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'm still surprised that the ER calls report to the individual nurse taking a pt. In my facility, the charge nurse takes that call and informs you(more likely not) and next thing you know is you see a pt getting wheeled in to one of your rooms. Then you have to drop everything and admit these people, call the doc for orders and then do everything else to get them settled them in.
To the poster who said meal time excuse is bs, it's not really, maybe you have not been around at meal times. At my facility, it's also when we give most of the last meds for the shift, give insulin coverage, and when all those fall risk people set off their bed alarms trying to get up from the bed. There's just something about 2 hoiurs to end of shift that releases the chaos on the floor. And when those new pts arrive the floor at this time, they also have(want) to get something to eat regardless of whether they even have a diet order or not (try explaining to a pt who has been in the ER all day that they can't eat cos they have no diet orders yet)
I wish hospitals would have admitting and discharge teams, it would go a lonnnnng way in helping ease some of these problems. Until then, let's stop with "my job is more important than yours" because it's not helping anything other than make us look like a bunch of kids. My 2 cents.
Ok, I admit that ER nurses are cool. But so are flight nurses, ICU nurses, BTU nurses, PACU nurses, L&D nurses, pretty much any nurse that possesses skill sets I don't have is cool to me...until I learn those skills and start looking for fresher sources of coolness!
Good thing for me the ER nurses from the hospital where I used to work are humble and helpful.They're not the type who talk endlessly about the exciting cases they encounter in the ER [at least not during the shift or while in the hospital, and, as I recall, not in a cocky manner]. They would even say sorry if they're endorsing several patients or one with a complex case. Afterall, they used to work in the ward before they got pulled out in the ER.
I've done a tele floor and an ICU...in a rural hospital, and I'm smart enough to know what we keep in ICU wouldn't hardly rate a tele bed at someplace like Grady, Cook County, or Emory. I am well suited to my limited scope of a rural hospital ICU....but even in our country ER, you couldn't get me to work ER for anything! I'm comfortable with a MI in a 70 year old, a stroke in a 60 year old, a OD/DTs in a 50 year old, DVTs in a 40 year old and DKA in a 20-30 year old. But a kid? A baby? Penetrating trauma to a 8 year old in a MVA? A woman in labor who's got a prolapsed cord? You'd see me bolting out of the room screaming, "Somebody call a nurse!"
ER nurses, hospice nurses, pediatric oncology nurses and burn nurses to me are the rock stars--I couldn't do what they do, because it's not my thing. God bless'm, and just send me that acute NSTEMI or new onset afib with RVR. Now, let me saddle up the crash cart and gallop back to work....
Specializes in ED, Neuro, Management, Clinical Educator.
Some of you folks have clearly never set foot in a bit city ER.
Yes, I choose to work there of my own free will. I do it because I want to fix broken people. I do it because I want to identify and treat life threatening problems. I do it because I want to stabilize the unstable. I do it to challenge myself, to see if I can put the puzzle together and figure out what's wrong with my patient. You are correct, I do enjoy a close relationship with the physicians and PA's that work shoulder to shoulder to me. The wisdom they have passed along to me over the years has helped me hone and perfect my emergency nursing skills to levels I never would have imagined. This is my specialty, and it's the thing I have taken countless hours of extra classes and training to master. It's someone else's specialty to monitor them to make sure they continue to improve. Once they're ready to move upstairs, they need to go there ASAP because if your hospital is anything like mine, there are at least 25 (or 40+ on a Monday) people in the waiting room at all times waiting to be seen, and ambulances bringing various levels of criticals through the door every 10 minutes.
You have the luxury of telling your secretary to say you're too busy to come to the phone when you don't want one more patient right now. I do not have the luxury of telling people it's an inconvenient time to have a heart attack, be stabbed, have a severe GI bleed with a HGB of 4 when they hit the door, fall off a roof, or get into a severe car crash. In fact, they still come in droves even when all my rooms are full, the waiting room is packed, and I'm out of beds to even put them in the hallway. When your rooms are all full, you don't get any more patients. When mine are all full, I still need to find somewhere to put the next ambulance or walk in MI from the front desk. I also need to find a nurse to take care of them which can be a chore since they tend to all have far more patients than they should ever be asked to take to begin with.
Those trauma alerts you hear overhead and promptly forget about while you're waiting hours for your doctor to call back? Those typically come at the worst possible time, and often on days when there are so many patients I had to put some in the trauma room to get treated and must then rush out of the room to make way for the trauma victim. Those codes you hear called? We have to drop what we're doing and go sprinting all over the massive campus to respond to them.
By no means am I trying to take away from the hard work that nurses do on the floors. I could not do that job. It's not my chosen specialty and I would hate every minute of it. I'm simply saying that you don't know how good you've got it. You may have a ton of orders to take off, doctors not calling you back, busy patients, and a million things going on when I call... but at least yours probably aren't likely to die without immediate intervention and if they are, you can call somebody to come take care of that for you or shuttle them off to the ICU.
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.
You obviously don't work in the ER. Even though you can go on diversion (and in the major trauma center I currently work in, we are unable to divert, AT ALL.), it's a request, ultimately. I've worked in an ER that was on total diversion, but the traumas and ambulances kept pouring in. If all the other trauma centers are on diversion or saturation, the patients still have to go somewhere.
Even if you're on diversion, a code needs to go to the closest facility, and if that's you, too bad. You have to make it work.
And regardless of an ERs diversion status, people will continue to walk in the front door.
So, ultimately, diversion and saturation don't mean ****.
If you want to feel the ER's pain, take about 4 med/surg patients, plus at least 1 1-on1 ICU patient. Now, once you have your med/surg patients worked up and situated, move them somewhere else and put a new work up in the bed. Now, watch another nurse's full load since there's another trauma landing on the helipad, and since all the float nurses are working up the other 3 traumas currently, someone has to watch the pulled nurse's patients. Since there are 40 people in the lobby (some of whom are actually sick as ****) you're also going to work up a LOL with possible c-diff in the hallway until a room opens up, and a 81 year old with crushing chest pain in the hallway as well. (This is in addition to your med/surg patients) Oh, and since we're out of stretchers, the chest pain will have to sit in a chair.
40 patients in the lobby, over 50 patients in "beds," 5 traumas in the bay, 5 ambulances waiting in the hallways, and only 13-15 nurses.
Not all ERs are like this at all times, but it's trauma season now, baby. I don't even bring lunch to work anymore. There's no point.
Also, once I started working where I work now, I promptly got malpractice insurance.
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'm just slightly annoyed in Ontario that our government gives the EMERG team only a 500$ bonus if they can get the patient up to the floor before an 8 hour deadline. Lots of times on the surgical floor received patients at shift change "5 mins before" who need an IV, a catheter and are going to the OR in 10 mins from EMERG. No warning, but hey that 500$ bonus isn't shared with any other department. Please don't take this post to be mean to ER nurses, just pointing out the health care system is majorly flawed somewhere. 500$ doesn't cut emerg wait times down at all.
The ER nurses have to think their cool because across the board..ED is the department that gets the most complaints and has the lowest patient satisfaction scores all over (we were told).
That said I find SOME do have a superior attitude and put down the nursing skills of those who aren't in the specialty where as this thread (IMO) was insulting the PROCESS not the intelligence/skill.
I graduated last spring, work adult inpatient psych, love it, was my first choice of specialty. Quite passionate about it. I did my Capstone last year in an ER, loved it, was a close second choice of specialty and woulda got a job if the hospital I did my rotation at didn't have a policy requiring 1 year med/surge experience to work the ER.
Anywho, my point is, I think ER nurses are way cool!!
Perhaps they think they're so cool because.. they are?
As I psych nurse I must ask.. Why do you think ER nurses think they're so cool?
Specializes in PICU now, Peds and med-surg in the past.
The whole "which specialty is harder" topic is something I really, really dislike and am sick of. Through my almost 7 years of nursing I have worked Med-surg, Peds and PICU full time (and of course floated here and there like most of us have to). I consider my current job in PICU to perhaps be the most technically challenging for me (vents, CVPs, Alines, ICP monitors etc) but Lord have I heard how easy my job is from some others (our monitors tell us everything, we only have one to two patients so how hard could that be etc). I personally think that no one regardless of how many specialties they have worked can give the definitive answer to the question of which specialty is harder or more important because it IS so subjective and honestly ridiculous to argue over. I am going to use this time to give some kudos to some of my nursing colleagues and show some appreciation for their specialties:
ER nurses - I really appreciate how you never get more then maybe a few minutes notice from an ambulance call of what is coming into the door (if you even get that). I appreciate the stress of having to balence patients of various acuity (newly intubated, psych, kids, crazy demanding patients and family etc) and trying to get people moved as fast as you can so you can be hammered again in a second.
Med-surg - I've been there and I think you don't get enough credit! I have worked on M/S units evenings and nights with 8-12 patients and the challenges of getting their 900 meds out on time, full physical assessments, charting, incontinent care (no CNAs arent that plentiful to the point where these nurses don't have to change massive code browns too), admits, discharges, postops, AMAs, needy patients and families who you don't have the luxury of shipping off to another floor..... oh yeah, and the random death/code blues/patients who go down the tubes while the rest of the unit doesn't stop. Not easy at all!
ICUs (adult, kids, neonatal etc) - Any of your patients could decompensate at any minute, care is complete and heavy in many situations, family stress is at a high, drips, monitors, vents, codes, almost codes, admits, transfers in or out, and sometimes everything seems like it should be the priority.
Tele/Step-down - I really feel for you here because as people are getting sicker and ICU beds are taken up so many of your patients really should be in ICU and you don't get to just have one or 2
Psych - Wow, I give credit to you guys! You're trying to treat things that you can't see or measure like a blood pressure or a blood sugar and you never know when a patient is going to go off. And from my times floating to behavioral health I know your ratios are ridiculous many times!
Peds - How many times have we been told that kids are "easier"? Never mind that just as adult are getting sicker so are kids; there are many 14 year old 100 lb plus MRCP kids, trach and G tube dependant, total care. Oh and the chemo that many peds nurses give on top of caring for a child like the above, the 2 year old who won't let you get an assessment done, the teenager being difficult, the parents being more difficult... oh and of course kids go down the tubes way more quickly then most adults!
L&D - As much as many of your cases end up great, when things go bad they go really bad and most other nurses would have no clue what to do with your types of emergencies (a good friend who is an ED nurse once told me that an obstetrical emergency is the one type of emergency that she feels most helpless in).
I realize I didn't touch on most specialties - I'd be here all night, and this post is already too long. If you made it through reading the whole thing thank you! To the others I didn't mention (OR, PACU, Pre-op, School, Home Health, Hospice, Rehab, office/clinic, long term care) you guys are as important as any other nurse and your job is just as vital to the health care system we all work in. Remember, if it wasn't for the ED nurses we'd all get our patients dropped off in a second's notice and unstable and if it wasn't for the rest of us the ED nurses wouldn't have somewhere to ship everyone off to once they're done with them. I appreciate all my fellow nurses!
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.
My hospital isn't that large, about 2/3 that size, but we aren't allowed to divert at all because we are the only hospital in the area.
I'm still surprised that the ER calls report to the individual nurse taking a pt. In my facility, the charge nurse takes that call and informs you(more likely not) and next thing you know is you see a pt getting wheeled in to one of your rooms. Then you have to drop everything and admit these people, call the doc for orders and then do everything else to get them settled them in.
To the poster who said meal time excuse is bs, it's not really, maybe you have not been around at meal times. At my facility, it's also when we give most of the last meds for the shift, give insulin coverage, and when all those fall risk people set off their bed alarms trying to get up from the bed. There's just something about 2 hoiurs to end of shift that releases the chaos on the floor. And when those new pts arrive the floor at this time, they also have(want) to get something to eat regardless of whether they even have a diet order or not (try explaining to a pt who has been in the ER all day that they can't eat cos they have no diet orders yet)
I wish hospitals would have admitting and discharge teams, it would go a lonnnnng way in helping ease some of these problems. Until then, let's stop with "my job is more important than yours" because it's not helping anything other than make us look like a bunch of kids. My 2 cents.
Meal times might be busy on the floor but it isn't fair to the pts in the ED to ask them to wait 2-3 hours to be transported when they already have a room assigned because other pts are hungry. Nor is it fair to those in the waiting room to have to wait that long to be treated for the same reason.
hecallsmeDuchess
346 Posts
I'm still surprised that the ER calls report to the individual nurse taking a pt. In my facility, the charge nurse takes that call and informs you(more likely not) and next thing you know is you see a pt getting wheeled in to one of your rooms. Then you have to drop everything and admit these people, call the doc for orders and then do everything else to get them settled them in.
To the poster who said meal time excuse is bs, it's not really, maybe you have not been around at meal times. At my facility, it's also when we give most of the last meds for the shift, give insulin coverage, and when all those fall risk people set off their bed alarms trying to get up from the bed. There's just something about 2 hoiurs to end of shift that releases the chaos on the floor. And when those new pts arrive the floor at this time, they also have(want) to get something to eat regardless of whether they even have a diet order or not (try explaining to a pt who has been in the ER all day that they can't eat cos they have no diet orders yet)
I wish hospitals would have admitting and discharge teams, it would go a lonnnnng way in helping ease some of these problems. Until then, let's stop with "my job is more important than yours" because it's not helping anything other than make us look like a bunch of kids. My 2 cents.