I used to work as an ER nurse and now a house supervisor. Two things about the job that baffles me are the floor nurse and on call staff.
What is with the attitude of some floor nurses and not wanting to take patients. When I call to place patients, oh the attitudes and excuses I hear.
Sure, ER should help out where they can and when they can. But when the waiting room is full and the hall beds are taken, cut 'em some slack. Do floor nurses understand the ER has an "open door policy." How many floor nurses have worked ER? It's a different world down there.
Remember most patients are admitted through the ER and it is their first impression of the hospital. Do you know what the biggest complaint on patient surveys are?
Second... on call staff. Two things to say about that. Save the whining for your spouse and if you don't like on call... Taco Bell is hiring.
i have frequently heard inpatient nurses in general, hate the admits because of the paper work involved. yet, our hospital policy gives them 23 hours to complete the admission paperwork. all the info cana be found on the er paperwork. (fact)
i'm a stepdown floor nurse. i love your post. i have some factual comments about my floor too!! #1. i do refer to e.r. paperwork. i ask the patient regarding all meds/hx. we have further paper work. our paper work goes through the entire body. (skin integrity, conditions home, gastro., resp. etc.) we have to ask individually regarding more than 100 diseases/conditions) we have pages of data to go through. but i do refer to e.r.'s paperwork. thanks that does help tons!! (even when a patient is a transfer)
in our facility, patients are not in the halls on the floors (fact). we have a special room on the unit for patients to wait for their procedure (angioplasty/eps etc.). yes the patients have i.v.'s in and we draw blood etc. their direct admits....during the week we're so busy we don't have enough rooms. post procedure's they'll have a room
when the rooms are full, nobody else goes up into hall. whether there are pending transfers/dc's or not. (fact) nope no one's in the hall. they're in the "special" room i mentioned above. because they are still on the unit they are assigned a nurse. for the most part at least heplocks stay in and sometimes monitors are on.
when patients go to the rnf/sdu from our er 98% are completely stable. if there is any concern, we relay that concern to the nurse taking report. (fact) we don't always get stable patients but hey we're stepdown...so we're part of the 2% though we only get a faxed report from e.r. in our facility....the e.r. staff is great. if i have any questions regarding my written report they'll answer everything.
***also jfr...i never saw anybody claim "floor nurses" just sit around and drink coffee......i find that intriuging and funny someone would think that. :chuckle
i'll chuckle at that one too. on our unit we don't get breaks. maybe once every few day's. but i love on the weekend when we have no secretary on the unit (it's policy) only 2-3 r.n.'s and one aide. our phone is ringing constantly. and no one but the aide leaves the floor for dinner. when we eat our dinner at the desk. yes hurriedly and between calls we get comments from family. it doesn't happen often but they'll say, "wow it must be nice getting a break." "since all you're doing is eating....my mom needs some water" as i'm getting off the phone...the call light is ringing and another line is on hold.
so i never did understand the issue of waiting until a half hour before and after shift change, to transfer a patient to the floor. ecspecially when we have 27 people, in a 21 bed er, with 17 in the waiting room. those people then become my responsibility. i have to decide with no room, which chest pain is real, which gib can wait, and which person with sob can get by with a wr aerosol tx. so if i appear a little narrow minded, you will have to excuse me, because that will not change.
in our facility. we have a policy that transfers can occur during change of shift. for the most part they occur right before 4 p.m. or at 10:30 p.m. on afternoons. that would be the weekday. on weekends we get most transfers from e.r. at 10:30 p.m. or right before 7 p.m.
unstable? everybody is busy? ever have to hang nitro, riapro, heparin, do a rectal in the hall, and only have a 12 lead machine, and a nurse on a stick that doesn't record past b/p's and pulses? i have......and will bet that doesn't happen anywhere else. hey my floor all the way. except a hallway rectal...not in our facility. they don't allow rectals for the most part. our patients are on reapro, heparin, integrelin, etc. and only r.n.'s do vitals on our floor. (including p.o. q shift and temp.) yep we have more than one 12 lead we have two.....he he he j/k!!!!!!!!
isn't nursing great!!!!!!!!! i love my job!!!!!!! hey i don't mind admission's either. in fact, in our facility we get along great with e.r. i work two different units and both units get along great with e.r. staff.
Specializes in obstetrics(high risk antepartum, L/D,etc.
I've worked both OB and LTC. (I know, a strange combination) Mom's show up in bunches. We used to say they came in by the bus load. Often they arrive at inconvenient times. Babies show up when they darn well please. Again babies are like bananas, they are in bunches. And we have absolutely NO control of them. So far as the LTC, I think the transfering facilities, be it a hospital or another LTC, wait till near the end of a shift to transfer. Those dear folks arrive when the care givers are trying to tie up loose ends and go home. Also, the grim reaper seems to arrive at similar times. Can't schedule him. Seems like maybe we could just roll with the punches and take them when the come in. Otherwise it's the patient and his family who suffers the most.
Yes, ER also gets patients at 10 minutes before change of shift. But ER is USUALLY the first to get sufficient staffing around the clock. When ER delivers a patient to another unit at 30 mins before change of shift this is needless, repetitive work on ONE of the nurses: Either the ER nurse going home who must give report to the next shift nurse who must transfer the patient to the floor, or the Recieving nurse who is going home in 10 mins, hasn't the time to admit/assess/do the family/etc, and then must transfer that to the oncoming nurse who is starting out FRESH. And that's the whole point. Give the patient to the NEXT shift ON the NEXT shift.
When it comes to basic, move em' in, move em' out transfers, hold transfers for two hours during shift changes. You won't lose your nurses from disatisfaction. Why this stupid numbers game when "staffing for night shift?"
The last 3 nights I have gotten admits from ER 30 minutes before it is time to start report. I work in ICU. It is frustrating but it is the nature of the beast. Our ER nurses work 6-6. We work 7-7. So I understand that they have been there 12 hours and want to go home. So in my opinion. If they have their work done and give sufficient report ( which they usually do) I don't sweat it. Yeah it makes shift change a little hectic but the on comming shift is usually very good at saying "just give me what you've got done and i will take over." We call it teamwork and I think people forget that the whole hospital is a team not just individual departments.
Yes, ED does get sufficient staffing round the clock - for a regular no. of pts. Unfortunately, some days (read most) are NOT regular. When we have pts lying down here for 24 hrs because no facility in the city has a bed to admit them into, we can't put up a sign out the front saying "Department Closed". However if all the ward beds are full, THERE ARE NO MORE ADMITS TO THAT WARD!! Not under any circumstances!! Bypass means absolutely stuff all if every other ED in the area is also on bypass - the ambos are going to come whether you tell them to or not - and even when bypass is actually effective, the ED still gets the same amount of walk-ins as any other day. We CAN'T close beds, we CAN'T cancel elective OT cases to make room, WE JUST HAVE TO COPE!!! (Can you tell I've had this discussion several times in the last few weeks, & I'm sick of it?)
Yes, ED does get sufficient staffing round the clock - for a regular no. of pts. Unfortunately, some days (read most) are NOT regular. When we have pts lying down here for 24 hrs because no facility in the city has a bed to admit them into, we can't put up a sign out the front saying "Department Closed". However if all the ward beds are full, THERE ARE NO MORE ADMITS TO THAT WARD!! Not under any circumstances!! Bypass means absolutely stuff all if every other ED in the area is also on bypass - the ambos are going to come whether you tell them to or not - and even when bypass is actually effective, the ED still gets the same amount of walk-ins as any other day. We CAN'T close beds, we CAN'T cancel elective OT cases to make room, WE JUST HAVE TO COPE!!! (Can you tell I've had this discussion several times in the last few weeks, & I'm sick of it?)
Yes, ER also gets patients at 10 minutes before change of shift. But ER is USUALLY the first to get sufficient staffing around the clock.
Someone needs to let my ER know about this! ...Yeah, l tell the ambulances..."hey, take a few more trips around the block, will ya?....l'm not ready to take another pt right now.".......LR
One of the nice things about moving from a Level I trauma center to a rural ER is that it's usually very easy to get beds - I was used to up to (and sometimes exceeding) a 24 hour wait period. Which is a blessing, because patients think that they will get that floor bed immediately upon being told they're being admitted and then ask you every two minutes if they bed is ready.
I've witnessed lots of game playing when it comes to beds. And it includes ER nurses, floor nurses, nursing supervisors and even the bed control folks. I agree with everyone who says we really need to work on the teamwork here.
However, it is annoying to get admit orders between maybe 6:30 and 7:30 (we all work 6:45 - 7:15 here). It is absolutely impossible to get a bed then, I call it the Bemuda Triangle of Nursing. Also, don't rag on me if I haven't done the floor orders - check and you'll see that I have started the IV and given all stat medications.
Next time the ambulance arrives at your ER, kindly tell them you're in the middle of shift change report and could they please come later, or tell them your maxed out and can't take patients right now. LOL
Stressed out floor nurses, with many patients and no help can't stand getting admissions. We have a policy that the floor nurse has no power to obstruct an ER transfer, if the ER insists they can even fax report if they've tried to call report and have gotten no respone in 30 minutes.
Usually however, the ER is good about working with the floors. I have a reputation for cooperating with the ER, so when I say I can't take a patient, they believe me, because nine out of ten times I take the patient, no whining or complaining.
When I've done house supervision, getting some floors to go the extra mile and cooperate with the ER is like pulling teeth.
It'd be nice if there was mutual understanding, but a lot of people are in their own stressed out little worlds.
I see both sides of the fence when I do supervision. Cooperation is the key.
...Yeah, l tell the ambulances..."hey, take a few more trips around the block, will ya?....l'm not ready to take another pt right now.".......LR
askater11
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