I get it, we on the floor don't see what you see- gunshots, knife cuts, fights, rape victims. But you chose that. Nursing is a wide, varied profession and ER is just a piece of it. So you work with firefighters, paramedics, police. Okay. But you're not a firefighter, paramedic or a police officer. You're a nurse. When you call the floor for report and we say we're too busy right now, we'll call you back, please don't call your boss, or the House Supervisor, and tell them we refused report. Again, I get it. Nobody is as busy as you. But we may have had our hands deep in poop, or in the middle of a dressing change, or with a doctor, or administering chemotherapy. Or we may be already getting report from the offgoing shift. And yes, another nurse is just as busy and can't take the report I would rather get first hand anyway. When we get report from you for a hip fracture patient and you say the BP is 191/92 and she has a history of hypertension, please don't get offended if I ask if you've covered the blood pressure. I know she's being admitted with a hip fracture and not for hypertension. But hypertension is something we're aware of, because it is also bad. If you send the patient up without covering the BP, by the time she's moved from gurney to bed that BP has spiked to over 200 and I have a possible stroke to add to that fracture. Will it kill you to walk over to your MD, the one with whom you enjoy a closer relationship, and ask for some Vasotec? And while you're at it, could you not forget some pain meds before you send the patient to the floor? You see, I have to call the admitting MD, that very MD your doctor just spoke with to admit the patient, and wait until he calls back, before I can give any medications. That can and does take hours. Meanwhile I have an increasingly uncomfortable, unstable patient and a family who is getting very concerned that this new nurse can't help their mother.
I'm sorry for the long post, but I just read another Megalomaniac ER blog slamming floor nurses as stupid and lazy, refusing report, fighting with ER because they're uncomfortable taking unstable patients ER wants to move because they need the beds. There is more than just you, ER.
I was a MS nurse, and I know how it works. MS nurses have a pretty heavy patient load, but with usually stable patients. I know you work hard we all do.
I know you have pt's with bowel obstructions- I put down that ng for you. I know you have people with pain issues-I started that pca for you. I know you have the granny/grandpa that fell and broke something- I put the immoblizer, splint,or traction on for you. I know you are busy giving blood- I gave the first two units. Yes I know you have that diabetic- I started the insulin drip.....and I know you don't like IV's in the ac (I didn't either) but you have an IV, and all night to pick a more convenient spot....if you don't like where I put it.
In addition to doing all that for you...I cardioverted that unstable SVT, tPA'ed the stroke, TNKased that AMI, tubed the Resp. distress, and they are nice and comfy on the vent. I have NG'ed/ lavaged/charcoaled the od....for ICU/cath lab/stroke team...and who do you think just responded to the code that was paged overhead??? And my shift is only getting started. So yeah when I call to give report....I expect you to take it the same way I am expected to keep taking patients as they roll through the doors....I will give you the best report I can, but I will only cover major issues. Just be glad you are getting a report....sometimes I do, sometimes I don't! So yes I think ER nurses are cool....not better.... just different, and cool! :)
...and I know you don't like IV's in the ac (I didn't either) but you have an IV, and all night to pick a more convenient spot....if you don't like where I put it.
I'm an ICU nurse in a small community hospital. WHY do the ER nurses put ALL IV's in the AC? Seriously every single admission I've gotten from the ER has had their only IV access in the AC and it was NOT pre-hospital. Is it because it's the easiest spot to find a vein? Now I've got to tell the pt all night long that they have to keep their arm straight because if they bend it, they'll set the IV pump off. Try telling that to a confused lol or psych/detox pt? After repeated bending of that arm, chances are that IV is gonna start leaking within 24 hrs so it'll need restarted. Most nights, I'm too busy to try to find a "more convenient spot" .......there are other veins on a person than the ac.
Or, I'll get called for an admission at 8:30pm....now I KNOW the ER will wait until 10:30pm or so to call report and then bring me the patient, thinking that they're screwing over the 2nd shift nurse, not knowing that hey, I'm here all night:D OR they'll wait till after 11pm when their tech has gone home so now I have to go down to ER and GET MY OWN PATIENT!!! Who is gonna watch the other 5 patients/monitors....my coworker? Yeah, that's safe!
While I don't expect a full head to toe assessment from the ER nurse, I DO expect you to tell me your assessment of whatever system brought them into the ER...you're sending me a pt with a CVA?? What's their baseline neuro status? What do you mean you didn't check??? Surgeon dropped a chest tube to correct that pneumo? What do their lungs sound like now? You mean to tell me you didn't listen to their lungs after the chest tube was placed?? Seriously, I've had two ER nurses where I work tell me those things!!
Our one ER nurse has made the comment that ER nurses are the best nurses in the hospital but whenever he has to intubate a patient...who does he call to set up the vent for him because he doesn't know how(we don't have Resp therapy on night shift,, they have to be called in but it's just quicker to have one of us ICU nurses run down to the ER--with the vent and set it up rather than wait for the on-call RT to get there)?? ME!!!
To the med-surg nurse who is offering a chance to walk in her shoes because he/she thinks she could handle ER/ICU? I did 5 yrs of med-surg before going into ICU. The med-surg nurses at my hospital couldn't handle ICU. when they are pulled into ICU, they tell me, "I don't feel comfortable doing that" or "I don't know HOW to do that"? Um ok then, you may as well go back to your floor because if I have to babysit your patients in addition to mine, you are not helping me at all. Thanks but no thanks.
While I don't expect a full head to toe assessment from the ER nurse, I DO expect you to tell me your assessment of whatever system brought them into the ER...you're sending me a pt with a CVA?? What's their baseline neuro status? What do you mean you didn't check??? Surgeon dropped a chest tube to correct that pneumo? What do their lungs sound like now? You mean to tell me you didn't listen to their lungs after the chest tube was placed?? Seriously, I've had two ER nurses where I work tell me those things!!
Thank you! I get incomplete reports from the ED and it drives me crazy.
"Pt is here for an intercranial bleed, No, I didn't check her pupils"
"Pt has a GI bleed, but he's stable. I don't know if he's ever had abdominal surgery" Then he arrives on my unit with a fresh dressing on his belly, 2 post discharge and within 5 minutes is in asystole.
A little more focus in your focused assessment would be great. Thanks.
Thank you! I get incomplete reports from the ED and it drives me crazy.
"Pt is here for an intercranial bleed, No, I didn't check her pupils"
"Pt has a GI bleed, but he's stable. I don't know if he's ever had abdominal surgery" Then he arrives on my unit with a fresh dressing on his belly, 2 post discharge and within 5 minutes is in asystole.
A little more focus in your focused assessment would be great. Thanks.
Not only did they not TELL me the assessment in report, they didn't even document it on their ER Nursing flowsheet!
I sure hope they never get sued because they will be hung out to dry by the plaintiff's legal team!
One thing I really hate is when a patient complains of pain as soon as they come to the floor and ask for pain meds and they say "the nurse in ER said I could have pain meds when I get to the floor", knowing I have no orders and now the patient will have to wait for me to get an order where it would have been easier to get from the ER doc.
UGH YES! Or my personal favorite, at 3am... "I've been in the ER since 11am and haven't had anything to eat, do you have anything?" Why yes dear, we have access to a couple crappy snacks at 3am, however ER could have gotten you a full meal ordered this afternoon but they just kept hoping you'd either be admitted or d/c'd so they wouldn't have to deal with your boring whims, like oh I don't know EATING! lol
Rnccrn9706, those are some pretty broad. brushstrokes you use to put down both m/s & er nurses. Do you spell team "teim"?
Anyway, this is a pretty entertaining thread. The strongest themes I see are a lack of understanding of er proceess. As stated by others, the flow of pts into the er does NOT stop. Divert is rare and really means nothing. Our management pushes us hard to get the pts to the floor. We have no control over when a bed becomes available. We call report when it's ready, not because we're trying to make the floor miserable.
Our priorities is stabilization, so the package isn't always neatly wrapped with a bow. Although it usually is.
And yeah, there are lousy er nurses. Just like there are some lousy nurses in all units.
We in the er are jacks of all trades, able to manage anything that comes through the door, with or without warning. Does that make us cool? Maybe. I know that's what people often say when they ask what I do for a living.
Being an er nurse is almost as cool as being a telemarking ski patroller.......
Some of you folks have clearly never set foot in a bit city ER.
You have the luxury of telling your secretary to say you're too busy to come to the phone when you don't want one more patient right now. I do not have the luxury of telling people it's an inconvenient time to have a heart attack, be stabbed, have a severe GI bleed with a HGB of 4 when they hit the door, fall off a roof, or get into a severe car crash. In fact, they still come in droves even when all my rooms are full, the waiting room is packed, and I'm out of beds to even put them in the hallway. When your rooms are all full, you don't get any more patients. When mine are all full, I still need to find somewhere to put the next ambulance or walk in MI from the front desk. I also need to find a nurse to take care of them which can be a chore since they tend to all have far more patients than they should ever be asked to take to begin with.
You're in such a big city that they don't divert ambulances if you're full? And I HAVE A SECRETARY???!?!?!?!??! WHERE ARE THEY HIDING THIS ******
OMG I was just thinking about them putting IV's in the AC. I absolutely understand why they do it, but when you've got someone on the Facebook version of this link smart alecking, "I sometimes wonder if floor nurses know HOW to put in an IV or a foley," my thought was yeah buddy, I DO have to put in IV's cuz your crappy 22 in the AC doesn't last more than a day!
You're in such a big city that they don't divert ambulances if you're full? And I HAVE A SECRETARY???!?!?!?!??! WHERE ARE THEY HIDING THIS ******
divert is only for ambulances and it's a request, not a locking of the doors. That stemi 2 blocks away? He's coming in, divert or not, medics are going to the closest hospital. And that guy walking up to triage clutching his chest? On a telepack in the hallway. If we're "lucky", he's a code mi and heading up to the cath lab within an hour.
Scrubby
1,313 Posts
hmmmmm you guys can argue all you like but surely you realise that OR nurses are the coolest nurses in the hospital?