Relationships with floor nurses?

PacoUSA, BSN, RN · Feb 7, 2015

As a floor nurse, I know where you're coming from and I'll tell you my side of the story.

I've been irritated with the ED nurse calling for report on an admission ONLY when (1) am in an isolation room gowned up and in the middle of pushing Dilaudid and they wont call back later and (2) it is within 30 minutes before or after shift change (which on the floor I feel is a very crucial time for the nurse to organize themselves for report or assessment). Otherwise, I have been nice as pie to any ED nurse :) I have never been an ED nurse so I cant really sympathize with your struggles down there, although I might be interested in becoming one someday. However, even when I was a staff nurse (I am a travel RN now), at my last hospital I never even walked into the ED to see what you guys go through (that is, until my last 3 months of work there) and I agree, every floor RN should have that opportunity. At my present hospital, we DO NOT get report from the ED at all, they just roll on up more or less a few hours after the bed is booked. Believe it or not, I much prefer that because I then have time to review their chart online at my convenience and once the patient is there I know what needs to be done. I don't need report to rehash what I can read myself on the computer. Just tell me if they are being accompanied by a neurotic family member that I should prepare for. That info is never really in a chart, lol.

I'm not one to be picky about what is NOT done down there because you guys are busy, we will do it on the floor. But if you try to send us a patient with a SBP in the 200s, I'm gonna have to question that and let the charge nurse get involved. That is not safe. I'm not saying you do that personally, but I have had ED nurses in the past try to send me patients that clearly needed to go to ICU and not my unit.

A nurse like yourself who does their best to package the patient well before transfer is someone I love to work with. I even love the ones that start the admission history. Those are rare tho and I miss working with the one that used to do that at my last hospital. She was very experienced in ED and used to work on my unit once so she knew our pain.

Basically, what I am trying to say also is that I think most attitudes for floor nurses stem from the fact that they are understaffed and are way too overwhelmed with work to be interrupted with ED report. That's my take right now.

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AZQuik · Feb 7, 2015

We try to do everything we can to pretty up pt's but it often does not happen. We are only required to call report on admits to the icu, but many of us try to call report to the floor.

That said, if all my pt's are stuffed and tucked waiting for a bed, and a stroke alert comes to the zone next to me, a pt might get a bed assigned, a call to the floor is placed by one of our expediters to make sure the bed is ready, and transport is arraigned. I might get done with the stroke alert to find the pt gone, room cleaned, and another stroke alertptr in there.

And it might happen at 0650.

Yes there are Ed nurses who are lazy and simply pawn things off to the floor, there are also hard working nurses with three ICU boarders and a revolving room getting a new pt every 3 hours.

Hard to say exactly why, there are many reasons that floor nurses get crapped in by us. Not all include inconsiderate, or incompetent nursing (of course this happens as well).

BSN GCU 2014. ED Residency

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That Guy, BSN, RN, EMT-B · Feb 7, 2015

Emergency. Yelled at for not doing enough, scolded for doing too much. Its a lose lose battle with any department so I just cut my losses, try to do the best I can to help and move on to the next.

Nenja · Feb 8, 2015

I'm a floor nurse, no ED experience beyond floating a few shifts. I honestly don't think anything either party does will entirely "stop" it. Y'all think we get snarky, we think y'all get snarky...and both do. We all have rough, demanding jobs and want the best for our patients but unless we are experiencing both situations *at that time*, we can't get what the other is dealing with.

My typical beef is - shift change. I have to get report on my other patients, I don't know if there is a surface to put the kid on in the room, if safety supplies are in there. We don't always have secs/techs to help with that and ED will call immediately after we are paged - no time. It is such a bad first impression for a family to roll up in the middle of report, be left on a stretcher and then sometime, someone will lay eyes and start an admission. We've gotten in report a kid is fine and they're dusky on arrival...but if we hadn't been able to get there right away? We have our own kind of busy and even emergencies at shift change...it's just a terrible time.

And - if I'm getting an ortho/trauma and they can't tell me what's broken. Good to know for transfer from stretcher to bed.

We've been told they aren't even the nurse taking care of the patient, just giving report...which should just never happen except in extreme circumstances.

This is a constant dialogue at my facility and both sides are working on it...but this is very common and I think there will always be some issue. Communication is key - "I know this is a bad time, but we are slammed and have a trauma coming in...I need to open up this bed"...same for us "I'm in an isolation room and trying to give meds to a squirmy toddler. Can I call you back in five?"

I don't really care if you've given antibiotics and made them pretty. I've never gotten a foley from the ED. Labs don't really need to be dealt with unless it's emergent...because that's why they're coming to the floor. If they're screaming in pain, yeah throw them some Morphine before transfer because if you're slammed, my docs are slammed too and it might be a bit before I can get some orders.

We're all trying to do the best that we can.

WhoniverseNurse · Feb 8, 2015

Knock on wood... from what I've seen at my hospital, ED and floor nurses get along pretty well. Sometimes the floor nurses will even come up to chat if they are slow, and visa versa (though that is very rare occurrence, indeed). I have had to give report during Med-surg's shift change d/t the ED being full, 3 patients in waiting, and 2 ambulances incoming. I got a dirty look, but not much else. I think we talk pretty well and the communication is pretty good :)

Lev, MSN, RN, NP · Feb 8, 2015

I've moved from the floor over to the dark side (ED). It's been an eye opening experience. For once thing, a "high" BP in the ED us anything over 200. They are more concerned about HR. Also, just because patient is monitor in ED does not mean the doc wants us to push IV drugs that are not administered on med-surg floor. At my facility we only give report to IMC and ICU (we transport those patients) and write a note with a call back number for MS and tele admissions. Also, the ED is written up a lot apparently.

Farawyn · Feb 8, 2015

Yes, it's an issue. We had floor nurses and ED nurses switch places for a bit and cross train and see how the other half lived. It cut down on a lot of tension.

Ms Z · Feb 8, 2015

I have been both a floor nurse and now a ER nurse..and have had the opportunity to experience the challenges that come with both and the most important thing I've learned is the importance of compromising. The floor is right to be frustrated when the ER nurse demands to take report right that second when the floor nurse is in an isolation room and giving medication then calls back one minute later. If that happens and I have a pretty stable patient ..no problem..il say call me back in 10 minutes ..but the times I get frustrated is when I call back to give report for the 3rd time and it is another "can I call you back" and that's because I have my charge nurse grilling me on why the patient is still here. :arghh: OR when I have alerted the doc about a lab value that they have decided not to correct in the ED..I have done my part in that matter and report still needs to be taken. I respect floor nursing so much ..it can definitely be tough. :yes:

foragreatergood · Feb 8, 2015

I cant count how many times a priority 1 unresponsive patient or cardiac arrest has rolled into my room at shift change. I have no option but to deal with it. I know I will get out late, but that's the nature of our work. When IMC wont take report because its near shift change I get frustrated. The incoming floor RN should take report on the ED patient as a priority. Its situations like this that causes tension on both ends. The majority of our floor units will take the patients, but our IMC seems to work harder at NOT taking the patient. They will scrutinize the chart to find a reason that they are not appropriate for their floor. So. Frustrating. We are moving to bedside reporting on all of our patients soon. Its better for the patients so I will gladly do it - it will be interesting to see if things get better or worse with our relationships with floor nurses!

zmansc, ASN, RN · Feb 9, 2015

Hum, sounds like some tension. I do a written report (SBAR) tubed to the floor, a phone report, and of course most of what I give in both of those is in the chart at least once, so the floor nurse has at least 3 places to find the same information if not 6 (yes our computer system leaves alot to be desired). For the most part, our floor nurses take the patient when we need them to. Some are slower than others, some are busier than other days, but in general they seem to try to take report and the patient on a reasonable timeframe. I've never worked the floor (since being a student that is), so I don't have much of a clue about their side, other than to say that I do my best to package the patient up well before hand. I also try whenever possible keep from slamming them, and in return most of them will suck it up when they know we are slammed and need to offload three admits at the same time.

I try to give them 30 min on either side of shift change unless it's an urgent situation in the ER, then I will call the floor, and let the clerk know all hell is breaking loose and the patient will be coming in the middle of report, sorry, sucks to be you. I've actually had floor nurses come down to pick that patient up because they know I won't dump on them if I don't absolutely have to. I think it's like anything else I'll help you out as long as you help me out too.

We did implement a charge nurse system, where the charge nurse would take all reports on incoming patients and do the intake then turn the patient over to one of the nurses. As was to be expected that simply created an extra layer of overhead and slowed things down. I'm sure someone got promoted for that idea....

michlynn, BSN, RN · Feb 9, 2015

I'm a floor nurse and it was never required for the ED nurses to call report to us unless the patient was a trauma alert and cleared by trauma to come to the floor. Now, because we've had some incidents where patients have coded or come up to the floor extremely unstable, they now have to call us report. I try not to be snarky towards anyone because I get that everyone is busy and it's never going to be ideal but we look up our patients as soon as they get put on our list so all I care about when you call is if anything has changed in the last 10 minutes, most recent BP, heart rhythm and if the patient is with it or not. We've already looked up labs, X-rays, previous admissions, etc. so most of the time the information is redundant but I know our ED nurses aren't thrilled with having to call report about every single patient either.