Now Ive heard it all!!!

Specialties Emergency

Published

In my ER, I think one of the worst problems we have is getting the patients up to the floor. I totally understand if there are no beds, there is nothing that anyone can do about that. However, I am sick of hearing the excuses "I cant take report the bed isnt washed", "the nurse is on break". The nurse is on break all night long when I call (I would like a transfer to that floor please), and you know damn well when you take report that the patient isnt going up right away, so by the time we get them up the bed is done.

Last night I couldnt believe my ears.

First I had the written/faxed report HAND DELIVERED to the floor because they claim thier fax is broken, and then 3 hours later when I finally got the patient rep to find out what was going on they told us "the room smells so I cant take report or the patient". Finally we got the patient rep up to the room along with 3 other people to find out if the room really did stink. It didnt. Its now approaching 6 am, and they wont take report after that. I understand not wanting to take report at 6, but if you put it off all night long, and its now 6 than tough $hit in my book. You could have done this much earlier.

I am sick of every night having to spend hours of time trying to get this patient up to the room. Faxing, calling, ect. Its ridiculous. Nurses blame the housekeeping staff, (which sometimes it is, but more often than not it isnt) and it seems that nobody is held accountable. I am sure if they did something like made the housekeeping staff supervisor notify the nurse supervisor whenever the bed is ready that this would put pressure on the nurses and call them out when they try to make excuses. in most other hospital the floors must take report even if the nurse is on break, she/he has someone covering for them, its not like there is no-one there.

Sorry about my rant!

Specializes in cardiac, diabetes, OB/GYN.

Should just come to where I am...They inappropriately float maternity to those floors and then dump admissions and the like on us because of COURSE nothing ever happens in maternity...

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We get the run around so much about whether a bed is clean and ready or not, we have to actually send someone to spy on on the floors and check the rooms. 9 times out of 10 it is clean when they say it isn't! And I, being a former Aide on a tele floor, help out in my transfer as much as I can. I will weigh the patient before I put them in bed if they are ambulatory, I will put tele on if needed and then get them comfortable in bed and show them the light and tv changer, so if the nurse is busy and don't get there for a few minutes, it's okay. So why do we get the bad rap?

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Originally posted by mjlrn97

On my floor, we often have a PRN nurse who does admissions and any STAT work, like restarting IVs, running specimens down or picking blood up from the lab, and so on. I wish we had one for EVERY shift......they can be invaluable, especially when we're overtaxed and the admissions keep coming. (Not to brag or anything, but I do a lot of PRN'ing myself, and I'm damned good at it.) You have to be really flexible to function in this role, and most nurses where I work don't like it much--which is why I take the responsibility most of the time when the shift changes at 7--but they do appreciate the help. I know I do, when I'm the one with a team of 6 or 7 patients and everything's in utter chaos and there's another admit coming up!

you would work well in an er. your prn nurse sounds alot like what we do.

i think that the prn nurse is an outstanding idea. i wish every floor in all hospitals had them. unfortunately, they are costly. what happens when they are not admitting or doing stat work? are they floating and helping out? the higher ups think that it would be cheaper to pay a tech, sadly.

we utilize float nurses in the er. this er that i work in now does not give them an assignment of pts - they only float. i think that a good thing to have in the er is to maybe have one of the float nurses take the boarders as thier assignment when there were a certain set number.

oh well, in a perfect world.....

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Originally posted by rstewart

In my opinion this is a perfect example of nurses being "set up" by the system. Of course there are lazy floor nurses/ICU nurses just as there are Emergency Departments who hold patients until shift change and move them all at once-----and when you look at their orders you see the patient was there all day and few of the orders were actually done. But does anyone really think that these are the most common reasons for the all too common strife between the ED and the in- patient areas?

EVERYONE is stretched beyond their limits. As long as the mentality is that if we have an empty bed we can fill it regardless of the nursing resources available, such problems will exist.

Who could argue with the ED nurses who suggest that the in-patient area nurses should come down and see what they are up against? But I must tell you that the in-patient areas these days have their own challenges. Patient transfers highlight hospital wide deficiencies because often many departments are invoved: nursing, respiratory, housekeeping, central supply, transportation etc...........and all are working short of manpower for one reason or another. And you might be interested to learn that the consultant groups that recommend efficiencies in care delivery for the most part conveniently ignore the fact that you need more manpower to run a floor whose census turns over frequently.

Administration does not want the hospital to go on divert and EDs have to deal with people coming through the door no matter what---so the ED gets the bulk of the support when difficulties arise, particularly when it appears that a bed is vacant because an order to transfer has been made which should "free one up" for an ED admit. But it's not like flipping a light swith on and off. The increased patient load and acuity, the additional paperwork, and the lack of adequate support services of today's nurse take their toll----delays which back up the ED are just one manifestation of that reality which the powers-that-be can not easily ignore. But they refuse take an honest look at the system; rather, they will analyze timing of the transfer in isolation, rather in the context of the nurse's overall load---and then blame the nurse. Much attention is focused upon getting a patient into a bed; much less attention is given to insuring that a nurse will be able to adequately deliver care to that patient once they arrive.

GREAT post!

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Specializes in critical care, ER,ICU, CVSURG, CCU.

I hear you, but as a nurse who works on the floor, please consider the fact that while you all downstairs in the ER are coping with overcrowding and nowhere to go with your patients, the nurses on the med/surg, MCU floors are most likely also coping with severe overcrowding. Lately on night shift at the hospital I work for it isn't uncommon for the average nurse to have fifteen patients. And there is usually only one aide. We've been full for weeks; that's 45 patients for one aide and three RN's; sometimes two RN's and one LPN who cannot call doctors, hang blood, do assessments, etc. I've done it--I don't anymore. I know that feeling of being hideously overworked and behind on paperwork. Getting told you have an admission to take when you already know you're getting out late in the morning--and the brass are leaning on everyone about overtime--well, you know what I'm talking about. Some nights if the patient was stable and didn't get any meds, I didn't even SEE them. I had to rely on the aide. Which is why I don't do it anymore.:D

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Specializes in Case Management, Acute Care, Missions.

I really try to understand ER nurse's frustration, I have floated to ER to take care of boarders and the place is a zoo... my hat's off to you all...

I work on a small observation unit and we have specific policy on who we can take and who we can't as pts. There are only 2 staff on the floor from 11-7, and we are pretty isolated. I - for the first time in my nursing career don't mind getting admits becuase often times there really isn't much going on.... I really enjoy being able to be a nurse instead of some automated machine!

Anyway - my frustration comes when we get faxed report - and they conveniently omit something important - like they are total spine (we can't take)... or just last week they sent up a 44y/o woman with a very critical calcium level, large dehissed midline incision, unable to ambulate let alone move or turn, incon't of bowel, temp of 40, septic.... the list goes on and on and on... but all the fax said was that her calcium was high - when I called just to verify they gave me the wrong lab value and didn't mention any of the above - AAAAAGGGGGHHHHH!!!!!!

We actually save our faxes and they get returned to the ER manager with what we found if there is a large discrepency.

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Originally posted by LilgirlRN

It all goes back to what I was taught in nursing school for me.... try to think of every patient as a loved family member. I would hate to think of my mom lying on a gurney in the ED for 5-6 hrs just because the person who was going to take care of her on the floor didn't think that way. Floor/Unit nurses have one up on the ED nurses, they can say I can't take report right now, I'm too busy etc. The ED never shuts it's doors, only in rare circumstances are we closed to ambulance traffic and we're never closed to foot traffic. I know many floor nurses are overworked, but heck so am I. All I can do is buck up and do the best I can to help those who need my help. I don't work on the floor and never have so I don't know if they actually think that the patient would be better off staying in the ED as opposed to coming to a bed where the assigned nurse is already overstressed. I firmly believe that an admission nurse would help tremendously. A nurse would get the bed assignment, meet the patient in the room and do all the admission paperwork and give any stat meds. I dunno, what do you guys think and has anyone ever seen this set-up?

Every so often if we have a float house nurse in the hospital and we are holding pt's to be admitted. She/he will come to ED do the admission data base and give the meds that are ordered by the attending. Not very often do we have a float house nurse so usually we are doing all of the stat meds and such.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

Gee I want to work there. If we can't take report, we have 30 minutes to take report, if we don't take report then, they fax report and bring the patient up anyway. Floor nurses are not allowed to obstruct ER transfers. A long ago lost battle that the ER won. (And rightfully so, as we are a busy ER most of the time).

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Originally posted by rstewart

In my opinion this is a perfect example of nurses being "set up" by the system. Of course there are lazy floor nurses/ICU nurses just as there are Emergency Departments who hold patients until shift change and move them all at once-----and when you look at their orders you see the patient was there all day and few of the orders were actually done. But does anyone really think that these are the most common reasons for the all too common strife between the ED and the in- patient areas?

EVERYONE is stretched beyond their limits. As long as the mentality is that if we have an empty bed we can fill it regardless of the nursing resources available, such problems will exist.

Who could argue with the ED nurses who suggest that the in-patient area nurses should come down and see what they are up against? But I must tell you that the in-patient areas these days have their own challenges. Patient transfers highlight hospital wide deficiencies because often many departments are invoved: nursing, respiratory, housekeeping, central supply, transportation etc...........and all are working short of manpower for one reason or another. And you might be interested to learn that the consultant groups that recommend efficiencies in care delivery for the most part conveniently ignore the fact that you need more manpower to run a floor whose census turns over frequently.

Administration does not want the hospital to go on divert and EDs have to deal with people coming through the door no matter what---so the ED gets the bulk of the support when difficulties arise, particularly when it appears that a bed is vacant because an order to transfer has been made which should "free one up" for an ED admit. But it's not like flipping a light swith on and off. The increased patient load and acuity, the additional paperwork, and the lack of adequate support services of today's nurse take their toll----delays which back up the ED are just one manifestation of that reality which the powers-that-be can not easily ignore. But they refuse take an honest look at the system; rather, they will analyze timing of the transfer in isolation, rather in the context of the nurse's overall load---and then blame the nurse. Much attention is focused upon getting a patient into a bed; much less attention is given to insuring that a nurse will be able to adequately deliver care to that patient once they arrive.

Very well said. And it seems that when we are so stretched it is human nature to start finger pointing at another department to take the blame.

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Originally posted by 3rdShiftGuy

Gee I want to work there. If we can't take report, we have 30 minutes to take report, if we don't take report then, they fax report and bring the patient up anyway. Floor nurses are not allowed to obstruct ER transfers. A long ago lost battle that the ER won. (And rightfully so, as we are a busy ER most of the time).

I want the name of the person that negotiated that sweet deal!!

We are a 20 bed ER and we routinely hold 10-15 pts.

It doesn't seem to matter how bad it is we still get flack from the floors when it comes to taking report. I worked TELE for 8 years. I remember how crazy it could be. It is still no where close the the ER.

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quote:

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Originally posted by 3rdShiftGuy

Gee I want to work there. If we can't take report, we have 30 minutes to take report, if we don't take report then, they fax report and bring the patient up anyway. Floor nurses are not allowed to obstruct ER transfers. A long ago lost battle that the ER won. (And rightfully so, as we are a busy ER most of the time).

We need to have a policy like that, too!! We get a room assignment, then see if it's clean and ready. (That's the part that can get tricky. They can tell us there is a stat clean for hours!) Then we fax report and then we have to wait 15 minutes to take the patient up to give the nurse time to get ready. (What were we waiting the 2 hours for?) I get tired of fighting for a bed and then getting flack when we get them upstairs. The floor that is the worst about giving me flack is one that I used to and still do on occasion work on. I mean.. I totally understand about how crazy it can get because I used to work on the floors, too. I remember getting that sinking feeling when bed board called, or when the elevators opened up with our new patient, but never acted discruntled to the ER employee or to the patient. And chances are if things are crazy on the floor it's because the ER is 10x as crazy and it's not our fault!! :-) We didn't bring the patient to the ER, we didn't work up the patient and decide the patient needed admitted and we didn't decide that they should go to your floor. But we love ya, anyway!! :kiss

LOL

Okay.. a disclaimer.. not all floor nurses do this.. but it does tend to be more of the rule than the exception at my hospital at least.

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Why DO the floor nurses look at us as the enemy???

I don't see the triage nurse as the enemy and she/he brings patients back all day long!!

When I worked Tele I didn't ignore the ER attempts to call report, or "forget" to let the supervisor know about a discharged patient, or get sooooooo busy that I couldn't accept the patient-ALL DAY!!!

We are NOT the ENEMY!!! We should be working together!! Healthcare is a team sport. And nursing is a continum...what I start you continue with. And what you start I will try to finish.

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