OK ED nurses, fill me in on the real story.

Posted
by eriksoln eriksoln, BSN, RN (Member) Nurse

Specializes in M/S, Travel Nursing, Pulmonary. Has 15 years experience.

You are reading page 4 of OK ED nurses, fill me in on the real story.. If you want to start from the beginning Go to First Page.

Roy Fokker, BSN, RN

Specializes in ER/Trauma. 2 Articles; 2,010 Posts

Here's my take:

1. 80% of the time, believe it or not - something ugly rolls in through the door right about near shift change time (4 PM, 11PM and 6AM seem to be the witching hours). That throws everyone off the track as we scramble. ER nurses have no control over that - being that we can't tell the ambulance crews "uhhh, come back in an hour. It's shift change time here and plus I need to call report on these two other patients I have".

2. ER nurses don't control when beds are assigned to us. The nursing supervisor puts the bed in when they put the bed in. Also, it doesn't happen very often - but it happens often enough that I mention this: beds are not supposed to be declared "open" until they have been cleaned and a nurse assigned to the bed to receive the patient etc. (basically, once the criteria have been met, nursing supervisor is informed and the bed is declared "open" and ready to be assigned). But now and again report is refused because "bed is not cleaned yet", "room is not ready", "there is no nurse assigned". etc. Waste of time, don't you think?

3. ER nurses can't control how fast orders are written for the patient. When admitting docs get backed up, we get backed up. It's out of our hands.

So often, it's a dance of "Have orders need bed" or "Have bed, need orders". And believe me, it's not just the floor that is getting ****** off - it's the patients themselves. And who do you think is the target of their frustration?

4. Our nursing supervisors ride our assess all night long in trying to move patients. ED throughput is a quality control measure - the faster we move patients, the higher we score. If the ED nurse doesn't call report or is suspected of "holding patients", the ED supervisor will find someone to call report or call report herself. Period.

5. Holding patients doesn't help anyone, particularly the ED. I can see how this misconception might arise however - because unlike floors where patient flow is generally static/controlled; patient flow in the ED is dynamic/chaotic. The waiting room could be empty for half an hour but within 10 minutes 25 different patients can sign up waiting to be seen....

As someone already mentioned earlier, when we get backed up, patients are assigned to hallway beds. Which means if I had 4 patients earlier, I now have 5... (or as was the case on Superbowl Sunday, 6 patients including 2 ICU/vented pts. and 3 Tele pts and 1 acute MI in progress...) Now ask yourself this question - why would I invite more grief for myself by taking on more patients thru hallway beds? Does it not behoove me to clear out my admitted patients so that I have fewer people to take care of?

Also, the comment about holding the PITA patients - really? Think that one through: If the pt. is a PITA - why would I hang onto them? Wouldn't I be rushing to get them out of the department and off my hands? I'm no masochist, right?

cheers,

Roy (former floor nurse now working in the ED)

MAISY, RN-ER, BSN, RN

Specializes in ER/EHR Trainer. Has 6 years experience. 1,082 Posts

Wow Roy, your Superbowl Sunday sounds like mine!

The other thing that happens, at least in my area is that any weekend or holiday that I must work, I can guarentee ambulances lined up in the bay from the local nursing homes, rehabs, group homes, and family homes. Usually it is because these other facilities are short staffed, they send everyone as altered mental status! That's their answer to short staffing! Soooooo, we get inundated with these elderly people who always for some strange reason (even though altered is their usual) they are admitted, sooooo there aren't extra nurses on the floor, soooooo we hold until beds are available, andddddd they are usually available as the next shift comes in because per diems and agency have been called to cover.

Just another reason they are there at shift change.

Maisy

eriksoln, BSN, RN

Specializes in M/S, Travel Nursing, Pulmonary. Has 15 years experience. 2 Articles; 2,636 Posts

Here's my take:

1. 80% of the time, believe it or not - something ugly rolls in through the door right about near shift change time (4 PM, 11PM and 6AM seem to be the witching hours). That throws everyone off the track as we scramble. ER nurses have no control over that - being that we can't tell the ambulance crews "uhhh, come back in an hour. It's shift change time here and plus I need to call report on these two other patients I have".

2. ER nurses don't control when beds are assigned to us. The nursing supervisor puts the bed in when they put the bed in. Also, it doesn't happen very often - but it happens often enough that I mention this: beds are not supposed to be declared "open" until they have been cleaned and a nurse assigned to the bed to receive the patient etc. (basically, once the criteria have been met, nursing supervisor is informed and the bed is declared "open" and ready to be assigned). But now and again report is refused because "bed is not cleaned yet", "room is not ready", "there is no nurse assigned". etc. Waste of time, don't you think?

3. ER nurses can't control how fast orders are written for the patient. When admitting docs get backed up, we get backed up. It's out of our hands.

So often, it's a dance of "Have orders need bed" or "Have bed, need orders". And believe me, it's not just the floor that is getting ****** off - it's the patients themselves. And who do you think is the target of their frustration?

4. Our nursing supervisors ride our assess all night long in trying to move patients. ED throughput is a quality control measure - the faster we move patients, the higher we score. If the ED nurse doesn't call report or is suspected of "holding patients", the ED supervisor will find someone to call report or call report herself. Period.

5. Holding patients doesn't help anyone, particularly the ED. I can see how this misconception might arise however - because unlike floors where patient flow is generally static/controlled; patient flow in the ED is dynamic/chaotic. The waiting room could be empty for half an hour but within 10 minutes 25 different patients can sign up waiting to be seen....

As someone already mentioned earlier, when we get backed up, patients are assigned to hallway beds. Which means if I had 4 patients earlier, I now have 5... (or as was the case on Superbowl Sunday, 6 patients including 2 ICU/vented pts. and 3 Tele pts and 1 acute MI in progress...) Now ask yourself this question - why would I invite more grief for myself by taking on more patients thru hallway beds? Does it not behoove me to clear out my admitted patients so that I have fewer people to take care of?

Also, the comment about holding the PITA patients - really? Think that one through: If the pt. is a PITA - why would I hang onto them? Wouldn't I be rushing to get them out of the department and off my hands? I'm no masochist, right?

cheers,

Roy (former floor nurse now working in the ED)

IDK which, but either you maybe should reread the post or I should word it different. Maybe a little of both.

PIA patients I said are the exception, they transfer right away, and the ones that are calmer/sensible stay until shift break.

Now mind you, i "said" that, past tense. After talking to people here I've changed my mind about stuff. I stated it a few times later in the thread..........I dont believe that stuff anymore.

Its been enlightening for me, this thread. With the elimination of the stereotype I had about ER nurses, its easier (and more important to me) to treat them like a team member. I'm a little different towards the ER nurses when they call me now.

eriksoln, BSN, RN

Specializes in M/S, Travel Nursing, Pulmonary. Has 15 years experience. 2 Articles; 2,636 Posts

Wow Roy, your Superbowl Sunday sounds like mine!

The other thing that happens, at least in my area is that any weekend or holiday that I must work, I can guarentee ambulances lined up in the bay from the local nursing homes, rehabs, group homes, and family homes. Usually it is because these other facilities are short staffed, they send everyone as altered mental status! That's their answer to short staffing! Soooooo, we get inundated with these elderly people who always for some strange reason (even though altered is their usual) they are admitted, sooooo there aren't extra nurses on the floor, soooooo we hold until beds are available, andddddd they are usually available as the next shift comes in because per diems and agency have been called to cover.

Just another reason they are there at shift change.

Maisy

OMG, again, a ray of wisdom from MY thread. lmao.

You know, I knew about this trend of nursing homes shipping out pt's during holiday weekends and such. What I didnt know was...........it upsets ER every bit as much as us on M/S (where most of these people end up). Again, learning to see things different. Nice.

canoehead, BSN, RN

Specializes in ER. Has 30 years experience. 6,837 Posts

I just finished a shift where out of a 16 bed ER we had 2 beds not occupied by admissons, plus chairs in the hallway. Every time an ambulance came in they stayed on the EMS stretcher until we could convince someone to take a floor admission. Not the floor's fault, but it was a sucky shift. I was rotating people in and out of my 1 free exam room for the initial assessment, and then into chairs right beside the ambulance door. It's only a matter of time before someone is badly hurt...and whose fault do you think it will be?

MAISY, RN-ER, BSN, RN

Specializes in ER/EHR Trainer. Has 6 years experience. 1,082 Posts

What a crappy shift for you and the patients:o BTW love your picture:D

Roy Fokker, BSN, RN

Specializes in ER/Trauma. 2 Articles; 2,010 Posts

I just finished a shift where out of a 16 bed ER we had 2 beds not occupied by admissons, plus chairs in the hallway. Every time an ambulance came in they stayed on the EMS stretcher until we could convince someone to take a floor admission. Not the floor's fault, but it was a sucky shift. I was rotating people in and out of my 1 free exam room for the initial assessment, and then into chairs right beside the ambulance door. It's only a matter of time before someone is badly hurt...and whose fault do you think it will be?
:o That sounds quite depressing - all the more when you think about the fact that the floors getting slammed with admissions often end up getting 3-4-5 patients in a 15 minute space.

Yech! You're absolutely right - not the floor's fault...

.... and it was a SUCKY shift (I don't think I'd have wanted to be a patient in the hospital during that shift!) Kinda-sorta sounds like my ridiculously pathetic (and dangerous) Sunday shift 3 weeks ago [ofcourse, management was 'pleased' that our 'numbers are up again'!!! :icon_roll]

- Roy

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