The War with the Floors

JessicRN · Aug 31, 2006

We tried to get three pt's up to the floor and was told to wait so the nurse could finish her meds. Iwas strange since all three pts had different nurses but we still can only send up one pt every 45 minutes. Onr of the pt's was confused and was climbing off the bed. We only have stretches with no alarms. As a result, a pt who should have been in a bed with an alarm jumped out of the bed and fractured her hip in many places. OH WELL the floor did not get that pt the pt went to the ICU and left 10 minutes after she was given a bed

Furoffire · Aug 31, 2006

I was always used to a phone report from the ER and like it that way. Now we receive faxes and I hate it. The ER faces about 10 pages of stuff and its just too overwhelming on a crazy unit as it is. I don't have time to sit down and make sense out of all the paperwork, which is nice like labs etc. but I have missed stuff. With a phone call I get just the "facts" and its alot easier for me and more effective.

RN2MSNasap · Sep 3, 2006

We give verbal report...by and large if there is a bed available and clean, and it is not change of shift giving report is generally not a problem where I work...The thing is that we change shifts at 6 and the floor changes at 7..We in the ER are generally mindful and respectful of that and give them a chance to settle in....I know it from both ends as I was a floor nurse for many many years and I know the feeling of having 8 to 10 patients, and having to take report and its close to the end of the shift...but there are times when there are ambulances backed up and you have to give report and get the patient up regardless of the shift change..but i think at least in my experience the communication between the er and the floor is generally good

SteveNNP, MSN, NP · Sep 6, 2006

Hi all,

I work in a Level I 80-bed ER, and we fax a one-page report form to the floor, then call to ask if they got it, and if they have any questions. If it's a critical pt, I'll call report. While I haven't worked ED that long, also having worked ICU/floors, I understand both sides. Once I "hear" that the pt is going to be admitted, I fill out the fax. I send it as soon as a bed is assigned. The reason my pts come up 2 hours after I send report is that I probably got 1-2 new sick pts to start IV's, give stat meds/tx, code, take to Xray/CT/MRI. I'll bring them up as soon as I have a free minute. Once I get my tail back to the ER, there's probably another critical pt in the bed, and my coworkers will be connecting monitors, charting, pushing meds, running crowd control. RN's get 4-5 pts each, with any acuity level combination. The floor nurses complain about getting 2-3 pts at a time from the er *per floor.* WE can get 4 pts at one time PER RN! I start out my shift with 4 pts and end with 4 completely new ones, having probably seen, transferred/discharged 12. If my pt's a mess, I apologize. It's only because I have 4 other critical pts to go back to, and I didn't have time to change his gown/sheets while we were coding him (the first time.) For the most part, the floors are good about taking report and opening up beds. The ED is the literal front door of the hospital. We can't make more room once our beds are full. We HAVE to get the pts to the floors so we can make room for the traumas/criticals who can't wait in triage, even if it's 7pm.

**zipping up flameproof suit*** ;>P

UM Review RN, ASN, RN · Sep 6, 2006

Hi all,
I work in a Level I 80-bed ER, and we fax a one-page report form to the floor, then call to ask if they got it, and if they have any questions. If it's a critical pt, I'll call report. While I haven't worked ED that long, also having worked ICU/floors, I understand both sides. Once I "hear" that the pt is going to be admitted, I fill out the fax. I send it as soon as a bed is assigned. The reason my pts come up 2 hours after I send report is that I probably got 1-2 new sick pts to start IV's, give stat meds/tx, code, take to Xray/CT/MRI. I'll bring them up as soon as I have a free minute. Once I get my tail back to the ER, there's probably another critical pt in the bed, and my coworkers will be connecting monitors, charting, pushing meds, running crowd control. RN's get 4-5 pts each, with any acuity level combination. The floor nurses complain about getting 2-3 pts at a time from the er *per floor.* WE can get 4 pts at one time PER RN! I start out my shift with 4 pts and end with 4 completely new ones, having probably seen, transferred/discharged 12. If my pt's a mess, I apologize. It's only because I have 4 other critical pts to go back to, and I didn't have time to change his gown/sheets while we were coding him (the first time.) For the most part, the floors are good about taking report and opening up beds. The ED is the literal front door of the hospital. We can't make more room once our beds are full. We HAVE to get the pts to the floors so we can make room for the traumas/criticals who can't wait in triage, even if it's 7pm.
**zipping up flameproof suit*** ;>P

Steve, please.

We all work hard. We all have patients that code or turn from great to critical in a matter of moments. We all have unbelievably impossible expectations thrust upon us from management.

I've been over this ER vs. the Floor thing ever since I realized that the ER nurses have as little control over who goes where and when as we do--and maybe even less.

May all your patients survive and be admitted to the Floor.

~Peace.

mvsnurse2b · Sep 12, 2006

Hello again, since my last posting we no longer fax report to the floor. It seems rather than getting typed information that was complete and sent at least 30 minutes in advance of the patient's arrival-some administrator or nursing supervisor/manager from the dark ages have decided that report must be verbal. So for those of us in the ER who are dealing with disasters(what else is new?), coding patients, assorted drips (that can only be done here or in ICU) etc. etc. now we must wait for our receiving nurse to take report. Of the past five days-I have done 4-13 hr shifts. On each of these days my admits have sat for the day!!! No one can tell me why. Although I give kudos to our hospital for not sending patients to an unstaffed floor-our waiting rooms have gotten ridiculous. What ever happened to your doctor directly admitting you to the hospital? Why are all of these people coming through the ER? And why does any floor nurse under these circumstances not love us? The iv access is established, all admitting paperwork and initial assessments are done, labs, dx, and initial meds as well as orders are written and established by us-in addition, to our "real job" of ER nursing. I just don't understand why we can't get along. Nursing is a second career for me-I don't get the hostility that emenates within the ranks. Get it together people-the business world is just as hard-the rules and the customers are just as tough-but employees take on challenges together. We need to do the same as nurses and make our work environment a little more supportive, so that the job gets done with less stress. If we don't help each other-who will?

noelle4 · Sep 15, 2006

Yes, funny...but let's turn it around...
I work in the ED and we are never busy. We just sit around the nursing station talking with docs or hang out in the ambulance bay flirting with the firemen. We do get a lot of patients, but we don't cover them, clean them, water them, or feed them. Hell, we barely speak to them. When a patient is ready to be admitted, we watch the clock and wait until we know the receiving nurse is at lunch, out smoking, or still in report. We are so bored in our department that we have time to keep track of the individual flooor nurses' schedules. We also know that the inpatient units are the only places in the hospital that actually work hard so try not to get too upset with us.
The shoe can fit on either foot. Can't we all just get along? :balloons:

I'm just seeing this post for the first time today, but feel I have to comment. I've been on both sides too and I have to side with the floor and Donn. I LOVED the ED, and will return one day. Most of the RN's were great, hardworking people. BUT...there actually was the same small group that DID sit at the nurses station most of the time, actually READING magazines, and then changing personalities before my eyes when there were paramedics around (even some married RN's ), shamelessly flirting...It was pathetic. I was told not to accept no for an answer when calling to give report b/c "they (tele, ICU, etc) just don't want to take the pt and will stall.." I almost believed it until I transfered to a tele unit and saw for myself.

I'd love to hear more from others who have experienced this.

Jennifer, RN · Sep 16, 2006

I worked on a tele unit and now work in the ED. I have seen it from both sides and can tell you that I had more lunch breaks, smoke breaks (though I don't smoke now) and sit on my ass breaks when I worked on tele than I ever have while working in the ED. In the Ed, I barely get to eat, pee, or whatever. All I do for 12 hours is run, run, run.... When I worked on the floor, at least I knew what was wrong with my pt. In the ED, the pt comes in with a general complaint and the problem could be a STEMI vs acute CVA vs ingidestion. WE DON'T KNOW. When I call report and the floor can not take report, I give them 10 minutes. I think that is an acceptable time unless they are coding someone. I need to get my pt's to the floor the make room for more sick pts without a diagnosis.

nuangel1, BSN, RN · Sep 20, 2006

I have experienced this from both sides. I HATED getting admissions at shift change when I worked on the floor. Actually I hated getting admissions period. They were usually a lot of work and took a lot of time away from my other patients on the floor. Working as charge on the floor was even more frustrating because I would have to not only deal with the cranky nurses on my floor who would try to refuse to take the pt, but also with the ER staff and administration. What a headache.
On the ER side, I truly lose track of time while working. I forget to eat, forget to pee. I usually work 11-11 or 3-3, so 7-7 means nothing to me. I forget it is shift change on most other floors. And other times, I have the charge nurse, the nursing director of the ED, the nurse manager, and the medical director of the ED on my case about moving pt's out NOW to make room for the pt's rolling in the door by ems. Going on divert is the ultimate LAST option. Sometimes, I have no choice but to call report when I call it. And trust me, most of the time, before the bed is even down the hallway, I have another "admission" in my room waiting for my happy, smiling face to put them at ease.
I have found that my attitude defines how beautiful or how crappy my day is going to be, no matter where I work. If I am getting the life sucked out of me by a busy day, I try to laugh it off in order to stay sane and productive. The same goes with getting an attitude from another nurse about bringing a pt up to the floor. I brush it off, because, ultimately, I am going to go home to my beautiful family and the silly, petty things we all argue about at work will not enter my mind or bring me down. Our jobs as nurses are challenging and difficult, even on the best days. We need to try to treat each other with a little respect and have a little dignity in how we communicate with each other. Our attitude at work reflects our attitude with life in general.

i too have worked floor/er/icu .we all work hard and need to try and understand each side .very well said jennifer.i agree with you.

NativeSundance, LPN · Sep 20, 2006

Our hospital tried faxed reports and it failed MISERABLY. Abysmal failure and total breakdown of communication. Scrapped the fax and went back to verbal report. It just works better, at least at our hospital.

The ED is insanely busy and so are the floors. There is little chance of pleasing both. Either the floor nurses are pissed off or the ED nurses are. Most of the floor nurses have never worked a single shift in the ED and have no idea what really goes on there. Likewise, many ED nurses have never worked on the floors and had to deal with the short staffed dangerous pt care assignments. I have no idea how it will ever be resolved. Probably never will be. The floors and the ED will likely dislike each other into eternity.

mysticalwaters1 · Oct 1, 2006

I worked on a tele unit and now work in the ED. I have seen it from both sides and can tell you that I had more lunch breaks, smoke breaks (though I don't smoke now) and sit on my ass breaks when I worked on tele than I ever have while working in the ED. In the Ed, I barely get to eat, pee, or whatever. All I do for 12 hours is run, run, run.... When I worked on the floor, at least I knew what was wrong with my pt. In the ED, the pt comes in with a general complaint and the problem could be a STEMI vs acute CVA vs ingidestion. WE DON'T KNOW. When I call report and the floor can not take report, I give them 10 minutes. I think that is an acceptable time unless they are coding someone. I need to get my pt's to the floor the make room for more sick pts without a diagnosis.

I guess it all depends. I found a lot of busy times in med surg I couldn't get to my meal break. In the ED it can be so many people comming in I have no time for meals or bathroom break, however I work nights so I found if I brought food and when it would slow down I had time to eat and talk with coworkers, and others would read magazines but I had to do it at the desk. But some nights it never slows down and I'm lucky to scarf a power bar down if that (in fact I didn't drink water hardly and had several leg cramps some nights). I think that's what the floor nurses feel is this unpredictability with degrees of business but at the same time it is the sole reason why pts need to move out to keep the ED flow going. I do notice lots of my ED coworkers it's allways the floor just doesn't want the pt, and this may be true to an extent but all of us are busy and differnt areas of work.

I did find in the ED we had way more teamwork and maybe it has to be so the nature of ED than I had on the floors. I was on a very heavy respitory med surg floor, then we hired some coworkers who were very lazy (I loved them as people but HATED working with them) low staff all the time b/c even the float nurses hated our floor. Just heavy constant care, needy pts. My theory was incopacitated unable to breath people therefore anxiety levels much higher and more support needed for them and it was so difficult. Also I felt stagnated there no advancement. Kept seeing the same stuff and same bull between different mds and the management of care with the pts. I mean no decisions being made. pt's staying literaly for 6 weeks. Could not stand it. Depressed, I cried, I HATED comming to work. I wanted try ICU but no job openinings. SPU became very appealing just to meet and greet treat the pt then let them leave became VERY appealing to me b/c I couldn't stand the constant care type pts which made me wonder do I really want ICU?

Finally I saw and ED position. I allways thought ED, NEVER just b/c you have no clue what's comming in and that made me very nervous. ON med surg even though stuff can be unpredictable you still had a framwork of your shift, med pass assessments ect. I was so desperate to get off this particular floor I didn't even want to try med surg. I wanted something totally different. Then I got to thinking there's ICU situations in ED, so many different pts so you don't stagnate, you do tons IVs so that skill would improve as well as other nursing procedures like NGT, OGT, they'll train you in code situations, you'll be doing code type situations more than on reg floor and deal with LOTS of intubations so you'll know the procedure with meds and at least the airway can get secured, if heart stop go what you know do the best you can. So I thought why not? And boy am I SO ECSTATIC I did it. So I ultimately came to the decision I don't ok I'll be honest I detest med surg nursing. Now does it mean Ed less busy? I think it's just a totally different setup. And I like ED setup better than Med surg. IN med surg it is constant care and many times horrible to say it is very hard to treat pt's and families continually. In the ED you for that moment do what you can and send people on there way. You don't have this heaviness to repeatedly deal with the same care over and over again mixed with bad managment and poor cooperation with coworkers. I might have just had a very bad experience but I know many nurses do not like med surg. EVen 2 of my ED coworkers med surg nurses one for 10 years and other 20+ were awesome med surg nurses and they couldn't take it anymore. They love the ED and say they'll never go back. WHAT HAPPENED! I did notice on med surg the pts seemed sicker and sicker.

Once again I don't think any one side is more or less busier I think it's the delivery of care is very different. I love the ED right now. Not that it doesn't have issues, I can't stand some of my coworkers cocky attitudes but at least there if you are not lazy and help as you can and jump in to do your part it's ok.

hogan4736, BSN, RN · Oct 1, 2006

... I see a cart going down the hall with and ER nurse pushing it. I ask stunned "are we getting a patient?" Technically yes, but do they come with ANY orders? Nope.

Call for orders...ER docs should NOT manage inpatients, period...