MA from the orders of a Dr.) Where is the objectivity?
If the MA is working for a Doctor (obviously under his license) who is looking out for the pt? An MA can't tell a Doctor "No" (well they can, but they will be saying it while a chart is being thrown at them, or maybe a computer now w/ the recent changes, while they are walking out the door.) A Nurse can voice a concern to a Doctor & has every right to say that they don't feel comfortable administering (let's say the above diuretic like I mentioned) to a particular pt, because that Nurse's training, knowledge, experience, license, and advocacy of the Pt gives them the right, and the privilege to do so.
I wonder if Pt's have any idea, what the difference between what an MA and an actual Nurse is? Especially because I have seen with my own eyes, MA's basically infer that they were "the nurse" and I've never ONCE seen an MA correct a pt when that pt called them "Nurse." Part of the reason why I'm going to school to become a Nurse is because, I want to earn that right, privilege and title.
I'm starting to think that maybe Nurses need to get together, ALL of us Nurses & future Nurses (RN's and LPN's will have to stand strong & unite on this one, for the love of our profession & our future pt's) and maybe start having "walks" and "demonstrations" and start passing out flyers informing people (who are not in the medical field) exactly what the differences are, and that an MA is NOT licensed, they are under a Dr's license (who isn't physically supervising them most of the time) & that there is NO objectivity or advocacy for the Pt with an MA. Let the Pt know what's really going on, and what is happening to the Nurses! (the real one's not the fake wannabe MA's) The way I see it, is that 1 of 2 things are going to happen: 1-Pt's will start demanding things to go back to the way it was (LPN's & RN's being treated fairly, working together in harmony, being allowed to spend more time & actually care for a PT, and most importantly living out what Florence Nightingale's vision was and staying true to our oath!) or 2- It's inevitable that eventually an MA will screw up to the point that it just can't be covered up (the future Nurse in me can't help but feel bad for the poor future pt who will be the 1 to really suffer) & Doctor's will grow tired of being sued over it and will hopefully take they're heads out of the sand.
libran1984, are you a LPN or MA? I'm going to be blunt and offensive in my comment, sorry. I went to school with a lot of idiots taking prereq math, chemistry, and anatomy and phys who were repeating these classes for failing, some were repeating them for the third time, still hoping to apply to nursing school. I thought to myself , oh god if they cant even pass a basic algebra class or anatomy and phys, or take the time to study for these classes in order to pass or get some extra tutoring to make it happen, I pray they do not ever become a nurse. When classmates of mine failed nursing school exams in the first semester and would argue for points in the exam reviews and sound like complete morons because they lack critical thinking skills, I thought good riddance when I finally noticed these same people never came back to class again because they had to drop out because they couldnt hack it. Nursing programs are competitive and weed people out who are not dedicated and who dont show some form of intelligence needed to do the job. Nursing school is intense and life consuming and if you dont have the dedication to study, make hard sacrifices, and deal with writing careplans, which require critical thinking, at all hours of the night just before you have to wake up at 5 am for clinicals, then you just are not cut out for it because real nursing is much harder than all of this. I dont know what MA school entails but MAs dont know what nursing school entails either and I hate when people- PCAs CNAs LPNs who have not been through the rigors of nursing school presume to think they can do our job. Yes anyone can learn the hands on nursing skills, but do you have the brains to make it to and through nursing school, and pass the boards to be licensed to take responsibility for the lives of pts when crap hits the fan? It's insulting after all of my hard work and dedication to hear this.
I just want to point out that LPNs learn about nursing theory and critical thinking skills...Practical nursing school is just as rigorous as a RN program.
I've been a Benner Fan since 2004-when I learned about novice to expert in PN school; when I went through my BSN program, I did a paper on a transition to practice model using the theory. I would LOVE to meet her...I think she is spot ON in her theory; her theory on clinical practice has allowed me not to burnout and to enjoy my clinical practice.
FWIW, working in this business for 13 years and have been in a "task position" to LPN to RN; one CAN NOT compare the skill set and scope in each; although I will say my LPN background helped me tremendously during my BSN program; however, the BSN did sharpen my critical thinking, learning more in depth about hospital economics (although I had extensive knowledge of those economics working as a contractor though CMS) nursing economics, policy preparedness (on a beginning scale for bachelors) that added, at least for me, added depth in terms of making informed decisions for my career and help me contribute to continuing this profession-carrying the torch for the ones who will be retiring and need us at the bedside and to educate and empower; I couldn't to that as a skilled tech after 5 years (proficient)-I saw the writing on the wall that I needed to do more for my patients; as a LPN after 7 years (considered expert per Benner) and I wanted to do MORE, although my scope is broad in my state, I wanted MORE flexibility; as a RN and now learning my first leadership experience, I can see where my past experiences and my new knowledge can help create an effective practice; it's NOT about the tasks; it's about knowing what I expect when one has to call the MD and advocate for the patient with one look at the patient or when you get new rest results; or creating teachable moments to unlicensed personnel when communicating to people who have emotional and mental health issues, as well as patients with Alzheimer's and Dementia; or residual effects from a stroke or TBI. I've seen "expert" CNAs have actual concern for a pt who is having a change in mentation, but because I utilize the nursing process, I am able to advise on how to handle those behaviors by having safety checks because it's not pathological, but psychological...that's the difference in being a proficient-expert nurse vs, proficient-expert "task worker." There will ALWAYS be a REASON behind the "tasks"; seeing the forest beyond the trees...I'm able to do it as a RN; I had to collaborate as a LPN to make sure it was effective, and I knew I had to do more as a tech, but did not have the information of the nursing process to do so...and CNA/MA, etc, do not have the hours entailed to go into depth..,they have to return to school, as many have done, such as myself.
As much as big business can try, nursing CAN NOT be replaced; and that's why our business has been so cyclical...what's happening has happened before as Esme stated on team nursing; I know nurses who did that model 20-30 years ago; one was my research instructor that helped instill changes at one of my local hospitals doing EBP. That's how she decided to contribute to nursing; her view was to make them LISTEN, she had to "back it up."
My instructor told us-I will paraphrase her wordy soliloquy-WE nurses must take the wheel NOW...any way we can; from bedside to leadership; we know know what works, and what doesn't.
libran1984, are you a LPN or MA? I'm going to be blunt and offensive in my comment, sorry. I went to school with a lot of idiots taking prereq math, chemistry, and anatomy and phys who were repeating these classes for failing, some were repeating them for the third time, still hoping to apply to nursing school. I thought to myself , oh god if they cant even pass a basic algebra class or anatomy and phys, or take the time to study for these classes in order to pass or get some extra tutoring to make it happen, I pray they do not ever become a nurse. When classmates of mine failed nursing school exams in the first semester and would argue for points in the exam reviews and sound like complete morons because they lack critical thinking skills, I thought good riddance when I finally noticed these same people never came back to class again because they had to drop out because they couldnt hack it. Nursing programs are competitive and weed people out who are not dedicated and who dont show some form of intelligence needed to do the job. Nursing school is intense and life consuming and if you dont have the dedication to study, make hard sacrifices, and deal with writing careplans, which require critical thinking, at all hours of the night just before you have to wake up at 5 am for clinicals, then you just are not cut out for it because real nursing is much harder than all of this. I dont know what MA school entails but MAs dont know what nursing school entails either and I hate when people- PCAs CNAs LPNs who have not been through the rigors of nursing school presume to think they can do our job. Yes anyone can learn the hands on nursing skills, but do you have the brains to make it to and through nursing school, and pass the boards to be licensed to take responsibility for the lives of pts when crap hits the fan? It's insulting after all of my hard work and dedication to hear this.
Although it's been more than 30 years ago, I remember the occasion very clearly. My first death on Peds as the charge nurse. It was horrible. A four-month old with a congenital heart defect was to be discharged that afternoon. He was to go home and grow a bit more before undergoing a surgery that would correct his heart anomaly.
I had just come from the room not 5 minutes earlier and the baby was laughing and playing on his father's lap. So cute..... The frantic father suddenly appeared in the hallway with the baby in his arms. He was no longer laughing but his little body was lifeless, his face very pale.
We rushed him to the treatment room as the code was called and the baby's physician was notified. Any code is unpleasant, but a code blue on a Peds floor is a dreadful experience.
The tiny treatment room was alive with a high level of anxiety and activity as the many responders crowded around the tiny pale body. Many were unsure of dosages for one so small, but were willing to help in what ever way they could. The baby's pediatrician arrived and took charge. Despite the long and valiant efforts of many, the baby did not survive.
We were all exhausted......emotionally and physically. The family was devastated as was the entire medical team, tears streaming down the faces of many. There were so many tears. Even the pediatrician was crying. So very sad..........
The parents were holding onto one another, sobbing quietly, as the doctor and nurses tried to offer their support. In the face of such an overwhelming and painful crisis, nurses were able to make a difference that day as they provided tender and compassionate care to the mother, father, and extended family....through their tears.
Because of the very nature of our work, nurses encounter many situations of grief, death, sorrow, and crisis. While we frequently witness others crying around us, we try to maintain a "level of professionalism", keeping our emotions in check, especially in front of the patient and/or the family, or other staff. Some people view a display of emotion as weakness, and will suppress their feelings, remaining controlled at all times. As a nurse, it is certainly necessary to control your emotions so you can handle a situation and provide safe and appropriate physical care for the patient. But periodically, not showing our emotions.....our humanness......is viewed as cold and unfeeling. In certain situations, expressing genuine emotion can be a sincere way to provide emotional support.
Nurses work very closely with their patients, providing intimate care to the whole person on a daily basis. We see their struggles against their disease; we hear their cries of pain. As we share intimate and intense conversations with patients regarding their care as well as their fears and concerns, we get to know more about them as a person. Because we get to know them and their families so well, we end up caring for them. It is easy to become attached, even though we try to put up our professional boundaries.
Patient suffering and death does affect us as nurses. How we respond is different for each of us. As nurses, we strive to provide compassionate care, sharing in the grief, loss, and fear experienced by patients and their families. We want to do more than just go through the motions, becoming numb to the pain of others.
Seeing that doctor cry openly after the death of that infant so many years ago, made a profound impact on a very young nurse who was just embarking on her career. My level of respect for him as a doctor and a person grew. Since that time, I have seen many nurses and doctors shed tears in the presence of the patient and/or family.
These days, I more often care for people on the other end of the life cycle. I am often called upon to stand alongside someone as they take their last breath. I still get tears in my eyes, but I don't even try to hide them.
My pet peeve is the customer service garbage where we give the patient whatever they want. Pt c/ o ankle pain, no swelling noted, nothing on X-ray but insists she can not walk and needs crutches. Why do we give these people them? Ugh.Same for the mvc people who turn their completely negative exam into a major drama. "Oh! Doctor says I can't go back to work for days." Or... You asked for an excuse For work and got it.
Aren't you supposed to chart what the patient says? If they say 10 that's what you're supposed to put down, not "eyeroll" and put down what you think it is.
1- Telling somebody your pain is 10/10 is actually impossible. 10/10 would be the most pain imaginable, which would obviously render a person speechless. The best way to make somebody understand this is to do something truly painful to somebody after they report pain of 10/10.
2- Poochiewoochie, why are you here?
You aren't a nurse, and and have a low regard for nurses.
"From my experiences over the past year and a half my perception of them has changed a lot and not for the better"
"maybe some of these nurses that are acting holier than thou "
"those who live in glass houses shouldn't throw stones. A lot of people in the medical field need to get over their prejudice "
"That's the problem-everyone is a drug seeker to some nurses and other medical professionals"
You are a patient who feels poorly treated by the medical system in general, and by nurses in particular:
"I've had 5 surgeries in the past 2 years"
" the one that was assigned to me the first night was too busy"
"Then I had to deal with some snotty CNA "
"doctors who treated me as if I was a drug seeker"
Maybe you should start a forum of likeminded folks. Or even better, a patient advocacy group.
If you read the heading of this particular sub-forum, you will see this isn't the place for you:
Emergency Nursing is available for the nurses and personnel from the Level 1 Trauma Centers to the smallest, most remote ED facilities, the Emergency Nursing forum is your place to discuss common practice issues, share knowledge, and even vent about the chaos that is your landscape.
Please note that it does not say that this is a place for people who feel they have been mistreated to educate nurses.
3- Answer to the OP: My pet peeve is how we validate all the nonsense people come in with. For example, somebody comes in c/o "dehydration", obviously tolerating po, and we run ivf. We are validating their concern. We are essentially saying "your problem is so severe, we ran the risk of poking a hole in a vein, and running stuff out of a plastic bag into your body"
Or- after multiple visits to a pcp, a pt does not get the medicine or procedure they want. They come to us, and get their perceived needs met. We arre essentially saying: "You were right to bypass your PCP. We know better than the provider who knows you best, and is familiar with your history. Come on back any time you don't get what you want from your pcp."
I'd give her the side eye and say "You may want to run that by risk management," on the way out of the door.
MedSurg/ICU nurse here. (okay, not in acute care anymore but my heart is still there).
When I found out I was getting an admission, as soon as I could, I looked up the patient - read a recent H&P if possible, wrote down all of the lab results and meds given, that sort of thing. And I have honed my assessment skills.
So when I would get report from the ED all I needed to know was the stuff NOT in the computer. Is this patient a jerk, have a crazy daughter who is hovering, that kind of thing.
I've got labs, vitals, and history. I'll do the assessment. If throughout my research I find something off (like when I was a MedSurg nurse and saw a positive troponin in a patient complaining of left shoulder pain - I'll probably ask why this patient is coming to me), I'm going to ask you about it. Otherwise, just let me know when the patient is coming. I know you have tons of crap to do and have no clue what's coming to you next.
In the ICU, I did a bath as I did the initial assessment (vitals willing) so I don't care if the patient's a mess. Just warn me that the daughter's cousin's best friend is a lawyer who's best friends with Joe Biden or if the patient speaks only Cantonese or is a kangaroo. Whatever I can't get from the computer.
But that time the ED sent us a corpse (yes it happened and no I don't really remember WHAT was going on, it was a long time ago) that was a bit different. But no different than if the nurse I was following on the floor left me with a corpse, really. I've gotten a LOT more pissed off at nurses working with the same resources I have because I KNOW what is going on with them and I have to follow them again and again.
So I think there are ED nurses who drop the ball but there are ICU nurses who drop the ball and MedSurg nurses who drop the ball, so on and so forth and everyone have a great day....
Wow this is becoming a heated debate. But I'm a Tele nurse in a crazy city hospital and I've shadowed down in my Ed while in school and I'll admit it's crazy down there. Sometimes the Ed does drop the ball but it's usually nothing crazy that affects the patient and I try to be understanding of that environment. Once in awhile I don't even get reported (technically they don't have to in my hospital, the pt is just sent up and I have a surprise admission) or they are on some form of isolation that I didn't know about until I had already come in contact with my pt, or they're on 1:1 pt watch and the pt is sent up alone.
But we all need to work together (every dept) to do what's best for the pt and like others have stated... Stop tearing each other down. If the staff is just lazy that's one thing but if the problem is truly out of the nurses' hands let's stop all the blaming.
I totally agree, in the ER, you don't have to start another line if the pt has a working line. You are expecting to much from the ED. We don't have time to give you a long & involved report, we may have had that pt for a brief time no matter how long they had been in the ED. I don't particularly care if he has had a BM unless he came in with Primary diagnosis of constipation. You really need to get some prospective. Also it wouldn't hurt you to come and orient a week in the ER & learn what is important & what in not,& what order you should do something as you juggle your multiple pt's & needs. As of today NO care tech on my unit, so I am doing it all by myself. Please get a grip!
Get a grip! I have been an R.N. for twenty years. I have worked MED SURG, E.R. I.C.U., O.R., PACU., HYPERBARICS They all are hard in different ways. Respect one another and stop putting on a another down! Everyone drops the ball. E.R. is there to stabilize and determine what the best ave. Is for treatment they don't fix them!
I hate department and shift war threads.
Incompetent or lazy nurses work in all different areas of the hospital. Everyone is overworked and understaffed. We're all busting our butts to provide the best care while having more and more expectations/requirements added to our workload. I agree we all work better as a team when a little forgiveness for small errors/mistakes is given, and we actually acknowledge that each department is doing their best. Every area has their own skill set and goals, along with their unique struggles.
I would say I've seen a nurse from just about every department "drop the ball" before. Heck, I've dropped the ball myself. ED gets the bad rep because they are the initial triage point, and most patients who are admitted come from the ED. Unless it's truly critical or particularly offensive (it rarely is) then I don't make a fuss.
I have advocated time and time again that this patient needs an ICU bed, this one needs telemetry...do the doctors listen? Nope. I've sent up patients who have needed telemetry but their rooms weren't wired for it. How is that my fault? Am I supposed to keep a patient in the ED because I disagree with what unit they've been admitted to?
And on that same note, I've sent patients to the ICU who only needed a med/surg bed. Usually that's because of staffing issues, but there have been other times that the doctor has seen something that I didn't and they didn't tell me about it.
Look, it's obvious that you are upset. But automatically blaming the nurses for the decisions of physicians doesn't get anybody anything. I can talk at my docs until I pass out and they won't change their minds. Teamwork? We have it coming out of our ears, but when the doctor is in the middle of telling you something about your patient and a crashing patient comes in, you're suddenly the last thing on their mind. Your patients are considered stable, they've got a nurse to keep an eye on things and have been admitted.
I agree with the posters who talk about the importance of teamwork and each department understanding that we all have different areas of practice and different roles in caring for patients.
I have worked in the Med/Surg setting before and now I work in the ED, I have transported patients with Chest Pain R/O ACS on telemetry to the Med/Surg floors and got them settled into a bed only to have the Med/Surg receiving nurse say "This patient has been here since 1 PM and it's 5:30 PM now and you haven't fed them dinner!". I will remain calm and realize that in their role this is a very important task that must be done as a part of the daily routine. My response is calmly and respectfully, "I apologize but the ED is busy and we weren't able to do that for this patient. He has had IV access established, fluids replenished, EKG completed/labs were drawn and I have gotten his chest pain, dyspnea, and GI upset under control. I know that he will continue to receive good care."
I have also transported patients up to the Med/Surg floor and had the admitting nurse ask why I didn't administer the patient's home medications from the admitting orders sheet. Again, I know this is an important task in this setting but not the priority in the ED. I take a breath and calmly explain that I have only just received the admitting orders prior to transport and most of the patient's home medications are not stocked on formulary in the ED as they are on the floors. I also explain that when I speak with the admitting physician/hospitalist I ask if there are any medications/treatments that need to be administered STAT in the ED and will do so prior to admitting to the floor which means that the other medications/treatments can wait until the patient has been admitted.
With that being said, I understand that each setting is different and it takes a special kind of nurse to work in that environment. We need to respect each other and remain focused on the task at hand which is the delivery of high-quality patient care and the safe transition of patients from one practice area/level of care to another.
!Chris
But you didn't change the field-started PIV??? Some nerve. /sarcfont/
Well then it's back to hitting the books again tonight for this little nursing student...I refuse & will NEVER ever let a patient suffer & not be able to receive the right kind of care, that they deserve; just because some bonehead bigwigs want to keep making cuts & unsafe changes. This coming from a person who is in fact a certified MA & a current Nursing Student (going for my LPN right now, & then God-willing a little further down the line RN.)
I can tell you for a FACT that going to school to be an MA (I didn't attend a 6-month program, I did a full yr.) However, even in that full year, I PROMISE you that it didn't even begin to scratch the surface in regards to what an actual Nurse has to know.
Yes, anyone (like a monkey/puppet) can just pump out meds, and stick an arm with a needle or two, and maybe even hang an IV bag. HOWEVER Nurses are trained to do so much more then that. Nurses are not only trained for the physical actions of performing tasks, but to know the "Why" and the Reason behind the specific task they are performing, & furthermore the reason why they are performing the specific task for the specific pt in question. There is a reason why we have our own license, there is a reason why a Nurse can be sued for Malpractice (rare, but can happen), there is a reason why NURSES have to know many things on the same level that a Doctor does.
MA's aren't trained to be pt advocates (Nurses are!) MA's are Doctor advocates! Biggest difference right there! An MA will listen to the Doctor's order's without batting an eye each & every time!! (Lord, I cringe to think of how many future pt's who have a potassium level of 3.5, will be given a diuretic at the hands of an MA from the orders of a Dr.) Where is the objectivity?
If the MA is working for a Doctor (obviously under his license) who is looking out for the pt? An MA can't tell a Doctor "No" (well they can, but they will be saying it while a chart is being thrown at them, or maybe a computer now w/ the recent changes, while they are walking out the door.) A Nurse can voice a concern to a Doctor & has every right to say that they don't feel comfortable administering (let's say the above diuretic like I mentioned) to a particular pt, because that Nurse's training, knowledge, experience, license, and advocacy of the Pt gives them the right, and the privilege to do so.
I wonder if Pt's have any idea, what the difference between what an MA and an actual Nurse is? Especially because I have seen with my own eyes, MA's basically infer that they were "the nurse" and I've never ONCE seen an MA correct a pt when that pt called them "Nurse." Part of the reason why I'm going to school to become a Nurse is because, I want to earn that right, privilege and title.
I'm starting to think that maybe Nurses need to get together, ALL of us Nurses & future Nurses (RN's and LPN's will have to stand strong & unite on this one, for the love of our profession & our future pt's) and maybe start having "walks" and "demonstrations" and start passing out flyers informing people (who are not in the medical field) exactly what the differences are, and that an MA is NOT licensed, they are under a Dr's license (who isn't physically supervising them most of the time) & that there is NO objectivity or advocacy for the Pt with an MA. Let the Pt know what's really going on, and what is happening to the Nurses! (the real one's not the fake wannabe MA's) The way I see it, is that 1 of 2 things are going to happen: 1-Pt's will start demanding things to go back to the way it was (LPN's & RN's being treated fairly, working together in harmony, being allowed to spend more time & actually care for a PT, and most importantly living out what Florence Nightingale's vision was and staying true to our oath!) or 2- It's inevitable that eventually an MA will screw up to the point that it just can't be covered up (the future Nurse in me can't help but feel bad for the poor future pt who will be the 1 to really suffer) & Doctor's will grow tired of being sued over it and will hopefully take they're heads out of the sand.
I've been a Benner Fan since 2004-when I learned about novice to expert in PN school; when I went through my BSN program, I did a paper on a transition to practice model using the theory.
FWIW, working in this business for 13 years and have been in a "task position" to LPN to RN; one CAN NOT compare the skill set and scope in each; although I will say my LPN background helped me tremendously during my BSN program; however, the BSN did sharpen my critical thinking, learning more in depth about hospital economics (although I had extensive knowledge of those economics working as a contractor though CMS) nursing economics, policy preparedness (on a beginning scale for bachelors) that added, at least for me, added depth in terms of making informed decisions for my career and help me contribute to continuing this profession-carrying the torch for the ones who will be retiring and need us at the bedside and to educate and empower; I couldn't to that as a skilled tech after 5 years (proficient)-I saw the writing on the wall that I needed to do more for my patients; as a LPN after 7 years (considered expert per Benner) and I wanted to do MORE, although my scope is broad in my state, I wanted MORE flexibility; as a RN and now learning my first leadership experience, I can see where my past experiences and my new knowledge can help create an effective practice; it's NOT about the tasks; it's about knowing what I expect when one has to call the MD and advocate for the patient with one look at the patient or when you get new rest results; or creating teachable moments to unlicensed personnel when communicating to people who have emotional and mental health issues, as well as patients with Alzheimer's and Dementia; or residual effects from a stroke or TBI. I've seen "expert" CNAs have actual concern for a pt who is having a change in mentation, but because I utilize the nursing process, I am able to advise on how to handle those behaviors by having safety checks because it's not pathological, but psychological...that's the difference in being a proficient-expert nurse vs, proficient-expert "task worker." There will ALWAYS be a REASON behind the "tasks"; seeing the forest beyond the trees...I'm able to do it as a RN; I had to collaborate as a LPN to make sure it was effective, and I knew I had to do more as a tech, but did not have the information of the nursing process to do so...and CNA/MA, etc, do not have the hours entailed to go into depth..,they have to return to school, as many have done, such as myself.
As much as big business can try, nursing CAN NOT be replaced; and that's why our business has been so cyclical...what's happening has happened before as Esme stated on team nursing; I know nurses who did that model 20-30 years ago; one was my research instructor that helped instill changes at one of my local hospitals doing EBP. That's how she decided to contribute to nursing; her view was to make them LISTEN, she had to "back it up."
My instructor told us-I will paraphrase her wordy soliloquy-WE nurses must take the wheel NOW...any way we can; from bedside to leadership; we know know what works, and what doesn't.
libran1984, are you a LPN or MA? I'm going to be blunt and offensive in my comment, sorry. I went to school with a lot of idiots taking prereq math, chemistry, and anatomy and phys who were repeating these classes for failing, some were repeating them for the third time, still hoping to apply to nursing school. I thought to myself , oh god if they cant even pass a basic algebra class or anatomy and phys, or take the time to study for these classes in order to pass or get some extra tutoring to make it happen, I pray they do not ever become a nurse. When classmates of mine failed nursing school exams in the first semester and would argue for points in the exam reviews and sound like complete morons because they lack critical thinking skills, I thought good riddance when I finally noticed these same people never came back to class again because they had to drop out because they couldnt hack it. Nursing programs are competitive and weed people out who are not dedicated and who dont show some form of intelligence needed to do the job. Nursing school is intense and life consuming and if you dont have the dedication to study, make hard sacrifices, and deal with writing careplans, which require critical thinking, at all hours of the night just before you have to wake up at 5 am for clinicals, then you just are not cut out for it because real nursing is much harder than all of this. I dont know what MA school entails but MAs dont know what nursing school entails either and I hate when people- PCAs CNAs LPNs who have not been through the rigors of nursing school presume to think they can do our job. Yes anyone can learn the hands on nursing skills, but do you have the brains to make it to and through nursing school, and pass the boards to be licensed to take responsibility for the lives of pts when crap hits the fan? It's insulting after all of my hard work and dedication to hear this.
Although it's been more than 30 years ago, I remember the occasion very clearly. My first death on Peds as the charge nurse. It was horrible. A four-month old with a congenital heart defect was to be discharged that afternoon. He was to go home and grow a bit more before undergoing a surgery that would correct his heart anomaly.
I had just come from the room not 5 minutes earlier and the baby was laughing and playing on his father's lap. So cute..... The frantic father suddenly appeared in the hallway with the baby in his arms. He was no longer laughing but his little body was lifeless, his face very pale.
We rushed him to the treatment room as the code was called and the baby's physician was notified. Any code is unpleasant, but a code blue on a Peds floor is a dreadful experience.
The tiny treatment room was alive with a high level of anxiety and activity as the many responders crowded around the tiny pale body. Many were unsure of dosages for one so small, but were willing to help in what ever way they could. The baby's pediatrician arrived and took charge. Despite the long and valiant efforts of many, the baby did not survive.
We were all exhausted......emotionally and physically. The family was devastated as was the entire medical team, tears streaming down the faces of many. There were so many tears. Even the pediatrician was crying. So very sad..........
The parents were holding onto one another, sobbing quietly, as the doctor and nurses tried to offer their support. In the face of such an overwhelming and painful crisis, nurses were able to make a difference that day as they provided tender and compassionate care to the mother, father, and extended family....through their tears.
Because of the very nature of our work, nurses encounter many situations of grief, death, sorrow, and crisis. While we frequently witness others crying around us, we try to maintain a "level of professionalism", keeping our emotions in check, especially in front of the patient and/or the family, or other staff. Some people view a display of emotion as weakness, and will suppress their feelings, remaining controlled at all times. As a nurse, it is certainly necessary to control your emotions so you can handle a situation and provide safe and appropriate physical care for the patient. But periodically, not showing our emotions.....our humanness......is viewed as cold and unfeeling. In certain situations, expressing genuine emotion can be a sincere way to provide emotional support.
Nurses work very closely with their patients, providing intimate care to the whole person on a daily basis. We see their struggles against their disease; we hear their cries of pain. As we share intimate and intense conversations with patients regarding their care as well as their fears and concerns, we get to know more about them as a person. Because we get to know them and their families so well, we end up caring for them. It is easy to become attached, even though we try to put up our professional boundaries.
Patient suffering and death does affect us as nurses. How we respond is different for each of us. As nurses, we strive to provide compassionate care, sharing in the grief, loss, and fear experienced by patients and their families. We want to do more than just go through the motions, becoming numb to the pain of others.
Seeing that doctor cry openly after the death of that infant so many years ago, made a profound impact on a very young nurse who was just embarking on her career. My level of respect for him as a doctor and a person grew. Since that time, I have seen many nurses and doctors shed tears in the presence of the patient and/or family.
These days, I more often care for people on the other end of the life cycle. I am often called upon to stand alongside someone as they take their last breath. I still get tears in my eyes, but I don't even try to hide them.
To read more articles, go to my AN blog: Body, Mind, and Soul Be the Nurse You Would Want as a Patient From the Other Side of the Bed Rails - When the Nurse Becomes the Patient
My pet peeve is the customer service garbage where we give the patient whatever they want. Pt c/ o ankle pain, no swelling noted, nothing on X-ray but insists she can not walk and needs crutches. Why do we give these people them? Ugh.Same for the mvc people who turn their completely negative exam into a major drama. "Oh! Doctor says I can't go back to work for days." Or... You asked for an excuse For work and got it.
2- Poochiewoochie, why are you here?
You aren't a nurse, and and have a low regard for nurses.
"From my experiences over the past year and a half my perception of them has changed a lot and not for the better"
"maybe some of these nurses that are acting holier than thou "
"those who live in glass houses shouldn't throw stones. A lot of people in the medical field need to get over their prejudice "
"That's the problem-everyone is a drug seeker to some nurses and other medical professionals"
You are a patient who feels poorly treated by the medical system in general, and by nurses in particular:
"I've had 5 surgeries in the past 2 years"
" the one that was assigned to me the first night was too busy"
"Then I had to deal with some snotty CNA "
"doctors who treated me as if I was a drug seeker"
Maybe you should start a forum of likeminded folks. Or even better, a patient advocacy group.
If you read the heading of this particular sub-forum, you will see this isn't the place for you:
Emergency Nursing is available for the nurses and personnel from the Level 1 Trauma Centers to the smallest, most remote ED facilities, the Emergency Nursing forum is your place to discuss common practice issues, share knowledge, and even vent about the chaos that is your landscape.
Please note that it does not say that this is a place for people who feel they have been mistreated to educate nurses.
3- Answer to the OP: My pet peeve is how we validate all the nonsense people come in with. For example, somebody comes in c/o "dehydration", obviously tolerating po, and we run ivf. We are validating their concern. We are essentially saying "your problem is so severe, we ran the risk of poking a hole in a vein, and running stuff out of a plastic bag into your body"
Or- after multiple visits to a pcp, a pt does not get the medicine or procedure they want. They come to us, and get their perceived needs met. We arre essentially saying: "You were right to bypass your PCP. We know better than the provider who knows you best, and is familiar with your history. Come on back any time you don't get what you want from your pcp."