Relationships with floor nurses?

[theantichick]

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.

[Anna Flaxis, BSN, RN]

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.

No, no, no- no sarcasm intended. I was posting in a super hurry because I was late getting out the door for work.

The only reason I mentioned it is that I've learned, and maybe you've had this experience too, that there are very few "alwayses" and "nevers"- the clinical picture can be muddy, and since we weren't there, we don't really know everything that went into the medical decision making. That's all I really was thinking, and in my haste, chose my words poorly.

[Anna Flaxis, BSN, RN]

Didn't mean to like this cause I don't.

Part of rsi protocol is sedation, no? It sure is with us.

You can click "unlike" if you want. It shows up in tiny little letters right above the person's profile info after you click the "like" button.

[FlyingScot, RN]

No, no, no- no sarcasm intended. I was posting in a super hurry because I was late getting out the door for work.

The only reason I mentioned it is that I've learned, and maybe you've had this experience too, that there are very few "alwayses" and "nevers"- the clinical picture can be muddy, and since we weren't there, we don't really know everything that went into the medical decision making. That's all I really was thinking, and in my haste, chose my words poorly.

No worries! Thank you for clarifying. I really do appreciate it. In this particular situation the patient was waking up after being intubated and after OG insertion among other things. The poster made it sound like they were only using Vecuronium and gave Versed because the Vec wasn't keeping her down. She later clarified that this wasn't the case. Sadly I have been in many hospital EDs where patients were paralyzed without sedation and it really is cruel. That being said, I have never placed an emergent airway (on a patient with a pulse outside of the neonatal population) without sedation. It's part of the standard RSI protocol. Of course there are always outlier situations which may be your experience. 😊

[Anna Flaxis, BSN, RN]

Thank you, again, I had no intention of being confrontational. Yes, I'm very familiar with RSI, but I have also seen some crash airways too, and if you (not you individually, but the collective "you) didn't know about the clinical indications for that and witnessed it, you might think something was done wrong- again, there are very few "alwayses" and "nevers".

I will just have to be more vigilant about not posting on the fly, lest I give the wrong message.

[theantichick]

To the OP, getting snarky with you when you're giving report is uncalled for and unprofessional, but it's also symptomatic of a bigger problem. It sounds to me like there is a problem here with expectations of the floor nurses and the ED nurses not matching up. It sounds to me like the managers for each unit need to collect information from their nurses about their perceptions and meet with one another to strategize on how the process could be smoothed out and the nurses understand one another's positions a little better. Can you talk to your manager about this?

I plan to discuss it with her, I posted here to get some feedback as to possible solutions. I like to have something to offer, even if it's just a plan for further investigation, whenever I gripe about something. :) Especially since I'm on nights, so it's that much harder to arrange face time with my manager. I am new to this hospital system and this facility, so I don't really have a handle on how well things like this are followed up on, but I think it's important to try.

I really appreciate your feedback!

[theantichick]

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.

Wow. I haven't had a situation that bad yet, but I get annoyed when I do everything I can given my constraints to package the patient and get whatever I can started so it's not all left to the floor crew, and yet they still find something to complain about. I guess some people just will never be happy. And I agree, we should all be on the same team, but it doesn't feel that way most of the time.

[stygianabyss]

OP, I found the best way to address communication breakdowns between units is to straight up ask them. I ask every unit, What can I do to make hand-off more seamless for you? Everytime I have done that, the floors and even ICU have come back to me with all reasonable and doable requests. What I think the main disconnect between ED and other units is that we ED folks are focused on different aspects of the whole. WE all here the whole cliche where ED Nurses are more big picture, get them stable, and ship. While ICU tends to be more detail oriented. While the floors also have characteristics they focus on as well. After doing enough bed holds for med/surg, you can appreciate the little things. While we may worry more about getting someone hemodynamically stable than VTE prophylaxis, it is not more important.