When will everyone understand things are different in the ER

~Mi Vida Loca~RN, ASN, RN · Jul 6, 2017

You work in a facility where you have your patient for 30 mins 27 of them stabilizing and they already have a bed and nurse to report too??

prmenrs, RN · Jul 6, 2017

Hypothetically, put the shoe on the other foot: you've got 30 minutes left in your shift; you need to close your charts out; answer those last minute call lights (@ opposite ends of the unit); check your charts in case some [damn] doc has sneaked an order in there you missed; gather your thoughts and brain sheet for report; take Mrs. "I can't go, Nurse!" off the pan for the eighth time today; check a blood sugar on Mr. "I don't feel so good."

Night shift is drifting in; an admission takes 45 mins to an hour, minimum. How would you feel, getting a phone call for an admission? Seriously, you've just handed him or her an hour's worth of work, paperwork to follow. You also know this will put you overtime, for which admin will now question your parentage.

I'm just saying give the freshly resuscitated customer a couple of moments to be monitored and then transfer him/her.

Nalon1 RN/EMT-P, BSN, RN · Jul 6, 2017

Hypothetically, put the shoe on the other foot: you've got 30 minutes left in your shift; you need to close your charts out; answer those last minute call lights (@ opposite ends of the unit); check your charts in case some [damn] doc has sneaked an order in there you missed; gather your thoughts and brain sheet for report; take Mrs. "I can't go, Nurse!" off the pan for the eighth time today; check a blood sugar on Mr. "I don't feel so good."
Night shift is drifting in; an admission takes 45 mins to an hour, minimum. How would you feel, getting a phone call for an admission? Seriously, you've just handed him or her an hour's worth of work, paperwork to follow. You also know this will put you overtime, for which admin will now question your parentage.
I'm just saying give the freshly resuscitated customer a couple of moments to be monitored and then transfer him/her.

While admin questions your parentage for taking to long to get the patient upstairs.

Plus the 20 patients in the waiting room are getting mad for the 3 hour wait, and EMS is standing in the hallway waiting for that bed for their stroke patient.

I have 30 minutes left on my shift as well, but need to get this one up so I can start the stroke patient.

Plus the other 2-3 patients that still need to be taken care of. Guess what, they have been on the bed pan 3 times in the past hour and "just can't go" (or have been given lasix and keep going), one needs a blood sugar re-check since his sugar was 32 when he came in and it has been 30 minutes since the D50 was given, and stat orders just placed on all of them as well.

The gripe is about floor nurses asking questions that don't matter to an ED nurse and truthfully nothing we can do something about, not about getting the patient upstairs.

Nothing against you, but your post is a perfect example of what is being griped about.

ShirlinDC · Jul 6, 2017

My head is swimming. Who is responsible for operations at a hospital? I'vs always had a fasination with logistics and how systems and processes work. Where can I go to find out about hospital operations?

Racer15, BSN, RN · Jul 6, 2017

I think OP is referring to patients you inherit with basic information because they are so critical. I try to be empathetic and understanding, but I don't get to delay taking a new patient because it is shift change or I am busy.

JKL33 · Jul 6, 2017

Don't really butt heads too much any more, it's only ever worth it if it's a matter of patient safety, ethics, or legalities anyway. Anything else is just ego vs. ego. Avoid that. Just refuse to be provoked.

Be ready with a relevant and concise report. Anything else, make no excuses and don't get mad, just use your calm/pleasant voice and say, "I don't know. That wasn't part of our focus down here".

Editorial Team / Moderator · Jul 6, 2017

I like it when ICU gets to float to the ED, and vice versa. It's always eye-opening to see how the other half lives.

bgxyrnf, MSN, RN · Jul 7, 2017

Do any other fellow ER RNs butt heads with other departments when transferring a patient up from the ER? I think sometimes other departments forget I only had this patient for 30 mins and for 27 of them I was trying to keep his heart beating. So no, I don't know when his last BM was or if he got a flu shot this year....

I don't butt heads over questions that I can't answer... I just say, "I don't know" and leave it at that.

What I find frustrating is the refusal to answer the phone to take report followed by protestations of "I didn't know that I was getting that patient" followed by "You'll have to wait so that I can find a bed for that room" and all the other stalling tactics.

3ringnursing, BSN · Jul 9, 2017

One thing that made me want to leave acute direct patient care in any capacity was the unrealistic expectations and extreme stressors placed on myself, and all of my brother and sister nurses doing the exact same thing in various departments scattered all over the hospital. ER, ICU, MED-SURG, PACU, OR, special procedures, cath lab ... It mattered not where you worked it was tough. And no one got to go home on time, or often get a full lunch.

I remember one day in particular (1999?) being charge nurse in our ICU (most people refused) and having 2 patients of my own was the norm. A nurse was telling me about one of her patients circling the drain and possible pending code - I looked up and rolling down the hall from PACU was a fresh AAA patient I didn't know about, and from the other direction was rolling a patient coming from ER that had just had a cardiac pacer floated in that I also didn't know about. We had open beds - but not enough nurses! Calgon: take me away!

EDNurseT · Jul 9, 2017

Haha!! I know EXACTLY what you are talking about..and no they don"t know. I think they have an idea but their brains are on a different wavelength due to the type of care they are focused on..Let's face it, all of us have a different objective and if nurses from other departments need to ask us these questions then just take a deep breath and tell them you don't know. I say this with the greatest respect of course, my brain doesn't work like the brain of a med-surg nurse, or even a ICU nurse. We all have our specialties...so I love your vent as I have said this very thing many times with desperation..just go with the flow..it is what you do best!

Guest219794 · Jul 9, 2017

Even if I am not particularly busy, and the patient is not that critical, I still don't know all the answers that a floor nurse likes to write down on a piece of paper.

It is not part of my job to know these things, and I don't waste my time memorizing details that are already written down somewhere. For example, I don't know what the last vitals were, but they are charted in the computer. And, if they were relevant, I would know them. It is irrelevant to me whether the SBP is 130 or 150. If it is clinically significant, I'll mention it. If it is something I treated, I will know the pretreatment SBP, as well as the response to treatment.

I have found that it actually saves time if I pull up the ER doc dictation, or the admitting doc H and P. Then, I spout off an abbreviated version of something that is easily accessible to the other nurse. If they ask a question not covered, I will sometimes say- "I don't know- would you like me to look that up?" (in the chart we both have equal access to.) They generally miss the irony, and wait, pen in hand, so I can read something aloud as they write it down.

While I believe this is an absurd waste of time, it actually can save time and avoid ruffling feathers.

In general, I think a lengthy verbal report is an out of date vestige of the pre-computer era. I think it is a dangerous game of telephone, (maybe I am dating myself by mentioning this old game.) and the practice should be banished. In what other industry is critical information electronically documented, then verbally communicated so it can be hand written?

And, yes, I clearly get the message sometimes that I must be a slacker because I don't do my job the way a floor nurse does hers or his. This is weird to me. I completely accept that their job is different from mine, and don't expect them to think the way I do.