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.
Are we done bashing the ER yet? We get it, ER nurses are the meanies and floor nurses are the victims in this horrible machine. Can we get on to something more useful, like why my week-long nurses week was renamed hospitals week?!?! But thanks for the Target gift card!
my first smart a**ed answer was......"because we are....:smokin:"
but seriously......
listen to us.....each one slamming the other......every single one of us are specialites in our own right. each one without the other would cease to function. each floor, icu, telemetry or pedi floor has their own special set of skills that are required to do the job well.
just to address the last few posts......ed nurses place iv's in the anticub because when the patient comes in an iv is usually in the anticub already.....why is the anticub a good spot? when people are anxious and afraid they go through peripheral vasoconstriction and a lot of patients are removed form an outdoor situation and are cold. the anticub is the only site to find and the biggest to find in a moving object. the shift change admission is a complicated process......mostly md driven and can be averted only wih cooperation of the md's. ed nurses do a focused assessment.......and when the chest tube has been placed and confirmed on x-ray time to move on. i agree they should do a more focused report and sometime get carried away with the "i'm busy" stuff.....you should hear how the ed nurses are treated by flight crews and terciary facilities because the little hospital nurses are so "dumb":uhoh3:. not all sates have continued with divert statuses......many have stopped diversion status due to some limited abuse by one facility and overburdeing the next and pulling fire resources away from their home towns. but diversion means you are busting at the seems and people in the halls.......ambulance traffic and be diverted by street traffic cannot be turned away. the secretary is the traffic cop and registrar operator and air flight controller....without which the whole hospital would not function.
but the biggest point to be made is if we could stop throwing each other under the bus and pretend that we can play nicely in the sandbox....thing would be smoother. there is no excuse for poor nursing and assessment nor is there time for boasting "i can intubate and you can'" because if the other person could learn, icu nurses usually don't like the ed because even though they can be just as sick the are too mobile,always going here and there, this test to that test.....twisted iv lines everytime they move:uhoh3: and ed nurses dislike the focused attention to detail of necessary to the icu nurses survival (and her patient) and ed nurses essentially adhd. focus pattern is better suited to the ed. and floor nurses...........i have no clue how you keep up!!!!!!
i think we should stop picking at one another and celebrate each others specilities........but this discussion is as old as the profession itself.......
i have always been a strong advocate of shadowing......walking a mile in someone elses shoes......trust me it brings a whole new prospective to the table. i long ago lost the ability to do floor nursing. i can code them if they go down the crapper but keep track, make beds, give baths,transport to tests, prepare discharges,accept new admits and pass meds on 10 people? i lost that the first year of nursing when i left the floors for critical care.
to the op.........i'm sorry you had a bad day. feel better???? :)
Wow, it took me forever to catch up on this thread! Lots of opinions...I can tell we're all the quiet soft-spoken types on this board. :)
I had a few things I wanted to throw out there...
My state passed a law a while back that outlawed diversion. Which has made it worse on every department from the ED down to housekeeping.
The IV in the AC thing used to drive me insane as well as a floor nurse. Until I asked an ED nurse "Why?" It made sense...if they're unstable, you want the largest access that's reasonable in a vein that will handle it...and many contrast CTs require an 18 in the AC for the power injector. I may get flamed for this, but in all honesty, if you add up the number of times you'll have to go in the room to shut up the IV pump or tell the pt for the Nth time to just keep their arm straight for the love of Pete...it'd probably take less time in comparison to just throw in another access.
The food thing too...it sucks for us and the pts when they roll up at 0100 and all we can give them is graham crackers and sugar free jello. But when it's in question what tests may be needed during the ED evaluation, it makes sense to not feed them.
The report thing and the dirty room issue etc...I try hard to work with the ED staff and not jerk them around. I have to admit, just on our floor, there are a few who have perfected that to a fine art. They generally don't get much slack from the ED b/c they have that reputation. But those of us who try to work with the ED nurses by calling back promptly for report or calling as soon as the room gets done being cleaned can usually get some extra leeway when we need it, b/c we don't ask for it that often. I try to embrace the philosophy that if I scratch your back you'll scratch mine, and that you catch more flies with honey. There's a handful of ED nurses I'd gladly do without...but many of them are pretty good to me.
Several of us on my floor have made it a habit to check the ED census at the start of the shift. If there's 50 pts in the ED and we've got seven open rooms, we know that we've got to get down to business b/c we're about to get hit hard and fast. It helps us prioritize and plan our shift so we can take report and get those ED pts right away.
Are we done bashing the ER yet? We get it, ER nurses are the meanies and floor nurses are the victims in this horrible machine. Can we get on to something more useful, like why my week-long nurses week was renamed hospitals week?!?! But thanks for the Target gift card!
You got a GIFT CARD? You stop complaining right now!
Basically, no matter how awesome anyone thinks their specialty is, there's always someone higher up waiting to poop on them.
Cool nurse? Who cares? What's cools is that you are getting a regular PAYCHECK and you probably have health insurance! Take this from a broke, slightly frustrated SAHM (stay at home mom)
Specializes in Acute Care Hosp, Nursing Home, Clinics.
This is why "Nurses Eat Their Young". This is why Nurses "Burn Out". ER Nurses-Don't tell us you're in "Crisis Mode" 100% of the time. Don't tell us you can't adjust some of what you do to accommodate the MS Nurses. This is nursing run amuck. This is where teamwork is extremely important but it sounds like "I'll take care of my problem but you are on your own to take care of yours. How many times have I had to take up your slack because you were too busy. Too many. Forget about how 'cool' you are and start thinking about how the two disciplines can work together to get a better outcome. Geez!
Thanks for this post. I have a few things to add but you saved me a lot of writing.
Wow, it took me forever to catch up on this thread! Lots of opinions...I can tell we're all the quiet soft-spoken types on this board. :)
I had a few things I wanted to throw out there...
My state passed a law a while back that outlawed diversion. Which has made it worse on every department from the ED down to housekeeping.
The IV in the AC thing used to drive me insane as well as a floor nurse. Until I asked an ED nurse "Why?" It made sense...if they're unstable, you want the largest access that's reasonable in a vein that will handle it...and many contrast CTs require an 18 in the AC for the power injector. I may get flamed for this, but in all honesty, if you add up the number of times you'll have to go in the room to shut up the IV pump or tell the pt for the Nth time to just keep their arm straight for the love of Pete...it'd probably take less time in comparison to just throw in another access.
RNCCRN9706, Let's not forget that the "E"in ED stands for emergency, so if you are getting my pt in the ICU, chances are that pt was a true emergency. That said, we don't have time to hunt and peck for a more convenient site, we take what we can get fast. Policy in my hospital for emergencies is minimum of 2 large bore PIVs, and usually the best place to get them is the AC.And if someone is intubated, chances are good that the pt will need 3 or more for all of the drips he/she will be on, so you may be lucky to get those, let alone have them all somewhere besides the AC.
Then you have your morbidly obese person who might take an hour or more just to get ANY access, so we are happy with whatever we can find, and again, the AC is the most likely spot.
I could go on and on with those who refuse IVs in the hands and the elderly who have few veins that will hold up without blowing, etc., etc., but hopefully you get the picture. If not, then I can't help you.
The food thing too...it sucks for us and the pts when they roll up at 0100 and all we can give them is graham crackers and sugar free jello. But when it's in question what tests may be needed during the ED evaluation, it makes sense to not feed them.
Exactly! If you are getting the pt to your floor at 0300 but they were in the ED in the afternoon, that would likely have put them start of the evaluation process, at which point almost all patients are NPO. You should have already known that one.
The report thing and the dirty room issue etc...I try hard to work with the ED staff and not jerk them around. I have to admit, just on our floor, there are a few who have perfected that to a fine art. They generally don't get much slack from the ED b/c they have that reputation. But those of us who try to work with the ED nurses by calling back promptly for report or calling as soon as the room gets done being cleaned can usually get some extra leeway when we need it, b/c we don't ask for it that often. I try to embrace the philosophy that if I scratch your back you'll scratch mine, and that you catch more flies with honey. There's a handful of ED nurses I'd gladly do without...but many of them are pretty good to me.
As for waiting 2 hours to bring the pt to the floor, I don't know why you would think that the ED wants to hold a pt for 2 hours just to screw second shift, but that's your issue, not mine.
I don't know how it's done where you work, but when we call for an admission, we have to wait for the floor to give us a room. That is supposed to happen within 30 minutes, but it often takes much longer. So yes, it might well take 2 hours to get the patient to you since we still have to track down the receiving nurse for report once we get a room assignment.
There are also times when we know a pt will be admitted from the time they hit the door and we give the supervisor a heads up as soon as possible so everyone is prepared. In this case it might be much longer than 2 hours before you get my pt because we have TRIED to be considerate of everyone involved.
And don't forget the times when the doc has put in orders for admission, but then adds some tests or treatments that need to be done before the pt can leave the ED, and you have many valid reasons for a pt to take 2 hours to get to you besides trying to screw you.
Several of us on my floor have made it a habit to check the ED census at the start of the shift. If there's 50 pts in the ED and we've got seven open rooms, we know that we've got to get down to business b/c we're about to get hit hard and fast. It helps us prioritize and plan our shift so we can take report and get those ED pts right away.
Just had to add more two cents.
RNCCRN9706, The point you made below is actually a good one. Nurses floated to the ED are next to useless because they "don't know anything" when they get there and refuse to take an assignment. But guess what, the m/s nurses are not the only ones who do this! I can almost understand m/s being out of their element in the ED, but the one group of nurses that you would think most likely to be able to transfer their skills to the ED is ICU nurses, but they are just as guilty as the rest of them.
It's also not unusual for certain ICU nurses at my hospital to refuse to take a pt in ICU because they are too "unstable." Seriously? Or they want to tell us what meds/treatments/tests that THEY WANT DONE before they will take a pt. Maybe when they get their MD!
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.
This is why "Nurses Eat Their Young". This is why Nurses "Burn Out". ER Nurses-Don't tell us you're in "Crisis Mode" 100% of the time. Don't tell us you can't adjust some of what you do to accommodate the MS Nurses. This is nursing run amuck. This is where teamwork is extremely important but it sounds like "I'll take care of my problem but you are on your own to take care of yours. How many times have I had to take up your slack because you were too busy. Too many. Forget about how 'cool' you are and start thinking about how the two disciplines can work together to get a better outcome. Geez!
Either you haven't read the rest of the thread or you have chosen to ignore it. ED nurses accommodate floor nurses when they can, but they are often FORCED to accommodate them by the floor taking their time to assign rooms, make moves, get rooms cleaned, take report, etc. Floor nurses have all the control. And if the floor is getting admissions, pts must be rolling through the doors so the ED must be busy. Simple logic.
While I understand your frustration, and I understand that most streets go both ways... I find the above statement to be inaccurate.
Floor nurses have all the control? Sups, CNs, administrators perhaps. Me have control? Not so much. If I did, all my admits would come only between 2-4am.
While I understand your frustration, and I understand that most streets go both ways... I find the above statement to be inaccurate.
Floor nurses have all the control? Sups, CNs, administrators perhaps. Me have control? Not so much. If I did, all my admits would come only between 2-4am.
LOL ok, I concede that point, maybe floor nurses don't have ALL the control, but they do control what they can
. not all sates have continued with divert statuses......many have stopped diversion status due to some limited abuse by one facility and overburdeing the next and pulling fire resources away from their home towns. but diversion means you are busting at the seems and people in the halls.......ambulance traffic and be diverted by street traffic cannot be turned away. the secretary is the traffic cop and registrar operator and air flight controller....without which the whole hospital would not function.
redhead_NURSE98!, ADN, BSN
1,086 Posts
Yeah, I saw that explanation already. Thank you.