Why am I now the enemy?

Nurses General Nursing

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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 : )

Our ER nurses dont usually bring the pt. either, it's usually a tech. I'm sure they transport them to ICU though if that's where the pt. it being admitted to.

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Our ER nurses dont usually bring the pt. either, it's usually a tech. I'm sure they transport them to ICU though if that's where the pt. it being admitted to.

We have 1 tech for the entire ED. It would be nice if they could transport all of the admits but it just isn't realistic.

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Specializes in Cardiovascular, ER.

We have the same... 1 emt (who does secretarial duties and stocking) on nights = I transport my pt's wherever they need to go.

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Specializes in Cardiovascular, ER.

Thank you everyone for your responses/words of encouragement. I try not to take these things personally - it just kind of grates under your skin when animosity towards you is palpable, even though you don't even know these people.

Who knows, maybe another ER nurse ticked the floor nurses off at this facility and now they just hate all of us. I have found one thing, poor attitudes are contagious - and I won't be catching any of that. I will just keep doing my thing - the best job I can do with a good attitude.

And I probably shouldn't, but if I have to deal with the nurse from my last shift again - I would do it all over again (if I have the time) - stay and help her clean the pt up. It's about helping the pt, not her.

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Specializes in ED, Neuro, Management, Clinical Educator.

In my hospital, we use a hand off procedure called SBAR Reporting. the SBAR acronym is probably familiar to some. It stands for "Situation, Background, Assessment, Recommendations." For us, SBAR is a long form we fill out prior to sending a patient up to the floor. It includes a system by system assessment populated by data from the electronic record (i.e. the lung sounds, the IV sites, the lab results, and so forth) as well as a section for you to add comments to each system such as Neuro, Cardio, Respiratory, etc. We put a little summary on there as well which explains why the patient is being admitted, or the "story."

We call the floor and tell them that this SBAR report has been completed. 30 minutes later the ED nurse calls the floor and asks if there are any questions after having read his or her SBAR note. The patient is then escorted to the floor by our transportation people. On night shift, when there is no transport on duty, they are brought up by one of our ED paramedics. If the patient has to go to one of the ICU's they must be accompanied by a nurse.

As a general rule of thumb, the admission process is one of the worst experiences when working in an emergency department. Over the years I have felt awful watching new orientees try to get their patients upstairs. I put in so much effort to encourage them and help them build confidence in an extremely difficult nursing field, only to have my nursing colleagues in other sections of the hospital tear them to shreds every time they try to send a patient upstairs.

As a leader in the ED, I am working with high level administration on a pilot program that would require all floor nurses to do one "shadowing" shift in the ED so they can get some insight into what actually happens down there. What few floor nurses realize is that they are ensured the luxury of only getting a finite number of patients. We ED nurses sometimes get extremely upset when the floor nurse refuses to take a patient because they "just got an admission." Oh, you just got AN admission? I just got three ambulance patients in the span of 15 minutes one of whom is already nagging me for something to eat and a taxi voucher to go home, the two patients I have in the hallway because we have no empty rooms are yelling at each other, the admitted patient you refuse to take from me who has been down here for over 24 hours is on the call bell every 5 minutes demanding to go to the room I told him an hour ago was assigned to him, and there are over 30 in the waiting room starting to come up to the desk and complain every few minutes because they've been out there for hours.

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Specializes in General Medicine.

as part of my orientation to a medicine floor, i got to spend a shadowing day in the ED and it was an extremely eye opening experience. its unbelievable what those nurses deal with and i have so much respect for them. however, please dont bring up a patient with prbc's hanging and run away, only to leave the floor nurse to discover the bloods been hanging for over 4 hrs, theres still 1/3 of it left, and its completely clotted in the line. that was not cool.

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Thank you everyone for your responses/words of encouragement. I try not to take these things personally - it just kind of grates under your skin when animosity towards you is palpable, even though you don't even know these people.

Who knows, maybe another ER nurse ticked the floor nurses off at this facility and now they just hate all of us. I have found one thing, poor attitudes are contagious - and I won't be catching any of that. I will just keep doing my thing - the best job I can do with a good attitude.

And I probably shouldn't, but if I have to deal with the nurse from my last shift again - I would do it all over again (if I have the time) - stay and help her clean the pt up. It's about helping the pt, not her.

I think you have the right attitude. It really is about the patient in the end. When your patient who's been sitting on an ER gurney for six hours finally gets a bed, it's really hard to justify any further delay in getting him there ASAP. Maybe it's an inconvenient time for the receiving nurse, and I get that because I used to be the receiving nurse and it seemed as if all my admits came at the worst possible time, but I see things from a completely different perspective now. I don't mind taking a little flack from the receiving nurse, and I don't take it personally anymore. I just get ticked off when it happens in front of the patient.

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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.

We have hospitalists 24/7, and the majority of the time, they come see the patient in the ED and write their admitting orders there. They're not supposed to, because it slows down the process of getting the patient out of the ED and opening up a room for someone else, but they do it anyway.

If the ED orders are not getting done, then that's not okay and you need to follow the appropriate channels to have that addressed. That is a patient safety issue. There are very rare times when carrying out an order in the ED would cause an undue delay in transport to the inpatient unit, and in cases like that I just call the inpatient unit and let them know what needs to be done so there are no surprises when the patient gets there. It's never been a problem, because I don't abuse it, and it's in the best interest of the patient to get them upstairs as efficiently as possible and not cause undue delay.

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as part of my orientation to a medicine floor, i got to spend a shadowing day in the ED and it was an extremely eye opening experience. its unbelievable what those nurses deal with and i have so much respect for them. however, please dont bring up a patient with prbc's hanging and run away, only to leave the floor nurse to discover the bloods been hanging for over 4 hrs, theres still 1/3 of it left, and its completely clotted in the line. that was not cool.

Not only was that not cool, that was totally unacceptable. We may not have time for the fluffing and puffing, but patient safety should be our primary concern. If you're getting patients from the ED under this kind of circumstance, I can see why you'd have a poor opinion of the ED nurses.

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I agree you do go above and beyond. I've been very lucky to have many such ER and ICU transfers with people like you on the other end of the stretcher. Some people are just not worthy of you!

You know what, don't waste your time sucking up to mean people who just don't matter. Notice the one's who are nice and appreciate you, get in, get out with the others, you don't owe them, it's part of the job to take admits.

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In my hospital, we use a hand off procedure called SBAR Reporting. the SBAR acronym is probably familiar to some. It stands for "Situation, Background, Assessment, Recommendations." For us, SBAR is a long form we fill out prior to sending a patient up to the floor. It includes a system by system assessment populated by data from the electronic record (i.e. the lung sounds, the IV sites, the lab results, and so forth) as well as a section for you to add comments to each system such as Neuro, Cardio, Respiratory, etc. We put a little summary on there as well which explains why the patient is being admitted, or the "story."

We call the floor and tell them that this SBAR report has been completed. 30 minutes later the ED nurse calls the floor and asks if there are any questions after having read his or her SBAR note. The patient is then escorted to the floor by our transportation people. On night shift, when there is no transport on duty, they are brought up by one of our ED paramedics. If the patient has to go to one of the ICU's they must be accompanied by a nurse.

As a general rule of thumb, the admission process is one of the worst experiences when working in an emergency department. Over the years I have felt awful watching new orientees try to get their patients upstairs. I put in so much effort to encourage them and help them build confidence in an extremely difficult nursing field, only to have my nursing colleagues in other sections of the hospital tear them to shreds every time they try to send a patient upstairs.

As a leader in the ED, I am working with high level administration on a pilot program that would require all floor nurses to do one "shadowing" shift in the ED so they can get some insight into what actually happens down there. What few floor nurses realize is that they are ensured the luxury of only getting a finite number of patients. We ED nurses sometimes get extremely upset when the floor nurse refuses to take a patient because they "just got an admission." Oh, you just got AN admission? I just got three ambulance patients in the span of 15 minutes one of whom is already nagging me for something to eat and a taxi voucher to go home, the two patients I have in the hallway because we have no empty rooms are yelling at each other, the admitted patient you refuse to take from me who has been down here for over 24 hours is on the call bell every 5 minutes demanding to go to the room I told him an hour ago was assigned to him, and there are over 30 in the waiting room starting to come up to the desk and complain every few minutes because they've been out there for hours.

Having SBAR populated by the software would be very cool! I'm assuming that it doesn't take any extra work ant that you only have to print it when ready to fax it to the floor? What software package do you use?

Unfortunately, we don't have dedicated transportation people, regardless of the time of day.

I could have written your last paragraph myself, as I'm sure many other ED nurses could. It has actually been worse lately. And not only do the floor nurses temporarily refuse the next admit, they get to cap themselves when staffing is an issue, but we can't tell the new pts coming in the door, "Sorry, we don't have the staff so we can't see you tonight."

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"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."

look on the bright side-- while you are there to drop the patient off, you can say offhandedly that you had a minute so you cleaned him up or whatever, and leave it at that. i'm betting that somebody is noticing that when you bring a patient up, the patient is in better shape than when others do, and word will get around.

remember the communications sandwich: praise, opportunity for improvement, praise.

when you really are slammed and you can't wash those filthy feet, say, "thanks so much for making time to take this guy, we really appreciate it," that you usually do try to clean your patients up before transfer but it just wasn't possible today, and it will be better tomorrow, and you have at least wrapped his dirty feet in a hot wet towel with lotion and that should soften things up.

then see if you can get buy-in from your head nurse to mention this at head nurse meeting that your er does, really, try to help out in this way before transfer. then see if you can get the others in the er to actually do that. it may take awhile to improve relations, but it can happen.

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