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Would this happen at your ER?

Emergency   (4,784 Views 34 Comments)
by AlisonBSN AlisonBSN (Member) Member

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I'm a brand new RN on a MedSurg floor. I had a patient last night that had an awful nose bleed around 5am. The doc consulted an ear, nose and throat doc to come in since the bleeding would not stop. The only thing was that I had to take him down to the ER, and that doc would meet us there at a certain time. I guess the doc wanted us down there instead of him coming up to our floor because of the equipment...? I guess that's a common thing.

So I call the ER to let them know what my ENT doc said, and they said that I have to stay with him the whole time since he's my patient...and I can understand that too I guess. Anyways, I had to leave my other 5 patients upstairs with my preceptor, and she would give report to the day shift since all this happened right at shift change. (I don't know who I would have left them with if this happened a week from now when I'm off orientation...I guess the house supervisor since we don't have a separate charge nurse or anything.)

I wheel the man down to the ER about 5 minutes before the doc is supposed to be there, and I'm directed into Room 6 where I try to get him set up as best as I know how. Well...the little O2 "Christmas Tree" thing wouldn't come off of the metal part so that I could hook up his humidified O2...so I go out to one of the two or three nurses at the nurses station and say "I'm sorry...Can you come here for a sec?" Actually...before that, I asked where they kept the water bottles for the humidified O2.

Anyways...somehow it led to them telling me a bunch of orders that the ENT doc had called up there with, part of those orders were to draw up some lidocaine, and gather up a bunch of equipment/supplies/stuff that I had never heard of. (And they didn't tell me any of that until I came out of the room to ask about the O2...but that's sort of irrelevant.)

So when they tell me to get those things, I say "I might need some help with all of that, I'm a new grad and never heard of some of that." After I said that, one of them starts going on about how they're not responsible for him, and that I'm going to have to chart on him...as if they haven't already established that. I wasn't really asking for patient care help, just a point to the right supply room.

(And some of you may be thinking that I wanted someone to hold my hand, but believe me, the last thing I wanted was to ask any of them for help, because I could tell that they weren't pleased with the fact that me and my patient were there in the first place. Heck...I didn't want to be there either, but that was the doctor's arrangement, not ours.)

I don't remember what was said after that but I just go back in the room and try to draw up the lidocaine that I now noticed had been set out on a tray...but there were no needles to draw it up with. So I go out again, and I ask where the needles were. I walk over to the place where they're getting the needles from (so that they won't have to walk all the way back to me...I'm trying to please these people). So I'm trying to make small talk and I comment on how crazy the night was upstairs with the FIRE and all...lol. (Yes...we got 7 transfers at once because something caught on fire on another floor...then there was a crazy guy wandering the halls where the fire started.) Anyways...that nurse starts on how much more horrible her night was with a lady in cardiac arrest, and this guy and that...But she was doing it in a way where she just kept talking about it...Like in a "put me in my place" kind of way.

So I was like..."Yeah I know, it's the ER, I'm sure it was bad."

Luckily, the doc put up with me not being fast at handing him what he asked for, and I found a nurse that I kinda know that helped me find the things I needed.

I just want to know if you all think they were snotty, or did I do something that was rude or aggravating? I mean...is that just our ER, or is that a typical ER? I'd like to work in the ER one day, or ICU, after I get a year or so of MedSurg, but if it's that bad where it makes you that rude to people then I'm not sure. I did a couple of hours in the ER before, but I was just doing IV sticks and the nurses kinda seemed the same way...Just unwelcoming and unfriendly. Not that I expect a big hug or anything, but geez. And I know they're busy, but we are too and our MedSurg nurses aren't that unfriendly.

I understand people don't have time to hold your hand, but everything they said was defensive. They'd squint at me when I'd ask something, then in their response they'd look away with raised eyebrows and kinda shake their heads quickly while talking. You know the look. lol

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errneducator has 11 years experience and specializes in ER.

26 Posts; 1,195 Profile Views

I am sorry you had that kind of experience in the ER. No we aren't all that way. In my training of new grads, I remind them all the time that the ER tends to get tunnel vision and we only see our side of the world and forget that the rest of the hospital world is busy also.

However, it is frustrating when a doc sends yet another patient to the ER when you are already busting at the seams. (The ER has many issues facing them that are difficult to understand if you are not working in that setting. The issues cover diversion, overcrowding, pts using the ER for their primary care, among many others. That is not to say that we are special, but that we do need some understanding from other areas, just like we need to understand the other areas also.)

Maybe you could suggest that the ER prepare an ENT cart that would have everything needed to take care of epistaxis and foreign body insertions. That way everything is right there and it would help those who are not familiar with the ER environment or the equipment supply areas. It would also help them out by having the supplies easily accessible.

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Dixielee has 38 years experience as a BSN, RN and specializes in ER.

1,222 Posts; 9,660 Profile Views

No, it would never happen in our ER, because we don't take patients who have already been admitted to the hospital. Sorry you had a bad experience, but as previously stated, the ER is usually already busting at the seams with patients, and then to have one come down from the floor would push me over the edge.

In fact I have never worked in an ER where patients came down from the floors. Try to remember too, that the ER is the only department in the hospital who cannot close their doors. They are the only ones who get walk ins and EMS patients and can not say "NO". We can never say we are full and can't take a patient. We can never say to EMS or triage "that nurse is at lunch, call back later to give report", or "The bed hasn't been cleaned yet, you will have to wait till housekeeping cleans the room". We have to take everyone who rolls thru the doors 24/7 no matter what.

The ER frequently has patients lined up in the halls because there are no more rooms. That is something you never see on a floor or ICU. Yes, ER nurses may come across as abrupt or rude, but it is because we have to move fast, think fast and act independently and instantly. When a trauma or MI comes thru the door, we don't have the luxury of waiting until we have orders. We decend on the patient and have certain things that must be done within minutes. Many times we are abrupt with each other, but it is not personal, nor do we take it that way. Many times in the interest of time and efficiency, we keep conversation to a minimum and concentrate on calling out vital signs, assessments, rhythms and meds being given to a recorder and to each other so we all know what has been done.

I am not excusing anyone who might have been rude or unhelpful to you, but try to walk a mile in our shoes. Most of us have walked plenty of miles in yours.

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4 Followers; 11,299 Posts; 76,573 Profile Views

Granted, we are a very small rural hospital . . but all consults are done on the floor and I wouldn't take a pt to the ER for an ENT doc or any doc.

The closet thing I can think of relating to how you were treated is when we orient staff to the ER. If you have no idea where even the most simple things are, it can be very frustrating. I'm sorry you were treated badly.

steph

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teeituptom is a BSN, RN and specializes in ER, ICU, L&D, OR.

4,283 Posts; 14,075 Profile Views

doesnt happen in our ER

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one_speed has 5 years experience and specializes in Emergency / Trauma RN.

32 Posts; 1,066 Profile Views

Please... This sounds like this came up in the early morning (started at 0500 ?). You can't use the "we're overworked and overloaded" argument all the time... at leastthe MRP was willing to consult ENT and didn't just send them down to see the ER doc.

Honestly, how difficult is it to get off of your ass and show somebody where things are kept in your dept. There is nothing worse than having to pull things together in 1. an unfamiliar place, 2. an unfamiliar scenario for pt care, then 3. probably get jacked up by the ENT consult for not being able to assist perfectly at 0 dark in the morning.

There is absolutely no time when we should have the right to talk to coworkers "to put them in their place", but then they probably talk to their own department coworkers and patients the same way and be classified as "that miserable nurse".

my 2 cents,

IAN

... and while I know I don't deal with people like this, I hate to admit that I know people I work with who would because "they are too busy...".

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CritterLover is a BSN, RN and specializes in ER, ICU, Infusion.

872 Posts; 11,396 Profile Views

no way the ent doc would have been allowed to send that pateint to the er to be seen. i'm surprised that the er charge nurse allowed that to happen. the house supervior could have been called to go and get the necessary stuf the ent doc wanted, and brought it to the room.

that said, since you were on orientation, your preceptor should have gone with you. i realize that this brings up the question of who would watch your other patients, but that did put the er nurses in an akward position when you told them you were still in orientation.

i hate to admit it, but i probably would have been irritated, too. however, i would have made sure you had everyting you needed (including the needles) so that you wouldn't have to keep on bugging me!!! :)

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Blee O'Myacin is a BSN, RN and specializes in ED, ICU, Heme/Onc.

721 Posts; 5,728 Profile Views

I wouldn't have allowed a nurse I was precepting off the floor alone with a patient. Period.

Besides, taking the patient down to the ER takes up an ER bed when the patient had their own bed on the floor, so what does that accomplish other than make more work for people? (Who cleaned up the mess when the doc was finished? I doubt it was the ENT doc) I would have called the house sup. ASAP if this was suggested by the night resident and the ENT.

As for the ER staff, I'm sorry that they were less than helpful, but I imagine that they wanted to stay as far away from that mess as possible.

I think a lot of people dropped the ball on this. You are a precepted new grad and should not have been wheeling a bleeding, potentially unstable patient through the hospital alone. At the very least, your preceptor should have gone with you or have gone him/herself, leaving another RN with you and your remaining patients.

I'd sit down and talk to your preceptor about this and see what they have to say about this. I think there are bigger problems than the ER staff not being friendly.

Blee

I'm a brand new RN on a MedSurg floor. I had a patient last night that had an awful nose bleed around 5am. The doc consulted an ear, nose and throat doc to come in since the bleeding would not stop. The only thing was that I had to take him down to the ER, and that doc would meet us there at a certain time. I guess the doc wanted us down there instead of him coming up to our floor because of the equipment...? I guess that's a common thing.

So I call the ER to let them know what my ENT doc said, and they said that I have to stay with him the whole time since he's my patient...and I can understand that too I guess. Anyways, I had to leave my other 5 patients upstairs with my preceptor, and she would give report to the day shift since all this happened right at shift change. (I don't know who I would have left them with if this happened a week from now when I'm off orientation...I guess the house supervisor since we don't have a separate charge nurse or anything.)

I wheel the man down to the ER about 5 minutes before the doc is supposed to be there, and I'm directed into Room 6 where I try to get him set up as best as I know how. Well...the little O2 "Christmas Tree" thing wouldn't come off of the metal part so that I could hook up his humidified O2...so I go out to one of the two or three nurses at the nurses station and say "I'm sorry...Can you come here for a sec?" Actually...before that, I asked where they kept the water bottles for the humidified O2.

Anyways...somehow it led to them telling me a bunch of orders that the ENT doc had called up there with, part of those orders were to draw up some lidocaine, and gather up a bunch of equipment/supplies/stuff that I had never heard of. (And they didn't tell me any of that until I came out of the room to ask about the O2...but that's sort of irrelevant.)

So when they tell me to get those things, I say "I might need some help with all of that, I'm a new grad and never heard of some of that." After I said that, one of them starts going on about how they're not responsible for him, and that I'm going to have to chart on him...as if they haven't already established that. I wasn't really asking for patient care help, just a point to the right supply room.

(And some of you may be thinking that I wanted someone to hold my hand, but believe me, the last thing I wanted was to ask any of them for help, because I could tell that they weren't pleased with the fact that me and my patient were there in the first place. Heck...I didn't want to be there either, but that was the doctor's arrangement, not ours.)

I don't remember what was said after that but I just go back in the room and try to draw up the lidocaine that I now noticed had been set out on a tray...but there were no needles to draw it up with. So I go out again, and I ask where the needles were. I walk over to the place where they're getting the needles from (so that they won't have to walk all the way back to me...I'm trying to please these people). So I'm trying to make small talk and I comment on how crazy the night was upstairs with the FIRE and all...lol. (Yes...we got 7 transfers at once because something caught on fire on another floor...then there was a crazy guy wandering the halls where the fire started.) Anyways...that nurse starts on how much more horrible her night was with a lady in cardiac arrest, and this guy and that...But she was doing it in a way where she just kept talking about it...Like in a "put me in my place" kind of way.

So I was like..."Yeah I know, it's the ER, I'm sure it was bad."

Luckily, the doc put up with me not being fast at handing him what he asked for, and I found a nurse that I kinda know that helped me find the things I needed.

I just want to know if you all think they were snotty, or did I do something that was rude or aggravating? I mean...is that just our ER, or is that a typical ER? I'd like to work in the ER one day, or ICU, after I get a year or so of MedSurg, but if it's that bad where it makes you that rude to people then I'm not sure. I did a couple of hours in the ER before, but I was just doing IV sticks and the nurses kinda seemed the same way...Just unwelcoming and unfriendly. Not that I expect a big hug or anything, but geez. And I know they're busy, but we are too and our MedSurg nurses aren't that unfriendly.

I understand people don't have time to hold your hand, but everything they said was defensive. They'd squint at me when I'd ask something, then in their response they'd look away with raised eyebrows and kinda shake their heads quickly while talking. You know the look. lol

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scattycarrot has 10 years experience as a BSN, RN and specializes in ITU/Emergency.

357 Posts; 4,348 Profile Views

No, it would never happen in our ER, because we don't take patients who have already been admitted to the hospital. Sorry you had a bad experience, but as previously stated, the ER is usually already busting at the seams with patients, and then to have one come down from the floor would push me over the edge.

In fact I have never worked in an ER where patients came down from the floors. Try to remember too, that the ER is the only department in the hospital who cannot close their doors. They are the only ones who get walk ins and EMS patients and can not say "NO". We can never say we are full and can't take a patient. We can never say to EMS or triage "that nurse is at lunch, call back later to give report", or "The bed hasn't been cleaned yet, you will have to wait till housekeeping cleans the room". We have to take everyone who rolls thru the doors 24/7 no matter what.

The ER frequently has patients lined up in the halls because there are no more rooms. That is something you never see on a floor or ICU. Yes, ER nurses may come across as abrupt or rude, but it is because we have to move fast, think fast and act independently and instantly. When a trauma or MI comes thru the door, we don't have the luxury of waiting until we have orders. We decend on the patient and have certain things that must be done within minutes. Many times we are abrupt with each other, but it is not personal, nor do we take it that way. Many times in the interest of time and efficiency, we keep conversation to a minimum and concentrate on calling out vital signs, assessments, rhythms and meds being given to a recorder and to each other so we all know what has been done.

I am not excusing anyone who might have been rude or unhelpful to you, but try to walk a mile in our shoes. Most of us have walked plenty of miles in yours.

As an ER nurse, I agree with the sentiment of what you are saying but this is the exact kind of attitude that gives ER nurses their bad name. All nurses regardless of where they work have pressure upon them and regardless of what that pressure is, we can still help each other out, surely?It doesn't matter how busy you are or what your in the middle of you always have time to answer politely, even if its just to say...'Im sorry but i am busy right now'. It sounds like the nurses standing at the nursing station,weren't in the middle of a trauma or dealing with an MI, but were to far up their own behinds to give a new grad a hand. And thats just not right.

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LZRN has 3 years experience and specializes in ER.

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I'm a new ER nurse but I've already learned that you have to be Fluid, because flexible not good enough! There is no room for egos in the ER, come one come all, gung ho, gung ho, gung ho!

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35 Posts; 1,386 Profile Views

Your preceptor should have been dealing with this one to show you what you need to do, and the supervisor definitely should have been involved. I can deal with snotty attitiudes, I think we all do, but I can be just as tough (I am never mean, I am just very direct and to the point because I want to get my job done and done right and there's no room in there for me for attitudes) right back where it concerns my patient. It is very uncomfortable to be put in a such a position, and you should have been directed on how to deal with it, being a new nurse. Please discuss this with your manager if only to find out exactly what route you would have needed to go in case it should crop up when you are on your own without a preceptor.

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Aggie RN has 18 years experience as a ADN and specializes in ER, HH, Case Management.

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Correct me if I'm wrong, but doesn't taking a patient from the floor to the ER constitute an EMTALA violation?

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