What Would You Change??

shill · Sep 25, 2006

I know one thing that I would love to change but it would be impossible, is to make the primary care physicians to stop telling their patients,:angryfire "if you're not feeling any better go to the ED". Sure it's different if the patient is short of breath, continued chest pain, conditions that are life-threatening etc. etc. etc.. That's different! But you get the ones that come in let's say, one example: with pain to their left wrist, from a fight :smiley_abthe were in at school yesterday, and Mom says," I called my doctor and told him about it and he said go to the ER". Granted, we do take an x-ray and 99.9% of the time there is no fracture, and send them home but the instructions to take ibuprofen and instructions on R.I.C.E.

:idea: How about changing the "Floating nurse" to "Keep going Nurse"... the keep going seems to be self-explanatory, and the floating title has a need to be explained to some nurses, at least where I work.

mysticalwaters1 · Oct 1, 2006

Not having to fight with the floors to get them to take admissions.
Not having to hold admissions in the ER for a couple of days.

I have been working in our ED now about 5 months. I really like it although still nervous with very critical pts. But I worked med surg for 3 years prior and there was allways this clash between the floors and ED. You really do not know what it's like until you've worked in each area. I understood ED very busy and you allways take in pts no matter what but had no clue how it felt untill I started down there. And wow did it open my eyes. Unless I was right in the middle of something on med surg I'd take report from Ed. Our ED now states the floors should treat ED report and taking the pt as OR pt's are treated. OR they take or send immediately just the nature so if there is a bed we need to take pt's upstairs was the point and I had to admitt the attitude to take OR stuff was more urgent than Ed pts.

It's no excuse but a lot of it is both sides are extremely busy, understaffed. But ultimately I think one huge factor is time management. I've gotten way better but many do not have it. I found the more experienced nurses I mean 20+ had it and I was floundering. But after a while with our turnover increasing draumatically a lot of my coworkers even myself it became a challenge to get everything done and having to deal with an admission comming in could be overkill and I know of many who would put it off.

Now our new critcal beds the pt's from ED are not allowed to come up b/c not lack of beds...no staff. So it strains the ED staff b/c we do not take admissions it's ED and it is incredibly frustrating and it's not the nurses fault.

A lot staff including Ed managers keeps saying can't they (floors) take an extra pt and I feel so torn b/c you want the pt's up there to make room for others but it's dangerous if not enough staff upstairs to even care for the pts. So then it's this war between one another with no respect b/c well you don't take the pt so you're screwing my liscense. It's just a mess and I really feel management feeds off this crap.

Now that I'm in the ED, I can't BELIEVE how many times I call for report and 9/10 x I get let me have your extension I'll call or so and so call you back. I totally get it's busy. Just how come certain busy med surg floors I can give report quickly but some of our telemetry floors I can't and it's same people all the time. I think it's b/c in our telemetry it's not uncommon for several admissions, get admission begining of shift and discharging at the end. Now our critical areas have had at times no manager and in 10 years our ICU had 10 different managers so I think staff have become complacent WITH getting busier.

But my experience comming from med surg floor...I would freak with just bp of 160/80. An ED nurse call report and I'd hound does MD know? I cringe now thinking about all the stuff that would frustrate me. So my priorities were different. And a peds nures I know had several issues she felt the ED would downplay critical cases just to get pts upstairs. Now look at me freaking over bp 160/80 could it be maybe not as critical as she thought but still lots work and followup? I don't know. She says Ed only worries about immediate needs and no one else. Now that is Ed nature but I don't think totally like that. I think it depends on the nurse. With Ed you may not experience something for an entire year then take care of someone and looking for someone with experience to ask ?s (but I do like how this makes ED so much different). The peds nurse complaints was that ED nurses with especiall infants drew blood from IV line and would clot off the line. I was originally taught to not stick an infant multiple times or make sure it's good first time. But I asked around and found out no you do not sacrifice a line on infant for blood draw b/c you can allways get a heel stick so only draw blood from line if it's very good. It freaks me b/c I didnt' know that! I'm really annoyed my ED educator was gone 2nd week into my orientation and had none for my entire orientation. Got a new educator my last few weeks of orientation. I'm not stupid, I ask ?s but I still wish more direction. I've seen a lot during orientation, active MIs, mult trauma with transfers, DKA ect.

But maybe management needs to find out all the complaints each side has and devise more edu on it. Just talking with the peds nurse helped me a lot just for I don't work with kids every day. I also found out Rocephin Im very painful especially in kids and lidocaine with it can help. I had no idea!

But especially ICU holds in the ED while interesting can be so time consuming. I took care one ICu pt, DKA and AWESOME experience but I had no time with other pts! It's not fair.

Another thing...with ED our #s of pts in are consitent so a required #staff remains, whether we have it all the times that's another issue but on our reg floors if certain pt census they'd take a nurse off. So then admissions would fly through and you still have the workload originally b/c even though census is low you still have the same pt load compacted now with a high # of admissions. Then supervisor would find another nurse after nurses already drowning and the entire thing totally ineffetive. Not to mention one holiday a nurse was allowed go home. Then admissions and pt's in ED a lot and had not enough staff upstairs b/c that nurse was let go then there was no replacement or way to get that nurse back. Then they were ED hold. It's disgusting!!!!!

Sorry I'm really going off here but honestly each side has there own issues but I have to admitt in the ED you really have no clue what's comming in so those pts do need to leave they can't hang out in the ED b/c we need our staff for all the pts comming in. Floor nurses I don't think it fully hits b/c they are in their own area and only worried about that which maybe is absolutely correct but it does create this discord between both sides and management should do more to fix it.