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.
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.
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. those horrible er nurses that you have will soon face their judge and jury if they continue to operate in this way.
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.
of course i agree with you in regards to the nurse who implemented those orders did show a complete lack of judgment and knowledge and is quite dangerous, in my opinion...we could go on forever about that... but my point was, and truly the scarier point, is that a doctor actually ordered the fluids and not any diuretic. there is a doctor that bears equal responsibility. that is the bigger concern, that a doctor didn't have the knowledge. worse even when ems starts the fluids because all they see is sob, even though they rattle off to us.... pt has a hx of chf, wet lung sounds, pedal edema.... and the ivf are wide open..... yikes
i worry that this doctor, in a code situation, will order other more serious meds that are inappropriate, or not order meds, or order them at an incorrect dose. (of course a good nurse will ignore that doc in that code and give what she knows is the correct dose, truly, or will insist the doc to recheck his drug/dose). i worry more about that.
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 don't recall reading about anyone having to eat worms because nobody likes them... you lost me.
But the song goes "Nobody likes me, everybody hates me, going to the garden to eat worms. Long thin shiny ones, short fat fuzzy ones, ooey gooey gooey gooey worms." Something like that. Used to love that one as a kid.
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!
YOUR experience. Got it. I don't recall where you had mentioned on this particular thread about you walking in my shoes. I reread your posts and it doesn't read as though you have worked in an ER at all. You might have worked as a representative or concierge for you to SERIOUSLY believe that an ER is easy compared to a floor. I mean, REALLY. You're just trying to kick up some controversy, because that comment is completely ignorant.
You seem to be getting flamed quite a bit, so I'm taking your post as just some more hot air on your part.
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!
no. i never said any eds crap on me. my original post even stated "they are just sometimes doing what they have to do to get through the day, just like we do on the units."
i think i went out of my even to point out how well i get along with them. i did say my current ed is inept..........gave an example (one of many) of why. but, thats just my current hospitals ed. i've made it clear i consider them the exception. again, i'm doing the scooby doo "errrrrrr" with you. idk....................you seem a bit easily aroused, almost emotional/defensive. is there something specific about my posts that makes you so cavalier or is it the thread in general? you strike me as..........someone who's had their "exposed" nerve stomped on a bit. personal problems?
i don't actually believe that it is exactly as you have described it, but i do understand that you believe it.
what part don't you believe? that i get along fine with my current ed or how our ed's ratios are maintained? i can clarify more for you if you wish. its not that complicated really.
Also, in real life, speaking louder and louder until you are shouting works too.
No, I can't do that. Not allowed. I'm....................a very big male, deep voice. My "shouting" often gets taken as a physical threat...........its, like................its too effective. I never shout anymore. Used to do it a lot when I was a landscape supervisor, not now.
Is it just me though, some of the ED nurses are being defensive, like.............EXPOSED NERVE about it? Is it that hard to believe that yes, some ERs just don't cut the mustard. (Since they needed it, I'll put it here: Not ALL EDs don't cut the mustard, not MOST EDs don't cut the mustard, SOME don't cut it.)
Wonder if we should explain to them that actually, when we slam the ED, its nothing compared to how the nurses working the units slam each other. Now, you want to see some historic, epic dept2dept fighting.............go up to the units. This trite stuff between the ED and units isn't even new's worthy half the time compared to that stuff. That might make them feel better, less "targeted" or picked on.
Have to agree that anyone who says "triage is easy" loses pretty much all their credibility.
The NCLEX triage questions were bad enough for me.
You know what though, this is one thing our ED got right (IMO, insert same disclaimer from before for the exposed nerves). They have a male doing triage a lot. Too many assaults on the prior girl (who, unfortunately, quit) who did triage most of the time. Now there is a guy who............well, is like I described myself above (very big, deep voice).
The mothers with sick kids don't act any differently, but the drug seekers tend to be a little less..........in your face. According to him anyway.
Is it just me though, some of the ED nurses are being defensive, like.............EXPOSED NERVE about it? Is it that hard to believe that yes, some ERs just don't cut the mustard. (Since they needed it, I'll put it here: Not ALL EDs don't cut the mustard, not MOST EDs don't cut the mustard, SOME don't cut it.)
Well, considering the thread started as a vent about ER nurses and how we all think we're too cool for school (and do X, Y and Z stupid things)....is it really surprising?
Just like that blog touched a nerve with OP: insulting people (that blog calling floor nurses lazy) is usually, well, insulting. And it's ok to be insulted when you're being insulted.
redhead_NURSE98!, ADN, BSN
1,086 Posts
Maaaan, and here all I wanted was a tool belt!