I've only worked in two ED's, but have noticed that both have the same tension between the ED staff and the floor nurses. When we're calling report on an admit, they seem to be really snarky and nasty to us. They'll grill us about why the doctor hasn't addressed this lab result, or why the doctor hasn't ordered a foley and why we didn't ask for said order, and get really nasty if we don't stop our report, go address whatever they think needs done before we transport, and then call them back to give report again. Or get nasty because we're transporting without waiting for that gabapentin to be sent up from pharmacy so we can administer it instead of them.
I tend to think it's because if they haven't worked ED, they have no idea the kinds of pressures we're under - not just with the patient we're transferring, but the other 3 patients who are at various levels of stability and needs. If we've made the doctor aware of an out-of-range lab value, and the doctor didn't think it needed addressed in the ED, I don't have time or the inclination to second-guess him. If the admitting doctor didn't order a foley, I don't have time to track him down wherever he is in the hospital to get the order so that I have to place it and not the floor nurse.
I know that floor nursing has its own challenges, and I try to be sensitive to that. I don't repeatedly call back every 2 minutes to try and give report when the receiving nurse is in a room or in report, I try to get all the information they need and the patient tasks as caught up as possible. I do everything in my power to make sure my patient is as well packaged as I can before I send him up - patent IV, antibiotics started, BP in a decent range, etc. Sometimes we just can't have the patient perfectly packaged, and all the meds given before we send them up. Sometimes things like how mobile they are or a complete skin assessment wasn't translated in report from the previous shift, and I just don't know the answer. It's not necessary to beat me up over it or imply that I'm a lousy nurse, yanno?
Anyway, I am not trying to go off on a rant... I'm honestly interested in if this is common, and if anyone's hospital has had success in putting a stop to this and how. It's not feasible to have every nurse in the facility shadow and ER nurse for a shift, though I'd love to see it. (And vice versa... I know sometimes ER nurses get high and mighty with the "lowly" floor nurses -- I don't see it that way, we have different focuses is all.) After all, the goal should be providing the best care for the patient, not proving that we're better than the other guy.
The whole shift-change thing is a lose-lose for everyone. I work ED. We have no control over when our pt gets assigned a bed. I have no choice but to call report if they get a bed at the end of my shift. The only alternative would be to let the next shift call report to the floor on a patient they know nothing about. I get that the floors are busy at shift change, so if they get snippy with me, I just thank them with a smile. I try to do everything in my power to package them nicely before I send them, but as for bad timing, that's just plum out of my control.
To be honest I'm getting more and more annoyed with floor nurses and I've only been in the ER for about 17 months now. It's like they expect you to send them the patient gift wrapped with a bow and practically cured some days. When you call to give report and they're busy they have absolutely no problem making you wait. When they call us to get report or ask questions about a patient we sent them whether we're in a patient's room, giving meds, triaging an ambulance, speaking with a doctor about orders, speaking with family members of patients, etc 90% of the time we drop what we're doing to answer the phone. Because we know how spotty floor nurses are about calling us back, let alone taking report when we try to give it to begin with. They never show us the same courtesy.
I find ICU nurses are the worst. I'll give you an example of my shift last night and how floor nurses, particularly ICU nurses can act:
Last night at 1900 when I came on my shift I had a hand-off patient on Bipap who was going to be a tele admit. She had a bed assignment on a tele unit around 2100. I called the unit to give report every hour on the hour for 3 hours only to be told repeatedly the room wasn't clean as they had transferred a patient out. Eventually I got fed up and called the operator to ask for the housekeeper. I asked if she could clean room 408 STAT as I was told it was dirty. The housekeeper told me she had cleaned that room quite some time ago. I promptly call back to the unit to inform them of this and I'm told to hold on. A minute later, they're able to take report (the nurse I had been dealing with on the phone the entire time apparently didn't feel the need to talk to me again after my little revelation to her)
So before I send the patient up, the hospitalist decides to order a repeat ABG since it had been several hours since the previous one and the CO2 readings originally had been elevated. We did another couple of repeats and realized the patient needed to be intubated. This is about 4 or 5 hours after she originally had a bed. So now she's an ICU patient, which is completely understandable. She probably should have been intubated before I had even arrived on my shift and been ICU to begin with. After the intubation she starts to wake up so we give her a dose of vocuronium. While respiratory is trying to monitor her vent settings, I have a tech trying to put in a foley (which she couldn't get), while I'm on my knees (literally) trying to get a second line in this patient which took me 15 minutes. Then I managed to get the foley in. On top of this I have another patient who needs a soap sud enema I have to set up, and a SOB coming in by ambulance who needs to be triaged and lined. I also put in an OG tube per MD request, which somehow the patient managed to dislodge with her tongue. Turns out she was waking up again and needed another dose of vorcuronium and we also gave her some versed for good measure. And managed to get in a second OG tube.
I make sure all my IVs are capped, labeled and dated as well as the foley. I write down all the information I want to relay to the ICU nurse so I can be organized when I give report and not waste their time. The report goes fine and she has no requests except I bring the patient up in restraints which she already had on anyway as it was protocol since she wasn't receiving any propofol.
Finally at 0600, I'm able to get the RT and a tech to help me take the patient up to ICU. When we get there and we move the patient over, the worst thing that could possibly happen happens.....the receiving nurse notices the sheets are damp -_-
"Wow you guys couldn't change the patient's sheets?? You always do this to us." The ICU charge nurse then states "Oh don't worry they'll stay and help you clean up the patient. This keeps happening with them." Needless to say I'm pissed. For one thing, I clean my patients if I notice they're wet, I had no idea this patient was wet as we had put in a foley and the sheets didn't appear damp to me down in the ED. If I knew the linens needed to be changed, I would have changed them in the ED before I brought her up.
Now in the ICU, and I don't know if this is how it works with all ICUs, when a patient is brought up usually 2 or 3 ICU nurses will jump in to make sure the patient is situated. So me and the tech are cleaning this patient while the 2 ICU nurses are basically just standing there. Another ICU nurses pops his head in the doorway and asks them if they need his help, they tell him "Oh no we're alright." Meanwhile I'm fuming. I get back down to the ED where my charge nurse tells me they almost wrote me up. Now I'm even more pissed.
And this always happens with the ICU. It's RARE when you bring a patient up there that they don't find at least one thing to complain about. No matter what it is. Floor nurses will call down asking us to help them with their IVs, or asking if we can spare any of our techs for blood draws, etc but they do absolutely NOTHING for us. I mean NEVER.
This is one of the reasons a lot of us in the ED do not care for floor nurses. Now I realize there are probably many things they deal with that I just don't realize, but we have nurses in the ED who transferred from the floor who have told us they now understand why ED nurses get so irritated with the floor. And they've been on both sides.
And it is unfortunate because we're all on the same team and it should really be about patient care. But it really doesn't feel that way. I'm becoming more and more jaded with floor nurses and I haven't even been doing this for a year and a half.
They were "punishing" you by making you do it alone with the tech. And yes, it's an @$$hole move.
For my first 2 years in the ED, the ICU would repeatedly rip me a new one because I would always say "I'm sorry, let me help fix it" until I had had so much of it that one night they gave me attitude and I went into a flying F-bomb rant right at their desk. They couldn't write me up because they'd have to admit to their own culpability to do it. Now they treat me like a human being. I will slap down (figuratively, of course!) the new hires who try to give attitude before they get too far.
I absolutely accept when I have done something wrong, but I simply will not tolerate being treated badly.
I also put in an OG tube per MD request, which somehow the patient managed to dislodge with her tongue. Turns out she was waking up again and needed another dose of vorcuronium and we also gave her some versed for good measure.
Not to hijack this thread but why on earth was the patient only getting Vecuronium and no sedation? Not blaming you of course but paralyzation without sedation is cruel.
Not to hijack this thread but why on earth was the patient only getting Vecuronium and no sedation? Not blaming you of course but paralyzation without sedation is cruel.
When we intubated we gave her 20 of Etomidate and 100 of succs. The Veruconium and Versed was given after she was intubated. We definitely sedated her lol, I would have insisted on that if the MD had tried to intubate with no sedation (I've actually heard of that happening once with a particular MD, the nurse was my preceptor and she was pissed)
When we intubated we gave her 20 of Etomidate and 100 of succs. The Veruconium and Versed was given after she was intubated. We definitely sedated her lol, I would have insisted on that if the MD had tried to intubate with no sedation (I've actually heard of that happening once with a particular MD, the nurse was my preceptor and she was pissed)
That's good to know but both those meds have a short half-life. Do you guys start a Propofol or Versed drip?
Specializes in Acute Care - Adult, Med Surg, Neuro.
I'm a floor nurse, med-surg, the lowest of the low I know you guys are having a hard time, just like me. So I put a smile on my face when you call (or I call you) because they say when you smile that your tone of voice is nicer. Inside I'm groaning about my 3rd admit of the day. Know it's not about you, it's about the system. I try to keep in mind that we're all in mess together.
Oh, and you know that crazy patient or psycho family that you have to deal with for maximum of a whole shift? I have to deal with them for probably several shifts in a row. Blerg.
That's good to know but both those meds have a short half-life. Do you guys start a Propofol or Versed drip?
We tend to go with Propofol. I've never actually hung a Versed drip. The ED doc didn't want to mess with her blood pressure though (although her BP was fine) in the ED and wanted the hospitalist to make the call on which drip to hang when the pt got up to the ICU. He was down in the ED at the time and aware so it wasn't really a problem. He had orders in by the time we got her up. I'm not sure what he went with.
Not to hijack this thread but why on earth was the patient only getting Vecuronium and no sedation? Not blaming you of course but paralyzation without sedation is cruel.
Not to further hijack, but have you never heard of a crash airway?
Not to further hijack, but have you never heard of a crash airway?
Kind of hard to read your tone but if you meant to be sarcastic take a look at my profile and draw your own conclusion. In an effort to prevent further thread hijacking feel free to PM me and I'll be glad to discuss the topic with you at length.
I know you guys are having a hard time, just like me. So I put a smile on my face when you call (or I call you) because they say when you smile that your tone of voice is nicer. Inside I'm groaning about my 3rd admit of the day. Know it's not about you, it's about the system. I try to keep in mind that we're all in mess together.
buckeyeRNED
10 Posts
The whole shift-change thing is a lose-lose for everyone. I work ED. We have no control over when our pt gets assigned a bed. I have no choice but to call report if they get a bed at the end of my shift. The only alternative would be to let the next shift call report to the floor on a patient they know nothing about. I get that the floors are busy at shift change, so if they get snippy with me, I just thank them with a smile. I try to do everything in my power to package them nicely before I send them, but as for bad timing, that's just plum out of my control.