I havent been a nurse for long ( a year and a half) so I have only worked in ER. I have noticed when I give report to ICU they often times speak "down" to us constantly asking why didnt you do this? Why that? why didnt the dr. do this? Its like they're trying to guilt me all the time...
Some of the questions I can answer but often times I just say "the dr. is aware and no further orders were given"
I had a RN get ****** last night because we didnt start a central line on a pt who was supposed to get an insulin drip!??? I DON'T PUT IN CENTRAL LINES!!!
Does anyone else have similiar issues? Also, I think its funny how the male ICU nurses NEVER give me crap when reporting...its always pleasant, short and simple. :)
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I have never observed or experienced any problems between ER vs ICU nurses. Many of the ICU nurses at my hospital also work part time or casual in the ER. We all get along great.
For us the problem is between ICU/ER nurses and the med-surg floors.
Somebody mentioned an ICU nurse wanted to know why a central line wasn't places for an insulin gtt. Why would you need a central line just for an insulin gtt?
It is a good point, but just to clarify, it was made by Fribblet, not me. I failed to negotiate the quote function properly the first time around and accidentally usurped Fribblet's thought while trying to agree with it. Sorry, Fribblet!
I'm going to be 100% honest here, it's because we're sick of getting s*it on constantly from the EC. I'm not saying YOU are one of the culprits, but there are *SO* many freaking lazy people in the EC it's ridiculous.
I'm going to give examples of situations *I* have encountered from the EC where I work.
Situations:
I'm sick of the RN's that do NOTHING for a patient other than an IV (that they have their techs put in)
The RN's that "got orders" for the patient, and when we look at those orders they include "floor RN to call for orders" and nothing else.
When the patient has been sitting in the EC and IN THEIR ROOM for 6+hrs (the room wasn't ready b/c we just had approx 50 discharges in our building alone), and nobody in the EC *mysteriously* can take the time to go over a nursing database. The database that is suppose to be a joint effort, but mostly SHOULD be done in the EC.
Just so everybody's aware, we have friends in nursing supers as well - and we *DO* ask how busy the EC is when they round. You having that patient for 6+hrs and not doing a lick of anything (including but not limited to: feeding a patient that has no contraindications, doing a database while family is there and before they leave prior to transfer, not getting orders when you have time ... we don't even need you to START them - just getting them would help us immensely, and most importantly keeping the patient and family updated on the transfer and how long it will take to get up to their room) is unacceptable.
When the EC RN doesn't put a foley in a patient when they're complete bedrest, unable to move without assist, are extremely painful and unable to use a bedpan, are demented or aphasic, and came to YOU soiled ... it's icing on the cake when the patient is left in their own excrement, never cleaned ONCE in that 6+hr period, and brought up on soiled linens. Cherry on top is when the EC nurse wants to skip on out of the room before you get the linens changed from the soiled ones to ones that are actually clean (and pitch a b**ch about you asking them to help you, alternatively it's also great when the EC nurse acts completely annoyed).
Or how's about when we ask "Does this patient have active chest pain?" because it's written into the hospital stepdown unit policy that we're not allowed to have a patient even admitted to the floor with ACTIVE chest pain. Ditto for NTG gtts >20mcg/min ... icing on the cake when the EC RN has the EC MD call up and attempt to bully/intimidate not only myself, but my supervisor. After failing to do so, they get the house supervisor involved (who agrees this pt is OK for our unit, but we refuse to take them), and eventually the floor manager AND CNO of nursing (both at home) for BOTH of them to tell the EC RN/MD *I* was right, *I* know our policies better than a person in the EC that never works on stepdown, and the *EC NURSE* needs to find a nice home in ICU for this patient. Double bonus points when you transfer a similar patient up WITHOUT monitor, or even better yet WITH monitor and with an UNLICENSED PERSON that may or may not have had CPR training! TRIPLE bonus points for getting angry that we are "taking too long" (while we're running like chickens w/ their heads cut off) and decide that proper SBAR communication "was received" (fax was never seen) even though *I* never talked to anyone as is suppose to happen per protocol, and when the EC nurse comes up they set the patient in the bed with the lights off, don't connect them to monitor, leave the paperwork in the room on the counter, and leave without telling me the patient was dropped off. It's a great start to the patients stay when I walked past the room, look at the patient like their face is melting off because I can't believe the audacity of the EC nurse, and have to apologize because the patient was in the room nearly TWENTY MINUTES because their room is at the end of the hall so not many go past the room, AND THEY HAVE A NITRO GTT RUNNING AT OUR MAX RATE.
What I'm saying is that we don't mean to be cranky assho*es too all of the EC, but the above situations are always at the back of our minds when we get admits. We hope to heaven that the EC nurse is not a person that would do some of the above things to us. We're hoping the EC does their job sufficiently enough where we can get the person comfy, spend an hour doing our thing, and move on. Finally you have to realize that while you're busy, we are also busy. We're having our butts handed to us sometimes because the prior shift on OUR floor left us a mess with our other three patients. We're trying to remedy issues with them and mitigate any issues that will arise before you guys bring a brand new patient. We're trying to get ourselves slightly ahead of the game so you have the ability to send your patient so it can be our patient and we can care for that person properly.
I'm sorry if I came off as being harsh, but these ARE experiences that I've encountered, and it's definitely not all the sh*tty things that have happened to me from the EC, but are definitely the ones that stand out the most. Please also note that I *know* these are not something that has happened in our EC / hospital only. This stuff goes on ALL the time.
Finally, when I first started working I was so overwhelmed that the notice that EC was sending a hott mess my way would throw me over the edge. I had one experience where the tone of the way I talked to another nurse was honestly EMBARRASSING to me. After it happened I told myself, "That was a horrible thing I just did to that poor person ... she didn't deserve it." Since then I've made it a point to attempt to always smile while talking on the phone to EC, always ask them how their night's going, and then get down to business. It takes the stress out of things, so maybe it's something you should try.
Below is something I suggest to you as well:
"Good evening how are you tonight? Good! This is shiccy from ER calling report on John Smith. Did you get the SBAR? I was wondering if you had any specific questions? Ok well Mr. Smith came in to the EC after have CP for 5 days (blahblahblah)." ALWAYS end in, "Are you guys ready for the patient?" The last sentence is key - sometimes you just 100% are not. I've actually said, "You know I'm just trying to get my folks super quickly assessed... is there any way you can hold them for like a max of 20 min and then start up? I've also done this when I've had a freaking ridiculous night already from the get-go and 3am is looming overhead and the cafeteria closes in 10 minutes. I've asked for 20 minutes to get food and bring it back so I can get something in my stomach before they bring the person up. A little common courtesy on your part (with the above statement of "are you ready?") can go a long way in dispelling any questions that you've done your job and you didn't intentionally miss anything.
When *I* get a new patient I get a welcome kit (toiletries, brush, fresh water) and put them in the room. I don't put the water in reach and kind of hide it *just* in case the patient is NPO after talking w/ the MD, and part of that 20 minutes is spent getting that ready. I also ensure there's tele patches, lead sets for heart monitoring, and any other equipment I might need.
Wow, Shiccy. Sounds like you aren't real familiar with the role and function of the "EC" nurse. But I have one question I've always been curious about. If you want an extra 15 min or whatever before you see the pt, why can't they lay in your bed as opposed to mine. I may have up to 10 pts who have been holding in the ER for hours waiting to get that ER stretcher. What's the difference between the admit sitting in your hospital bed, upstairs, waiting to see you for ten minutes or them lying in my high in demand ER stretcher for ten minutes, unseen by you? Just curious. I have never been unable to understand that. If I get a new pt and can't see them immediately, guess what, I don't! And these are ER pts that can have anything going on . If I am telling you I am a sending you a stable pt that's been laid up in the ER going on 14 hours, what's the difference other then your way delays the care of ER pts?
PS, hope your venting helps. Sounds like you needed it. Fair warning, you'll probably get flamed. Just sayin'
From my perspective as an ICU nurse, I want to know why the pt is here, what you did for them, and what wasn't done. I personally don't mind if stuff isn't done, but please tell me so I can be ready. E.g. "Mrs Smith is here with sepsis, she came in with a cough/congestion x 1 week with decreased LOC today. She was lethargic and febrile on arrival with RR 40-44 and was working very hard to breathe, so she was intubated with a 7.5 @ 19cm. We gave her rocephin and avelox, 650 APAP for her fever, was started on versed for sedation, heparin for a troponin of 2.39, and levophed for hypotension. She also got a 1L fluid bolus. She has 3 IV's, RFA, LAC, LFA, and a foley." My questions were if an NG was placed (not to complain, just wanted to get one in the room if I needed it) and did she have family in the waiting area. (I had already looked up labs.) Would have liked to have been told which intensivist was consulted.
Things I do not expect: pt to be bathed, fluffed & puffed, lines perfect (or even all placed), a complete health history (basic is very helpful though).
Just my thoughts. I try not to give you guys a hard time, I appreciate all you do. :redbeathe
I'm going to be 100% honest here, it's because we're sick of getting s*it on constantly from the EC. I'm not saying YOU are one of the culprits, but there are *SO* many freaking lazy people in the EC it's ridiculous.
I'm going to give examples of situations *I* have encountered from the EC where I work.
Situations:
I'm sick of the RN's that do NOTHING for a patient other than an IV (that they have their techs put in)
The RN's that "got orders" for the patient, and when we look at those orders they include "floor RN to call for orders" and nothing else.
When the patient has been sitting in the EC and IN THEIR ROOM for 6+hrs (the room wasn't ready b/c we just had approx 50 discharges in our building alone), and nobody in the EC *mysteriously* can take the time to go over a nursing database. The database that is suppose to be a joint effort, but mostly SHOULD be done in the EC.
Just so everybody's aware, we have friends in nursing supers as well - and we *DO* ask how busy the EC is when they round. You having that patient for 6+hrs and not doing a lick of anything (including but not limited to: feeding a patient that has no contraindications, doing a database while family is there and before they leave prior to transfer, not getting orders when you have time ... we don't even need you to START them - just getting them would help us immensely, and most importantly keeping the patient and family updated on the transfer and how long it will take to get up to their room) is unacceptable.
When the EC RN doesn't put a foley in a patient when they're complete bedrest, unable to move without assist, are extremely painful and unable to use a bedpan, are demented or aphasic, and came to YOU soiled ... it's icing on the cake when the patient is left in their own excrement, never cleaned ONCE in that 6+hr period, and brought up on soiled linens. Cherry on top is when the EC nurse wants to skip on out of the room before you get the linens changed from the soiled ones to ones that are actually clean (and pitch a b**ch about you asking them to help you, alternatively it's also great when the EC nurse acts completely annoyed).
Or how's about when we ask "Does this patient have active chest pain?" because it's written into the hospital stepdown unit policy that we're not allowed to have a patient even admitted to the floor with ACTIVE chest pain. Ditto for NTG gtts >20mcg/min ... icing on the cake when the EC RN has the EC MD call up and attempt to bully/intimidate not only myself, but my supervisor. After failing to do so, they get the house supervisor involved (who agrees this pt is OK for our unit, but we refuse to take them), and eventually the floor manager AND CNO of nursing (both at home) for BOTH of them to tell the EC RN/MD *I* was right, *I* know our policies better than a person in the EC that never works on stepdown, and the *EC NURSE* needs to find a nice home in ICU for this patient. Double bonus points when you transfer a similar patient up WITHOUT monitor, or even better yet WITH monitor and with an UNLICENSED PERSON that may or may not have had CPR training! TRIPLE bonus points for getting angry that we are "taking too long" (while we're running like chickens w/ their heads cut off) and decide that proper SBAR communication "was received" (fax was never seen) even though *I* never talked to anyone as is suppose to happen per protocol, and when the EC nurse comes up they set the patient in the bed with the lights off, don't connect them to monitor, leave the paperwork in the room on the counter, and leave without telling me the patient was dropped off. It's a great start to the patients stay when I walked past the room, look at the patient like their face is melting off because I can't believe the audacity of the EC nurse, and have to apologize because the patient was in the room nearly TWENTY MINUTES because their room is at the end of the hall so not many go past the room, AND THEY HAVE A NITRO GTT RUNNING AT OUR MAX RATE.
What I'm saying is that we don't mean to be cranky assho*es too all of the EC, but the above situations are always at the back of our minds when we get admits. We hope to heaven that the EC nurse is not a person that would do some of the above things to us. We're hoping the EC does their job sufficiently enough where we can get the person comfy, spend an hour doing our thing, and move on. Finally you have to realize that while you're busy, we are also busy. We're having our butts handed to us sometimes because the prior shift on OUR floor left us a mess with our other three patients. We're trying to remedy issues with them and mitigate any issues that will arise before you guys bring a brand new patient. We're trying to get ourselves slightly ahead of the game so you have the ability to send your patient so it can be our patient and we can care for that person properly.
I'm sorry if I came off as being harsh, but these ARE experiences that I've encountered, and it's definitely not all the sh*tty things that have happened to me from the EC, but are definitely the ones that stand out the most. Please also note that I *know* these are not something that has happened in our EC / hospital only. This stuff goes on ALL the time.
Finally, when I first started working I was so overwhelmed that the notice that EC was sending a hott mess my way would throw me over the edge. I had one experience where the tone of the way I talked to another nurse was honestly EMBARRASSING to me. After it happened I told myself, "That was a horrible thing I just did to that poor person ... she didn't deserve it." Since then I've made it a point to attempt to always smile while talking on the phone to EC, always ask them how their night's going, and then get down to business. It takes the stress out of things, so maybe it's something you should try.
Below is something I suggest to you as well:
"Good evening how are you tonight? Good! This is shiccy from ER calling report on John Smith. Did you get the SBAR? I was wondering if you had any specific questions? Ok well Mr. Smith came in to the EC after have CP for 5 days (blahblahblah)." ALWAYS end in, "Are you guys ready for the patient?" The last sentence is key - sometimes you just 100% are not. I've actually said, "You know I'm just trying to get my folks super quickly assessed... is there any way you can hold them for like a max of 20 min and then start up? I've also done this when I've had a freaking ridiculous night already from the get-go and 3am is looming overhead and the cafeteria closes in 10 minutes. I've asked for 20 minutes to get food and bring it back so I can get something in my stomach before they bring the person up. A little common courtesy on your part (with the above statement of "are you ready?") can go a long way in dispelling any questions that you've done your job and you didn't intentionally miss anything.
When *I* get a new patient I get a welcome kit (toiletries, brush, fresh water) and put them in the room. I don't put the water in reach and kind of hide it *just* in case the patient is NPO after talking w/ the MD, and part of that 20 minutes is spent getting that ready. I also ensure there's tele patches, lead sets for heart monitoring, and any other equipment I might need.
This is what stands out most to me about your post...only once (maybe twice, I wasn't exactly counting), in this quite lengthy post about how things were done to you, do you mention the welfare of the patient.
From my perspective as an ICU nurse, I want to know why the pt is here, what you did for them, and what wasn't done. I personally don't mind if stuff isn't done, but please tell me so I can be ready. E.g. "Mrs Smith is here with sepsis, she came in with a cough/congestion x 1 week with decreased LOC today. She was lethargic and febrile on arrival with RR 40-44 and was working very hard to breathe, so she was intubated with a 7.5 @ 19cm. We gave her rocephin and avelox, 650 APAP for her fever, was started on versed for sedation, heparin for a troponin of 2.39, and levophed for hypotension. She also got a 1L fluid bolus. She has 3 IV's, RFA, LAC, LFA, and a foley." My questions were if an NG was placed (not to complain, just wanted to get one in the room if I needed it) and did she have family in the waiting area. (I had already looked up labs.) Would have liked to have been told which intensivist was consulted.
That's a pretty long laundry list, I think. If my ED did all that, I'd be THRILLED. In my facility, pretty much all of that is up to the ICU --- NOT the ED.
I don't expect much, really. If a patient needs to be admitted to the ICU, they need to go to the ICU. The ER nurses don't have to do 1/2 of my job before I get there. Starting 3 IVs plus antibiotics, plus all the drips....ahhh....yeah. At my facility, not happening. I could see them sending up the patient intubated with an IV, having started the fluid bolus in this scenario, and that's about it....maybe the levophed if patient's B/P was really in the toilet.
I DO get mad if 1. You send up a patient poopy. That's not cool....not cool at all. 2. You send up an ICU patient without an IV. COME ON. You know the first thing the ICU doctors are going to order is either fluids or some stat IV med or products. For us to have to monkey around getting one in along with doing all the admission paperwork and everything else, I feel that one PIV insert is just a courtesy. Please. Please, send your ICU patient to the unit with an IV. Thank you. (I got a pre-op bowel perf about 6 months ago from the ED -- he had to come to me first so I could reverse his INR before he went to the OR. So, with the ED knowing full well that I was going to have to dump 6 units of FFP into the patient, what did they do? Send the patient up with NO IV. Grrr. Another good one...altered MS/unresponsive, ended up being a head bleed -- no IV. Really?) 3. If the patient looks like they are gonna be really sick, are intubated or out/unresponsive, it's nice if you think about a foley. Especially if you have to hold them in the ED for any length of time, please think about a foley.
So that's my list, pretty much. 1. No poop (at least, let me start out that way!), 2. 1 IV, and 3. Maybe a foley, if indicated. I'll take care of everything else.
That's because most critical care RNs (myself included) are generally neurotic, anal, perfectionistic, detail-oriented, obsessive compulsive, hypercritical, control freaks --that's what makes us such good ICU nurses
Im sorry if we come off as unpleasant. Just remember that no one is ever really thrilled to have an admit and ICU nurses need information and it can be frustrating to get such a minimal report.
I used to get annoyed but then I did PACU (which isnt ED but is similar with the whole stabilize and ship them out concept) and I realized that I cant expect you guys to do everything and know everything in the limited amount of time you have with them on top of all your other responsibilities.
this topic comes up a lot. i have worked a bit in both environments. let's start with the assumption that you did your job well, and properly prioritized what we do in the er. it's not your fault an icu nurse doesn't understand your job, and it's not your job to educate him/her. it's not your fault or problem is somebody else is cranky or has an attitude.
so, do a good job with your patient, and give a good report. i have no trouble getting a 2 minute report from another er nurse at shift change, but icu nurses are trained and think differently. putting it into a format that they can understand can help. below is one possible format- or, ask a unit nurse if any of them use report sheets. some of them probably do, and that help you see what they are expecting.
for reasons i have never understood, icu nurses like to hear verbally things that are well documented, and could be more quickly and accurately read. it is not unusual for an icu report to take 10-15 minutes on one pt, mot of which is documented and easy to look up. in a lot of icu's this tradition of a lengthy detailed verbal report has been unaffected by the advent of computers.
my reports often include: "vitals within expected limits, and documented". or, "pt has a complex hx documented in his h&p. most relevant now is his chf and htn". if the unit nurse wants no know when the pt had a gallbladder removed, he/she can look it up.
don't be defensive about things you did not do.
if the receiving nurse wants to know why a ct wasn't ordered, make sure they have the doctor's number. if they think certain labs should have been ordered, they may be right, and can feel free to order them. if they ask me about skin breakdown in a respiratory distress pt, i simply tell them i did not do a head to toe assessment.
i feel bad for the icu nurse when a patient who should have really solid access has a 22g in his finger. or needs a bed bath, or a foley, or dinner. hell, if i had the time, i would have done it. and if i had only 2 patients for 12 hrs, i would definitely do a full skin assessment, but that's not my reality in the er.
here is a thought next time your manager asks what you need for professional development: request to spend a shift in the icu. having an understanding of what happens at the next level will help you provide better care for your pts. you will notice that the unit nurses who don't nitpick the er are often nurses with er experience. and the er nurses who are relaxed about turning a pt over to the unit frequently have icu experience.
one report format:
name
age (gender if not obvious)
pt is being admitted by dr. ________ for:___________
pertinent medical hx
allergies to medications
safety needs-fall risk, skin risk, etc
came to er at _____ (by ems if applicable) c/o:______________
describe pertinent interventions by ems, or at home. (ntg, asa, nebs, etc.)
pertinentassessment findings
interventions including:
meds
fluids
treatments
pt's response was:
other nursing interventions, ordered or not.
vitals including telemetry
pertinent lab and radiologic findings
iv gauge placement, and running gtt's
psychosocial issues: (family concerns, etc...)
for critical pt's a brief systems base report: at least mention each system, even if it is wnl, or you have not assessed it. this shows that you are aware that the system exists.
What you describe sounds pretty normal to me. In the hospital I have just left, after 3 years as an E.D. Tech (I am not an RN, but am bound for pre-nursing elsewhere), the constant area of contention was between E.D. & PCCU (Post- or Progressive-Coronary Care Unit). (There seemed to be no problems with ICU.)
Charts were routinely faxed to PCCU, followed up by a phone call from the E.D. RN to a PCCU RN for report. When the Tech (who was to transport the patient) called PCCU to say, Hey, we're just leaving now, it was entirely--not to say routine--common to be told, "We haven't received the report on this patient," etc., etc.
Read, Delay, more delay, and then some more.
Other issues relating to patient transfer, from a Tech's point of view, could be discussed; but I reckon this'll do for the nursing perspective.
--that's what makes us such good ICU nurses
PMFB-RN, RN
5,351 Posts
I have never observed or experienced any problems between ER vs ICU nurses. Many of the ICU nurses at my hospital also work part time or casual in the ER. We all get along great.
For us the problem is between ICU/ER nurses and the med-surg floors.
Somebody mentioned an ICU nurse wanted to know why a central line wasn't places for an insulin gtt. Why would you need a central line just for an insulin gtt?