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 : )

[canigraduate]

Who transports your critical patients?

Ahh. I may have spoken too soon. I don't have any experience in critical units. On our non-critical units, transporters or techs deliver the patients.

[GM2RN]

Ahh. I may have spoken too soon. I don't have any experience in critical units. On our non-critical units, transporters or techs deliver the patients.

I meant who transports your critical patients from the ED to the ICU? You said that your ED nurses don't leave the ED, so I assumed you worked in the ED. In every hospital I have worked in, an RN was required to go with critical patients whenever they were being transported.

[nfdfiremedic, BSN, RN]

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."

We use EPIC. Indeed, much of the SBAR is self populated. We hand write a little 2 or 3 sentence summary up top i.e. "Came in complaining of X. We found Y, and he's being admitted for Z." And we add a comment to each system (i.e. Neuro section I usually write "A+Ox4, no focal deficits" Cardio section I normally write "Was NSR in the ED, had a normal EKG done, but is not ordered for tele upstairs.")

We have a transport team on first and second shift. We have to use our paramedics to bring them up at night. I'm actively in meetings with the head of transportation to try to get their hours extended even to 3am to start, but it's a tough battle.

[felineRN]

Hmmm... Just because it was ordered in the ED does not mean I have to carry it out.

Take for example: Cipro, Vanc, and Rocephin are all ordered "STAT" at the same time. Our MAR generates all those meds to be due at 1000 (hypothetically). It's my nursing practice to give one antibiotic at a time. I will give the abx that takes the least amt of time to run first (depending on the situation).

Now let's say I've run Rocephin and Vanc still has about 30min to go and all of the sudden my pt has a bed. In the MAR it may appear like my third antibiotic is overdue...however, in reality I couldn't give it.

I will say, I do call the receiving floor nurse and *let them know why* this has not been carried out etc... I think a breakdown in communication is the cause for a lot of gripes. Generally the floor nurse is ok with it. I'll even send up the third antibiotic with the pt.

In terms of feces/urine yadda yadda. I'll admit I struggle with meeting people's creature comforts. That is one of the main reasons I went to the ED (don't hate me) because I get frustrated meeting the needs of the pillow fluffers, ice cuppers, incontinent vegetables etc... However, I do bite the bullet and make sure my pt is somewhat presentable when sent upstairs. I'm not going to shine and wax the pt, but they will have a clean brief and clean linens. The pt and droves of family members will be informed of their room # and who the admitting doc is.

I have been a floor nurse where the ratio is 7:1 and our floor often had the chronically ill, chronically non-compliant, and nursing home types. When I got a new pt from the ED it was one more thing to deal with and it does suck to get "one more" person to be responsible for.

However, now that I work in the ED, I see the flip side. We *constantly* get "another" pt. The ED is a revolving door.

I'm not trying to make a comparison, but *we know how you feeeeeeel!!!* (trust us!)