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 graduated last spring, work adult inpatient psych, love it, was my first choice of specialty. Quite passionate about it. I did my Capstone last year in an ER, loved it, was a close second choice of specialty and woulda got a job if the hospital I did my rotation at didn't have a policy requiring 1 year med/surge experience to work the ER.
Anywho, my point is, I think ER nurses are way cool!!
Perhaps they think they're so cool because.. they are?
As I psych nurse I must ask.. Why do you think ER nurses think they're so cool?
Me thinks OP wants to be an ER nurse.
hahaha
you're a psych nurse?? ER is just the place for you on a full moon. Seriously.
Coulda used your help last night with my 4 suicidal patients, one heavily ETOH'er, and a paranoid MR patient. Not my cup o tea, to be sure, (psych), but hey, what are you gonna do? Keep rollin', that's what.
Psych nurses tend to focus on psychosocial only without seeing the big picture in an ER setting - like their brain has been trained in psych and can't break out of psych.
So why do ER nurses "think they're cool?" I suppose some think they are, but they would think they're amazing wherever they went.....
I guess I'm the same way w/ ER - I see a kid who has fallen off the jungle gym and think he might have a c-spine injury...
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.
seriously, you being an icu nurse know that a patient coming into the ed without a diagnosis, we start lines in a large vein to give meds/fluids rapidly - usually 18 gauge. most ct's you have to bolus a patient with contrast and it has to be in an ac site. trauma's and any unstable patient are going to get a large gauge iv in a large vein. period. that is common sense er nursing. sorry if the site beeps with the patient bending their arm, but that is not our concern when we're trying to figure out what is wrong with that patient that is confused when they arrive and we know nothing about the reason why.... you can put some sort of elbow restraint to restrict bending if it's that bad.
sounds like your er experience isn't great, but certainly don't clump that into all er nurses are that way, just like i'll try not to group all icu nurses into the group that all they care about are bowels and keeping cords untangled.
keep in mind, a patient comes in, there are trauma docs, neuro team, etc assessing the patient and their lung sounds. there a bunch grouped all over the patient, so you are writing their assessment as they call it out in their assessment. often times you barely have time to write anything before a patient is wisked off for intervention or the floor. that's just how it is. there isn't any time to do a head to toe assessment on a trauma/critical patient that is just being stabilized and moving on. that is how it goes.
your tone in your post is just nasty, i have to say. you have such disdain for er nurses and it is quite misguided. you really don't know what goes on in an er by what you posted.
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!!
Yup, 2 ED nurses did that so the entire group MUST be bad nurses!
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.
oh please. That is ridiculous and you know it. MOST Er nurses would give you a basic neuro assessment on a stroke patient. SERIOUSLY. Don't put out this misinformation when you know it's absolutely false.
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've been where you are with er nurses before. i even had a thread in here, a couple years ago, calling out the er nurses who claim to be soooooo busy but yet can time their transfers to the unit (yes, we all know, 90% of transfers occur at shift change, its not just some unexplainable coincidence) so that they can avoid taking new cases.
that thread ended with the explanation that er nurses don't have ratios like floor nurses do, hence it doesn't help to hold onto patients until the end of their shift. i saw er nurses in a new light after that.....................until i started working for my current employer. i used to be a travel nurse so i've seen a wide variety of different hospital styles. i must say, the er at my current hospital is embarrassing. they don't seem to know enough to be embarrassed about their performance, but trust me, the nurses on the unit are embarrassed for them. whenever we get an er admit, we can pretty much expect to spend the first 30min. after they arrive apologizing for how poorly run our er is.
i found out, after my orig. thread in here, that not all hospitals triage the same. in many ers (including the one at my current hospital), the nurses do indeed have ratios. if it looks like the er is busy and everyone is close to max pt. load, part-time and casual people are called in. if everyone in the back of the er is at max pt. load................everyone else in the lobby waits until (yep, you guessed it) next shift change, and patients are sent 3/4/5 at a time up to the units and then new patients are accepted by the nurses (the oncoming shift). thats the system. anyone, with any medical background, can see the problems with this.
i realize the er nurses at my facility are, for the most part, very lazy and even more of them are inept. they've worked very hard to earn that label (it's not just me, pretty much the whole hospital knows this) and will have to work twice as hard to be rid of it. don't believe me, here is, as close to word for word, a report i had called to me from the er about three months ago:
76 year old woman comes to er via ambulance with c/o inability to ambulate. pt. claims she is ambulatory and performs adls independently when healthy. she as hx of: chf, mi, copd....................(there were more). upon arrival to the er, she was sob, generalized edema of at least 1+ was noted, with ble edema of 3+. the patients lungs sound very wet, she has railes audible without auscultation. pt states her son helps care for her because her eyesight is bad and hence she can not organize/take her pills on her own. her son is out of town on business, and the gentleman who was supposed to show up and dispense her pills has not visited her for the past week, as per pt. report. blah blah blah..................................................(leading to home meds) the pt. is on lasix po daily (at this point, i already see the problem, with the guy not showing up to dispense her meds) blah blah blah.
so we bolused her with 500cc of ns, have her on fluids of ns @ 100cc/hr and we are sending her up for admission to your floor:eek: call me with any questions.
i resisted the urge to call and ask the one question i did have: if she was a gn or nurse extern of some sort. took care of the problems myself after the pt. arrived. pt. received no meds in the ed, had not been placed on iv lasix........................nothing.
with that said, where are we to go with this as unit nurses? you can, as i did, write up incident reports about the grossest of infractions and all, but you have to decide for yourself if that is going to do any good or not. after that, as i see it, you have two choices:
1. get over it, maintain pt. focus, and keep your patients safe once they arrive to you. holding onto a resentment about the ed nurses just burns up energy better spent on making things right (as in, for me, getting iv lasix ordered and contacting the woman's son so he knew there was a problem with her getting her home meds).
2. stay angry, fall into the trap of turning into another snippy/catty rn who runs around doing all these passive aggressive things in an attempt to "put ed nurses in their place"and risk being thrown under the bus when something goes wrong.
i've gone with #1. part of being a great nurse vs. just a nurse is: you must be able to work with the other parts of the care team. the ed is part of that team. your job will be easier if you just accept their shortcomings and get along with them. its how i do it anyway (although, when i think there is a gross/unsafe incident, i do not hesitate to document it). and, despite the obvious flaws with the people currently staffing our er, getting along with them and transitioning the pt. from one stage of care to the next is what is best for said pt.
i'll also add, i've known a lot of ed nurses in my time in the field. i do get the other end of the story a lot of times. one thing to note is that, er nurses "think they are cool" as you put it............because they are their own little cult. they often feel (and are) shunned by the rest of the nurses in the hospital, as if they are on some island away from "the real" or something. so, they are their own little world, sometimes by choice sometimes not. they do this to survive the day, just as we do our own things to get by. just as we have our little rants about how they don't "get it" or understand what we the unit nurses go through/need.....................they same the same about us.
i go out of my way to be accommodating to er nurses, and they return the favor. don't think for a second those nurses don't get together and talk about which nurses on the unit give them a hard time and which one's they like. you can be blacklisted by them. me, i cooperate with w/e needs done that day to help them out. in return, often my patients arrive with little things done for them to help out (pain meds already ordered, fluids already hanging with pump there so i don't have to order it etc). it makes a big difference on bad days. and................if they call report to me and i respond "omg, i'm trying to help this pt. avoid a code situation, i won't even see this admit for an hour after they arrive......................", guess what happens? they wait even longer to send them up, and help me out. all that just for not being rude when they call report and not trying to avoid taking report. seems like a fair trade to me.
that is a hasty generalization. not all er nurses deal with floor nurses this way. it is entirely specific to who the nurse is, the floor, and the patient/scenario. there are some raging er nurses, just as there are some raging floor nurses who are all about the bm questions on a patient being admitted with cp/mi. really. some questions that totally waste our time, such as skin status on a young, ambulatory patient being admitted for a headache.... when we're trying to be quick, efficient, and get the patient out because we have fourty patients in the waiting room and ambulance patients lining up in the halls with no nurses available to take care of them. do you have to deal with that on the floors, i ask? do they admit patients to a hallway spot until "someone" can take care of them? no.
things are very different in an er. some nights are crazy and chaotic, sometimes not. sometimes we are neck deep in a c-dif patient, as well as out of control etoh'ers who are trying to elope, while also dealing with patients on call lights every 2 minutes with very needy families.
i get that sometimes floor nurses are mistreated, i really do. not all nurses are created equal and it's unfair to assume some are stupid or smart. assume they can all do their job until they prove otherwise. sometimes a nurse opens their mouth and removes all doubt about their lack of common sense.
i find that doctors that hang out in the er to admit patients tend to talk poorly about floor nurses because they are called about every little thing (including a temp of 99.0 at 0200 and wanting tylenol, i kid you not). i remind them that their orders call for those parameters. i think what the docs get frustrated about is when some floor nurses don't use their clinical judgment prior to calling the doc. maybe the nurses don't feel comfortable or able to do that, i don't know. i do know, for myself, that when i worked on a floor, i did not have the ear of physicians like i do now. they are willing to listen to what i think is going on with a patient when they're in the er talking to me.
as far as the anger between er and other floors go will never change. unless you have walked in my shoes, you don't get it. you never will. i, on the other hand, have walked in your shoes, and let me tell you this: er is harder. scarier. more chaotic, less controlled. sometimes a bit looser when the waiting room is empty or have some empty rooms, so there are less ears to hear when you cut up.
next time you deal with an er nurse, keep in mind, they might be stressed out too. we have pressures to get patients out of rooms and upstairs the second the room is ready. they chomp at the bit to get the next patient in the room, often putting the patient in the hall next to the room so you can start treating them. do you do that on your floor?? i don't think so.
easy to judge when you haven't walked on my wild side. try it. for at least some perspective.
actually, i have walked in your shoes, as i've stated a couple of times already on this thread. as i've also stated, this is not a "gospel truth" statement, but my experience says that most of the er nurses i worked with were like this. i've been an er triage nurse before as well, and it is frustrating to the max with petty complaints, but hard, no.
but, it's not to judge other nurses. this speaks of my experience!
"I'm also kind of upset that my hospital staffs the E.R. with more nurses than any other Dept."
Where the heck do you work where you have MORE nurses and not being short every night???? GEEEEEZZZZ!!!!
Louisiana.
I must apologize. Like I've tried to state, I was harsh on ed nurses. I've seen that now. But, my point is, this is my experience, not to be a stereotype of all ER nurses.
I'm sure I've been a "Dramaking" sometimes, too. Let me not be unfair about other nurses. But this is my experience.
If that's what you call drama then you must lead a very boring life.
What I call drama is taking something small and making it big. If calling your job "Easy" is the WORST and MOST DISRESPECTFUL thing you've heard from a fellow nurse, then you must lead a very boring life.
MassED, BSN, RN
2,636 Posts
you're a psych nurse?? ER is just the place for you on a full moon. Seriously.
Coulda used your help last night with my 4 suicidal patients, one heavily ETOH'er, and a paranoid MR patient. Not my cup o tea, to be sure, (psych), but hey, what are you gonna do? Keep rollin', that's what.
Psych nurses tend to focus on psychosocial only without seeing the big picture in an ER setting - like their brain has been trained in psych and can't break out of psych.
So why do ER nurses "think they're cool?" I suppose some think they are, but they would think they're amazing wherever they went.....
I guess I'm the same way w/ ER - I see a kid who has fallen off the jungle gym and think he might have a c-spine injury...