Why am I now the enemy?

[FancypantsRN]

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 : )

[rkitty198, BSN, RN]

It does suck to get an admit that has been down in the ED with feces crusted on their skin, urine dripping down their legs who have been in the ED for over 12 hours. The patient I got last week was like this. A little elderly man who was incontinent because he had probable norovirus. Poor guy was in need of a bath, hungry and in pain. I am sorry if I get mad about that and take it out on you (to the sending ED nurse). But who else do I blame? The patient? I can always blame management but we all know that gets us no further to a resolution.

It's one of those things that it happens to us floor nurses once and we blame the ED nurse every time

I thank you for cleaning up that patient, but if I don't show it to you I am sorry. It is a thankless job even from our own kind.

[DLS_PMHNP, MSN, RN, NP]

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."

Thank you!!

[abooker]

They're "flicking" you.

I think flicking might be appropriate or even necessary if someone needed their egos deflated just a bit to keep the team functioning well and keep things safe. But some people don't do it correctly, or do it to coerce excessive cooperation.

Sometimes there is Munchowsens or some other pathological condition.

[NightNurseRN]

I work the floor and I completely understand the ER nurse has less time for "fluff". the only time I do get a bit snippy (im also pregnant) is when orders that are ordered hours previously are not done such as antibiotic administration, blood cultures or other labs. Also if there is a CT, MRI or some other test ordered, it's so much easier if they do it before they come to the floor...it makes no sense to get them all settled in then move them back downstairs again! I work night shift so it's all the more irritating to the pt. These are the only times I have probably come off ****** to the ER nurse. otherwise things like a wet diaper or the dirty gown dont bother me a bit! keep doing what youre doing! :)

[Anna Flaxis, BSN, RN]

I work the floor and I completely understand the ER nurse has less time for "fluff". the only time I do get a bit snippy (im also pregnant) is when orders that are ordered hours previously are not done such as antibiotic administration, blood cultures or other labs. Also if there is a CT, MRI or some other test ordered, it's so much easier if they do it before they come to the floor...it makes no sense to get them all settled in then move them back downstairs again! I work night shift so it's all the more irritating to the pt. These are the only times I have probably come off ****** to the ER nurse. otherwise things like a wet diaper or the dirty gown dont bother me a bit! keep doing what youre doing! :)

If it's ordered in the ED by the ED doc, then it's my responsibility to get it done in the ED prior to transfer to the floor. If ED orders are not getting done on patients prior to transfer, then you certainly have every right to write an incident report.

If, on the other hand, it's ordered by the admitting physician, then it's to be done by the admitting unit and I am not responsible for that. I will start maintenance fluids or the like if I have time, and there's no reason I can't run in an antibiotic or give some meds if it's going to be a while before the patient gets a bed assignment and *I have the time*. I may have a cardioversion, pediatric sedation, trauma, cardiac arrest, stroke alert, cath alert, or some other situation that needs my attention more.

The thing to keep in mind is that in the ED, something that might be obviously urgent or important to a floor nurse might not be on the tippy top of my priority list, because the little kid down the hall isn't breathing, or the STEMI needs to get to the cath lab STAT.

Sometimes the admitting doc wants a diagnostic done prior to the patient being admitted to the floor, so it's up to them to communicate that to me. We can certainly have them stop in CT or what have you on their way to the floor if we know that's what the admitting doc wants. But, it is not my responsibility to carry out admission orders. That is for the floor to do.

[Anna Flaxis, BSN, RN]

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.

I have experienced this on many occasions. Sometimes it can feel like if you give 'em an inch, they'll take a mile. I find I've become a bit more hardened and have no problem doing the "dump and run" because of it. I simply *do not have time* to stick around once the patient is off my gurney and into their bed. That is not to say that I am rude or less than civil, or that I don't make sure to take a moment to straighten things up a bit before I take the patient to the floor. It just means I don't stick around any longer than I need to, and I don't make any apologies if the patient is not presented neatly pressed with every hair in place and a big bow tied around them.

[Anna Flaxis, BSN, RN]

Another thing that used to really irk me as a floor nurse was when the patient would be demanding food the second they rolled into the room, before they were even off the gurney. I could have sworn someone down there in the ED was spreading the rumor that the patients would be fed immediately upon arrival to the floor. But there is a process. We have to transfer them to their bed, take vitals, do a head to toe, look over their orders for anything STAT, etc. It's not like food is going to just magically appear the second they hit the floor, yet they always seemed to think that. Often the kitchen would be closed by the time they arrived, so the best I could do would be whatever I could scrounge up in our unit's kitchenette.

Now that I'm in the ED, I *never* promise patients they will be fed "as soon as you get to the floor". Ever. If I have time, I will give them some juice and crackers or some custard or something to tide them over, and I will tell them the truth; that they will need to be tucked in first, and whatever is available is what they'll get.

I also warn them that lab draws will no longer be pulled from their PIV, that it's against the rules on the inpatient unit, and that they will be poked for their lab draws. I remember patients getting really upset on the floor when they found that out for the first time.

There is a lot we can do in the ED to prepare patients for how different things will be once they are on the inpatient unit. As much as I tell them that they will be in a comfortable bed in a private room with their own bathroom, I also tell them about the food and lab draw situations too.

[NightNurseRN]

Since I work nights, the admitting doc almost never sees the patient before they come to me, all the orders I spoke of previously are ER orders. The ones for the floor are ordered by the ER doctor and are put on "hold". Im talking about the orders that are not on "hold" and just havent been carried out. We also have emergencies on the floor too, with less help, especially at night! :)

Omg i know what you mean about being fed right away. it's really hard when they are very sick and dont even realize it. like we need to keep then NPO and are trying to prep them for surgery fast and they just lay there ******** about how we are "starving them" and "how can we treat them like this?" even after explaining why we are doing what we are doing. if it's an old lady or man i understand but a young a/oX3 pt. who acts like this gets on my last nerve!

[GM2RN]

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.

For the sake of all floor nurses reading this thread who may feel this way, I'd like to provide my perspective.

I know that different hospitals do things differently, but where I work, report is given on the phone prior to the pt leaving the ED, so there is no need to give any report at the time the pt arrives to the floor. If my pt is a walkie talkie and can safely be left alone, I will "dump" the pt and leave. Otherwise, I will get a nurse to the room before leaving.

ED nurses/techs should help with the transition when it's warranted, but just like you can't understand it when they don't, I don't understand why some floor nurses aren't considerate of ED nurses time by preparing the room ahead of time. Ninety-nine percent of the time that I transport a pt to the floor, the bedside table is still tucked under the bed, the bed is still in low/high position (necessitating that it be put low for the walkie talkie, or raised for the one needing help to transfer), covers have not been turned down, chairs are in the way, and no iv pump and/or pole is at the bedside. Just like floor nurses, I have other pts waiting for me in the ED, sometimes critical ones, and need to get back to them as soon as possible. Having the room readied by taking care of these things prior to the pt's arrival greatly cuts down on the time needed to settle the pt and makes for a smoother transition.

Another issue is some floor nurses themselves not helping with the transition. One floor in particular at my hospital is famous for nurses sitting at the desk and watching the ED staff pass by them with a pt, but they don't come to the room to help until you go tell them that they are needed, or you have to hunt them up because they have miraculously disappeared since you just saw them.

I'm not sure what you mean by "explain everything" in report, but some floor nurses want a detailed, HTT report and that isn't the focus in the ED. We report on things that are relevant to the pt's current condition and what he/she is being treated for. We don't have the time, nor is is necessary, to do HTT assessments and report the same on every admit.

I have worked the floor so I know what it's like. I think every nurse should be required to work the ED or floor, whichever is opposite of what they usually do, for at least one, very busy, 12-hour shift to gain some understanding from other nurses' perspective's.

[canigraduate]

Huh. Where I work, the nurses don't leave the ED. Interesting concept.

[GM2RN]

Since I work nights, the admitting doc almost never sees the patient before they come to me, all the orders I spoke of previously are ER orders. The ones for the floor are ordered by the ER doctor and are put on "hold". Im talking about the orders that are not on "hold" and just havent been carried out. We also have emergencies on the floor too, with less help, especially at night! :)

Omg i know what you mean about being fed right away. it's really hard when they are very sick and dont even realize it. like we need to keep then NPO and are trying to prep them for surgery fast and they just lay there ******** about how we are "starving them" and "how can we treat them like this?" even after explaining why we are doing what we are doing. if it's an old lady or man i understand but a young a/oX3 pt. who acts like this gets on my last nerve!

There is no excuse for ED orders not to be done, or at least addressed, before pts go to the floor. There have been rare occasions when it was so busy that I couldn't start something in a timely manner without having a pt wait longer in the ED, and I asked the receiving nurse if it would be ok to send the pt and have them start it there (with the docs permission). The floor nurses know that this is out of the ordinary for me and I've never had a problem over it.

We keep sack lunches in the fridge and every admit who has a diet ordered gets one before leaving the ED if they want one. Pts tend to be very unrealistic about eating though. They might not have eaten all day because they have been puking or their bellies hurt, but as soon as they hit the ED they want to eat and complain when we don't feed them right away as if it is somehow our fault. I wish people would understand that it takes quite a bit longer than several hours for someone to "starve" to death, and there are good reasons to keep them NPO for awhile!

[GM2RN]

Huh. Where I work, the nurses don't leave the ED. Interesting concept.

Who transports your critical patients?