Why am I now the enemy?

Horseshoe, BSN, RN · May 14, 2011

I am sure this topic has been discussed to death but I need a brief vent....
I was a floor nurse for about 3.5 years..... I know and understand how stressful floor nursing can be. As a travel nurse working on an intermediate care floor, the ratio was 7-8:1. I would usually start my shift with 3-4 pt's and all my other beds were filled with admits. That is the nature of the beast, you work on the floors and you get admissions/transfers. Did it suck sometimes when you already have a heavy pt load? Why yes, yes it did - but it's nobody's fault. It is what it is, someone has to take the pt.

I think it IS "someone's fault." The hospital should be staffing properly. Maybe I'm misunderstanding what "intermediate care" means at that facility, but 7-8:1 seems just dangerous. "It is what it is" is meaningless if you get sued for making a mistake that is a result of improper staffing and dangerous nurse to patient ratios.

FancypantsRN · May 14, 2011

Horseshoe, you are correct about unsafe staffing ratio's. I should have clarified more - I meant to say it is not the fault of the person bringing the admission up.

The 7-8:1 was not a good or normal ratio for a floor that titrates gtts and such and I would never work there again (it was a travel assignment). The facility I currently work at the max is 5:1 on nights for the medical floor, and less for higher acuity floors.

Anna Flaxis, BSN, RN · May 14, 2011

In my experience, the receiving nurse almost always finds something to pick at. Very few of the floor nurses where I work actually understand that our job is to stabilize and transport, and that things can be so chaotic down there that we don't have time for the minutia. Of course, I was a floor nurse once and did not understand that either. I probably found things to pick at, too.

I remember one particular nurse on our floor who absolutely hated the ED. She had a giant chip on her shoulder, and each and every time she received a patient from the ED, she would look for things to write incident reports about. When I decided to go to the ED, she would barely talk to me.

So, I would guess that it's mostly because the nurses you are encountering have no ED experience and just don't understand the conditions under which we work, and maybe there are a few with a chip on their shoulder.

My strategy is to just be friendly and helpful, but get the patient there and get out as quickly as possible.

Also, I think that when you have a positive interaction, it's a good idea to somehow recognize it. For example, one time the floor nurse was exceptionally graceful in receiving my admit, and I made sure to mention her by name to my charge nurse, in front of the House Supervisor. The House Super's ears perked right up (he knew the nurse I was talking about), and I'm pretty sure he must have gone upstairs later and given her kudos.

KareBear0609 · May 14, 2011

That is why there are PCT's, like myself, who would love to work in a hospital helping the nurses with stuff they don't have time for and stuff that I am perfectly capable of doing.

It's a shame that hospitals make it so hard to get a job just to wipe a butt! I would be honored to work in the ER cleaning up patients.....

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · May 14, 2011

Floors are always staffed according to last shifts census guarenteeing they'll be short staffed once admits come. Most admits come through the ER. Don't take it personal, you're not the enemy. Hospitals understaff to make a profit, leaving the nurses to do whatever the need to just to survive. You're at the begining of the admit cycle, so the floor nurses treat you like any other ER nurse. The floor nurses are just trying to survive this screwed up system that "for profit" has created. Nurses are the biggest controllable expense that hospitals have, so the cut staffing to the bone. If a nurse can't survive this inhumane staffing, they find another, and work them till they burn out, then find another. IMHO, of course.

TinyHineyRN · May 14, 2011

I'm with you. As a floor nurse, I understand that the "fluffy" stuff isn't what the ED is all about. I'll do the clean up stuff, no problem. And most of the ED nurses I have received pts from are fabulous. What drives me nuts about a few of the nurses I have received pts from is, for example, when I would get a sickle cell kid or an oncology kid in the ED and the peds satellite pharmacy sent the antibiotics to the ED....please start the antibiotic!!!!! Starting abx on a febrile hem/onc kid IMMEDIATELY is a huuuuuuuge deal! This isn't a big problem because our hem/onc kids usually don't come through the ED. They are usually direct admits.

I once had a little one with a neonatal fever come in and, in report, the RN told me they already did blood and urine cultures. All we would have to do is the LP. Awesome! Thats a fantastic help! When I got the patient settled, I happened to have a few free moments to read through the notes. I read from the nurses note that the CNA attempted to cath the baby for a urine culture but was unable to get urine, so a bag urine was sent to the lab! For those who don't work with pediatric patients, we have urine bags that we can use for clean catch specimens that attach to the perineum and sit in the diaper, waiting to collect urine. Obviously, this can't be used for a culture as it has a very high risk of contamination with stool. The most frequent cause of neonatal fever is UTI (specifically e. coli UTI), so we have to have a GOOD urine culture! I would have loved if the nurse had told me the culture was a bag urine, not a cath, instead of telling me the culture was already done!!

You are at a unique advantage that you have been a floor nurse and pretty much know what proper "etiquette" is in terms of transferring patients! And just remember that some nurses are just going to be ticked off that they are getting an admission and will take it out in anyone they can!

Forever Sunshine, ASN, RN · May 14, 2011

I am sure this topic has been discussed to death but I need a brief vent....
I was a floor nurse for about 3.5 years..... I know and understand how stressful floor nursing can be. As a travel nurse working on an intermediate care floor, the ratio was 7-8:1. I would usually start my shift with 3-4 pt's and all my other beds were filled with admits. That is the nature of the beast, you work on the floors and you get admissions/transfers. Did it suck sometimes when you already have a heavy pt load? Why yes, yes it did - but it's nobody's fault. It is what it is, someone has to take the pt.
I have been working ER now for 3 months. I love it - it's what I have wanted to do since I started nursing school. Now I am on the flip side of the admit cycle. As my experience has primarily been tele/cardiac step-down units, I know how much it sucks to get a pt who is sitting in urine and feces. Right off the bat, you are bombarded with having to bathe the pt, deal with new orders, probably deal with VS issues from the transport, the pt now has multiple requests, etc. Keeping this in mind, I try to tidy the pt up as much as possible, I do a quick clean up if need be prior to transport. I also take a couple minutes (if the ER isn't being slammed with ambulances) to help settle them in before I leave.... I think I go above and beyond how ER's have dropped pt's off in other facilities I have worked at. They just left the pt in the room in whatever condition, hit the call bell, and left.
Isn't this the ideal when bringing a pt up? I sure would have appreciated it when I was a floor nurse. I find I am being treated pretty rudely by receiving nurses.... the more I do to help out, the worse the attitude is towards me. I am not sure how to bridge this gap.
Thanks for listening to my rant : )

I receive residents from the ambulance crew so this is coming from an non-hospital environment. I'm still in the receiving nurses boat.

Of course we are upset, we now have another patient on our workload.. in addition to the 7, 8, or 30 residents we already are responsible for. Its nothing personal. And we don't expect you to stay there and take care of them all night lol.

I would be ****** if the resident was just left there with the call light on. We go in, we greet the resident(putting all our troubles outside the room), we take vital signs, do a quick assessment, then we get a report from the EMT and any papers given by the hospital, then we sign and they can go on their merry way. We don't let the EMT leave until we have taken vital signs and an LPN/RN has signed for the resident.

If I were you I would do what you have time for, ignoring their poor attitudes. We all have bad days and when my attitude starts to hit the floor and I'm getting an admission, I take a minute and think to myself, "Ok this is someones mother, or father or grandma or grandpa.. and how would it look to me if it was my relative and I got here and saw the nurse in a rotten mood towards everyone."

morte, LPN, LVN · May 14, 2011

I am sure this topic has been discussed to death but I need a brief vent....
I was a floor nurse for about 3.5 years..... I know and understand how stressful floor nursing can be. As a travel nurse working on an intermediate care floor, the ratio was 7-8:1. I would usually start my shift with 3-4 pt's and all my other beds were filled with admits. That is the nature of the beast, you work on the floors and you get admissions/transfers. Did it suck sometimes when you already have a heavy pt load? Why yes, yes it did - but it's nobody's fault. It is what it is, someone has to take the pt.
I have been working ER now for 3 months. I love it - it's what I have wanted to do since I started nursing school. Now I am on the flip side of the admit cycle. As my experience has primarily been tele/cardiac step-down units, I know how much it sucks to get a pt who is sitting in urine and feces. Right off the bat, you are bombarded with having to bathe the pt, deal with new orders, probably deal with VS issues from the transport, the pt now has multiple requests, etc. Keeping this in mind, I try to tidy the pt up as much as possible, I do a quick clean up if need be prior to transport. I also take a couple minutes (if the ER isn't being slammed with ambulances) to help settle them in before I leave.... I think I go above and beyond how ER's have dropped pt's off in other facilities I have worked at. They just left the pt in the room in whatever condition, hit the call bell, and left.
Isn't this the ideal when bringing a pt up? I sure would have appreciated it when I was a floor nurse. I find I am being treated pretty rudely by receiving nurses.... the more I do to help out, the worse the attitude is towards me. I am not sure how to bridge this gap.
Thanks for listening to my rant : )

It may seem counter intuitive, but, STOP. Their attitude caused you to change, and they may keep it up to see how much more you will do for them.

Katie5 · May 14, 2011

It may seem counter intuitive, but, STOP. Their attitude caused you to change, and they may keep it up to see how much more you will do for them.

You know, you bring up an interesting point, where a person trying to help out gets shafted.I wonder why that happens.

LegzRN · May 14, 2011

ER nurse = public enemy number 1

Welcome to the zoo.

CaLLaCoDe, BSN, RN · May 14, 2011

I used to hate it as a floor nurse receiving a patient from ER without a proper report and hurried ER staffers dumping a patient off, running away from the scene of the crime. Sometimes that's just the nature of the beast.

I would always be grateful for the good ER nurse who would take the necessary time on report to explain everything and work for a smooth transition to the floor. I can't understand staff who will not help out when a new patient reaches the floor to assist with the transition. I can understand your frustration with staff that give you heat for doing your job well.