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.
Oh GAWD I am sorry! I thought about that possibility after I wrote it. Well now you get worms, hot peppers, tomatoes (cherry and homestead), and cucumbers.
I think I will discount my worms for all AN nurses. Probably won't have enough left to garden with after a while.
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.
eh, maybe i didn't get my point across well. i did ramble a bit. something tells me you didn't read my post though (couple things you say make me do the scooby doo "errrrrrr") and that you only skimmed it. like when you say "no one here said we don't have ratios." no one here said anyone did either..............................reread it, you'll figure it out (hint, the answer to the riddle is hidden in the words "other thread i started years ago"). said thread (https://allnurses.com/general-nursing-discussion/ok-ed-nurses-368296.html)
but maybe it was just me, so i'll cliff notes it. my point is, i've been where the op is with regards to disliking ed nurses and they way they do things, but i worked through it. in the end, you realize, if you want to do what is best for your pt. you will not waste time worrying about what the ed should be doing. it won't get you anywhere. i work hard to be a good interdepartmental team player, and i've seen the benefits of it. even if the face of working with an ed that is inept on epic levels, i stick to my guns and try to cooperate with them because..........its what benefits the patient.
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.
thats great that the staffing at your place reflects, well, rl like that (mostly good people with bad apples mixed in). thats not the reality at my hospital. our ed is the black eye of the facility, and its common knowledge. heck, housekeeping and maintenance..........everyone knows they are they weak link of the chain, its not just floor nurses slamming the ed nurses. our ed is primarily bad apples...........period. they (the bad apples) are the only ones who stay. can't even say there is a sprinkling of good apples amongst them because, the good apples (and i don't blame them) look around, see that their co-workers are dangerous and move on. thats life at my facility.
with regards to the ratio thing and "what do you do if a trauma or blah blah"................the situation you described would be handled the same way as at your, except its the floor nurses who go over ratio, not the ed. yes........you heard it right. if all of a sudden, a whole bunch of chest pains, traumas and other things that can't sit in the lobby show up...............bam, people are sent up to the units..............4/5/6 at a time so the ed nurses ratios are maintained.
at my hospital, icu and ed nurse ratios come first.............step down gets some respect, but m/s and everyone else.......forget it. if the situation you described happened, it would be us, on the unit, with stretchers linning the halls while we take on 3/4/5 patients more than the unit can hold. thats how it works for our ed and how they get to maintain ratios.
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.
no.
on so many levels.
no.
no such thing as "stupid nursing judgement aside" these days. stupid nursing judgement is front and center, always.the days of being off the hook because an order told you to do it are over, have been for some time. if you initiate an order and it brings harm to the pt, do not sit on the stand and tell the judge "your honor, stupid nursing judgement aside, you do realize some er doctor actually ordered this." i'm not a lawyer, but............i wouldn't.
yes, it is a very clear example of "some dumb nurse". regardless of what order was written. would you have initiated that order? mind you, you even pointed out "its a common nursing skill to know not to bolus a wet chf'r"..................sooooo........you think the "but a doctor ordered it" defense would hold water against a panel of peers?
here is what i did (good example of how i try to support our hopeless ed):
1. disconnected the ivf the second the pt. got to the unit. when she asked "why?", i avoided answers that made it clear they never should have been on in the first place. my explanation was "i am going to be calling your attending to see what home medications he wants you on while you are here. they like to start with a clean slate and order everything themselves." no harm, pt. not freaked that she shouldn't have been on fluids.
2. call attending, get ivf d/c'd first, and, since i have him on the phone, get home meds ordered and a diet ordered (ed doc never does it, even though the ed admit form has it there that it needs done).
at this point, i might possibly be able to claim "but it was ordered, i had to do it". but even then, i wouldn't. i didn't have to worry about it though, attending (duh) agreed with me, turned them off.
taking a "but the doctor ordered it, so its not the nurse's fault" approach is not the attitude of a nurse who believes they are a professional at what they do. that's the stuff of a labor force/burger flippers. "well, thats what the directions say, its not my problem". nurses want to consider themselves professionals and be treated like them, but then will turn around and make statements like "the doctor ordered it, its his fault." we possess autonomy and responsibility. we do have the right to refuse orders.
Aren't they too busy saving lives to look at any other nurses?
No, we're too busy adjusting our aviator sunglasses that we wear at night, our shoulder holster rig that carries our trauma shears and extra tape, and European style trauma fanny packs that houses our Ipad2.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I'm only jumping in to provide worm context. As I remember it. In the Smart Sexy Nurse thread Eric referenced eating worms "nobody likes me everybody hates me. ." etc,
I told him he couldn't eat any worms as dthfytr (Paul M). had already cleaned out the allnurses worm supply in the "what AN member would you like to meet" thread when he said he was going to eat worms because nobody liked him . .etc.
Much silly worm talk ensued, and we all agreed the worms were a wonderful thing for the most part. Nobody ever came back to talk about Sexy Smart Nurses after that.
No, we're too busy adjusting our aviator sunglasses that we wear at night, our shoulder holster rig that carries our trauma shears and extra tape, and European style trauma fanny packs that houses our Ipad2.
Now, I am picturing a cross of two of Ben Stiller's characters - Fokker and Starsky.
I'm only jumping in to provide worm context. As I remember it. In the Smart Sexy Nurse thread Eric referenced eating worms "nobody likes me everybody hates me. ." etc,
I told him he couldn't eat any worms as dthfytr (Paul M). had already cleaned out the allnurses worm supply in the "what AN member would you like to meet" thread when he said he was going to eat worms because nobody liked him . .etc.
Much silly worm talk ensued, and we all agreed the worms were a wonderful thing for the most part. Nobody ever came back to talk about Sexy Smart Nurses after that.
Funny part is, all the worm stuff started (because of my quote) where I work. I was having a bad day, doing the "no one likes me" blues and someone sang that song to me. Now I walk around saying "Geee, I may as well eat worms" whenever someone gives me attitude (deserved or undeserved alike) at work. Then, one day, I felt like saying it here.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I am just amazed this thread has made it thi--- okay I am not going add anything that might draw karmic retribution a la uttering the "Q" word but I'm in awe. Carry on.
eh, maybe i didn't get my point across well. i did ramble a bit. something tells me you didn't read my post though (couple things you say make me do the scooby doo "errrrrrr") and that you only skimmed it. like when you say "no one here said we don't have ratios." no one here said anyone did either..............................reread it, you'll figure it out (hint, the answer to the riddle is hidden in the words "other thread i started years ago"). said thread (https://allnurses.com/general-nursing...es-368296.html)
i understood what you said the first time. if you read my post with any comprehension, you would have understood that i emphasized "here," as opposed to you describing what you perceive happens at the hospital where you work and others. i also assumed that it was common knowledge, as well as common sense, that all floors (ed included) at all hospitals at least have stated ratios, even if they don't abide by them, so it shouldn't have needed to be said that we have ratios.
but maybe it was just me, so i'll cliff notes it. my point is, i've been where the op is with regards to disliking ed nurses and they way they do things, but i worked through it. in the end, you realize, if you want to do what is best for your pt. you will not waste time worrying about what the ed should be doing. it won't get you anywhere. i work hard to be a good interdepartmental team player, and i've seen the benefits of it. even if the face of working with an ed that is inept on epic levels, i stick to my guns and try to cooperate with them because..........its what benefits the patient.
yes, it's just you. even though i didn't agree with everything you said, i thought your other post was at least fairly rational and i gave you the benefit of some common sense, but here you are arguing again. thanks for showing me that i was wrong on that point!
thats great that the staffing at your place reflects, well, rl like that (mostly good people with bad apples mixed in). thats not the reality at my hospital. our ed is the black eye of the facility, and its common knowledge. heck, housekeeping and maintenance..........everyone knows they are they weak link of the chain, its not just floor nurses slamming the ed nurses. our ed is primarily bad apples...........period. they (the bad apples) are the only ones who stay. can't even say there is a sprinkling of good apples amongst them because, the good apples (and i don't blame them) look around, see that their co-workers are dangerous and move on. thats life at my facility.
with regards to the ratio thing and "what do you do if a trauma or blah blah"................the situation you described would be handled the same way as at your, except its the floor nurses who go over ratio, not the ed. yes........you heard it right. if all of a sudden, a whole bunch of chest pains, traumas and other things that can't sit in the lobby show up...............bam, people are sent up to the units..............4/5/6 at a time so the ed nurses ratios are maintained.
at my hospital, icu and ed nurse ratios come first.............step down gets some respect, but m/s and everyone else.......forget it. if the situation you described happened, it would be us, on the unit, with stretchers linning the halls while we take on 3/4/5 patients more than the unit can hold. thats how it works for our ed and how they get to maintain ratios.
i don't know why you feel the need to repeat all of this again. i repeat, i got it the first time, so let me provide you with my cliff notes.
you perceive that the ed where you work (and many others) craps on you and every other nurse in the hospital, but you have risen above it as white as the driven snow. hallelujah!
i don't actually believe that it is exactly as you have described it, but i do understand that you believe it.
Sigh. I know this post was a vent, and it's probably not even worth responding, but...
Yes, I know you may be elbow deep in poop or with a doctor. Me too. I might be calling report to you while toileting a LOL or starting a gtt. And if I wait for you to have time to call me back, I may be the one elbow deep in poop, starting an IV, or assisting a doc with suturing or a pelvic exam when you call; and I'll still give you report.
When you refuse report, I am *not* running to my charge nurse to tattle. My charge nurse is already breathing down my neck to get my patient upstairs *yesterday*, and when they ask why the patient is still there, I'm gonna be honest and say "Because I haven't been able to call report yet." You see, our lobby is packed and the ambulances are rolling in one after the other, and we need that bed. If you don't like how pushy I am, feel free to call my charge nurse and tattle on me. I'm sure s/he will be very sympathetic to your plight.
A BP of anything less than 200/100 tends not to impress us too much in the ED. And no, it's not as simple as walking over to the doctor to get an order to cover it. We have six zones and 55 beds, and the doctor has anywhere from 15-20 patients spread all over the entire department, and very well may be in the middle of intubating, placing a central line, or placing a chest tube at any given time. They may be on the phone with the neurologist discussing a stroke patient, or the cardiologist discussing a STEMI patient, or any number of things that make a non-lethal blood pressure reading NOT the biggest priority on their list.
I know you did not mention this, OP, but for the edification of others who have raised the subject, tne reason that we place PIVs in the AC is that our CT department will not inject contrast into anything less than a 20g in the AC. Another reason is that anybody that may be a candidate for rapid infusion of fluids or blood products needs at the very least one large bore PIV in a large vein that can handle the pressure.
One thing that really frustrated me when I worked the floor was that you need a doctor's order just to pass gas, it seems. I'm sorry your admitting docs are slow at getting things going, at the expense of the patients. I do feel your pain and think that really stinks. But that is not the fault of the ED nurses.
And, to answer your question, most of the time, I do NOT think I'm cool. I feel woefully inadequate to address the needs of my patients, worry that someone is going to die on my watch because I was too busy with some stupid JC charting requirement instead of at the bedside, and I'm starving and have to pee and have a migraine. Every great once in a while, I connect with a patient or I catch something the doctor didn't see, and I feel pretty cool then. But most of the time, nope.
caregiver1977
494 Posts
Oh GAWD I am sorry! I thought about that possibility after I wrote it. Well now you get worms, hot peppers, tomatoes (cherry and homestead), and cucumbers.
I think I will discount my worms for all AN nurses. Probably won't have enough left to garden with after a while.