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.
of course we have ratios, i don't recall anyone here saying they don't, but we all know that ratios easily go out the window when there's not enough staff to handle the influx of pts, same as on the floor.the flaw with your scenario is that the vast majority of the time, at my hospital at least, there isn't anyone to call in to help. if there happens to be someone on one of the floors to spare, we might get a nurse from there to help, but again, they don't know the ed and they won't take a pt assignment, so the best we can do with them is to utilize them as a tech.
the difference between the floor and the ed is that the floor can and does cap their census when they have gone over their ratios by a certain number, even when they still have empty beds. but the ed can't do that. we still have to care for every pt that comes in, even if they have to be treated in the hallway.
another flaw with your scenario is that mis, traumas, anything serious simply cannot be left in the lobby for shift change, so it's very common for us to have more pts than our ratios call for. and, i might add, none of our pts wait in the lobby until shift change. this simply makes no sense because rooms don't magically open up or new ones appear just because it's shift change.
your first paragraph sounds like you think ed nurses are holding pts until shift change so they don't have to take new cases. even for the ed you describe i don't see how this is possible when there are seriously sick pts coming in. i'm not in a position to speak for that ed, but i can tell you that this doesn't happen where i work. in my hospital, if pts wait until shift change at all it's because they don't have a room assignment from the floor, even after requesting one sometimes hours before, or because the receiving nurse is "too busy" to take report until shift change so he or she doesn't get a new case.
if your description of your ed is accurate, then they have more of a problem than most.
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.
if the above case was real, then there is a problem with more than just the nurse.
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:
i will always write these up, even if i don't feel it will change anything. i have to protect myself if the treatment of a pt is ever questioned.
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.
ok, so let's get real. first, i completely agree with your last paragraph. second, there are good nurses and bad, lazy nurses and those who go the extra mile, nurses who are absolutely fabulous in their skills (and every other way) and those who are just adequate. but all kinds of nurses can be found in every specialty, mine included. some hospitals just seem to have more than their share than do others, but i blame management for letting that happen.
there has been a lot of accusations thrown around here that have been sweeping and generalized in nature, and that is what bothers me about this thread. but jokesters aside, no one here has stated that they are "cool" the way that the op has accused an entire group of nurses. if someone has a problem with a specific nurse then i say go for it, but let's not denigrate an entire group because of the actions of one, or even a few.
in all seriousness, the truly bad apples at my hospital, in all specialties, are at a minimum, and i have a good working relationship with all of them most of the time. sometimes we have issues, but we work it out and move on. overall, given some of the stories i've heard, i feel lucky to work where i do and i would hesitate to work somewhere else for fear that the environment would not be so great.
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.
You DO need to learn reading comprehension. I said ONE of them, not THE worst. In any case, I'm done playing with you and feeding into YOUR drama (which seems to be your MO on this board). Have a good one!
You DO need to learn reading comprehension. I said ONE of them, not THE worst. In any case, I'm done playing with you and feeding into YOUR drama (which seems to be your MO on this board). Have a good one!
Lol. Very funny. Ok, You're right, My mistake. Well, You're right and wrong. Right, I misread your comment, wrong about my "MO" being drama. but anyway, have a good day.
P.S., the point is, I'm not calling you unqualified or incompetant, I would think THAT would be insulting.
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.
stupid nursing judgment aside, you do realize that some er doctor actually ordered the bolus and chose not to order a diuretic??? not some dumb er nurse.
though it's a common er nursing skill to know not to bolus a wet/chf'er, but.... it is all too common for ems to bring in a patient with sob, wet lungs and pitting pedal edema with ivf wide open..... just sayin'.
so before you blame the nurse, who should have obviously figured it out about the fluid, consider the dumb er doc first.
One time an ER nurse looked at me the wrong way and my whole week was ruined.
I grow worms for my organic garden. On another thread some nurses were contemplating eating worms because no one liked them (or they weren't sexy or something). I offered my worms to them (I would be honored to offer my worms for such a worthy cause). Would you like some? I mean, I know you are now going to cry, crawl under your bed, and eat worms anyway:lol2:
I'd rather offer you organic vegetables, but if it is worms you want...
I grow worms for my organic garden. On another thread some nurses were contemplating eating worms because no one liked them (or they weren't sexy or something). I offered my worms to them (I would be honored to offer my worms for such a worthy cause). Would you like some? I mean, I know you are now going to cry, crawl under your bed, and eat worms anyway:lol2:
I'd rather offer you organic vegetables, but if it is worms you want...
huh???? The post you responded to, they have their CEN, so it was a tongue-in-cheek post....
I know the song/child's rhyme... but what does this have to do with anything???
Okay, I was being sarcastic because she said her week was ruined because an ER nurse looked at her the wrong way. I have heard people say "nobody likes me, I might as well eat worms" or something to that affect. I had a teacher that used to say that as well. I was just saying that if she was sad enough to contemplate eating worms because her week was ruined that I would be happy to provide them (I actually do raise worms for my organic garden).
I figured she was being sarcastic, and I was just adding to it (or at least trying).
I grow worms for my organic garden. On another thread some nurses were contemplating eating worms because no one liked them (or they weren't sexy or something). I offered my worms to them (I would be honored to offer my worms for such a worthy cause). Would you like some? I mean, I know you are now going to cry, crawl under your bed, and eat worms anyway:lol2:
I'd rather offer you organic vegetables, but if it is worms you want...
I will only accept said worms if you also offer me a "happy nurses week" and not a "happy hospitals week."
okay, i was being sarcastic because he said his week was ruined because an er nurse looked at him the wrong way. i have heard people say "nobody likes me, i might as well eat worms" or something to that affect. i had a teacher that used to say that as well. i was just saying that if he was sad enough to contemplate eating worms because his week was ruined that i would be happy to provide them (i actually do raise worms for my organic garden).
i figured he was being sarcastic, and i was just adding to it (or at least trying).
:cheers: too funny.
GM2RN
1,850 Posts
ok, so let's get real. first, i completely agree with your last paragraph. second, there are good nurses and bad, lazy nurses and those who go the extra mile, nurses who are absolutely fabulous in their skills (and every other way) and those who are just adequate. but all kinds of nurses can be found in every specialty, mine included. some hospitals just seem to have more than their share than do others, but i blame management for letting that happen.
there has been a lot of accusations thrown around here that have been sweeping and generalized in nature, and that is what bothers me about this thread. but jokesters aside, no one here has stated that they are "cool" the way that the op has accused an entire group of nurses. if someone has a problem with a specific nurse then i say go for it, but let's not denigrate an entire group because of the actions of one, or even a few.
in all seriousness, the truly bad apples at my hospital, in all specialties, are at a minimum, and i have a good working relationship with all of them most of the time. sometimes we have issues, but we work it out and move on. overall, given some of the stories i've heard, i feel lucky to work where i do and i would hesitate to work somewhere else for fear that the environment would not be so great.