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?
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".
That is kind of disappointing. I work on a unit and there are many days we don't get meal breaks let alone any other kind of break and we just run from one room to the next. We hear a lot of the "us vs them" as well but really we are supposed to be on the same team so when I take an admission from the ED I try to take a minute to talk to the nurse making the transfer. "Thank you" and "How are things going down there?" can go a long way.
Oh Silverlight2010 I know! Believe me I do not agree with her mode of thought when it comes to unit nurses. It really bothered me when she said that. I worked the unit my first 7 years of nursing--I don't regret one moment. I too tried to be friendly to the ER nurses when getting admissions, tyring to make the transition as smooth as possible for both patient and staff. Just bugged me how she was so quick to shoot them down--when she is my manager and she is the one I am trying to get through to.
I think it is pointless to try and change this. I think it all boils down to people wanting to think their job is more important than someone elses. I think the only fix to this problem is a zero tolerance ideal where the first person to ***** about the other unit gets fired and is made an example of. That will be the only thing to shut people up is fear of losing job. The ER needs a floor to send pt's to and the floor needs an ER to send pts to them.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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 situation 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.
The unfortunate part is you will not get a ton of cooperation without administration on board to allow nurses to leave their departments and provide the extra staffing to cover for these absent nurses. You can try to get a voluntary group together for shadowing but asking nurses to come in on their days off will probably not be met with enthusiasm. This costs money. Although it was extremely beneficial to everyone, and they still practice this way to this very day, it will be a hard sell with the tightened belts of administrations of today and nursing satisfaction a low priority. Without your manager's support......it will be a hard sell.
What is your ED wait time? ED wait times are linked to patient satisfaction, positive outcomes and shorter stays. This may be a selling point for you.
Maybe a task force to help clear the air. Get together to discuss how to better the transfer of patients and their information. Have clear cut guidelines as to what is who's responsibility. Get the floors and the unit involved and go to your CNO...pitch the idea.
For example....beds need to be assigned within 1 hour. Orders to be completed for the floor, all stat labs blood cultures completed before antibiotics given, Antibiotics initial dosed. Heparin gtts/bolused and started... baseline labs complete. All completed orders to be initialed and timed. Things that can wait, timed IV's, routine home meds. Faxed report to floor, pre-printed with latest vitals, assessment,interventions, pertinent information, with a copy of the orders. Patient arrival without phone call from floor.......... 1 hour.
The fax sets the time clock accurately ticking. It Stops the time waiting on the phone while they "Look" for the nurse who is getting that patient. Inquire about a admissions nurse or have the first couple of admissions assigned to the nurses on the floor prior to the start of the shift as a part of their assignment. Meet once a month to air "feelings" and share ideas, brain storm on how to improve the process.
First and foremost we need to empathize with the plight of our fellow worker and realize if I am busy we all are busy. Remember why we as ED nurses left the floor. Acknowledge the importance and respect for our co-workers job. Engage the supervisor as a part of the process to "look" for beds and assign beds as necessary.
Get clear concise guideline and expectations, get every one on the same page. But you need to engage your manager to assist with this improvement processor go to the CNO with your improvement process idea.
YOU can't PM right now, you need 15 posts, unless you get a paid membership but I can give you/help with ideas suggestions anytime PM me.
Specializes in LTC, assisted living, med-surg, psych.
Reminds me of my old float nurse days.........I sometimes worked several different departments in the same shift! Didn't see much time in the ER, which was fine with me, but occasionally I'd get pulled down there to take non-critical patients or help out in a code, and it really opened my eyes to what ER nurses deal with. In fact, I was actually somewhat intimidated by their strong presence, their self-confident manner, and their sheer competence---and I was a seasoned nurse who could take care of almost anyone, from newborns to centenarians. God bless ER nurses!
I have also worked in all areas. I understand "walk in my shoes".
Whenever I feel negative energy during a hand off.. I just reply with .." I did the best I could " ...I know you will continue my efforts to take care of our patient.
Crosstrain critical care areas -- let ICU see what it's like when half the county shows up in the ER, and let ER see what it's like when you've got 2 codes going on on different sides of the unit and ER comes in pushing a patient they haven't called report on. Make them one big pool and you go one way or the other based on patient load.
The only way to stop "us" vs. "them" is to turn "us" and "them" into "we."
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.
I just wanted to elaborate on our rotation system so you can decide if it is something that may work for your facility. Nurses volunteer, but are highly encouraged by our educators to do so. The nurses who swap have identical working hours and skill level in terms of respective experience. This minimises cost and ensures fairness between departments. The only obvious requirement for the ED / ICU nurse is Vent competency and ALS prior to rotation and they have to be finished their transition program (at least 1 year). Upper management regard these rotations as an expansion of skills and ability to adapt. Nurses who volunteer are seen to be contributing to a team driven institutional culture. It is an unofficial rule that to be promoted, you must demonstrate willingness to do a rotation (or have already done it).
I think it is easier to implement between ICU and ED as a starting point, critical care dominates the skill set and both specialties are an asset to their respective swap. It's a good start. Swapping with floor or ward nurses is something we are currently working on. The selling point from our ED educators is generally: de-mystifying ventilators, becoming expert in terms of respiratory support, drugs. For ICU the selling point is largely procedural: intubation, access, arrests, assessment. If you start with one or two nurses who are interested in spending a couple of months in ICU, send them there and when they come back they tell everyone else how much they learned, how much it has built their confidence etc. The word filters through both ways, it will catch on. In my department there is actually a waiting list for "my ICU rotation". It really works and it's the same on the other side of the fence. Rotations are 3 months, hope this helps.
nursefina
4 Posts
Nope, I am in South Florida. Started out in Ohio, moved here 4 years ago :)