'Us and Them' mentality

I'm concerned with the 'us and them' mentality between the wards and emergency at my hospital. I'm just wondering if it's just me or does it happen in other areas? It feels like I am always inconvienincing them when I take a pt up. We get icy reception and the poor pt often feels like they shouldn't be there. I feel really embarrassed to be there. Don't they realise we are all there for the same reason, and we are all busy. We should be supporting each other. Or is it just me?

It happens across the board and from their perspective you are always inconvenient and you are never welcome. Not because of you naturally, but you are bringing a patient and that implies additional work and probably disrupts their plans to do XYZ.

Same goes with Ward vs ICU and ICU vs Ward, ICU vs ER and ER vs ICU, and I guess Ward vs Ward as well. I've grown used to it over the years. Whenever I bring an ICU patient to the Ward I'm treated on a scale of nicely to rude. I have to admit I just adjust my response style accordingly. On occasion a nasty female dog fight breaks out and management gets involved my management supports me and theirs them. And with that the new week arrives and we start all over again. I learned not take it personal and unless it involves actual hurtful things said, I shrug and tell my patients to do the same.

But I do recognize what you say about patients being in the middle of it and not feeling welcome. It's sad when you see the look on their face. That's why I always try to do my arguing away from the patient whenever possible.

Ha. It's an age old tale in nursing. :)

I'm concerned with the 'us and them' mentality between the wards and emergency at my hospital. I'm just wondering if it's just me or does it happen in other areas? It feels like I am always inconvienincing them when I take a pt up. We get icy reception and the poor pt often feels like they shouldn't be there. I feel really embarrassed to be there. Don't they realise we are all there for the same reason, and we are all busy. We should be supporting each other. Or is it just me?

Ive worked in the ED for 3 1/2 years now, and before that i used to work on a trauma ward so ive seen both sides of it... Ive gotten round it mostly by 'making friends' with as many ward staff as possible. If im friendly and positive and all the initial care tasks for the patient are complete then when i arrive on the ward... no problems... still have problems getting some wards to answer the phone when trying to call them to see if the bed is ready, let them know they need air matresses or IV pumps etc... its like they see the extension im calling from and think NOOOoooo...

An MD from our ER pointed out that we are just as unhappy to hear from EMS as the ICU and floors are to hear from us...and as a former EMT, I can tell you there are endless complaints and recriminations from nurses as you bring a patient in and I TRY to convince my colleagues not to...

nobody likes additional work and a "report" just means, "I am giving you more work to do."

I was a floor nurse for many years before I went down to the ED. The biggest problem we have, is that the floor expects all the admission orders to be done prior to the patient arriving on the floor. They do not understand that the ED has our own orders and that our priority is to stabilize and transport, not to give out routine meds. I have suggested that all new orientees spend one or two shifts in the ED so they can see the process. I think if they understand the process and flow of the ED, they would be a little more understanding of the necessity of moving patients though. One thing the floors don't understand, is that although they can say that they cannot take another patient because of poor staffing, or some emergent thing going on, the ED can never do the same. We have to take and treat everyone that walks in the door.

I often times have seen when a floor nurse comes to the ED as a float, grabs the radio, grabs a chart, and then has a charge nurse telling her to get a patient upstairs because there is a bad trauma on the way in. She/he seems to have a glimmer of respect as to why that patient cant stay in the ED longer. The same goes for floating to the floor. They have hard jobs as well and you are creating further work.

My response to you is to be helpful, kind, and understanding. It may not always work with some of those that suffer with CPO (Chronically ****** Off) but it may with others. Take the extra time to hook up the bed, attached the Tele monitor, perhaps set up the pump with the orders given, etc. Those small actions go a long way and I have seen it first hand.

Jonathan Coleman RN

My response to you is to be helpful, kind, and understanding. It may not always work with some of those that suffer with CPO (Chronically ****** Off) but it may with others. Take the extra time to hook up the bed, attached the Tele monitor, perhaps set up the pump with the orders given, etc. Those small actions go a long way and I have seen it first hand.

Jonathan Coleman RN

In a few words, are you seriously asking me to set your patient up in your bed?

in a few words, are you seriously asking me to set your patient up in your bed?

i don't imagine the "icu vs. the floor" is any different that "er vs. the floor", really. we're bringing them a patient and increasing their workload. when we bring a patient to the floor, we have to wait in the room with the patient until the floor nurse can get in to assume care. as long as i'm waiting, i might as well attach the telemetry monitor, set up the pump, switch over the o2, etc. it's not taking any extra time out of my day and it helps the floor nurse out. so why wouldn't i?

The only time I have seen this done was when I did my senior practicum on a med/surg floor. The PACU was required to wait until the floor nurse came in the room before they left. This was done to prevent the drama of "this patient is not suitable for the floor. too sedated." It was an expectation that the floor nurse literally arrive within five minutes of the patient's arrival. The requirement was actually something like ten minutes but mostly people arrived fairly instantly (even if it wasn't the assigned nurse).

If I were in the situation described by you, I would wait till the floor nurse came in the room to do anything and then, depending on the culture of my ER, I might stay and help. (Most ERs will happily be cleaning your room and putting a new patient in the room and the clock is tick tick ticking away...) Otherwise, the only one of those three things I see myself doing is the O2 for the patient's benefit. The pump is meds you are administering and you should set up (and I find the best nurses will insist on setting their own fluids up).

Further we don't start routine orders until patients have been holding in the ER for two plus hours so I have no routine meds unless I hung them SPECIFICALLY for the floor nurse and the tele monitor is delivered to the bedside and having no specific training on portable tele boxes and it being inside the scope of the practice of the inpatient staff, I wouldn't touch the darned thing.

So...yeah...I guess when I think about it...the floor vs ICU is a little different than ER vs floor because the patient is continuing some orders over from ICU but would be starting fresh if they came from ER. (and rightly so...ICU patients that step down are likely sicker)

We have this same problem in our hospital. I think part of the problem is because of poor staffing, part of it is that we in the ED are all computer, and the units still use paper charting so all admission paperwork is done by hand, and some is just plain laziness. I try to sympathize ( I used to be a unit nurse), but where I worked on a unit we were all computer, so I would get notice that I was getting an admit, and they would be there within 15 minutes, so was MY responsibility to look at the chart and call the ED if I had concerns. At this hospital, the nurses have gooten away with the excuses for so long , that it's just getting old. Our ICU and stepdown units are great (because they understand that they are really the best care for an unstable patient), but the units are hard to take sometimes. We are supposed to give them 30 minutes between admits even if it is 2 different nurses taking new patients. It really bugs me like the OP said, because it makes the patient feel unwanted and inconvenient which is a horrible thing if you are sick enough to be admitted.

We are going over to all computer in August and I have been told that we will not have to call or fax report anymore, and it will be 30 minutes from bed assignment to floor. We'll see how that works out!

I agree that all unit nurses should shadow in the ED to see what we go through, they might just get it then.

Amy

I am not a floor nurse, I am a Cath Lab nurse and ED nurse. I do all of those things but not while the floor nurse sits there and does nothing. I help and that is what we are there to do.

Jonathan RN

Frankly, the "Us Vs Them" mentality, nurses eating each other (not just their young) and punitive management are my most despised aspect of nursing work. Nothing boils my blood more than members of a health care team attacking each other before considering each others' circumstances. I am guilty of being on the attack myself, but largely, at the bottom of this hostility is a team that is understaffed, under-resourced and under pressure. We are members of an emotionally and physically taxing, and often thankless profession. Sometimes frustration simply gets the better of us and assigning blame is our easiest option or outlet, it's just mislaid. I consider myself lucky to have worked in the wards for 10 years, I've walked that mile in the other's shoes and it truly helps when I need to transfer/handover a patient. I know how to make sure that the pt. is as well "packaged" as they can be.

Emergency nurses bring work to a ward/floor nurse who is more often than not already incredibly busy. If the pt. I bring up hasn't had certain things done it creates more pressure and hostility understandably evolves. Facilities create animosity by placing unrealistic demands on nurses who are expected to give far more than they are reasonably capable of, then encourages them to report each other when mistakes are made. Emergency nurses in my city often treat ambulance crews appallingly and I have heard stories of such blatant rudeness I am ashamed. The principle is the same, they bring us more work that we can't manage. I once delivered a pt. to a surg floor and the three nurses at the nurses station saw us, literally turned their backs, and walked away, one even rolled her eyes. The pt. asked me if she could come back downstairs with me. Everyone loses out when this sort of toxic rubbish goes on, especially the patient. I honestly believe that the only way to fix this entrenched mentality is to encourage nurses to work in both environments, it's the only way that we can truly understand each other.