Professionalism in nursing!!!!

[smjlpn]

Ok so I lost my temper with a nurse I was trying to give report to.

I work in LTC and to often when I am sending a patient to the ER I get a nurse with an attitude.

Today was more than I could take. My afternoon shift started with an event, multiple issues to deal with, new furniture in the building so every resident is either mad, at the desk, or on the call light complaining of missing belongings, plus I am getting a new admit.

So then I get a CNA to the desk because the patient has just pulled his feeding tube out.

Now first off I am more than able to put a tube back in I have the training and the experience to do this. However our facility policy is that they are to be sent out. So I call the MD and then I call the ER to try and find out prior to transport if he will go to ER or elsewhere (outpatient) to have a tube put back in.

I no sooner say to the ER nurse. I have a pt who has yanked his feeding tube out, and she is literally screaming at me. Oh you can put that tube back in, why don't you just go do it!

Well I did not scream & I did not curse. Although had she been in front of me she would have been bald! I interuppted her very quickly to let her know in no uncertain terms that I was quite capable of putting the tube in & it would be much less work for me than the sendout & paperwork & her mouth. But I am required to follow policy.

She did not have much to say to me then.

I did notify my DON of the problem. She was ok with what I did.

I am just very tired of ER nurses assuming that I enjoy sending pts to them. It happens to be more work for me it is easier to keep them in the facility & I am fed up with their abuse!!!!!

[Blee O'Myacin, BSN, RN]

Blee

Yikes - thanks for a glimpse into your horrible day - I think we all could learn from ea other - and if we all took turns in diff depts we can understand the frustration level. The ER always seems to start dumping all their patient's on us from 4-7 - and often they'll try to give us all the patients within 1 hour - it's too much to handle on the floor which is often short staffed. I always think they are trying to "clean" house before the next shift starts at 7pm because often I'll walk through the ER and it's empty- waiting room and maybe 2-3 cubicles have someone.

Lately we've been so full (upstairs) that the ER has been on divert....it's just so hard on all nursing staff....I think we never get paid enough or are appreciated enough.

It stinks for night shift in the ER too - they get four brand new patients in their beds that have been waiting for hours, are sick, grumpy, and seething with emnity for all of us trying to do our job. I wish our ER had an empty waiting room for the night shifters at shift change, but more often than not, they come in to mass chaos since 20 beds just opened up. We have two full time admission RNs come and do all that paperwork, and we do all the "now" orders off the admission orders, so usually its just a matter of passing off the patient to the night shift on the floor. Which stinks because the ER nurse is long gone when the night shift floor nurse has a question. I just make sure my notes are very detailed.

But to bring things around to the original topic of the post, (professional vs. unprofessional behavior) I am thankful when the nurses up on the floor graciously accept that 1840 transfer, and especially to the ones who come in and help us with the transfer from bed to stretcher, tele pack in hand! :) Even if they all groan at the nurses station when they see us coming, not dodging the report call means a lot to me.

Our management has us ride with the paramedic units for a 12 hour shift during orientation. I think that gave me tremendous insight into their world and solidified the fact that we all work on the same team. Even four hours per unit might not be a bad idea, especially for nurses that have only worked in one specialty area. (ie - four hours each of LTC, med/surg, tele, PCU & ICU for the new ER nurses if they are new grads; and a few hours in the ER for the nurses who either accept patients from the ER or send them in). If we are ever going to survive as a profession, then we need to become a force to be reckoned with. Do we ever see doctors go back and forth like this?? A good friend of mine who is a physician told me that it is poor ettiquite to talk badly about, or criticize how another physician does their job if they are peers. Not a bad model to emulate, if you ask me...

Blee

[canoehead, BSN, RN]

. provider order is to transfer patient to ed. is it the nurses' prerogative (ed or ltc) to overturn the order or contravene facility policy for convenience sake?

perhaps it should be a nursing judgement to some extent. that elderly person is going to be triaged as nonurgent and put in a corner for a few hours until someone is free to put the tube back in. would it make sense to replace the tube after 10pm when the resient is going to be sleeping anyway (and a wait would not be as difficult) and the er is likely to be winding down after the post supper rush?

if the resident can tolerate it we should discuss the best time for transport with the md, and possibly the er. if you call the er, and they have just had a 5 car pile up is it better for the resident to wait at home or in the er hall? by the same token, they shouldn't have to wait forever. can they get in the "line up" from home and be transported 30 min prior to being seen....

lots of issues, and i'm just thinking out loud.

[canoehead, BSN, RN]

Blee

Yikes - thanks for a glimpse into your horrible day - I think we all could learn from ea other - and if we all took turns in diff depts we can understand the frustration level. The ER always seems to start dumping all their patient's on us from 4-7 - and often they'll try to give us all the patients within 1 hour - it's too much to handle on the floor which is often short staffed. I always think they are trying to "clean" house before the next shift starts at 7pm because often I'll walk through the ER and it's empty- waiting room and maybe 2-3 cubicles have someone.

The docs all write their orders after office hours, hence the end of shift rush. Families see the doc and push even harder to get upstairs. PI requires that patients get up within a certain amount of time of the orders being written. I often feel guilty about flooding the floor with admissions, and in the middle of the night try to make up for it by cutting a little slack with the excuse that the patient was sleeping and we didn't want to wake them to move them, or some trsh like that.

[leslie :-D]

another point:

by the time the resident is seen in the er, good chance the stoma will have closed, necessitating another surgical procedure.

hoping ltc nurse kept it open w/a foley.

they close fast.

while the er nurse's response was not professional, need to cut some slack.

there really isn't any reason why gtube cannot be changed in ltc facility.

it's done all the time.

i understand the frustration from both sides.

leslie

[proud2b1]

:bow:Amen sista!!!!Brotha?:wink2:

[TazziRN, RN]

as for an unprofessional nurse ... it's unimaginable

when did i say the er nurse was not unprofessional? i never said that. i said that i could not imagine the nurse screaming those words. that would be an out of control nurse who has other issues.

by the same token, they shouldn't have to wait forever. can they get in the "line up" from home and be transported 30 min prior to being seen....

lots of issues, and i'm just thinking out loud.

oh, nononononono!! we had people call all the time asking if they could give me the info on the phone and "would you call me when i can be seen so i don't have to wait?" no!!! i feel bad for the ltc pt who waits longer than he needs to but this is not a solution.

[ecnav]

perhaps it should be a nursing judgement to some extent. that elderly person is going to be triaged as nonurgent and put in a corner for a few hours until someone is free to put the tube back in. would it make sense to replace the tube after 10pm when the resient is going to be sleeping anyway (and a wait would not be as difficult) and the er is likely to be winding down after the post supper rush?

if the resident can tolerate it we should discuss the best time for transport with the md, and possibly the er. if you call the er, and they have just had a 5 car pile up is it better for the resident to wait at home or in the er hall? by the same token, they shouldn't have to wait forever. can they get in the "line up" from home and be transported 30 min prior to being seen....

lots of issues, and i'm just thinking out loud.

i agree, for the patient, yours and previous responses are best. but aren't we constantly stuck between the right decision and some overreaching 'policy'?

nursing judgment works and i'm in agreement so long as administration supports the decision. i recall many instances where someone's informed nursing judgment was adjudicated upon by anyone and everyone the next day only to result in a warning letter from the don. if the facility works like this... i recommend following policy 1st ask questions later.

[Katie82, RN]

I am going to play devil's advocate here:

Were you wrong to be upset? Oh no! No one should be treated like that by their peers or anyone else. That ER nurse needs education in the policies of the local LTCs.

I am, however, having a hard time picturing this ER nurse screaming these words at you. Being snotty, yes, but screaming?

You are right,there are usually two sides to every story, but that is no excuse for disrespect. She propably yelled at you because she thought she could, unlike the calls she had been getting all evening from parents wanting to know if they should bring their kids in because they had a cough for 3 days or were pulling on their ears for the past two hours..... I think your policy should be changed, why put an obviously confused patient through the trauma of transfer to an ER for something you could do. Not in the best interest of the patient.

As for the lack of respect between peer groups, I have not always held LTC nurses in high esteem. I entered the profession before the days of DRGs and CPT codes. Had a lot of patients "dumped on me by LTC facilities who were trying to reduce their census around the holidays or because they wanted to get rid of a patient (can't take him back, we gave his bed away) THis is much more difficult to do now, and LTC facilities have evolved into a totally different type of setting. Not many people realize this. As a case manager, I work with several LTC/Skilled Nursing Facilities in my area. I understand what you do now, but not everyone does.