Would this happen at your ER?

AlisonBSN · Jun 8, 2007

Thanks for all of your responses.

The doc said to take the patient down to the "treatment room" in the ER. So I went bouncing down there asking for the treatment room, and they just put me in a regular room. I found out later that there is no treatment room.

They said later on that stuff like that used to happen all the time, where the ER nurses would have to take that patient from upstairs for such consults, but now they make the floor nurse stay. I understand that...he's my patient whether he's in a different location for 30 minutes or not. I guess they were defensive because they expected an argument from me about it, but they had already said on the phone that they aren't responsible for him, and that one of us would have to stay the whole time.

And I understand how people can seem snappy in critical situations, but there wasn't one going on right then. It looked pretty slow to me. There were a few of them talking at the nurses station, and they were the ones that I asked for the stuff. It was a male nurse that came in on the day shift that wound up making like 7 trips for me for every time the doc asked for something that wasn't on his first list. I sent him a Smart Service award too because it was very much appreciated. He didn't make me feel like I was being a pain in the butt, although I'm sure I was.

Before I left the floor, our nurse manager happened to call to ask about the fire and everything, and we told her what was going on so my NM and my preceptor decided to send me down with him, and have my preceptor stay with the other 5. It would have been the other way around if I would have known what I was getting into. I just thought I was going to be "babysitting" more or less...like hooking up his O2 and getting him out of the wheelchair onto the table while the doc did his thing. I didn't know I'd be assisting in a minor procedure. I guess if I was on my own, and didn't have the luxury of a preceptor, I would have called the nursing supervisor, or I would have left the other patients with the other floor nurses to watch while I was gone but the other patients had junk going on as well.

When I told the nurses down there that I was new, it was to excuse myself from not knowing where things were, but now that I think about it, I still wouldn't have known where all of that stuff was if I had been doing MedSurg for years, because it's in the ER. Someone said that I put them in an awkward position by telling them I was new, but I assured them that I was capable of drawing up lidocaine if they just showed me where the needles were. I guess it still freaked them out a little, but he wasn't their responsibility anyways, right? So what did it matter if I was new?

Again, thanks for your responses and understanding.

arual56 · Jun 9, 2007

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

I am soooo sorry that you were treated like that. It is not the way all ER nurses act, but unfortunately, there always seems to be that one person, or group of people, that think that they are so much more important than you and your patient that they can't be bothered to help out someone else. Take it from me, getting your ER legs takes some time for everyone who has not experienced it before. I moved to the ER as a PCT, and now work there as a nurse. It took me the better part of six months to feel even half way comfortable with the environment, and then only because I had some really wonderful people who were willing to show me the ropes and teach me when my preceptor quit unexpectedly. I have been there almost three years now, and I am still learning. I started off thinking that I would try to learn one new thing each day. Well that was no challenge because you learn at least one new thing each day without even trying. But there was a new process implimented by our manager that makes things much easier for new grads, new the unit, new to the facility, etc. Our manager had buttons made up that had nothing but a big red heart and the title of the person, RN, LPN, Tech, etc on it. The patients don't know what it means so it doesn't make them feel they are getting less than appropriate care, but the rest of the staff is very aware that they are new, and that each of us should show patience and consideration for them as they learn. It has helped tremendously.

lovemyjob · Jun 9, 2007

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.

I can promise you have never walked a mile in my shoes....

I have a huge issue when one nurse acts as though their department is the only one to have horrible crazy shifts or to have any sort of major problem. Each area of nursing has its own hang-ups.... whether it is the ER or the NICU (FYI, a lady crowning with a 24 weeker...... NICU is called.....we cant say no to that patient either....even if we have to move babies to transport monitors and line them up against the wall to make room for a sicker kid, we do what we have to do b/c you cant say no-can-do when a sick newborn is delivered and there is "no room at the inn.") We all have our issues, so to assume that yours is worse is a bit pretentious.

No matter how busy you are, there is no excuse for rudeness. Unless you are running a code or trauma, which it doesnt sound like this is the case in the OP, what is 2 minutes to show someone where the supply room is? Put yourself in the other persons shoes and imagine how it would feel to be in an unfamiliar unit and be required to assist in an unfamiliar procedure. I am sure you would appreciate someone giving you a little direction (even if that is just a smile and a finger point to the supply room!)

nuangel1, BSN, RN · Jun 9, 2007

i agree she should not have been treated rudely and someone should have been nice enough to show her and help her get supplies.BUT,that said that pt should never have been brought to the er in 1st place .the pt is admitted and is a floor pt .the er nurses are not responsible for the pt .the nurse manager supervisor etc should have been called and the dr should have been told to come to the floor pt was on .the supervisor or someone else needed to get ent tray and supplies . if need be i am sure the er would have provided them .the pt needed to be treated on the floor.we never take floor pts that are admitted .i have worked 4 ers and this never would have happened .once it did though you needed to stay on floor with another nurse as backup and the preceptor should have gone with the pt.or gone down with you to er .but the staffing issue ie who watches your pt was your charge nurse and supervisors responsibility .as er nurse i would gladly have helped you but i would have expected you and the md to clean up bring pt back to floor .so all that had to be done was call housekeeping to clean room .other issue is you and your pt were tying up a bed an er pt needed .not cool.someone needs to f/u about this so it never happens again.

Dolce, RN · Jun 9, 2007

Why on earth did they allow the ENT to order a transfer to the ER? That is really bizarre and a waste of time. I'm sure it was convenient for him but no one else. I actually have worked in a hospital that transfered patients to the ER for emergencies--symptomatic chest pain, etc. But, that was only because these were outpatients. It is completely inappropriate to transfer a patient to the ER for "treatment" if it is available on the floor. Unfortunately some docs think they can get away with anything.

RNinSoCal · Jun 9, 2007

I agree with the other posters, that situation should not have happened to you or your patient. I would have refused to leave my other patients to take a pt anywhere for longer than 15 minutes. There should be charge nurses who have no pt assignment and a nurse supervisor to handle critical situations on a med/surg floor. I know that what "should happen" is not what does happen, but no new nurse should be put in that type of situation alone. In my 5 years of hospital nursing I have never sent a pt to ER. I have sent pts to tele or ICU when they go bad, but never back to ER. The ER Doc comes up to the floor if a MET team ( Medical Emergency team) call is made, not the other way around.

Sounds like a dysfunctional workplace to me. Watch out for your license!!

**canoehead, BSN, RN** · Jun 9, 2007

I'm an ER nurse and I think those nurses were a bit snotty. If you had come to me I would have said "show me the list" and quickly grabbed anything you needed. If we weren't busy I would have stayed close, and told you to ring the call bell if he asked for something more. They could also have had a tech stay with you to help you find things.

That said, the MD should have done his thing on the floor, and told you what you needed before he began. You could have kept the patient in his own bed, and had a support system of floor nurses you knew. going to the ER was easier for the doc, but harder for the patient, and the patient's needs should have come first.

bill4745, RN · Jun 9, 2007

1. In my hospital, inpatients never go to the ER for treatment. They are treated on the floor or go to OR.

2. A new grad orienting to med/surg should not float to the ER. Even if the pt went there, he/she should become an ER pt and cared for by ER nurses. Most hospitals have policies that orientees do not float.

3. The staff should have welcomed a nurse taking one of their pts, and gone out of their way to help you.

I hope you consider ER nursing, but you might want to spend some time in your ER shadowing, so you can check the place out. Could have just been a bad day, but it also could be overall morale problems.

vamedic4, EMT-P · Jun 9, 2007

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.

:yeahthat: :yeahthat:

How completely true. And it sounds as if the nurses in the ER were "taking it out" on the new grad on top of all that...as if it were her fault...that's a NO NO, no matter where you work, or who you are.

AmandaBrittainy · Jun 9, 2007

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

Sounds like the ENT should have got his own crap and got up to the floor - that is probably what irked everyone off and they took it out on you because it was easier than telling the doc what he needed to hear. I have to deal with this as an ER nurse and it always has to do with a physician (usally ortho, though). I dont take it out on other people though, I usually just tell the family and the patient the truth - this was done for the conveneince or paycheck of the doc not you-so please be kind to me I am here to help you. We should not have to make excuses for our supposed team members.

AlisonBSN · Jun 10, 2007

I'm the OP again (if you didn't notice my name)

When I left I cleaned up all the stuff, and the guy that ended up helping me told me which stuff I could throw away and which ones needed to be taken to sterile processing, then I took the chart and took the patient back up to the room. We were there for maybe 20 minutes.

The fact that the attending physician is a very well known Pulmonologist around here may have had something to do with it...He's known for yelling and pitching a fit and has been practicing at our hospital since the late 60s I think. I also think he didn't know that we don't send patients down to the ER anymore.

Another reason that I just thought of that might half-way excuse their nastiness is that my preceptor may have been nasty to them. I wasn't there when the call was made to the ER, but I did suggest that we call as a courtesy to let them know that we're coming. I assumed that we would stay with the patient from the beginning, but when I came back to the nurses station my preceptor was like, "They said we have to stay with him the WHOLE time!" I was thinking...Well yeah! He's not an ER patient.

Everybody just had their heads up their butts that night I guess. I'm sure it was one of those full moon nights for everyone, but without the full moon.

I definitely learned something from all of this. If I were alone I would have called the supervisor, or either told the doctor what the deal was. But I'll also assert myself more with the ER nurses, because they could have helped me more considering they weren't in the middle of anything. I'm still new so I don't know what the norms are, but I'm learning! Thanks guys.

tbaytraveler · Jun 10, 2007

You have to remember that people are people, and that in every profession, and every work place there are people who are just nasty. Some people make themselves feel better by treating others like they're a complete inconvenience (or incompitant), and taking advantage of the fact that you probably have "green" writen all over you. I have recently change facilities, but the last ER I worked in would take inpatients for special procedures on certain occasions as long as they were with an RN and a MD other than the ER doc was responsible for the patient. Would you have been treated the same way there? Possibly, but that would depend on the person you were speaking to. You will always run into people who you would like to tell where to go. Just don't take it personal because it has nothing to do with you, it's them. Generally if you need help with something, it is best to ask the charge nurse (for future reference). Hope you never have to experience that again!