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 don't understand from reading this why nurses can't take report right away? When a patient is admitted we HAD to take report - even in the middle of something (true emergencies excepted). Is this a US thing?
We had to multi-task, no question about it. And a good report only takes a few minutes really, when you think about it (unless maybe if they're going to ICU)- I have not worked in those more critical areas myself.
I don't get this myself, putting aside the fact that nurses are busy on any unit/department.
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.
This is a very valid point. In many hospitals I've worked in, nurses are not allowed to clean the room, as crazy as that sounds. The housekeeping staff have to clean it a certain way (ie: with certain cleaning fluids etc), and it also must be signed off, either on a list or on their computer database. Also floor nurses must also always check the O2 and suction every shift, etc & also BEFORE a new admit comes in. We have to sign it off with the time as well in the hospitals I worked in, and is also a legal requirement.
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?
You totally left out the @ssless leather chaps and bandoliers filled with caprujects of dilaudid, morphine, and ativan.
"kudos, my dear. i am a m/s nurse who dare anyone to walk in my shoes too. i volunteer to float er anytime. er to is very convenient ms floor with md around to attend your need, no waiting for pharmacy, no phone call necessary with less patient. what is the percentage of real emergency that came to the er? anyone know in a given night. i will tell you one thing a m/s nurse can survive anywhere. er icu pacu bring it on. we will have plenty time to focus."
ok, i worked as a float lpn for a few years. mainly, floats went to m/s, tele, stepdowns, etc. but, i was cross-trained in ed due to my ems background and had acls, pals, and nrp. so.. i worked m/s. i worked ed. i know lpns and rns have a lot of differences in their scopes, but i did and saw enough that i formed my opinions. i worked with awesome m/s nurses.. i worked with awesome ed nurses. i worked with crappy m/s nurses.. i worked with crappy ed nurses. some shifts, i could barely take 2 minutes to use the restroom on the floor...some shifts, i could barely take 2 minutes to use the restroom in the ed. etc., etc., etc. every department has it's advantages and disadvantages and gripes and groans. that being said, in my opinion, the above quote is ridiculous. having been in both departments, i definitely know the ed is not just a very convenient m/s floor with mds to cater to their every need. that just made me laugh. the ed does sometimes still have to wait for pharmacy..and make lots of phone calls for alll those non-emergent people who fill up the ed. yes, there are usually more stable, non-emergent cases, but they need care too! whether they are drunks, psychiatric clients, or someone with gastroenteritis, you can't kick them to the curb. you have to do whatever is needed for them just as you do for the stemi patient who just rolled in the door. a lot of times, those non-emergent patients take more time because you have to assist social work in arranging placement for them, call transport agencies to come get them, give report to nurses and doctors at receiving hospitals, etc etc etc. alll this while ambulances are bringing more patients and the waiting room is full. it really, really got hairy sometimes. when i was on the m/s floor, one saving grace for me was that when the rooms were full, they were full. in the ed we couldn't rely on that.
now that i have graduated from college and am preparing to take my nclex-
rn
, i can honestly say i'd take the ed or icu any day. i've worked nicu the last few years and love it.. and actually just had an interview for a full time
rn
job in the picu. m/s really is not my thing and i am grateful for my float job because it led me to know where i wanted to be. it also led me to realize how it is for many different departments.
again.. every department deserves kudos and every department has a few employees who give the whole place a bad rep.
also... has the op ever responded? or did she post that and now is sitting back enjoying the drama that she, a m/s nurse, originated??? things that make you go hmmmm.
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.
When I was on the floor, my floor preceptor told me how when I went to the ER I should never let anyone else call report for me. Here's te thing though- in the ER, people jump in and help others in a way that I didn't really see happen on the floor. There have been many times where I've gone to take a patient to radiology or been handling something else and come back and see that another patient has a room assignment- and someone who had a free minute says "don't worry, I called report on patient X for you, they're ready to go up now" or have come back to a completely new patient in that bed because someone else called report, got the patient upstairs and turned over my room for a new patient. Frustrating for the floor, but it's one of the things I love about my ER- I have my assignment, but everyone helps everyone else.
Also, frequently the assignment splits during the day as the staffing changes. We start our shift with a certain number of nurses that is supposed to reflect the *usual* pace of that time and then get a few more in a few hours so we drop down on our rooms. So if a patient gets a bed on the floor 15 minutes after the new nurses come in, the new nurse is the one responsible to call report and just doesn't know the details like the previous nurse did.
And honestly, sometimes even when it's my patient who has been my patient for the entire time they've been there, I just don't have everything about them in my head because I'm 5 hours in to my shift and they are my 8th or 10th or ZOMGth patient of the day and I know they are getting this treatment and got that diagnostic but I haven't looked at the lab results yet and sometimes things start to blur a little especially when you have a lot of similar patients. This is one of the reasons I try to get them to the floor as soon as that room is ready- because I will not be able to give the time to their details that they deserve.
Lastly, I think we sometimes get used to the type of report that other ER nurses want, which is much, much more bare bones than what the floor nurses want. When I first moved down to the ER I got a lot of flack for trying to do reports (and discharges and initial assessments) like we did on the floor. I've learned to trim a lot for report to other ER nurses and sometimes that comes out in reports I give to the floor nurses. I do try to remember my audience, and if you ask me questions about the patient during report I will look up the answer.
When I was on the floor, my floor preceptor told me how when I went to the ER I should never let anyone else call report for me. Here's te thing though- in the ER, people jump in and help others in a way that I didn't really see happen on the floor. There have been many times where I've gone to take a patient to radiology or been handling something else and come back and see that another patient has a room assignment- and someone who had a free minute says "don't worry, I called report on patient X for you, they're ready to go up now" or have come back to a completely new patient in that bed because someone else called report, got the patient upstairs and turned over my room for a new patient. Frustrating for the floor, but it's one of the things I love about my ER- I have my assignment, but everyone helps everyone else.
Also, frequently the assignment splits during the day as the staffing changes. We start our shift with a certain number of nurses that is supposed to reflect the *usual* pace of that time and then get a few more in a few hours so we drop down on our rooms. So if a patient gets a bed on the floor 15 minutes after the new nurses come in, the new nurse is the one responsible to call report and just doesn't know the details like the previous nurse did.
And honestly, sometimes even when it's my patient who has been my patient for the entire time they've been there, I just don't have everything about them in my head because I'm 5 hours in to my shift and they are my 8th or 10th or ZOMGth patient of the day and I know they are getting this treatment and got that diagnostic but I haven't looked at the lab results yet and sometimes things start to blur a little especially when you have a lot of similar patients. This is one of the reasons I try to get them to the floor as soon as that room is ready- because I will not be able to give the time to their details that they deserve.
Lastly, I think we sometimes get used to the type of report that other ER nurses want, which is much, much more bare bones than what the floor nurses want. When I first moved down to the ER I got a lot of flack for trying to do reports (and discharges and initial assessments) like we did on the floor. I've learned to trim a lot for report to other ER nurses and sometimes that comes out in reports I give to the floor nurses. I do try to remember my audience, and if you ask me questions about the patient during report I will look up the answer.
Another reason floor nurses sometimes don't get report from the nurse who has cared for the pt is because the floor nurse "hasn't had time" to take report, so when they finally "get time" to take report, the ED nurse that has cared for the pt all day has gone home, leaving the oncoming nurse to give report on a pt that that he/she doesn't know.
I don't understand from reading this why nurses can't take report right away? When a patient is admitted we HAD to take report - even in the middle of something (true emergencies excepted). Is this a US thing?
We had to multi-task, no question about it. And a good report only takes a few minutes really, when you think about it (unless maybe if they're going to ICU)- I have not worked in those more critical areas myself.
I don't get this myself, putting aside the fact that nurses are busy on any unit/department.
Where I am, we don't "take" report, we "get" report... Form is faxed, someone in ER calls to confirm (with clerk usually) that fax was received, and I TRY to watch for it so that I can look at it before the patient gets to the floor.
So, while we sometimes ask ER to delay, we can't actually stop them from "giving" us report...
Some people are probably forgetting that not all ED's are equal. An ED in the rural country will be a completely different world than an ED at a Level 1 trauma center in the downtown of a large city.
Gsw's, od's, assaults, rapes, mvc's, police bringing in justice center patients, ambulances lined up to get in, trauma rooms full but the medical helicopter keeps taking off to pick up more trauma patients, waiting room full with people waiting 8 hours, triage rooms being used as regular rooms because rooms are not ready upstairs and some people are too sick to be out in the waiting room. ...typical day during the summer...
The ED nurses I know are awesome. I'm sure our floor nurses are too. But until you have worked in THAT kind of ED... You just wont understand.
I've done ER and MS, the ER is more technically difficult with procedures and critical care stuff, but the floor is more prioritization difficult. I say that because priorities are already laid out for you no matter what else is happening. So all the meds must be given, treatments done, and it doesn't matter if you get an admit from hell at 12pm, your two feeders are still hungry, with families keeping track of linen changes.
We do lots of prioritization in the ED, but usually noone questions us when a tray is late, or a bath is missed. I like having more say-so about my work. I'd also get behind floor nurses if they wanted an hour's notice before getting their admits, just to try and organize. Unfortunately sometimes it's impossible on our end, and there's always people taking advantage. I've found that if you stay at a job long enough people know who you are and how you work. So if I say "no hurry," to someone one night, but I'm pushing for action another time it all comes out in the wash.
That said, when there are no beds and no staff we are set up for conflict. I do find the statement "that nurse needs to go to lunch," galling when I'm hungry and need to pee too. (If the ER is manageable I won't mind, but could you ask?)
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?
Happy
Not true I work at 430 bed facilty and our ER regularly goes on bypass if the hospital census is at maximum capacity. What point is there in them accepting a bunch of people that will never be seen in under 10 hours let alone admitted to the floor? I can't speak for every ER but ours does refuse patients and they are allowed to do that legally as are the other hospitals in the area. When paramedics or the fire department is in route, dispatch notifies them as to which hospitals in the area are on bypass status. If OR and radiology are backed up more then 4 hours thats right ER is notifed to bypass anyone who is transporting a head injury or gunshot to a different hospital. The choices come down to come to our hospital on that day with those things and you will certainly die in the parking lot or get bypassed 15 extra minutes to a hospital that can handle it that day and get a chance to live. We are lucky in the fact that we have more then 6 hospitals in a 30 mile area that have ERs with another 10 in the two neighboring counties.
carolmaccas66, BSN, RN
2,212 Posts
I don't understand from reading this why nurses can't take report right away? When a patient is admitted we HAD to take report - even in the middle of something (true emergencies excepted). Is this a US thing?
We had to multi-task, no question about it. And a good report only takes a few minutes really, when you think about it (unless maybe if they're going to ICU)- I have not worked in those more critical areas myself.
I don't get this myself, putting aside the fact that nurses are busy on any unit/department.