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.
Lol.... irrational rationalizatios.... states and joint com mandate that there be one RN per patient in OR. I challenge any of you m/s tele guys to do sedation on these sometimes quite critically ill patients in gi/cath lab with a physician in the room that usually can't even work an ambu bag much less a lifepak 20. Lol. I would also challenge you to come work in the OR but that is an entirely different skill set. However try some pacu nursing for a day or two.... I have worked in all of these areas and m/s is nothing in comparison to them.... you loose an airway real quick in these settings anyour patients crash real quick, you always have to be in a code mindset and on top of your game or you can have someone die real quick.....
I HAVE worked in all these areas and I stand by my comments. Med surg and tele nurses have it the hardest!!!
One thing I have to say...that I've heard from some physicians in the ER.
The biggest difference between the floors and the ER, is that the floors can refuse patients if they get full, but the ER has no choice but to keep taking everything that comes their way.
Specializes in LTC, assisted living, med-surg, psych.
Friendly Reminder:
Please, everyone, remember to be civil and to think twice before hitting the "Post Reply" key. Ask yourself if what you're about to post is a) true, b) respectful, and c) necessary......and if not, just take a deep breath and let it go.
Besides, EVERY nurse has a difficult and challenging job, no matter where we work. We have long, stressful, crazy days, and we have to deal with impatient doctors, fussy patients, looney families, and petty co-workers on a regular basis. That's true whether one is a Med/Surg nurse or a CNO. So please, can we have a little more respect for the hard worke we ALL do, and a little less one-upmanship? Thank you!
I have never worked ER and I know I would never want to. I work step down and I love it. I have also worked med/surg and I loved it when I was working there. I will always be a "floor nurse". I know every department could have a vent about another department. Since this is about ER I will say some things that really annoys me about the ER. Why is it when report is called the nurse that took care of the patient all shift is not the one calling report. So when I have questions I'm told 90% of the time "I don't know I just got here" or " I don't know let me find the chart......." If you're calling report have your information. For example, If a patient is coming in with a GI bleed at least find out what the hgb is before calling report because I'm going to ask you. Some of our MD's give admission orders to the ER nurses and if a patient is being admitted for resp issues but while they are in your ER and they have been nauseaus or in pain. Even though that is not their dx, as least ask the dr for prn meds for that because chances are they are going to have the same complaints on the floor. Also, another problem I have encountered is when you call abnormal labs to me don't leave important ones out. Dont tell me someones sodium is 132 but leave out the much important lab result of a potassium of 2.5. I think some nurses leave out the important ones because they will then have to explain why this issue was never addressed. One thing I really hate is when a patient complains of pain as soon as they come to the floor and ask for pain meds and they say "the nurse in ER said I could have pain meds when I get to the floor", knowing I have no orders and now the patient will have to wait for me to get an order where it would have been easier to get from the ER doc. I know in this case you just want the patient out of there so you can get one of your many other patients taken care of but this is not fair to the patient you just brought to me that has to lay there in pain while I'm waiting for the doctor to call me back. Now, I know you ER nurses can have just as many complaints about step down nurses but just giving my opinions. Like I said in the beginning I have never worked in ER and I know it's not for me. I say GREAT JOB however to all ER nurses I know you have a tough job just as I do and all nurses. A hospital could not run without all of us. :)
Specializes in Adult and Pediatric Vascular Access, Paramedic.
Well you should remember as a floor nurse that ER nurses dont have the privlage of refusing patients, they just keep comming in. We cannot tell our patients to come back in say an hour when we are less busy, it just doesn't work that way which is why we get annoyed when we call the floor to give report and get told that the nurse is "to busy" to take it right now, what do you think we are, not busy?
My hospital does not have an ER. Patients who are established with us often come in and we play mini-ER with them, drawing labs, doing EKGs, giving meds, and waiting to see if they're stable enough to go home. I'm glad we don't have the drama associated with an ER (never realized there was so much drama)- we're too busy with the night shift vs. day shift argument!
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. 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.
Don't forget the ER nurses have to move their patient because they have new ones coming in the door who cannot wait for assessment and treatment.
Just what do you propose the ER nurse does with the new chest pain, SVT, hypertension of 230/120, bleeding, GCS 7 patients ? ....... while you need to spend some time making beds /cleaning the room /making phone calls/reassuring families of much more stable p'ts.
They are typically good at prioritizing and multitasking. They seem to able to take report themselves while watching their exisiting p'ts and receiving orders from a couple of docs ....all at the same time.
If you watch them they can clear a room in about 30 secs and organise it for the next p't. It doesn't take them 10 minutes to sort the room.
They also never say they wont receive p'ts during report .... they keep taking them right through. Ever see one say to the paramedics - sorry we are having report, can you hold the p't?
ER nurses do the stretch all the time and probably get a little touchy when others refuse to
Huh, didn't know I (or my floor) could refuse patients... I've tried, hasn't worked yet. The only time I've seen us not get admissions is when our unit is literally full = no empty beds.
Mostly I have no gripes with our ER peeps. I know they battle the same BS as we do, and I know that like most of us, most of them have the patient's interests in mind.
I wish we had spoken report, really. I wish that either the primary ER nurse had to bring the patient up, or that I had to go and get them. We get faxed report, and you never know if the patient is going to arrive in 5 minutes or an hour. Occasionally, the beeping of the Zoll from down the hall is the only advance warning that my patient is actually on the way!
As for the original question - Why ER nurses think they are so cool? I really think its not because they think they are cool, its because they LOOK cool - who else (in the hospital) can get away with cargo scrub pants and wearing trauma shears in a holster?
while you need to spend some time making beds /cleaning the room /making phone calls/reassuring families of much more stable p'ts.
Yes, yes, this is what floor nurses do. I'm glad we've come to an understanding. Cause ya know, as so as those aforementioned patients leave your ER they immediately become stable.
Oh, and I am not naive to think that it doesn't happen... but...
Please believe me when we report that the room is not clean. It really isn't. We don't have much housekeeping coverage at night, and the rooms don't automatically immediately get cleaned when someone leaves or dies (on night shift). Often we have to page housekeeping when we get notified of an admission. And, no, I won't be cleaning the room. I don't have the time, equipment, or training.
Not good when a patient and family arrives to a dirty, tore-up room. Plus, admissions aren't my favorite thing, but they are part of my job. The sooner I can get the patient settled with orders, the better for all of us.
I've only done a few agency shifts in the ER/ED - but I worked in one of the largest EDs in our city, and it was a full moon that night. It was anything but easy! But I DID honestly get a general opinion that ED nurses think they're better than other nurses. But then when I worked on a plastics specialty ward, the plastics nurses thought THEY knew more than the ED nurses, so there you go. A GP nurse who had worked in her job for 17 years, thought she knew more than the hospital nurses. In some ways, they are better in their specialty than others are, but we all need to help out each other I think.
And I enjoyed my ED shifts - they were busy, but very interesting. When it boiled down to it, it was basically all common sense nursing care, for my shifts anyway.
Maybe ER nursing is more prominently featured due to the show ER that used to be on? Just a thought!
So..Gayle the Rn, If I actually am a fulltime Fire Fighter\paramedic as well as an ER nurse, is it ok for me too think I am cool:D.....
Please dont judge us all from the bad eggs you've had to deal with. I think there is a mutual respect between the floor\ICU\ER nurses for the most part. I have found the longer i am a nurse, the more respect I have for all the different areas and the different skill sets. Kinda like the more you know, the more you realize you don't know.
Any ways... Happy venting to you, hope the relationships get better for you.
inshallamiami
203 Posts
I HAVE worked in all these areas and I stand by my comments. Med surg and tele nurses have it the hardest!!!