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. :)
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.
so what floor do you work on, Tele? I don't know what "EC" is but I'm assuming this is an ER of some sort.
Sounds like you work in a rough small small dinky town hospital, because poor behavior from poor nurses won't get you too far in a larger town hospital ER.
It also sounds like you should visit an ER, or perhaps float there, to see what it's really like before you judge how another floor operates....
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'
GM2RN: You took the words right out of my mouth for fiveofpeep. I know ED is well-regarded for IV access but honestly, if the patient is a hardstick, its going to take an hour!
In my head, I was thinking of multiple lumen central access which is what ICUs typically need. Two peripherals really won't cut it anyway especially when levophed etc is running!
GM2RN: You took the words right out of my mouth for fiveofpeep. I know ED is well-regarded for IV access but honestly, if the patient is a hardstick, its going to take an hour!
In my head, I was thinking of multiple lumen central access which is what ICUs typically need. Two peripherals really won't cut it anyway especially when levophed etc is running!
my hospital runs levo and dop peripherally so we really could do okay for at least the night with 2Ivs with chicken feet attached to them
As an ER nurse, if you are confident in your ability to provide great care for your patient, who cares what another nurse thinks?! If you send them anywhere in the hospital - alive, breathing, heart beating, and with a diagnoses you have successfully fulfilled your role. The problem now days is every other dept in the hospital wants a patient handed to them on a silver platter... You mean someone else has to work?!
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
One option for those hospitals who have severe ER/ICU report problem would be to eliminate report between them. At my hospital there is seldom any reason for an ER nurse to give report to our SICU nurses. When there is a level I or II trauma that comes into the ER it is the SICU nurses would handle it. We go down to the trauma bay and are the trauma nurses. That way when the patient comes to the SICU the nurses already knows all about him/her.
One option for those hospitals who have severe ER/ICU report problem would be to eliminate report between them. At my hospital there is seldom any reason for an ER nurse to give report to our SICU nurses. When there is a level I or II trauma that comes into the ER it is the SICU nurses would handle it. We go down to the trauma bay and are the trauma nurses. That way when the patient comes to the SICU the nurses already knows all about him/her.
YES! I agree. I dont work for a trauma hospital, but I also think that we should give a report in person with the chart in hand so that we can both look at the patient and the chart together to assure we are both on the same page. Obviously, we would not just bring the pt to the floor without warning, but give a BRIEF background over the phone and then bring them up so they kind of know what to expect...
Amen to brief reports, everything is electronic now. The ICU can see labs, triage notes, MD Record, Vitals... everything that I document you can see realtime in the whole hospital. I still will call report but don't expect much other than the importants stuff from me when I'm an ER nurse, and when I am an ICU nurse I don't expect much from you.
so we really could do okay for at least the night with 2Ivs with chicken feet attached to them
MassED, BSN, RN
2,636 Posts
so what floor do you work on, Tele? I don't know what "EC" is but I'm assuming this is an ER of some sort.
Sounds like you work in a rough small small dinky town hospital, because poor behavior from poor nurses won't get you too far in a larger town hospital ER.
It also sounds like you should visit an ER, or perhaps float there, to see what it's really like before you judge how another floor operates....