The War with the Floors

[zima60]

I am writing a paper for school on the all out war that goes on between the ER and the floors. I have worked at several hospitals for the last 27 yrs-it's always the same. They do everything in their power NOT to take report. Is this a problem for you? Please tell me how you handle this at your hospital. Does your administration pamper the floors? Do you utilize fax reports? Do you have a time limit for patients to be sent to the floor? What is working in your hospital? Appreciate your input! Pam

[33-weeker]

ER vs. the floor are not the only ones with this problem. We see it too in L&D vs. Post Partum.

Some L&D nurses will hold on to their PP patients when there is no medical reason so that they won't get new admits. The problem is that PP gets slammed with admits all at once just prior to change of shift.

The same is true for PP (and nursery). They will 'forget' to erase their patients off the board so the charge nurse will think they still have a full load and not give them more or send them home early when census drops.

[lyraesullivan]

I don't hold on to patients til the end of the shift just to annoy the floors, but I think we have already covered the myriad reasons why that happens. what gets me is the floor refusing to take a patient at change of shift, does all nursing care come to a halt because of report? Of course not. There is no reason the patient can't go up to a bed, get greated by a nurse, quick set of VS and tucked in until the next shift comes out of report. Don't tell me that this can't happen because I have worked the floor and ICU and that is exactly what we did.

Please remember why we are here, to take care of patients. They are our customers and we have to treat them well or they will vote with their feet. Good customer service is not keeping them laying on a hard uncomfortable ER cart in a noisy chaotic ER. Would you want to be in that environment if you were sick? Good customer service is having someone from the floor in the room to great the patient and make them feel welcome. Have the furniture moved and the bed turned down. The patients see these things (or lack of them) and it makes them feel welcomed. Think about how you would want your mother/father/etc treated if they were in the ER and needing admit or sitting sick in the lobby because there was no open bed in the ER to lay down on.

We are all busy and overwhelmed, no one place more than another but remember, the ER is the front door to the hospital. The ER I work in brings in 60% of the hospitals admits. Without those admissions we'd all be out of a job!

[Jen2]

I don't buy the shift change thing. I stated before, the shift change in the ED means nothing. A lot of our shifts are 11a-11p, and 3p-3a. The floors at our hospital record report. When the 7a or 7p nurse comes in to start listening to report this means that either day shift or night shift is there until 0730a or 0730p. The half hour overlapping is supposed to be for getting a new admit in the room, and to be able to answer questions regarding the taped report if needed. It is not intended to give a half hour to change shoes, put coat on and stand by the time clock until it's time to punch out. Which I see often. I work 7a-7p also in the ED and when I am taking a patient up at 7p I will see people standing at the clock with their coats on. I go to the room move furniture around, turn the bed down, get the patient in the bed, go to the nurses desk to get the telemetry pack because I cannot leave a monitored patient unmonitored, orient the patient to where the bathroom is and call bell is, pack up all of my equipment, go back to the ED, and report on my patinets it is now 8p and the hospital has now paid me a half hour overtime. Believe me no one likes to take a patient up at shift change, but it has to happen that way sometimes. Holding on to my patients. Are you kidding? Thats one of the main reasons I work ER is so that I can get rid of them just as soon as I get a bed. Sometimes I cannot take them upstairs even after I know I have a bed until the bleeding headwound is stapled or the broken bone has been reduced under sedation. I cannot transport someone with blood spewing from their head. So yes there have been times when I have had a bed for an hour, but did not transport the patient until shift change because I had to make sure all the ABC's were covered first. When thats done the patient goes upstairs. Believe me there would be no better benefit than to not have to deal with the politics of taking a patient up at change of shift, because I would like to leave on time also, but sometimes it just has to be done.

[JessicRN]

I don't hold on to patients til the end of the shift just to annoy the floors, but I think we have already covered the myriad reasons why that happens. what gets me is the floor refusing to take a patient at change of shift, does all nursing care come to a halt because of report? Of course not. There is no reason the patient can't go up to a bed, get greated by a nurse, quick set of VS and tucked in until the next shift comes out of report. Don't tell me that this can't happen because I have worked the floor and ICU and that is exactly what we did.

Please remember why we are here, to take care of patients. They are our customers and we have to treat them well or they will vote with their feet. Good customer service is not keeping them laying on a hard uncomfortable ER cart in a noisy chaotic ER. Would you want to be in that environment if you were sick? Good customer service is having someone from the floor in the room to great the patient and make them feel welcome. Have the furniture moved and the bed turned down. The patients see these things (or lack of them) and it makes them feel welcomed. Think about how you would want your mother/father/etc treated if they were in the ER and needing admit or sitting sick in the lobby because there was no open bed in the ER to lay down on.

We are all busy and overwhelmed, no one place more than another but remember, the ER is the front door to the hospital. The ER I work in brings in 60% of the hospitals admits. Without those admissions we'd all be out of a job!

I so agree with you can you come and explain that to the nurses on our floor. First we fax report and are told 30 minutes (we are not given beds until everything is done on the floor). If the 30 minutes is at shift change we have to wait until after report (up to 1 hour) before we can send a pt. No they are not seen by a floor nurse. They are placed in bed by us and usually by the time we are leaving the aide comes in rarely do I even see the RN. So why the wait? The only one who suffers is the patient. The ICU and Step Down are different we have to wait but the pt is greeted by the RN.

[anne74]

I've worked on both sides - although I'm in the PACU rather than the ED. We have the same problem with trying to get patients up to the floors.

However, as a former floor nurse, I recall how difficult it was to admit patients when you're already swamped with handling your existing load. Admitting a patient requires more than "greeting them and tucking them in." There's also a huge load of charting involved, not to mention you have to drop everything your existing patients need. When you admit a patient near shift change, you can count on being there an additional 1.5 - 2 hrs, charting the new patient info, and then finishing the stuff you never got to with your previous patients. Staying hours late once in a while is expected - but if you don't try to manage it, it will become a daily occurence. You ED people make it sound like floor nurses are just sitting around and simply not in the mood to get a new patient.

Also, on the floor - or the unit for that matter - you may not have the constant influx of new patients, but you have to go much more in depth with your patients. In the ED - and PACU - your main focus is on ABC's, vitals, triage, etc. On the floors, you have to fix the issues that couldn't be dealt with in the ED.

I really enjoyed the inference that we should be grateful for the ED because they bring in our customers, and without the ED we wouldn't have jobs. Please - it's not like we're hurting for business.

Everyone is stressed beyond our limits. It's easy to blame the other side, but you really don't know what that other nurse is dealing with at the time. Give them the benefit of the doubt.

[NicoleRN07, RN]

This is a huge problem where I work. I have been on both sides, so I understand that getting new patients is a lot of work, but at the same time, as an ER nurse, I get a new patient every time I turn around. We have a very busy ER, and need to get patients to their rooms as quickly as possible, and I do everything in my power to make that happen. I had to Clinical Coordinator tell me one night that the Progressive Care Unit, just couldn't possibly take my patient for at least another hour, because things were just "too crazy up there". As the charge nurse, I had the primary nurse place the patient on a life pack, portable O2, and we went upstairs with the patient and gave a bedside report. The patient had already been there for hours, I had 40 people in my waiting room waiting to be seen, 6 which where chest pains, a trauma 10 minutes out, and EMS hitting us every which way we turned.....I didn't want to hear any complaints about being too busy. BTW, when we arrived on the floor with the patient, the nurses were sitting around the desk laughing, talking, and having a good ole' time.

[CaLLaCoDe, BSN, RN]

Jennifer RN quote: I have found that as an Ed nurse, some floor nurses are never happy with report or receiving pts. Being on the other end of the phone while trying to call report has been a real eye opener on how rude and obnoxious some (note: I said some) floor nurses can be

I am so grateful for the ER nurses...for what they go through and how they handle everything and I go out of my way to make the transition to the floor for an ER patient smooth and effortless... I hate it when I here a nurse (one with experience) sounding like a drill seargent with these good ER people..really sorry.

The ER nurses receive very little thanks for their work; I as a Tele nurse can't help but be reminded from this above ER nurse's quote to remain kind and thoughtful with our ER staff, a dream team and not to be taken for granted. :+)