Over the Animosity

SMARN · May 15, 2012

I don't know if anything works but I for one would like every one of the floor and icu nurses at my hosp to have to work one day in the ER. I know their jobs are hard too but they have no clue how it is downstairs and yet complain like nobody's business!! Most of our icu nurses have worked floor and step down only - and many of the whiniest floor nurses are fairly new and been on the floor since graduation.

Gets me hot when they complain bc it's usually over the pettiest things. Meanwhile, the lobby's backed up 20+, ER is full, EMS is steady pouring in, and I haven't eaten or peed since getting to work...

Ryan RN · May 15, 2012

It is ER against the whole hospital usually

sauconyrunner · May 15, 2012

What worked for us...and REALLY worked was last winter we had a HUGE overcrowding problem in the hospital. TO help the ER out, they sent PCU and floor nurses down to take appropriate assignments.

Over those 4 months we got to know the upstairs nurses, and they got to know us. They watched us perform code after code after code (mostly elderly found down unknown period of time...not the greatest outcomes...but hey I live in the sunshine state lots of this here). And realized that the patients they see upstairs are only the tip of the Emergency Dept Iceburg.

We also got to know them and watch them struggle with consults that did not want to be consulted, attempting to teach smoking cessation to the guy found in the bathroom smoking with his oxygen on, finding an IV on a difficult stick on IV site rotation day, and all the other hassles that come with inpatients.

It was a tough winter. In the end we all became friendlier. The upstairs staff told me... "Wow, I had no idea how fast they fill your empty rooms." We were amazed at some of the BS the nurses get when trying to talk to an MD about a legit patient problem.

Now that we can put a face to a name, calling report is a lot easier...people ask about each others kids, and then civilly get report 87% of the time.

It was a crisis year for our facility, but it helped us immensely to learn to play better together. I think it worked better than any "retreat day" or Exchange program Hard to duplicate though.

One1, BSN, RN · May 15, 2012

I agree, "walking in each other's shoes" seems to be the only thing that works. We had a few floor nurses shadow us for a shift and the change in attitude shortly after was dramatic. We heard lots of "We had no idea.." and communication was great. Unfortunately, this was a voluntary sign-up and the project died out quickly. Now we are back to the same old with only a few exceptions. And by all means, have an emergency nurse shadow the floor for a day if it helps.

NO50FRANNY · May 15, 2012

I totally agree with sauconyrunner- We have a great rapport with our ICU and I think it is largely to do with an encouraged rotation system. We have an agreement with ICU, we swap nurses for three months, usually 3 nurses from ICU at any given time will be on a rotation in ED while our nurses are upstairs. When both sides of the fence are aware of what's happening in each others' backyard, they can empathise and understand. There is essentially NO animosity and I rarely hear any direct complaints. It is the ONLY strategy that has worked in our facility but we are having a hard time convincing the ward nurses to give it a shot. It has to work both ways though, and I hear comments from ED nurses occasionally which demonstrate a lack of understanding of how ward culture works also but most ED nurses wouldn't second to a ward. I don't know if your facility would encourage this kind of arrangement but it really does work, everyone knows everyone and then it's just a bigger happier team.

Dixielee, BSN, RN · May 15, 2012

I can't agree enough about that problem! ED is the only department where the door can never close, and cots can be lined up and stacked in every nook and cranny but we can never say "ENOUGH!!". We can't say, "It's shift change and I can't take that patient", or " that nurse is at lunch, you will have to call back", etc.

I was reading an editorial in the most recent ENA journal that one thing that helped throughput was to have a charge nurse on the floor make hourly rounds in the ED until patients who were "boarding" could be placed. I also read an article once that once a patient was deemed stable for transfer to the floor, they were sent to a "hall bed" on a floor. If they can be in a hall in the ED, why can't they be in a hall on the floor, after they have been stabilized and treatment begun? This article said it was amazing how quickly beds opened when that happened!

There are answers! There are good answers, but admin, the public and the politicians don't want to hear it.

SHGR, MSN, RN, CNS · May 15, 2012

...We have a great rapport with our ICU and I think it is largely to do with an encouraged rotation system. We have an agreement with ICU, we swap nurses for three months, usually 3 nurses from ICU at any given time will be on a rotation in ED while our nurses are upstairs. When both sides of the fence are aware of what's happening in each others' backyard, they can empathise and understand.

What a great system. I have always thought it would be a great idea to try rotating everyone every two years, like the police do here (they used to, anyway). every two years, boom. Everyone's all shifted around. It would get rid of some of the really toxic enmeshed staff situations I've seen, and build bridges.

sapphire18 · May 15, 2012

I don't know that this problem is ever really going to be solved. ICU/floor nurses have no idea what it is like to work in the ED, and ED nurses have no idea what it is like to work in the unit/on the floor. I work both but still get aggravated when a critical pt comes over with orders not complete, or even worse when it is unclear what was done and what wasn't, and then I have to call back. It is a huge problem, and the only thing I see as having any hope of helping is some type of exchange program, like others have mentioned above.

Esme12, ASN, BSN, RN · May 15, 2012

Nursefina, Welcome To An! The largest online nursing community.

This has been talked about hundreds of times. This has been an ongoing argument even when I was a new nurse in 1979. I worked at a hospital that took a leap of faith, bank rolled and offered voluntary cross training as an experiment to see what worked. What they found was that walking a mile in someone else's shoes was paramount to the amount of empathy, tolerance and patience to another floor's dilemma. Nothing worked as well as experiencing someone else's point of view first hand.

We did 1 month rotations with the ability at the end "float" or sign up for extra in the area of choice. When it came to floating those who participated only floated to their area of choice as a reward for participating. The largest beneficiaries? The ED and critical care units. They actually found a relief from the usual routine was refreshing. The ED could now actually have a float that worked as a part of the team. The "losers" but actually the winners were the floor nurses for now everyone know realizes how hard they work and how difficult being a floor nurse really is.

redhead_NURSE98!, ADN, BSN · May 15, 2012

I know this is by NO MEANS a new topic...but I am at the end of my rope. I am over the griping, bickering and all-out bitterness between ER/ICU/Floor nurses. I have been a nurse for 12 years and in doing so have covered all areas. I am now a per diem (working full time hrs) ER nurse and simply stated. I am tired. I am exhausted, hungry and ****** after 12 hrs, but the icing on the shift? Hearing that others have the time to BADMOUTH the ER during their shift--while they fix our mistakes, blah, blah, blah.
Fastforward to speaking with our new manager who states she wants to work on the division that exisits between the different areas. Her idea didn't really impress me, no need to elaborate. But here I sit at 0100, not sleeping, reading old blogs about team building and conflict resolution...which leads me to ask, "Does anything work? Is there anything that I can do to remedy this situation?" I think there is too much talk, not enough focus on why we are there--to take care of the patient. I could go on for days. I beg...any thoughts? Ideas?

Huh. Do you work in Tennessee, by chance? lol

nursefina · May 15, 2012

Wow, I truly appreciate the feedback. For sure the only way to get the point across would be to rotate staff through the units and ER. But this is where I hit the wall. How do I approach it? Perhaps trying 2 or 3 nurses at a time? Just allowing to shadow? Do I just hand select a few staff members that I think will be interested? Hope it catches on and others follow? I have to wonder if administration will go for it. The really frustrating part is when I mentioned to my nurse manager how bad the situtation is, she kid of let me down a little. She says she knows how busy the ER is, knows how busy the floors can be, but "the units really just sit on patients some times, they aren't that busy up there". WOW. Hard to think that I will get full cooperation from her if she is so short-sighted.

Don't staff members want to get along? Don't they want to work together for patients? Or is it just easier to continue to play the role? I for one am over it.