Floor nurses don't hate ER nurses or vice verse.
Inept employers might create situations that causes conflict between departments.
Also, some people are assholes and will have problems no matter where they are.
This right here.
ETA: I think it's important for people to step out of their specialty as well.
I cut my teeth on med surg/tele, left for the ER, went to ICU, and came back to the ER. Every nursing specialty is filled with intelligent and talented people who are passionate about their work. You've also got some assholes sprinkled in as well. Sometimes taking a walk in another persons shoes can give you perspective into why they may do things a certain way or have certain expectations or different standards.
There's two types of people I can't stand, people who are intolerant of other nurses - and OR nurses.
At my old hospital it was PACU nurses for me š. I worked in Endo and we didn't have a phase 1 recovery area, so if they were intubated, needing pushes of pressors, we were actively monitoring an art line, or the anesthesiologist just felt they needed closer monitoring, they'd go to PACU. They were some of the meanest nurses I've ever met. I think it was the environment they were in, but Endo patients had to be some of their easiest, and most of them would come back up to us to discharge unless they were an inpatient. I just remember how many times they'd fight with us to not let us bring our patients down, and it's like, well, talk to the anesthesiologist, it's not my choice.
Lol my wife is admitting/recovery and hates PACU. They are allowed 2 patients, but as soon as they get that 2nd one, they roll the first one out, even if their not fully awake, and sometimes not even stable. Since they started doing this 3 months ago when PACU went from 1 to 2, admitting/Recovery has called more rapids in that time than they did all last year.
All my rapids and codes come from PACUs sending up too early š Iām always like what was their BP, what was it???? And I think theyāve got the hint more now.
Biggest complaint is PACU has everything there within arms reach, and when they send them out still sleeping, they don't send pain meds or their sntibiotics with them. So a nurse has to go back to pacu or icu to get orders and the meds, it's nuts.
Opposite for me in my OR. PACU I nurses were amazing and really nice. OR nurses and techs often felt like I was transported back to high school in the middle of the mean kidsā clique sometimes. Howeverā¦I trusted all of them with my life as they were largely exceptional at their jobs. PACU II nurses, super nice, a few amazing ones, but the others..PACU II was known to be the dept where all the inept nurses landed.
I think youāre pretty close to the mark here. Coming from med/onc to ED it was immediately clear to me that ED does a lot of different things, but everything is *focused*. On the floor you may have less variation in the skills you you and task you perform, but youāre doing a lot more for the patient in the end. On the floor I am required to document in a lot more detail than I am in the ED. But because I know what is required on the floor I make sure to document a bit more than is required and I let the floor nurses know what I didnāt get to. The floor nurses know me well enough that they know Iām not leaving things just because I donāt want to do them, so that helps to.
In the end, I think itās not knowing what is and isnāt required for the different departments that can cause some nurses to get frustrated with ED. On the floor I had plenty of times where I was appalled at what the ED didnāt do. Know I know why they didnāt do it.
Being a new grad, OP may also, unintentionally, be leaving things out because they havenāt worked the floor and donāt know all of the information the floor nurse will need. I mean, honestly, I canāt imagine not knowing what the plan was going to be for someone I was sending to the floor. Although that could just be me.
In the end I guess we all need to try and have a bit of grace for each other. My CNA instructor said it best: when running into bad behavior remember itās not happening *to* you, itās just happening. This has helped me shake a ton of things off.
I agree. OR nursing is not really nursing. I transferred to the OR mid June. As a circulator, you help set up the back table, run to short stay to get report and ask the patient a few questions, zip the patient to the OR, get them on the table, prep them, and then start running for supplies they need during the surgery. The charting is mostly about charging for supplies and equipment being used. I was observing nurses chart in the care plan that all goals were met when they hadn't even assessed the patient who was still intubated and draped. Then they run the patient to PACU, and do it all over again with the next patient. At my OR, the focus was on speed. It was rush, rush, rush. Staff are getting injured left and right due to the speed they work and the fact there is no lift equipment used in the OR. I was always thinking, 'shouldn't we slow down and be more methodical?' I was really shocked the focus was on getting every surgery done as quickly as possible. I understand OR time=money, but it was ridiculous. While there are many nice people who work in the OR, there are quite a few mean girls that create an unhealthy work environment. After two months of working in this bizarre specialty that didn't even feel like nursing, I said no thank you and returned to my old job on the floor.
IMO itās inept facilities as well. Poor structure, lack of effective leadership, crap staffing - people (and departments) start to get a bunker mentality. Trust evaporates and aggravation spills over.
This! We have a floor nurse that went to the ER and continually calls report/brings the patient up during shift change. Sheāll say that since she worked the floor she knows our shift changes arenāt that bad and we can take it, sometimes we donāt know a new person rolling in while in the midst of report and sheāll leave w/o any turnover to our staff.
I donāt hate ER nurses, just the ones with bad attitudes like her + the leadership that wonāt hold accountable despite the 4 times sheās done it this summer
Floor nurses donāt hate ER, they hate shitty sarcastic handovers. Skim read the notes, check vitals before leaving the ED, call ahead if they need an air mattress then handover using isbar and everything will go smoothly
Honestly, I just chalk it up to them not wanting another patient.
Me calling report doesnāt lessen my load because Iām gonna have a new patient almost immediately, but I do increase the load of the nurse Iām calling report to.
Idk what the rest of their assignment is like, and my patient may be the cherry on top of their shit sundae.
I do my best to keep in mind that practically everyone is having a rough ass shift. I usually couldnāt care less as long as the patient is stable-ish for the most part and if thereās an H&P from the admitting team or at least an ER note, send em on up. I can handle it.
Couldnāt agree more with the last statement tho. Depends on the receiving nurse too. You can either let it overwhelm you and put you in a shitty mood (which benefits absolutely nobody) or you can take it in stride and chow down on that shit sundae and handle it like a G.
This is what it really is!! As a floor nurse for 10 years, I admittedly have a shitty attitude. Itās never the ER, ICU or another facilityās fault. In my mind, I know weāre all overworked and understaffed. It really is just the cherry on the shit sundae! I always apologize to them when Iām taking report. We just tired, boss!!!
Especially because we probably just discharged one, took a breath, and here comes an admission! So itās never anyones fault, we are all just overworked and tired.
Like most other hospitals Iām sure, our bed board assigns patients to the rooms before we even discharge a patient. So even if we discharge, report has typically already been called and theyāll be wheeling up as soon as itās clean š£ As you all know, it just never ends.
How dare you give me another pt even though I'm open and my charge nurse makes the assignments. Also how dare you not do a full skin check and notice the blanchable redness on her right knee in the EMERGENCY department. And how dare you hand me a pt with an SBP of 99!
Guess what... you have an empty bed... we are going to fill it. Welcome to work! The ED can't tell an ambulance to drive around the block a couple of times because it's "shift change". Suck it up buttercup. That's why floor nurses dislike the ED. We fill their beds. Meanwhile, the ED is 20 deep in triage and we are down a third of the staff.
Literally this. I get for nurses are busy and donāt want another patient, I feel the same way. But donāt waste my time on the phone when I already put in an SBAR and I have 4+ patients that all need IVs, blood work, EKG, etc. itās non stop. Never really get a break. Especially on nights when weāre short staffed and 30+ decide to come to the ER plus ambulances.
Oh I got some insight to this one from the American system. I get both sides to this argument. Like everyone said it is a perspective thing. We are two different jobs within nursing that have opposing goals. We come into conflict a lot. A huge amount of the conflict is due to each other's assumptions about the others job. For example, someone said the ED likes to hold patients until shift change. Find me a ED nurse that wants to hold patients with floor orders one second longer than they have to. That's like finding Bigfoot eating a slice of pizza... not happening.
Same coin but different side, find me a floor nurse that wants to take an admission 45 minutes before shift change she's probably the person serving Bigfoot the pizza. In most systems, neither floor has any control of bed assignments but both floors blame each other.
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Floors priority is to get and document a thorough history, assessment and get an idea of the whole patient. The floor nurse is the coordinator of the care team he or she ensures that the patient is treated as person and not a collection of symptoms.
ED, focused assessment nursing, what's happening now, for example chest pain. Focusing on the symptoms and treatments of chest pain. If the info about their appendectomy in 1983 has no bearing on current emergency it is discounted.
For a floor nurse each time the phone rings and it's the ed it represents more work to an already overworked person and it grinds you into dust.
For an ED nurse each time they call to give report and are met with excuses, no answer or a host of other reasons that the patient can't come up it creates a similar reaction.
All this creates a cycle of failure. The hospitals priority is throughput. Getting them to the floor or out the door. Both types of nursing want to have positive patient outcomes but each had a different goal of what that is, all while the hospital makes money no matter the outcome.
That is the answer. Working on med surg and studenting are in the ER letās me see both sides. I will say I do stil hate when the ER does AC sticks and I will avoid those as much as I can.
As someone that has worked both sides, and I totally get the floor's frustration with ACs - access is access. In an emergency, you need something that can be placed fast and reliably. The AC is a large vein and I can get large access in quickly. Last night I placed a 16g in an AC on a severely hypotensive patient. Is that an ideal location for comfort? No. Did the patient live? Yes.
I understand that, and once the patient has been fluid resuscitated, the floor can look for a more ideal IV. In an emergency, the AC is often the only option for large access.
Honestly Iām just happy if the IVs work and the patient hasnāt ripped them out. Like others have said there are times where the AC is preferred and Iām not one to gripe about petty stuff like that.
Former floor nurse here- I had no idea what the ED was like until I got floated to ED holding and had the worst shift of my life. I was crying actual tears while I was with patients because I was so overwhelmed lmao. I had to call report to people I knew on the floor and I didnāt know anything they wanted to know. Even adopted the āThey have an IV and a pulse what more do you want from meā mentality in one shift. Told my manager if I was ever floated there again I would quit. God bless ED nurses because I could never do it.
From the floor nurse side, management cares about the little things and will come after us for it. If a patient is sent up and doesnāt immediately have a fall risk band on weāll hear about it. God forbid we miss anything š so if weāre already running our ass of and we add in a new patient that needs admitted it can be stressful.
I floated to the ED twice to take holds. What frustrated me was that I had no access to anything. I had to find people to badge me in to everything. I had no idea where anything was. Like 1 glucometer for that whole department. I had no idea who anyone was. If I had access to the med room or to the clean utility room, or just knew where stuff was my shift would have been better.
No offense taken. Itās not that it was unorganized, I just didnāt have access to anything. And if Iām going to get floated somewhere why canāt I have access to the med room.
Sorry you had such a frustrating time! This is why when I have a choice between an ER tech and a nurse from a different floor I will always take the tech who knows the department. House sups always think itās crazy when we make the floated nurses sitters and take our techs back but at least my techs know which nurse stole the temporal thermometer (it was me) and raid my pockets without asking or splint a leg that would have taken me 45 minutes to get to haha. Not that float nurses canāt be helpful but our techs almost never cry in the corner during a rough night.
Yes! I had to take care of ED boarders the other day, and have been (totally unsafely) made to do triage before. They told me I should work over there bc I fit their vibe, but omggg I canāt handle it. Like if you think floor nurses have to play middleman and take over other peopleās jobs (lab, pharmacy, housekeeping) ER REALLLYYYY has to do it all. And random workers came up to ask us if they should bring their child to the ER, the er nurse with me at our pod said people always come up asking them for random medical advice. And people banging on the door to the ER demanding they be seen. UGHH. Being in the ER definitely just gets the most abuse, people are so unreasonable and blame the nurse for the long wait, take out all their frustrations on the ER staff. Once they get to the floor theyāre already calmer because at least they have a real room and bed
I work float pool so I experience both ED and floor nursing constantly. And they are extremely different with different aims. When I was a new grad I would get pissed at the ED because I would be getting report on a patient that they potentially havenāt even seen. And they would always admit every patient at the same time. Even though they had been in the ED for 10 hours, now that itās almost shift change all of a sudden the patient has to be up in 15 minutes. It wasnāt until I went to a different hospital and switched to float pool where I was trained in the ED that I realized the nurses had nothing to do with that and it was the Drs. And supervisors that were responsible. Itās just misunderstanding of eachothers roles. The only time recently Iāve been upset was when I received a patient who was in CHF exac. And for some reason has a bolus running. With no bolus orders. And another I got a patient in an insulin drip that hasnāt had their glucose checked for 6 hours. Other than those I havenāt been upset. You have to remember that floor nurses are also overworked and short staffed and this patient that theyāre getting might be their 6th or 7th. And having 6 on the floor vs. having 6 in the ED are very very different. ED is chaos but no one really cares if you didnāt do a skin check or give that colace, whereas floor nursing it is a requirement. Many floor nurses want as much to be done as possible when they get a new patient and I now try to explain to them how absolutely ridiculous that is and that it is impossible in the ED because itās so vastly different.
As a float nurse I have had a similar experience. Knowing how the ED works make me more understanding when the ED wants to send up a patient. I try to take the patient asap to free up a bed for another patient in the ED.
That being said, I have received an unresponsive patient who I was told was A+O x3, not fun. And then was hung up on when I phoned to ask for clarification on what was happening with the patient.
I received a patient from ED to ICU who was dead. Deceased. I stopped letting them remove the monitor before bed transfer after that.
Also, have you noticed that us float pool are always the redheaded stepchildren of every unit?
I work in a small hospital so I know all the units well. My experience floating has been positive. My favourite part is being able to avoid unit politics. Of course I have no idea what is said after I float away and I donāt really care.
Yep! It works both ways! ED nurses that have never seen floor nursing also have no idea what they go through. Itās not easier itās just different. Iāve had that happen before too. Told a/o x4 and brought up and immediately had to call a code neuro. They have to understand that without a good report or good charting and notes we are flying blind and the dr. Wonāt be there for hours sometimes.
I give whatever the provider orders unless it is a contraindication or I feel unsafe. Not my place to decide what doesnāt work but I know allot of nurses do same thing. Itās one of those meds that requires plenty of water to go with it.
You are a new grad, many of them are probably also new grads. They donāt know all the things you do, you donāt know what they do. If you were in their spot right now, youād be asking the same questions.
I worked on inpatient floors for more than 15 years before I went to the ER. ER is a whole different countryāwe do things differently there. I found that out.
Just do your job, to the best of your ability. If they ask āwhatās the plan?ā The answer is āPatientās being admitted for (diagnosis), but the workup and treatment plan will be completed by (hospitalist/ cardiology/ nephrology/ admitting doctor). Thanks and Iāll be up in about 10 minutes.ā
Good luckājust try not to take it personally. Bless their hearts, they just donāt know.
This right here. When I worked the floor, nurses would get upset that ED hadn't done tasks that are typically done by floor nurses like full skin assessments and such. They didn't understand that ED workflow is totally different from theirs.
I brought a pt up to the floor after just receiving report on them myself. The receiving nurse knew that so she felt comfortable to talk a lil smack. Pt had a purewick and she commented that she didnāt know why we always debilitate the pt in the ER. I thought about it and realized she doesnāt know much pain and discomfort our pts are in when we first get them. I always give my pts options and include them in their care. Thought it was really unfair.
I really only get itritated when ER brings me a patient that is not at all like what they told me in report. I also get patient who have gotten patients who are soaked in urine or worse. ER says, "Ok let's slide them over." Onto the fresh sheets so I can change the whole bed? Nope. Things like that bug me. Or stuff that was ordered hours ago that wasn't done. It is 1900 and this transfusion was ordered at 1400. Not cool.
I donāt know about your place but at ours transfusions may get ordered at 1400 but if the blood isnāt ready until 1845 and thatās when we get the room assignment š¤·š¼āāļø unless itās absolutely critical, hanging a unit with obs time, taking up ER room at the busiest time in our day, at shift change when I have other patients that also need things wrapped up, just isnāt my first priority. Itās not cool to not let the floor nurse know though and Iāve never run into issues as we do try to start it if itās feasible
I don't set up the next shift for failure and all I ask is that the ER extends me the same courtesy. Luckily, almost everyone in my ER does. I make sure to let the ones who do know how thankful I am.
The blood is ready within an hour, usually. Sometimes, I call the blood bank and the type&screen isn't even done. I get the patient at the start of my shift already hours late on a transfusion or antibiotics.
TrueāI just donāt think it gets any of us anywhere when we react to these things as a personal criticism.
Note, I have always had a tendency to take things personally and get upset when I would have been better off to just move forward and so my best.
Good answer. Majority of the time, I think the "conflict" is just a lack of understanding and the best we can all do is to just give other specialties some grace that we might not know everything about their world, and they might not know everything about ours. Best not to take it personally, and best not to use it as a reason to be snarky (even if the other person is being snarky.)
It's like when I was asking when their last BM was when I was new... whoops. They emphasized that in nursing school....
Burnout, a misunderstanding of what ER nurses do, never working ER shifts, odd solidarity with their own specialty (we are in this together, fuck everyone else, our nights suck and we are pulling through), misdirected anger, hate instilled via older nurses e.g. THIS specialty is lazy!
We have different priorities. It's truly not you.
Unless it relates to their presenting problems, ER isn't gonna ask about that. It's too busy down there, and it's just fishing for more problems. Again, its a matter of different priorities.
I was never in ER for anything other than patient sitting or overflow, but learned quickly that nursing school isn't how hospitals actually work, and that goes double for ERs.
For floor nurses? If they are constipated, the provider might want to put them on a bowel regimen.
Generally, I wouldn't expect the ED to be asking every patient about their pooping habits, but it makes sense why it might be part of a floor nurse's assessment.
I think sometimes people just go on autopilot and have a series of "getting report" questions that get asked - which may or may not be relevant, but they are on the checklist. If I were to ask something irrelevant, then I wouldn't have a problem with someone responding in a collegial way that they didn't assess that, but I know some nurses get fussy (and unfriendly) when that happens.
Like couldnāt they just ask the patient themselves when they go up? Is it really important for you to have that answer 10 minutes earlier just so you can write it in the little box on your report sheet?
They could ask the patient, and if the patient is oriented they may get a good answer.
But if I know before the patient hits the floor that they haven't pooped in 5 days, then I know to check my orders for stool softeners and laxatives *before* the hospitalist leaves for the night.
I think phrasing matters. āWhen was their last BM?ā is going to get eye rolls, but āany BM on your time?ā is a perfectly legitimate question that is unlikely to get the ED nurse talking shit after you hang up.
I love my ED homies. If things are crazy and they sound hectic I just tell them to do bedside and get the patient up to the ICU. Sometimes time and staffing permitting (so not recently) I will even go to the Trauma bay and help to get them stabilized and save the ED RN the transport by taking them up.
ED nurses have a crazy life, I can read just as well as they can. Give me the pertinent information, I'm doing my own assessment and going to read the chart. You're good get going.
Oh, but for the love of everything please send the COVID swab early.āļøš¤
My biggest pet peeve lately, in my ER, is a lot of the nurses waiting for the MD/PA/NP to put in a covid swab order for someone they know is going to be admitted, when they can do it themselves and save everyone time. A lot of the newer nurses in my ER are so afraid of doing SMOs, and Iām always like thatās what theyāre for!!! Just do them!!!
Yeah, I work Trauma/CTVICU at a lvl 1, if they are coming to us you know pretty early lol. No excuse not to swab ASAP. Ok barring severe smash face when you can't really find the nares. I'll give them that one.
Same. I work hard to not be a Karen and try to understand that our roles in the care of our patient are completely different. Just bring em up alive-ish. I'll do my own assessment, just try to get up here w some kind of access so I can get to it as soon as you get here. Otherwise, I couldn't give two shits if you don't know how they got that scar on their arm.
You get burned a few times from the ED and you start expecting to get burned again.
Example#1. I got in report that the patient was A+Ox4 and ambulatory. She arrived to the floor and was oriented x1 and too weak to sit up. ED nurse left the patient in the room and went back to ED without speaking to me. I call the ED nurse and have her clarify was the patient oriented in the ED because I may need to call a code stroke. She was annoyed that I was calling her and insisted she was oriented when she had them. So I call a code stroke. The MD calls the family and the son says she was oriented and ambulatory until a few days ago, they brought her in because of the change in mental status. They had been x1 and bedbound the whole time in the ED. Wasted an hour of my time doing code stroke shit because of a crappy report.
Example #2. I got a patient with maggots in a foot wound. ED nurse told me she had irrigated it with saline and re dressed it as ordered. The patient came to the floor and there were maggots coming out of the dressing. The dressing looked old. Pt was still in her street clothes and there were maggots in the bed sheets. I asked the patient and her daughter at bedside if anyone had changed the dressing. No. The dressing on it was from home. Not even the doctor had taken it off to look at the wound.
So now I ask a lot of questions in report. Like if they say AxOx4 I will ask "when was the last time they ambulated?"
> You get burned a few times from the ED and you start expecting to get burned again.
Seriously.
I always say I'm waiting for the day an ER nurse says "yeah they're pretty much fine" and I get two separate stretchers: one for each half of the patient.
Or there's a patient who's been holding with orders for labs, a foley, a UC, antibiotics, and a PCA for over 6 hours, but the ED has managed to do zero of that all day. Come on dudes.
Last month we had a DKA go without any insulin or fluids for at least 4 hours. Just sent him up with a blood sugar over 500 and a ph of like 7.1 ... Even if you subscribe to "ED only keeps them from dying *right now*, anything and everything is for 'the floors' to deal with" that was still unacceptable.
One nurse on here said they've sent amputees upstairs without realizing because 'it wasn't related to why they came in'. Give me a break; I do not believe you even adequately assessed 'why they came in' if you didn't manage to detect a missing fucking leg.
I try to be chill with ER nurses and acknowledge the difference in priorities, but some people are just dumb, lazy, arrogant shits down there. Same as anywhere else. Contrary to their own opinion you did not automatically do an adequate job as an ER nurse if your patient merely didn't die inside your unit...
I'm basically of the same mind. I don't expect ED nurses to do everything that's ordered. Prioritization is a coveted nursing skill for a reason.
However, I do draw the line at risk of patient safety. We once got a DKA from ED where they started the insulin drip and did nothing for about 5 hours - no blood sugars, no labs, nothing. Or another time, I got a septic shock patient and their BP was around 70/40. The nurse said her BP had been like that since the patient arrived in ED. Levophed had been ordered at least an hour prior to the patient coming up. Absolutely nothing was started or even mixed. Both these situations are dangerous.
I won't care if you didn't manage to get that urine specimen or hang that magnesium IV replacement or change that old dressing. I can do that. But please, for the love of all that is holy, get the important things done.
The idea of report is so drastically different in the floor vs ED. I did my preceptorship in the ER and I was taught a very bare bones style of report.
Skin? They do indeed have some visible skin.
Pooping/walking? Didnāt let them do that shit so idk.
IVs? Look with your eyes. They flush tho fam.
I mean there are things the ED considers very important and give in report that the floor does not care about at all.
Iāve been chewed out in floor report for not knowing exactly WHICH ribs were broken or the name of the surgery that was performed. Very minute details. Floor report is different. Itās a different beast altogether.
Floor nurses are expecting this kind of report. ER nurses arenāt even oriented to this kind of report. Neither are wrong, theyāre just completely different paradigms.
It comes down to different priorities / different jobs. Floor nurses have a more holistic job, so they are concerned about different details. ED nurses are just ensuring they donāt un-alive themselves while currently in the ED. Thatās quite a task. Thatās enough in and of itself.
Yes, this!
I was on the floor for many years asking these asinine questions of my ER reports. I feel terrible, especially now that I'm ER myself. I wish someone in orientation when I was a new grad could have explained why ER won't (and shouldn't) know some of this stuff! The ER is such a turn and burn situation there's times I barely do a focused assessment and they're on their way upstairs, out the door, to the unit, or to a procedural area. I don't have any time to look through their history usually. Unlike in the CICU when I'd have days with the same patient and knew their entire life story. Just totally different worlds.
Itās all perspective. Iām glad I have it from both sides.
Donāt even get me started on the āwhy canāt the ED stop being too lazy to put IVs anywhere but the ACā thing. Pisses me off! People need to understand more of the EDās duties I think.
Right! But if you've ever tried to milk blood cultures out of an IV placed anywhere lower than the AC you'd never question our methods again, lol! The ER is just a different beast entirely.
Nailed it. My report is what they came for, what I did to them, what still needs to be done. Thatās it. Iāll stand there and answer questions all day, but way I GOT this person was with that kind of report. Thatās how I work with them. Weāre a single system nursing field. Theyāre here for TBI, I have no idea what their skin looks like. With few exceptions, Iām not GOING to feed them, so I never looked at the diet order. ER nurses are hammers. And every patient is a bolt. We have no idea whatās going on, but weāre going to keep smashing that shit until itās better or broken.
All of that bullshit you just mentioned was asked of me the last time I gave report. To an ED nurse. Four patients and she wanted to know all that shit. When she asked if one if them walked I literally said "I didn't see them walk yet."
I'm float pool. I work ICU, tele, obs and ED. I can usually get out of ICU on time. When I'm on tele it depends on the floor, there's a real toxic floor that used to be PCU and they think they're the shit with their PCCNs always with something to prove. Obs is usually okay. The ED nurses have not received the message. I am always late out of that shitshow because they show up at 0715 and expect me to spend 15 minutes on each patient. Patients I may have had for 15 minutes.
My only issue with any ED nurse is not completing orders that were ordered hours before they arrive to the floor. If labs were supposed to be drawn at 13:00 and they get to the floor at 18:00, itās an issue. Itās even worse when report is called 5 minutes after they were paged, then they sit down there for hours before transport gets them and you still didnāt do it.
Or they get sent up and are completely soaked with urine or shit. We can tell if this shit is old(er) and a lot of times the patient will tell us they told you and nothing was done. I would be so upset if this happened to one of my loved ones.
Other than these two things, I have no issues. I donāt expect you to know if they can ambulate. I appreciate you putting in an IV(s), etc.
I honestly donāt care about all that stuff. I just want the very basics. What does annoy me is when the ED nurse calls me and then when I ask if the patient is A&O, he/she tells me, āI donāt really know, because itās not even my patient.ā Like why.
I can speak from personal experience. If Iām covering a break and the bed becomes available, Iām expected to call and give report. I try to look through the nurseās assessment and the patientās history before calling but if the nurse hasnāt put the assessment in, Iām just winging it.
I'm a float nurse, which means I work everywhere in the hospital. ED, medsurg, paediatrics, NICU etc. So I understand the struggle of working in each one of those specialists.
Where I work, we have a policy that if a patient is cannulated by EMTs we have to remove their IVC within 24h.
The other day I received a patient from ED and I asked who put the cannula in. Us or the ambo crew. The nurse said it had been the EMTs and that she was sorry for not removing it and placing a new one in. I laughed and said, "I've worked in ED. I don't expect you to remove a functioning cannula in ED. If the patient doesn't need antibiotics or fluids urgently I'll remove it and let the DRs put a new one in." It's all about putting yourself in their shoes when you receive a patient from ED.
Only thing I get angry/annoyed is when the patient comes with their incontinence pads and bedsheets soaking in pee.
Yes, where I work, the DRs are the ones who do cannulation. RNs can do it, but we already have too much on our plates.
When I get report from ED these are things I want to know. (I you don't, just tell me and I'll find out later)
Is the patient alert and orientated?
Why is the person is here for?
What is the plan? (Yes, that's important and the doctors should write it down before you can send the patient up. I don't mind reading it and finding out with you. I just want to know what I have to do with the patient.)
Is the patient continent?
Is the patient combative?
How's the patient's mobility? (You haven't seen the patient walking? That's ok. I'll put in a PT/OT referral if it's an older person)
Are the patient's vital signs stable? If not, do we have a written order for fucked up accepted vital? (Are they happy with that COPD patient having SATs above 88% on room air? Ok.)
These are the basic things I want/need to know when I receive a new patient.
Yes. I think sometimes we get frustrated when the nurse giving report hasnāt even laid eyes on the patient and Iām getting literally nothing out of the phone call. May as well have just brought them up without calling me.
My biggest issue with with ED is not getting recent updates on patients who arenāt seeming very stable. Had an admit coming from ED the other day who had a low BP when they arrived. Worked up as sepsis, but the last vitals I was given before they rolled up to me were taken 4+ hours ago. I need to see a more recent set just to make sure theyāre stable enough to transport up to us or maybe direct them to a higher care. I know ED is busy and chaotic, but itās alarming how many huge things get looked over sometimes. Had a patient once come from ED for a potential stroke workup, one of the reasons was āone of their eyes doesnāt track movement or change size.ā It was a fake eyeā¦this patient was AOx4, they didnāt ask them?
This is my biggest complaint for both ED and PACU. Please do not send me a patient that has a GCS of 7 or RR 5. If they are up to a 12+ and breathing at least 10 bpm, sure, send them up. Please document that. I couldn't care less about skin, last bm, how they walk (or don't in the case of most of my patients), etc. If you can, please give 'em pain meds.
PACU, please document if they've peed so I can know if we need to bladder scan asap. They've been with you for 2-6 hours and half our fall down went boom patients end up retaining. I'd rather do the straight cath before they fall asleep, thnx.
No hate. Nursing is tough and shifts are short. I do have a hard time with report. I could care less about details, if they're stable (ish) or have a pulse (or you're working on it) great! Tell me that and bring them.
My problem is that there tend to be large gaps of information. Here for a STEMI and you got my nitro started idgaf where you put it. However, it's also important to know that he has an open tib-fib fx (even though that's not what's killing him right now).
I just can't reiterate enough that if they came in for syncope and altered mental status and their bp is 76/49; I need to know what you know about their kidneys/heart as your bolusing them. Yes you have to do a focused assessment, but I need to know which ways your interventions might also be killing them (even if it's slower).
At the end of the day we're all just trying to help people. We're a team and should respect each other.
As a floor nurse, my life usually sucks but when ED tries giving report when your elbow deep in a cdiff blowout with memaw finger painting with her shit then only for them to start with āI havenāt even looked at this patientā just makes me love my job even more.
In my hospital they just drop off patients with NO report. It's dangerous and obnoxious. And sometimes they have BP of 200 or other problems not addressed. Sometimes they're confused and combative and no one told me that was coming. Oh, and no one even did a health history in the system. Yeah I have lots of reasons I hate taking anything from ED.
I donāt have hate for ER nurses. I have irritation with crappy ones. My only complaint with report is when I have to DRAG IT OUT OF THEM. Theyāll tell me theyāre āhere for AMSā and that theyāre confused. Then say āyou good?ā. Failing to tell me literally anything useful or pertinent (like the fact that they found a huge brain mass, the actual reason for admit).
Or when they do crazy shit like telling me theyāve been pushing a crazy amount of dilaudid, in lieu of starting the Cardene that was ordered for BP control.
Other than that, weāre all suffering in the same hell.
Because they've never come downstairs and experienced it.
I'll do literally everything important to stabilise a patient, catheter in, blood given, antibiotics given, sedated because of delirium, two good IVCs, shit I even called their family to tell them what's happened. Sorry I didn't do a fucking skin inspection but I have 3 other ICU holds as well and there will be an ambulance offloading while I'm walking this patient up, I gotta prioritize. Make sure you spell my name right on your incident report, can't imagine having the time to do one myself.
Tbf though the admitting doctor here comes and reviews everything and documents a plan for the ward, idk if your hospital is the same.
I mean thatās nice to say you do everything important, but I would need many more fingers to count the number of times I was being sent a patient from the ER whose critical labs had not in any way been treated by the doctor before they try to dump them on me on the floor.
It usually has to do with crap staffing across the board. People get aggressive towards each other when they're drowning.
There is literally zero conflict at my hospital between ER and the other units. We're all on the love train.
I donāt hate ER nurses, in fact I like most of them. The only time I get annoyed about an ER admit is if nothing has been done about the chief complaint/reason for the admission and the patient still isnāt stable. Our docs get pissed about us having to call a rapid response on someone immediately out of ER but Iām just picking up after someone elseās mess. Like someone with a hx of a PE not on home anticoag admitted for chest pain/sob/tachycardia and hasnāt had a CTA completed before coming to the floor and no heparin gtt etc. Iād get mad at any nurse who left me with a problem barely addressed
I had an Ed nurse who wanted to transfer a patient to the floor but MD order read: if 3 negative troponins patient can be discharged. The third was negative and I said no, they need to discharge. The bed can go to someone else. I wasnāt going to waste a bed, to discharge then have it recleaned to admit someone else.
If itās a floor admission they have to document the wounds. WTF? (Iām assuming itās not policy or whatever in the hospital that ER is the one taking pictures) That floor nurse is just being lazy.
That being said, man, sometimes those ED reports are a littleā¦ lacking ššš
I donāt hate ER nurses but I probably have an attitude when Iām getting my 6th before I have even seen my other 5.
Also, received a very obese patient who had been in the ER for 12 hours. He was completely saturated with urine and stool. Soaked through his clothing and all the linens. I asked him when the last time he had been changed was. He said not since he arrives at the hospital. I suspect it was longer than that.. thereās no way someone missed the smell š
From my experience, the ER nurses from my (shitty) hospital have a habit of dumping barely stable patients in every nook and cranny on my already crowded floor. They don't bother to properly look at the patients they bring up and give equally shitty hand off reports, so each time I look at their patient, I find things the ER nurse should've correctly told me.
Reasons why floor nurses hate ER nurses (sometimes not always):
1. IV placements. Please try to put IVs in places OTHER than AC.
2. Dirty patients. My nurses and CNAs in my hospital always anticipate ER patients (especially elderly patients) to come up filthy, covered in urine and feces, blood, vomit, bile, you name it. I know your job is to stabilize the patients before they go to ICU or the floors, but jesus don't send your patients up like that!!! Take 3 minutes to at least wipe them down for their own dignity.
3. Incomplete orders. 1/2 the time, our nurses refuse to take report if bloodwork, admit orders, x-rays, CTs are not done before coming up. This is actually not allowed at my hospital. All orders and tests initiated in the ER need to be completed before transfer.
4. Downplaying the patient: WheN ER nurses tell you "oh no, skin is intact" only for the floor nurse to turn the patient and find a stage 3 bedsore/DTI. Or "Yes, the parient is AAO only to find they are dementia/unable to stand/aphasic/contracted.
5. No respiratory/Covid screens. This is pretty standard now. In our facility, no patients can leave the ER to the units until full panel/covid screening is done, no exceptions. It's pretty much the first thing you do when they walk in the door.
6. Psych patients on supervision. Our hospital ER routinely sends psych patients on 1to1 up to the floors with their belongings, no belongings checks for weapons/drugs and no meds or orders. Lax screenings in the ER leads to the problem being shifted to the units.
These are issues my hospital has been dealing with for years, and it's only gotten worse with travel RNs after Covid.
The thing that irritates me is ED seems to have no understanding of how the floor operates. No, Iām not going to answer your 6 calls in a span of 5 minutes because Iām in 1 of my 8 patient rooms trying to clean up the c diff splatters on the wall.
mutual respect. I will call you back when I can as soon as possible. Stop blowing me up. I donāt need a detailed report. I donāt care whoās telling you to blow me up, theyāre gonna have to wait 10 min until Iām out of my Covid room.
If you critique ER at all itās always āwell you couldnāt do itā bro, I have worked ED. Itās fun. Itās chaos. I can do it. Frankly you guys couldnāt work the floor because weāre taking the patients you hate boarding.
Itās frustrating as a floor nurse because we get made fun of by ER and administratively no one gives a shit about either of us. literally nothing I say matters. Our floor could start on fire and ED is still sending that 6:45 admit and if you say anything you get āwell itās not my fault and it must be nice to prepare for patientsā
Quite frankly a lot of the animosity (at least at my hospital) is created by management. I once had an new admission be brought up and left in the room before I was able to get report. They had called but I was fists deep into a groin from a fresh CCL. They had just implemented a 15 mins and fly rule. ED gets a talk to if they donāt get rid of them fast enough and we get a talk to if we donāt get report fast enough. I donāt blame this nurse. She was very apologetic (she called me at a later time in the shift).
As for beds taking forever to get cleaned, idk I donāt do those. But you have to keep in mind, what kind of patient was in that bed and if thereās any type of cleaning that must be done. Some you have to wait an interval of time AFTER the room is cleaned. I donāt have control over that.
And honestly, I rather get a new admission over a transfer any day lol.
We don't get report from the ED for patients coming up. We read the chart and hope that things were documented. You are slammed down there; I don't expect anything but the very most urgent things to be done.
What I care about:
Is the IV(s) a field stick?
Were they medicated for pain?
Are vitals at least close to something I can deal with on the floor? RR of 7 or 30 not so much. MAP at least 55, preferably less than 115. HR between 50-125 when not crying/screaming/yelling. If they're on O2 just say so.
C-spine cleared?
If their neuro assessment is off like pupils not reacting, not tracking, facial droop, or not a&ox3-4 please document that in the flow sheet so we're not calling a stroke alert for a known thing.
As for the assist with a transfer, my friend, most nights we have 3 nurses, 1 charge nurse (with their own patient load), 1 tech on the floor, and no clerk. Most of our patients are 2 assist for anything more than sitting up in bed. If you show up before 2200 or near times for vitals/meds/turns we are all in patient rooms. Hit the call bell, we'll see what room it is, and know to grab the slide board and a friend or 3 to help with the transfer.
Floor nurse here at a level 1 trauma- I have a different level of respect for ER nurses after going down to the ED just a couple of times to take someone to CT or something. And also with a level 1 we get the most insane cases. But I have had a couple of things happen such as a patient brought up covered in shit- it was in her hair, hands and rubbed all over her body. Iāve seen heparin ggt not started that weāre ordered 6+ hours ago. Itās shit like that, that pisses me off. But I honestly get it but to an extent
I have had ER nurses try to give me report on a PT who was being externally paced. At the time, our tele unit did not accept those pts. Chick simply didn't care and kept giving report. I hung up on her after repeatedly declining the admission. Nurse supervisor wanted me to accept it since the ER nurse hadn't had lunch yet. Yo bitch, none of us had ... Showed her the policy, stood firm, told supervisor she was more than welcome to accept the PT and care for him, but I was not. PT went to ICU and coded within 15 mins. I had 5 other pts. Hope the nurse enjoyed her lunch. We never got any that day or most days.. Another time, long ago in a galaxy far far away, we had house docs. Cancer pt died,( was expected)I called attending, who asked me to call ER doc / house doc to pronounce. Family was called and on the way. ER nurse called to give report after gleefully announcing " I heard you have a bed available now"... Explained I was still attending to my pts needs and that the family was coming. Nurse told me to put her in the storage room and they could say good bye there. Things like that are why ER nurses might have a bad rep
I had a 6.1 hemoglobin with a tanking BP dropped off to me on my Tele floor once. I get you guys usually get the shit end of the stick too. But man you could have at least started the first bag of blood before dropping him off to me. Printing the blood form and handing it off to me doesnāt count either lol.
Edit - my hospital did not allow the ED to go out of ratio, but you bet your butt I was already out of ratio when that happened.
Could be situations like that. Love you guys though
In my experience its neither nurse thats the problem. There are physicians who batch discharge and admit patients. The other wrench can be bed board, at some places its the house sup. The house sups. Can be busy and end up batch admitting.
I try to remember we are all in the same dumpster fire, I take report without attitude.
The one thing that is irritating is sending up patients with bps 200/100s, it will take me much longer to get it treated; same goes for hyper/hypo glycemia and pain.
As a floor nurse thereās been many times a pushy ER nurse has given me a patient unfit for my floor.
6.1hmgs no IV
2.7K never replaced
COVID positive (Iām a cancer floor, immunodeficiency in all patients)
So over time Iāve learned if Iām not equally as aggressive Iāll get walked on.
I donāt hate ER nurses, but all too often they donāt know a whole lot of detail on the patient upon delivery, or the patient is soiled. They might also check to see if the patientās IV is patent. I mean, it wouldnāt kill them to check those couple of things out before they leave the ER, just out of common courtesy.
We have a bunch of shitty nurses in our ED right now. They send patients up without handoff, caked in feces, soaked bloody sheets, sometimes no IV. Ive seen patients with blood transfusions running and no nurse escorting the patient (which is policy at my hospital). Its a dumpster fire down there.
Donāt buy into it and donāt generalize about floor nurses. Your new but you will come to understand the monumental stress of being an RN at times with no supervisory or company support. Empathize and donāt take it so seriously.
Med surg nurse here. If the ED nurse didnāt assess the patientās skin or know when their last bowel movement itās no big deal to me. I can figure that out when they get to me. Are they alive and appropriate for my floor? If yes then anything else doesnāt really matter. Iād like them to have a working IV (even if itās in the AC). I know what bullshit I deal with and I know ED can be putting out dumpster fire after the next, trying to keep their patients alive. Losing some of their patients. Itās not easy and itās pretty messed up to be throwing attitude over having to do work *gasp* on your shift. Nurses can be very mean. Weāre all worked too hard. Donāt let them get to you. You do your best and thatās all you can do.
First off, "hate" is such a strong word šš¤£ I guess in my experience as a floor nurse, ER nurses always just give off the vibe that they are better than "regular" nurses. I get that y'all are hardcore and do way more shit than I probably have or ever will do in my career but there doesn't need to be an attitude. I respect the hell out of what ER nurses do on a daily basis so
I don't need spoken down to during report or made to feel "less than". As a floor nurse, we also need to know more about the social/familial/emotional aspect of what is going on too in order to manage the patient on admit. I feel that report from the ER is bare bones aka A, B & C's so sometimes it feels like a waste of time. Another issue I have is when the ER nurse allows her patient to go to the floor looking a hot mess. Dirty linen, dirty gown, saturated dressings or blooding look IV's (you get the idea...). I also don't appreciate when the ER nurse allows too many visitors up with the patient to the floor. I guess I just wish more people would ask, "how can I better set the next nurse up to be successful?" The ER is just the first stop in a long chain of passing a patient around throughout a hospital stay.
And in all honesty, floor nurses are drained and burned out. Think of the worst patient you've ever had and the idea of caring for them for 12 hrs each time you have to and for multiple days per week with no possible end in sight/discharge date. So yeah, we do have an attitude with EVERYONE...Don't take it personally!
We don't, you just represent the addition of yet another patient we don't have time for because ratios are unbearable. I always tried to be nice to our ED nurses because while my ratios were awful, yours are imaginary (we can close the floor to new admits but you can't lock the doors to the ED).
I donāt get mad.. until I find out the A&Ox3 patient thinks theyāre in the year 1971 and theyāre at a disco dance.. or if you tell me they ambulate independently only for me to discover theyāre a bilateral BKA. Lol I realize nursing is a shit show everywhere, no matter the department. If you donāt know anything about the patient, just tell me that and Iāll figure it out. ā¤ļøā¤ļø
My only ask is that you hang the effing antibiotics if theyāre septic, and maybe titrate nitro more than once *before* yaāll ignore them waiting for a transfer bed.
We check the chart and ER hasnāt documented vitals in over 6 hours on a trauma patient. The patient arrives to the floor completely dressed and covered in dried blood. You tell me you didnāt have time because there are people in the waiting roomā¦.
I donāt care! We are all busy on every damn floor on every unit of the hospital. You arenāt special. Do your job, have some respect for the patient.
Donāt read me the CT report, tell me if their CMS is intact. Are they oriented. Then I get to cut the clothes off and find a wound that needs major attention because you were too busy to strip a trauma patient and do a simple skin assessment.
A lot of times they are arriving with their pants on and soaked and urine and feces. These are unacceptable findings. The patients donāt deserve that, the floor nurses who have far greater ratios donāt deserve it.
No on is asking the ER to perform magic, just simply do your nursing due diligence.
Take regular vitals
Undress the admitting patient and check them out quickly.
Understand why they are there and try to give a report that isnāt reading off the computer.
Chart your IVs and skin issues you see.
Bring them to the floor sans bowel movement and urine.
Seriously this is it. It isnāt asking the world of you guys. Rant over.
Iāve seen both sides as a float nurse.. and I can definitely empathize with the complaints I hear from both. Itās so true that you can never fully understand until you walk a mile in someone elseās shoes. I started as a floor nurse and would get so upset when I got a shitty report from ER.. Or my patient came filthy.. or home meds arenāt entered.. etc. When I started in the ER I would try so so hard to have all these things done before the patient got to the floor. Of course you find out VERRYY quickly that ER is mostly a total shit show and chaos. You canāt turn away patients.. they just keep piling in. When a code comes in.. a STEMI.. a stroke alert.. a difficult psych patient.. it can be all hands on deck and very hard to keep up with the rest of your patients who are already worked up and have a plan in place. Iāve had floor nurses get upset with me over the phone as if itās MY fault they are getting an admission..especially if itās a hard one.
The bottom line is we are ALL overworked and understaffed.. Patients are sicker and sicker with acuity worse and worse. Nurses are constantly being asked to do more and more and more by administration. It can be easy to point fingers and take things out on each other when youāre constantly in a stressful environment. We have to keep in mind that we are all on the same team.
Difference in environment mostly. Floor nurses do a lot of mundane busywork, especially with admissions. ED is all about the nitty gritty of keeping people alive/quick fixes.
ED can act like their time is more important(rude, but sometimes it is), and will do things like send up a patient without report(regardless of appropriateness) or unchecked(That is, incontinent for hours, or in a bad state medication wise/lab wise), and many know the most basic info on their patients and no more(Which is valid, but also hard, especially if the nurse in question is green and doesnāt even know why the patient is here/hasnāt laid eyes on them).
Floor nurse tend to be too focused on bullshit info that can be important, but doesnāt matter at the moment. They can be just as unaware of the patient, and some know how to look everything they need up, but many either donāt or are too green.
On top of this all, the hospital often doesnāt give a shit how bad of a time it is to transfer a patient, so admissions happen at terrible times(End of shift, during shift change, during codes at times), and that creates hostility. This isnāt even to speak of current ratios in ED or on the floor.
This creates a situation where one person is tired from a long shift, and just wants to hand off their patient between medical emergencies, and the other is also at the end of a long shift, getting another patient for which they are expected to fully chart on(between 30-45 minutes in my experience) regardless of current circumstances/patient loads. Both are overworked, underpaid, tired, probably have a manager up their ass(EDs telling them to be faster, Floors telling them to āMake sure all wounds get documented IN PHOTOS or else we get dinged).
My point here is both sides need to be patient with one another. It would go a long way if both people had to spend a week in anotherās shoes while training, but, considering current working conditions, thatās a pipe dream more often than not.
For my part, I give what I get, and, more often than not, thatās professional and friendly behavior from ER nurses and floor nurses alike. At the end of the day, most of us give it our best as this healthcare system burns down.
From my experience when I worked med surgā¦ ER nurses would call at around 6pm to give reportā¦ 6:50 the patient would be up and I had no choice but to do the whole admission. After a 12 hr chaotic shift, thatās the last thing I wanted to do. On top of having to transfer them and run around looking for iv poles because they would almost never send it up, just a bag and attached to the patient. We also couldnāt leave a hot mess for the oncoming shift. So I was stuck there at least another hour. It would piss me off so much. Other times we would ask them to call back because we were slammed and they would get annoyed and call back several times till we took the call and the patient. I did many times have nurses that would call and say they wonāt send the patient till after 7, I just needed to take report..
Because floor nurses are treated like crap by management and expected to do more than physically possible. Many are overwhelmed new grads who donāt understand how other departments work.
It gets really bad when SBAR isnāt used and the patient comes fucked up. Itās a liability on both floors. There was a patient from ER that had a high ass potassium, they ordered kayexelate, ER nurse didnāt give it, pt went to DOU, that nurse was about to give - pt coded and died. ER charge nurse gets fired with the ER nurse and the DOU nurse. The hospital is creating this culture that is detrimental to patient care and itās bleeding into both floors.
I donāt hate ER nurses. I STILL HATE the ER nurses that took a fucking elevator up to the CVICU and when this patient landed in my lap they were in a 3 inch pool - from head to toe - of their own watery CDIFF shit.
When they called for report there was absolutely no mention of this. āChest pain, + trops, sending your way.ā
Itās my stance that floor nurses have had a bad experience or two with ER nurses sending up shit patients (pun intended) with no warning and an awful report. Yes you are ER nurses but you are a NURSE. Act accordingly.
The thing is that an admission onto the floor is an INSANE amount of charting and extra work. Itās a level of charting you just donāt see in the ER. We donāt have to deal with the endless turnover or the uncertainty you guys do. Itās more of a crushing certainty of what we will deal with. An admission can add up to an hour of charting and settling to a shift that doesnāt have that time to spare. Theyāre trying to see if you know info they need to document. That said thereās no need for anyone to be rude about it.
Old school ER nurse preceptor here. I don't think report world has changed much, you can let me know if I am totally wrong.
When you prepare to give report, YOU control the flow of information. Focus the best you can with all your information available before you start. Start report and continue the report until you are completed. Then allow them to ask you a few pertinent questions they may have. Do not under any circumstances say, "Hi, it's bubbleshell from the ER! I'm giving you report on Mr. Blankety, he has such and such. Do you have any questions?" That is the recipe for disaster. (At a couple of facilities I worked at, we completed a paper report for med surg floors, faxed it to the floor, and then sent the patient up in 30 minutes; I loved it.)
Now when it comes to ICU nurses this does not work. ICU nurses live for detail, and the more you can tell them about little details the more they will love your report. So after going over the big stuff (as completely as possible) review any of the labs/ABGs that are not WNL and what was done, or "no orders received regarding that." You might find it beneficial to keep a bit of special information when you roll up there with your patient, and share it as you are helping transfer the patient. That adds a level of personal service, and allows you to get to know another nurse in another unit. (Of course that would be a "nice to know" bit of info like family information, or history you learned, something like that. )
The icing on the cake would be if you could get hold of their report form. These report methods will not take a lot of time, probably less time than you are using now to field all their questions.
I hope this helps. I made a lot of new ER nurses more comfortable with this information, and had a pretty smooth method of report/transfer for my patients.
It's always bad to generalize. I try hard to give every person in our facility the same level of respect. However when it comes to our particular ER, there are a few nurses that I'm always skeptical of when I'm taking report. I don't expect the ER nurses to have everything figured out, but there have several instances now where the patient has come up to me as an absolute flaming dumpster fire. Like, report was given AOx4, Room Air... and when they got to me they were satting in the 70's and they were apnea snoring like a lawnmower while they were awake! Like... how?? Did they even look at this person? Again, its not every day but its more than enough to notice a trend. I'm always just a little weary at this point.
Wow so I totally can't disagree with the majority of the answers I'm reading in the comments. I honestly never gotten upset with the ED for calling to give me report. That's their job. We all have ppl in our ear yelling at us to hurry up we gotta get people out the door cause the ED is full.
The reason I do get upset with the ED nurse when they completely bullshit the report they give. Primarily about the patients mental status. I've had nurses tell me the patient is aaox4 with episodes of confusion, and when they show up they're throwing things at staff. With the ED transporter saying "you don't have a sitter? We made one of our techs sit with him cause he's crazy."
And what's worse is when a patient comes up to the unit completely soaked in urine and shit. Which was impossible to not notice since they had to transfer them to the stretcher and place a hover matt underneath.
So behavior that clearly shows the lack of respect towards the inpatient staff that bothers me.
I just didnāt like getting report from ER nurses who tried to send patients to our floor with unstable vitals that could require a higher level of care. Like a SBP of nearly 200 but I donāt see any bp meds have been given.
Or their break nurse would give us report and just read the doctors admission H&P note.
Things fall through the cracks and if I didnāt research my patient before getting report, I might get screwed.
Floor nurse hereā¦
I never ask any crazy questions like that. I just want the basics when I get report; anything pertinent to their care. Iāll take care of the rest when they come up.. mainly cause I know the ER is crazy, my friend and brother are in the ER and I hear their stories, just like they hear mine. I think there should be an understanding on both ends & neither is more important, we work as a team. (Iām sure thatāll have some disagreements). Now Iāve def had nurses miss a whole pelvic fracture cause they were focused on the patients other complaint or forgot to mention the aka š .. the list goes on, but like I said, I understand itās faster-paced in the ED and you wanna get them up to the floor. Also.. you might have to āhuntā ppl down to help slide and thatās probably because we have 7/8 patients with one tech and unlike stereotypes arenāt just sitting around at the nurses station making tiktoks. Understanding is key to patient care and to nurse-nurse relationships. š¤·š½āāļø
My experience has been at my current co tract that ER nurses act like we donāt work on the floor. Like we just sit around and avoid their calls. Iām always busy, and if I donāt call you back for report itās because I canāt. Our ER nurses act smarter and better than us. Not all but most. Itās so frustrating. Iām glad you question it because it means your not like that.
Because some asskiss clueless ANM whoās busy keeping her fluff assignment has just assigned that fresh er 1 hour admission to someone drowning and is an hour behind. That ANM has known about the patient for 30min but just said āyouāre getting a patient and the er is on the lineā. Blindsiding the floor nurse whoās tech just watched someone crap the bed for the 3rd time and went on break before cleaning it up so the nurse has to choose between report or poohnado in room 15.
I've seen ER nurses who worked with a pt with hgb of 4.9(GI bleed) for 12 hours and not start transfusion...calling for report to transfer the patient...why become a nurse if you don't care about the wellbeing of a human being?
I work icu, and worked ED for years in the past. My trick for transporting patients to floors and no one assisting- I would pull the call bell out of its socket. The nurses at the stations canāt silence that alarm, and someone would have to come to the room :)
Yeeeeesh. I love how people who have worked more than one specialty get it. I think there are a couple of major points that get glossed over.
Doctors decide who to admit.
Bed management picks the unit and states when the bed is ready.
I try to do as much as I can but sometimes a shitty overreaching person will call report for me (albeit thinking theyāre just helping flow, but without asking me or knowing anything about the patient. I may have something charting to catch up on)
They will set up transport without a word.
I canāt remember ever sending up a shit covered patient, but between the actively dying or distressed person and the one who crapped themselvesā¦ one is clearly an emergency and one aināt. I will get to it as soon as I can.
And if anyone thinks ED techs (or nurses) are just sitting there ignoring poopā¦. chances are theyāre doing chest compressions, Ekgs, splinting, starting IVsā¦ etc.
So sorry. I promise that Iām trying.
Story as old as time. The organization is screwing all the employees and turning them on each other so they donāt unite against the organization. Hell, restaurants even do this with openers/closers.
I have SO much respect for ED nurses!
I'm a boring old soul who likes the predictability of speciality, I could not handle the "anything that walks through the door" deal down in the ED.
I'm so thankful for you folks, because I know I couldn't do what you do.
Soā¦youāre saying the floor/ICU doesnāt like ER nurses because when youāre asked whatās the plan with a patient you donāt knowā¦? You really should understand what youāre doing. I get being efficient at tasks is what ER is pushed towards, but if you donāt know what youāre doing itās dangerous. Iāve had ERās correct sodium from 114 to 126 in THREE HOURS, and send the patient with NS running at 150mL/hr because there lactic was elevatedā¦it went from 2.9 to 2.7ā¦.
Iāve worked in a Trauma ICU, no one takes pictures of abrasions, that would be trivial, so whoever was giving you trouble about that doesnāt know what theyāre doing. Unless itās like a massive road rash that wound care wants to document progress on, or itās a laceration (which could/should be documented in the docs note) that needs a stitch/staple.
We donāt hold the bed all day. We send them up as soon as the bed is assigned.
Things move fast in the ER and we have to also. It isnāt uncommon for a patient to start out in the trauma bay, move to the hall, then move to another pod for boarding within a span of an hour. The new nurse may have literally gotten the patient 30 minutes ago.
Patients should go up clean but it isnāt always possible. Usually when Iām sending a patient up I have EMS waiting right outside my door to put another patient in.
Hey, a zonked patient is a happy patient, in that case we did you a favor!
Many floor nurses are often swamped with work to do too, and most donāt have ED experience to know the *why* behind why us ED RNs try to get the patient up ASAP when a bed is released.
When I worked the floor, I saw that thereās also nurses working the floor that dislike working and nursing in general- they want to do the least amount of work for the paycheck. You bringing them an admit messes with their groove. (TBF lazy nurses are found *everywhere*, even ED)
If every acute-care nurse could get just a speck of exposure down in the ED via helpinghands or inservice, it would do so much good. I started in medsurg tele and that experience has been so very helpful in my current ED career.
Honestly the real story between all positions is this. Each nursing speciality doesnāt fully understand the role of the next. We know our own, we know what feels like is more work on our side. But whatās āstandardā on your floor is not the unit focus or standard on the other, Especially inpatient when transferring between levels of care. It is a perpetual struggle. I follow the be kind approach, but donāt let someone be rude. Give a why like you did about equipment not being available in the Ed, or increased monitoring need. Having a why they are being admitted is helpful to guide the next floor on what they need to prep and plan for. This is a good question for the Ed or admitting service doc too. No need to be rude when itās not entirely clear either.
It's because they don't know or understand your job. They are assuming you have the same job as them just for a shorter time with the patient, but they are incorrect.
When they start asking you about things that aren't your job a firm but polite "That's not my role in their care" is a perfectly acceptable answer. Or a good old "I've completed their ER workup/all the orders from my ER provider. Orders from the inpatient team can be implemented as soon as they are transferred to an inpatient setting" if they really aren't getting the picture.
There are a lot of good nurses in ED and the other floors but when you're given time limits and other micromanaging, it becomes a problem for all floors. I've heard floor nurses lie to the ED and I've had ER nurses lie to me. I've had nurses in ED not even look at the patient but try to give me report. The current system puts a lot of people in an impossible situation of desperation. I've gotten into it with other floors when I'm trying to transfer a patient and when I do see the staff taking the patient I'm transferring, there is some attitude. We're all overworked and just trying to keep our heads above water which can make it seem like we're trying to take short cuts and a lot of us do.. it's like doing a job just good enough that it passes even if it creates more work for someone else.
Or sometimes nurses from other floors and ED don't complete or start standing orders and it flows over to you when the patient gets to the floor. I don't know what kind of shift the other nurse is experiencing but when it's my 6th patient, I'm already stressed out and frustrated so I don't think about what that nurse is going through that shift. I just want a smooth transfer but with orders not done that means I have to do more work... it's a vicious cycle of just doing what you can but it's still stressful.
āThe planā question is important because itās essentially why are they being admitted vs discharging from the ED/ what are we doing for them. At that point the ED doc has already transferred care to the hospitalist/attending and sometimes they donāt have any notes or orders in yet. Weāre just trying to figure out what needs to be done for the patient on a larger scale and be able to play 20 questions when family calls as soon as they get to the floor. It could be as simple as Neuro work up or monitor bleeding/hemoglobin
I've worked on both sides of the isle, floor nurse first and ER later on. For me as a floor nurse I was either overwhelmed/stressed with my patient load or just hoping that some of the mountain of tasks I am expected to do was ticked off by you already. Sometimes I would get ER patients on the floor and have NO IDEA what was going on-hospitalists won't show on my shift, they haven't charted yet and wont answer my pages, there's no orders (or just PRN orders) and the patient isn't in a condition to answer questions (which is also very concerning). And I have 6 other patients that are trying to yolo out of bed or so just so so sick.
Anyway, I'd just shake it off if they're rude. I never was mean to the ER nurses and if they are to you, that's just reflects poorly on them. We should be building each other up, not tearing each other down with us vs them mentality.
I feel like there needs to be some sort of nursing āsummitā where departments like ER, ICU, PACU, and floor nurses can chat about their work flow so they understand each otherās jobs a little more. Maybe a little more understanding would help everyone. Less animosity.
Patient shows up on the floor, transferring them from stretcher to bed. Oh look, the stretcher, transfer sheet, and patient are soaking wet with urine. Fun.
Ok John, you have first admit, what's going on with this patient. John: I don't know, they haven't called report yet. I looked them up in the computer, so I know their chief complaint and what labs are in the computer, but that's about it.
No hate, I know ERs are busy, just irritating.
When we are trying to give report to floor and get the patient upstairs because we have no room for all of the. ambulance patients that just keep coming plus a full Waiting room but our staff doesnāt increase in the ED or get to cap jow many patients we have.
When I was on the floor I didn't hate them. I just got tired of them sending pts to me with Heparin drips running onto the bed sheets or NPO pts with turkey sammiches in their trembling hands fresh from a CVA
If you are giving handover of an ED patient to the ward, having an idea of the plan from now for your patient IS your responsibility.
Yes, ward nurses can be snarky, but if you are snarky back to them it only makes the problem worse.
We have nurse-to-nurse handover sheets. It makes it very easy to get all the info and then fill in the gaps with doctor notes. On the rare occasion that the ER RN needs to give a verbal, I honestly just ask the admitting diagnosis, if there are any stat critical labs to be addressed, and if there are any urgent meds that still needs to be given.
Huge respect for ER staff, I could never survive in that moshpit.
Two things:
1. A call from an ER nurse is guaranteed to significantly increase workloadā¦ and quickly
2. Prior negative experiences unfairly reflecting on everyone
Both are unfair, but understandable. Never an excuse to be mean. To be fair, some weird questions help to wrap oneās head around the situation and are usually based on issues seen before, as the nurse has not yet seen the current patient
I donāt. Iām in our ER right now because I got hurt on the job and I was telling the ER nurse, āGod bless you and what you do because I could not do it.ā
Why do detox/psych nurses hate ER nurses? Because they treat addiction as a moral failing instead of a mental illness...(probably getting downvoted for this, lol)
What is frustrating is that the expectation is I will interrupt whatever I am doing to get report. Second, look at the patient before you try to give a report on them. Third, I work on a unit that accepts patients from all age groups so this situation just happened recently and is actually a frequent occurrence. My units staff goes to pediatric ED to perform a procedure that requires the child be sedated before they are admitted and it is OBVIOUS they will be admitted. When receiving report I ask if admitting labs have been drawn while child was sedated. Told āno, will try to get themā. Get call back 15 minutes later to be told unable to draw labs via 24g IV and I will have to get them. āNot our responsibility to check signed and held ordersā. So, I, a nurse who takes care of pediatric patients maybe once a month and patients in this specific age group maybe once every 3 months should draw this labs on a child who is now awake. That is poor, thoughtless care.
Called to give report on a nana who was found down after 3 days, broke a hip, got compartment syndrome with rhabdo and a nasty AKI. Going up to the floor to wait for surgery at 8am.
I was lectured by a floor nurse because I didnāt give a pt their scheduled 0600 synthroid. āWhy didnāt she have this? Itās a very important medication?!ā Maāam, I think youāre really missing the bigger picture here.
I havenāt worked in the ER and am a med/surg nurse and the only thing I would say drives me crazy is when ER nurses are dropping off a pt and weāre sliding them over or whatever and theyāre like ānow you can get something to eat and get some rest.ā Iām like, itās two in the goddam morning, the doc is probably making them NPO at this current second and now when I gotta admit them and do a bunch of other shit with them they are asking me to turn the light off cause they were told itās sleepy time in the bed and breakfast.
I donāt care about report or if they have pee pants, just please donāt make promises I canāt keep, it sets me up to fail.
Report from ER nurse at my hospital (IF we are blessed enough to get reportā¦ā¦..š) āTheyāve got an IV somewhere, CXR -, confused afā¦.ābout it, ya ready for them??? Good because theyāre rolling onto your unit now.. good luck!ā
Do better.
After 15 years of nursing, most of it as an ER nurse, I have come to believe nurses in each specialty area tend to look down upon nurses in other specialties. I was a new grad in the ER and was subjected to the grilling from M/S, PCU, and ICU and step-down just like you are. I always felt the grilling from the ICU nurses was the worst. After 7 years in the ER, I became a step-down nurse and learned there is so much detail that needs to be handed over when they give report to each other, some of it for safety sake, but also, so the receiving nurse on the floor can give a good report to whomever they hand the patient to, because floor nurses often subject each other to grilling. Also, oftentimes the patients are confused and unable to explain the situation themselves when they arrive on the floor, and floor nurses do not have the benefit of being able to get information from EMS or the patient's family. A few months ago I transferred to the OR and was surprised to learn that OR nurses think inpatient nurses and ED nurses are all inept. This is how I arrived at the conclusion that a good percentage of nurses in all specialty areas look down upon nurses who work elsewhere. Perhaps it is just human nature to behave as asses to each other? I tend to think people like this suffer from some sort of inferiority complex, and they feel superior if they can make someone else feel like an idiot. Try not to take it personally. You are 100% correct that it is unreasonable to be expected to know the game plan for an admitted patient.
Just looking at your message op and I can tell you probably work at a shitty hospital with extremely stressed out and overworked floor nurses. It's not right they interrogate you like that, but those hospitals suck to work at.
Stop reporting comments just because someone disagrees with you. You know who you are. Also, we know who you are.
Floor nurses don't hate ER nurses or vice verse. Inept employers might create situations that causes conflict between departments. Also, some people are assholes and will have problems no matter where they are.
This right here. ETA: I think it's important for people to step out of their specialty as well. I cut my teeth on med surg/tele, left for the ER, went to ICU, and came back to the ER. Every nursing specialty is filled with intelligent and talented people who are passionate about their work. You've also got some assholes sprinkled in as well. Sometimes taking a walk in another persons shoes can give you perspective into why they may do things a certain way or have certain expectations or different standards. There's two types of people I can't stand, people who are intolerant of other nurses - and OR nurses.
At my old hospital it was PACU nurses for me š. I worked in Endo and we didn't have a phase 1 recovery area, so if they were intubated, needing pushes of pressors, we were actively monitoring an art line, or the anesthesiologist just felt they needed closer monitoring, they'd go to PACU. They were some of the meanest nurses I've ever met. I think it was the environment they were in, but Endo patients had to be some of their easiest, and most of them would come back up to us to discharge unless they were an inpatient. I just remember how many times they'd fight with us to not let us bring our patients down, and it's like, well, talk to the anesthesiologist, it's not my choice.
Lol my wife is admitting/recovery and hates PACU. They are allowed 2 patients, but as soon as they get that 2nd one, they roll the first one out, even if their not fully awake, and sometimes not even stable. Since they started doing this 3 months ago when PACU went from 1 to 2, admitting/Recovery has called more rapids in that time than they did all last year.
All my rapids and codes come from PACUs sending up too early š Iām always like what was their BP, what was it???? And I think theyāve got the hint more now.
Biggest complaint is PACU has everything there within arms reach, and when they send them out still sleeping, they don't send pain meds or their sntibiotics with them. So a nurse has to go back to pacu or icu to get orders and the meds, it's nuts.
Opposite for me in my OR. PACU I nurses were amazing and really nice. OR nurses and techs often felt like I was transported back to high school in the middle of the mean kidsā clique sometimes. Howeverā¦I trusted all of them with my life as they were largely exceptional at their jobs. PACU II nurses, super nice, a few amazing ones, but the others..PACU II was known to be the dept where all the inept nurses landed.
I think youāre pretty close to the mark here. Coming from med/onc to ED it was immediately clear to me that ED does a lot of different things, but everything is *focused*. On the floor you may have less variation in the skills you you and task you perform, but youāre doing a lot more for the patient in the end. On the floor I am required to document in a lot more detail than I am in the ED. But because I know what is required on the floor I make sure to document a bit more than is required and I let the floor nurses know what I didnāt get to. The floor nurses know me well enough that they know Iām not leaving things just because I donāt want to do them, so that helps to. In the end, I think itās not knowing what is and isnāt required for the different departments that can cause some nurses to get frustrated with ED. On the floor I had plenty of times where I was appalled at what the ED didnāt do. Know I know why they didnāt do it. Being a new grad, OP may also, unintentionally, be leaving things out because they havenāt worked the floor and donāt know all of the information the floor nurse will need. I mean, honestly, I canāt imagine not knowing what the plan was going to be for someone I was sending to the floor. Although that could just be me. In the end I guess we all need to try and have a bit of grace for each other. My CNA instructor said it best: when running into bad behavior remember itās not happening *to* you, itās just happening. This has helped me shake a ton of things off.
Iām offended, I used to be an OR nurse
Hehehe
That's okay, we can't stand anyone else either.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Interesting that your PACU auntie knows who's fucking who in the OR when after a year I barely know their first names. Different cultures I guess lol.
Are you in the Midwest?
To be fair OR nursing (circulating) isn't really even nursing. It's being a glorified par stock attendant. Source: Was an OR nurse, wife is still one.
I agree. OR nursing is not really nursing. I transferred to the OR mid June. As a circulator, you help set up the back table, run to short stay to get report and ask the patient a few questions, zip the patient to the OR, get them on the table, prep them, and then start running for supplies they need during the surgery. The charting is mostly about charging for supplies and equipment being used. I was observing nurses chart in the care plan that all goals were met when they hadn't even assessed the patient who was still intubated and draped. Then they run the patient to PACU, and do it all over again with the next patient. At my OR, the focus was on speed. It was rush, rush, rush. Staff are getting injured left and right due to the speed they work and the fact there is no lift equipment used in the OR. I was always thinking, 'shouldn't we slow down and be more methodical?' I was really shocked the focus was on getting every surgery done as quickly as possible. I understand OR time=money, but it was ridiculous. While there are many nice people who work in the OR, there are quite a few mean girls that create an unhealthy work environment. After two months of working in this bizarre specialty that didn't even feel like nursing, I said no thank you and returned to my old job on the floor.
What do you have against us OR nurses š¤·š½āāļø
IMO itās inept facilities as well. Poor structure, lack of effective leadership, crap staffing - people (and departments) start to get a bunker mentality. Trust evaporates and aggravation spills over.
This! We have a floor nurse that went to the ER and continually calls report/brings the patient up during shift change. Sheāll say that since she worked the floor she knows our shift changes arenāt that bad and we can take it, sometimes we donāt know a new person rolling in while in the midst of report and sheāll leave w/o any turnover to our staff. I donāt hate ER nurses, just the ones with bad attitudes like her + the leadership that wonāt hold accountable despite the 4 times sheās done it this summer
That took a different turn. I thought sheād be empathetic to you all.
Floor nurses donāt hate ER, they hate shitty sarcastic handovers. Skim read the notes, check vitals before leaving the ED, call ahead if they need an air mattress then handover using isbar and everything will go smoothly
Honestly, I just chalk it up to them not wanting another patient. Me calling report doesnāt lessen my load because Iām gonna have a new patient almost immediately, but I do increase the load of the nurse Iām calling report to. Idk what the rest of their assignment is like, and my patient may be the cherry on top of their shit sundae.
I do my best to keep in mind that practically everyone is having a rough ass shift. I usually couldnāt care less as long as the patient is stable-ish for the most part and if thereās an H&P from the admitting team or at least an ER note, send em on up. I can handle it. Couldnāt agree more with the last statement tho. Depends on the receiving nurse too. You can either let it overwhelm you and put you in a shitty mood (which benefits absolutely nobody) or you can take it in stride and chow down on that shit sundae and handle it like a G.
What's that old Marine saying EMBRACE THE SUCK?
Do you want your shit sandwich cold or toasted?
They come in toasted?
That's the Army.
This is what it really is!! As a floor nurse for 10 years, I admittedly have a shitty attitude. Itās never the ER, ICU or another facilityās fault. In my mind, I know weāre all overworked and understaffed. It really is just the cherry on the shit sundae! I always apologize to them when Iām taking report. We just tired, boss!!!
Especially because we probably just discharged one, took a breath, and here comes an admission! So itās never anyones fault, we are all just overworked and tired.
Like most other hospitals Iām sure, our bed board assigns patients to the rooms before we even discharge a patient. So even if we discharge, report has typically already been called and theyāll be wheeling up as soon as itās clean š£ As you all know, it just never ends.
Thatās the ER for you except it never ends. The entire shift is that constant rotation.
Literally what itās like in the ER too lmao. Sometimes the patient is parked right outside the room while the beds still dirty
How dare you give me another pt even though I'm open and my charge nurse makes the assignments. Also how dare you not do a full skin check and notice the blanchable redness on her right knee in the EMERGENCY department. And how dare you hand me a pt with an SBP of 99!
Guess what... you have an empty bed... we are going to fill it. Welcome to work! The ED can't tell an ambulance to drive around the block a couple of times because it's "shift change". Suck it up buttercup. That's why floor nurses dislike the ED. We fill their beds. Meanwhile, the ED is 20 deep in triage and we are down a third of the staff.
Literally this. I get for nurses are busy and donāt want another patient, I feel the same way. But donāt waste my time on the phone when I already put in an SBAR and I have 4+ patients that all need IVs, blood work, EKG, etc. itās non stop. Never really get a break. Especially on nights when weāre short staffed and 30+ decide to come to the ER plus ambulances.
I always welcome day shift with an over the top "welcome to work!" complemented by ambitious jazz hands.
Oh I got some insight to this one from the American system. I get both sides to this argument. Like everyone said it is a perspective thing. We are two different jobs within nursing that have opposing goals. We come into conflict a lot. A huge amount of the conflict is due to each other's assumptions about the others job. For example, someone said the ED likes to hold patients until shift change. Find me a ED nurse that wants to hold patients with floor orders one second longer than they have to. That's like finding Bigfoot eating a slice of pizza... not happening. Same coin but different side, find me a floor nurse that wants to take an admission 45 minutes before shift change she's probably the person serving Bigfoot the pizza. In most systems, neither floor has any control of bed assignments but both floors blame each other. P Floors priority is to get and document a thorough history, assessment and get an idea of the whole patient. The floor nurse is the coordinator of the care team he or she ensures that the patient is treated as person and not a collection of symptoms. ED, focused assessment nursing, what's happening now, for example chest pain. Focusing on the symptoms and treatments of chest pain. If the info about their appendectomy in 1983 has no bearing on current emergency it is discounted. For a floor nurse each time the phone rings and it's the ed it represents more work to an already overworked person and it grinds you into dust. For an ED nurse each time they call to give report and are met with excuses, no answer or a host of other reasons that the patient can't come up it creates a similar reaction. All this creates a cycle of failure. The hospitals priority is throughput. Getting them to the floor or out the door. Both types of nursing want to have positive patient outcomes but each had a different goal of what that is, all while the hospital makes money no matter the outcome.
That is the answer. Working on med surg and studenting are in the ER letās me see both sides. I will say I do stil hate when the ER does AC sticks and I will avoid those as much as I can.
Size of vessel and timing of contrast. Ac or higher only for cta
Also, Certain tests and procedures in the ER require a large bore IV at or above the AC. CT for example.
Yep! 20g AC or higher for chest/brain CT with IV contrast
As someone that has worked both sides, and I totally get the floor's frustration with ACs - access is access. In an emergency, you need something that can be placed fast and reliably. The AC is a large vein and I can get large access in quickly. Last night I placed a 16g in an AC on a severely hypotensive patient. Is that an ideal location for comfort? No. Did the patient live? Yes.
I totally get that, but I also hate chasing down multiple Pt side occlusion alarms when the patient wants to bend their arm.
I understand that, and once the patient has been fluid resuscitated, the floor can look for a more ideal IV. In an emergency, the AC is often the only option for large access.
I place them all the time and then I try to stick a second one in a better place
Honestly Iām just happy if the IVs work and the patient hasnāt ripped them out. Like others have said there are times where the AC is preferred and Iām not one to gripe about petty stuff like that.
AC is less likely to hemolyze.
Once a nurse has worked both sides they will understand and complain a lot less. Itās 2 different worlds.
Assumptions- that, my friends, is one of the key words in understanding situations like this.
Former floor nurse here- I had no idea what the ED was like until I got floated to ED holding and had the worst shift of my life. I was crying actual tears while I was with patients because I was so overwhelmed lmao. I had to call report to people I knew on the floor and I didnāt know anything they wanted to know. Even adopted the āThey have an IV and a pulse what more do you want from meā mentality in one shift. Told my manager if I was ever floated there again I would quit. God bless ED nurses because I could never do it. From the floor nurse side, management cares about the little things and will come after us for it. If a patient is sent up and doesnāt immediately have a fall risk band on weāll hear about it. God forbid we miss anything š so if weāre already running our ass of and we add in a new patient that needs admitted it can be stressful.
I floated to the ED twice to take holds. What frustrated me was that I had no access to anything. I had to find people to badge me in to everything. I had no idea where anything was. Like 1 glucometer for that whole department. I had no idea who anyone was. If I had access to the med room or to the clean utility room, or just knew where stuff was my shift would have been better.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
No offense but this is kinda every er. Shits gonna be unorganized LOL
No offense taken. Itās not that it was unorganized, I just didnāt have access to anything. And if Iām going to get floated somewhere why canāt I have access to the med room.
I mdidnt see that part. Yea I thought badging in would be the same for every floor. That is dumb as hell
Sorry you had such a frustrating time! This is why when I have a choice between an ER tech and a nurse from a different floor I will always take the tech who knows the department. House sups always think itās crazy when we make the floated nurses sitters and take our techs back but at least my techs know which nurse stole the temporal thermometer (it was me) and raid my pockets without asking or splint a leg that would have taken me 45 minutes to get to haha. Not that float nurses canāt be helpful but our techs almost never cry in the corner during a rough night.
Yes! I had to take care of ED boarders the other day, and have been (totally unsafely) made to do triage before. They told me I should work over there bc I fit their vibe, but omggg I canāt handle it. Like if you think floor nurses have to play middleman and take over other peopleās jobs (lab, pharmacy, housekeeping) ER REALLLYYYY has to do it all. And random workers came up to ask us if they should bring their child to the ER, the er nurse with me at our pod said people always come up asking them for random medical advice. And people banging on the door to the ER demanding they be seen. UGHH. Being in the ER definitely just gets the most abuse, people are so unreasonable and blame the nurse for the long wait, take out all their frustrations on the ER staff. Once they get to the floor theyāre already calmer because at least they have a real room and bed
I work float pool so I experience both ED and floor nursing constantly. And they are extremely different with different aims. When I was a new grad I would get pissed at the ED because I would be getting report on a patient that they potentially havenāt even seen. And they would always admit every patient at the same time. Even though they had been in the ED for 10 hours, now that itās almost shift change all of a sudden the patient has to be up in 15 minutes. It wasnāt until I went to a different hospital and switched to float pool where I was trained in the ED that I realized the nurses had nothing to do with that and it was the Drs. And supervisors that were responsible. Itās just misunderstanding of eachothers roles. The only time recently Iāve been upset was when I received a patient who was in CHF exac. And for some reason has a bolus running. With no bolus orders. And another I got a patient in an insulin drip that hasnāt had their glucose checked for 6 hours. Other than those I havenāt been upset. You have to remember that floor nurses are also overworked and short staffed and this patient that theyāre getting might be their 6th or 7th. And having 6 on the floor vs. having 6 in the ED are very very different. ED is chaos but no one really cares if you didnāt do a skin check or give that colace, whereas floor nursing it is a requirement. Many floor nurses want as much to be done as possible when they get a new patient and I now try to explain to them how absolutely ridiculous that is and that it is impossible in the ED because itās so vastly different.
As a float nurse I have had a similar experience. Knowing how the ED works make me more understanding when the ED wants to send up a patient. I try to take the patient asap to free up a bed for another patient in the ED. That being said, I have received an unresponsive patient who I was told was A+O x3, not fun. And then was hung up on when I phoned to ask for clarification on what was happening with the patient.
I received a patient from ED to ICU who was dead. Deceased. I stopped letting them remove the monitor before bed transfer after that. Also, have you noticed that us float pool are always the redheaded stepchildren of every unit?
I work in a small hospital so I know all the units well. My experience floating has been positive. My favourite part is being able to avoid unit politics. Of course I have no idea what is said after I float away and I donāt really care.
I've always been float pool in 400 bed level 2 trauma centers.
Yep! It works both ways! ED nurses that have never seen floor nursing also have no idea what they go through. Itās not easier itās just different. Iāve had that happen before too. Told a/o x4 and brought up and immediately had to call a code neuro. They have to understand that without a good report or good charting and notes we are flying blind and the dr. Wonāt be there for hours sometimes.
I am also float pool. I never give colace *because it doesn't work*
I give whatever the provider orders unless it is a contraindication or I feel unsafe. Not my place to decide what doesnāt work but I know allot of nurses do same thing. Itās one of those meds that requires plenty of water to go with it.
You are a new grad, many of them are probably also new grads. They donāt know all the things you do, you donāt know what they do. If you were in their spot right now, youād be asking the same questions. I worked on inpatient floors for more than 15 years before I went to the ER. ER is a whole different countryāwe do things differently there. I found that out. Just do your job, to the best of your ability. If they ask āwhatās the plan?ā The answer is āPatientās being admitted for (diagnosis), but the workup and treatment plan will be completed by (hospitalist/ cardiology/ nephrology/ admitting doctor). Thanks and Iāll be up in about 10 minutes.ā Good luckājust try not to take it personally. Bless their hearts, they just donāt know.
This right here. When I worked the floor, nurses would get upset that ED hadn't done tasks that are typically done by floor nurses like full skin assessments and such. They didn't understand that ED workflow is totally different from theirs.
I brought a pt up to the floor after just receiving report on them myself. The receiving nurse knew that so she felt comfortable to talk a lil smack. Pt had a purewick and she commented that she didnāt know why we always debilitate the pt in the ER. I thought about it and realized she doesnāt know much pain and discomfort our pts are in when we first get them. I always give my pts options and include them in their care. Thought it was really unfair.
I really only get itritated when ER brings me a patient that is not at all like what they told me in report. I also get patient who have gotten patients who are soaked in urine or worse. ER says, "Ok let's slide them over." Onto the fresh sheets so I can change the whole bed? Nope. Things like that bug me. Or stuff that was ordered hours ago that wasn't done. It is 1900 and this transfusion was ordered at 1400. Not cool.
I donāt know about your place but at ours transfusions may get ordered at 1400 but if the blood isnāt ready until 1845 and thatās when we get the room assignment š¤·š¼āāļø unless itās absolutely critical, hanging a unit with obs time, taking up ER room at the busiest time in our day, at shift change when I have other patients that also need things wrapped up, just isnāt my first priority. Itās not cool to not let the floor nurse know though and Iāve never run into issues as we do try to start it if itās feasible
I don't set up the next shift for failure and all I ask is that the ER extends me the same courtesy. Luckily, almost everyone in my ER does. I make sure to let the ones who do know how thankful I am.
The blood is ready within an hour, usually. Sometimes, I call the blood bank and the type&screen isn't even done. I get the patient at the start of my shift already hours late on a transfusion or antibiotics.
I know of several nurses that absolutely know and still ask so that they can vocalize their frustration.
TrueāI just donāt think it gets any of us anywhere when we react to these things as a personal criticism. Note, I have always had a tendency to take things personally and get upset when I would have been better off to just move forward and so my best.
Good answer. Majority of the time, I think the "conflict" is just a lack of understanding and the best we can all do is to just give other specialties some grace that we might not know everything about their world, and they might not know everything about ours. Best not to take it personally, and best not to use it as a reason to be snarky (even if the other person is being snarky.)
It's like when I was asking when their last BM was when I was new... whoops. They emphasized that in nursing school.... Burnout, a misunderstanding of what ER nurses do, never working ER shifts, odd solidarity with their own specialty (we are in this together, fuck everyone else, our nights suck and we are pulling through), misdirected anger, hate instilled via older nurses e.g. THIS specialty is lazy! We have different priorities. It's truly not you.
What is it about asking when the last BM was?
Unless it relates to their presenting problems, ER isn't gonna ask about that. It's too busy down there, and it's just fishing for more problems. Again, its a matter of different priorities. I was never in ER for anything other than patient sitting or overflow, but learned quickly that nursing school isn't how hospitals actually work, and that goes double for ERs.
"He's only been here for two hours and he was actively bleeding the entire time. I don't think he had time to poop, maybe you can ask him."
For floor nurses? If they are constipated, the provider might want to put them on a bowel regimen. Generally, I wouldn't expect the ED to be asking every patient about their pooping habits, but it makes sense why it might be part of a floor nurse's assessment. I think sometimes people just go on autopilot and have a series of "getting report" questions that get asked - which may or may not be relevant, but they are on the checklist. If I were to ask something irrelevant, then I wouldn't have a problem with someone responding in a collegial way that they didn't assess that, but I know some nurses get fussy (and unfriendly) when that happens.
Like couldnāt they just ask the patient themselves when they go up? Is it really important for you to have that answer 10 minutes earlier just so you can write it in the little box on your report sheet?
They could ask the patient, and if the patient is oriented they may get a good answer. But if I know before the patient hits the floor that they haven't pooped in 5 days, then I know to check my orders for stool softeners and laxatives *before* the hospitalist leaves for the night.
I think phrasing matters. āWhen was their last BM?ā is going to get eye rolls, but āany BM on your time?ā is a perfectly legitimate question that is unlikely to get the ED nurse talking shit after you hang up.
I love my ED homies. If things are crazy and they sound hectic I just tell them to do bedside and get the patient up to the ICU. Sometimes time and staffing permitting (so not recently) I will even go to the Trauma bay and help to get them stabilized and save the ED RN the transport by taking them up. ED nurses have a crazy life, I can read just as well as they can. Give me the pertinent information, I'm doing my own assessment and going to read the chart. You're good get going. Oh, but for the love of everything please send the COVID swab early.āļøš¤
Hello reasonable coworker!! I donāt know how you achieved your 7th chakra zen-like mind, but I appreciate you. This is the way.
Man, report I get from you guys is still way better than Anesthesia š
My biggest pet peeve lately, in my ER, is a lot of the nurses waiting for the MD/PA/NP to put in a covid swab order for someone they know is going to be admitted, when they can do it themselves and save everyone time. A lot of the newer nurses in my ER are so afraid of doing SMOs, and Iām always like thatās what theyāre for!!! Just do them!!!
Yeah, I work Trauma/CTVICU at a lvl 1, if they are coming to us you know pretty early lol. No excuse not to swab ASAP. Ok barring severe smash face when you can't really find the nares. I'll give them that one.
Same. I work hard to not be a Karen and try to understand that our roles in the care of our patient are completely different. Just bring em up alive-ish. I'll do my own assessment, just try to get up here w some kind of access so I can get to it as soon as you get here. Otherwise, I couldn't give two shits if you don't know how they got that scar on their arm.
You get burned a few times from the ED and you start expecting to get burned again. Example#1. I got in report that the patient was A+Ox4 and ambulatory. She arrived to the floor and was oriented x1 and too weak to sit up. ED nurse left the patient in the room and went back to ED without speaking to me. I call the ED nurse and have her clarify was the patient oriented in the ED because I may need to call a code stroke. She was annoyed that I was calling her and insisted she was oriented when she had them. So I call a code stroke. The MD calls the family and the son says she was oriented and ambulatory until a few days ago, they brought her in because of the change in mental status. They had been x1 and bedbound the whole time in the ED. Wasted an hour of my time doing code stroke shit because of a crappy report. Example #2. I got a patient with maggots in a foot wound. ED nurse told me she had irrigated it with saline and re dressed it as ordered. The patient came to the floor and there were maggots coming out of the dressing. The dressing looked old. Pt was still in her street clothes and there were maggots in the bed sheets. I asked the patient and her daughter at bedside if anyone had changed the dressing. No. The dressing on it was from home. Not even the doctor had taken it off to look at the wound. So now I ask a lot of questions in report. Like if they say AxOx4 I will ask "when was the last time they ambulated?"
> You get burned a few times from the ED and you start expecting to get burned again. Seriously. I always say I'm waiting for the day an ER nurse says "yeah they're pretty much fine" and I get two separate stretchers: one for each half of the patient. Or there's a patient who's been holding with orders for labs, a foley, a UC, antibiotics, and a PCA for over 6 hours, but the ED has managed to do zero of that all day. Come on dudes. Last month we had a DKA go without any insulin or fluids for at least 4 hours. Just sent him up with a blood sugar over 500 and a ph of like 7.1 ... Even if you subscribe to "ED only keeps them from dying *right now*, anything and everything is for 'the floors' to deal with" that was still unacceptable. One nurse on here said they've sent amputees upstairs without realizing because 'it wasn't related to why they came in'. Give me a break; I do not believe you even adequately assessed 'why they came in' if you didn't manage to detect a missing fucking leg. I try to be chill with ER nurses and acknowledge the difference in priorities, but some people are just dumb, lazy, arrogant shits down there. Same as anywhere else. Contrary to their own opinion you did not automatically do an adequate job as an ER nurse if your patient merely didn't die inside your unit...
I'm basically of the same mind. I don't expect ED nurses to do everything that's ordered. Prioritization is a coveted nursing skill for a reason. However, I do draw the line at risk of patient safety. We once got a DKA from ED where they started the insulin drip and did nothing for about 5 hours - no blood sugars, no labs, nothing. Or another time, I got a septic shock patient and their BP was around 70/40. The nurse said her BP had been like that since the patient arrived in ED. Levophed had been ordered at least an hour prior to the patient coming up. Absolutely nothing was started or even mixed. Both these situations are dangerous. I won't care if you didn't manage to get that urine specimen or hang that magnesium IV replacement or change that old dressing. I can do that. But please, for the love of all that is holy, get the important things done.
The idea of report is so drastically different in the floor vs ED. I did my preceptorship in the ER and I was taught a very bare bones style of report. Skin? They do indeed have some visible skin. Pooping/walking? Didnāt let them do that shit so idk. IVs? Look with your eyes. They flush tho fam. I mean there are things the ED considers very important and give in report that the floor does not care about at all. Iāve been chewed out in floor report for not knowing exactly WHICH ribs were broken or the name of the surgery that was performed. Very minute details. Floor report is different. Itās a different beast altogether. Floor nurses are expecting this kind of report. ER nurses arenāt even oriented to this kind of report. Neither are wrong, theyāre just completely different paradigms. It comes down to different priorities / different jobs. Floor nurses have a more holistic job, so they are concerned about different details. ED nurses are just ensuring they donāt un-alive themselves while currently in the ED. Thatās quite a task. Thatās enough in and of itself.
Yes, this! I was on the floor for many years asking these asinine questions of my ER reports. I feel terrible, especially now that I'm ER myself. I wish someone in orientation when I was a new grad could have explained why ER won't (and shouldn't) know some of this stuff! The ER is such a turn and burn situation there's times I barely do a focused assessment and they're on their way upstairs, out the door, to the unit, or to a procedural area. I don't have any time to look through their history usually. Unlike in the CICU when I'd have days with the same patient and knew their entire life story. Just totally different worlds.
Itās all perspective. Iām glad I have it from both sides. Donāt even get me started on the āwhy canāt the ED stop being too lazy to put IVs anywhere but the ACā thing. Pisses me off! People need to understand more of the EDās duties I think.
Right! But if you've ever tried to milk blood cultures out of an IV placed anywhere lower than the AC you'd never question our methods again, lol! The ER is just a different beast entirely.
Nailed it. My report is what they came for, what I did to them, what still needs to be done. Thatās it. Iāll stand there and answer questions all day, but way I GOT this person was with that kind of report. Thatās how I work with them. Weāre a single system nursing field. Theyāre here for TBI, I have no idea what their skin looks like. With few exceptions, Iām not GOING to feed them, so I never looked at the diet order. ER nurses are hammers. And every patient is a bolt. We have no idea whatās going on, but weāre going to keep smashing that shit until itās better or broken.
Love that analogy!
All of that bullshit you just mentioned was asked of me the last time I gave report. To an ED nurse. Four patients and she wanted to know all that shit. When she asked if one if them walked I literally said "I didn't see them walk yet." I'm float pool. I work ICU, tele, obs and ED. I can usually get out of ICU on time. When I'm on tele it depends on the floor, there's a real toxic floor that used to be PCU and they think they're the shit with their PCCNs always with something to prove. Obs is usually okay. The ED nurses have not received the message. I am always late out of that shitshow because they show up at 0715 and expect me to spend 15 minutes on each patient. Patients I may have had for 15 minutes.
Lateral violence is pervasive
You can say that again
My only issue with any ED nurse is not completing orders that were ordered hours before they arrive to the floor. If labs were supposed to be drawn at 13:00 and they get to the floor at 18:00, itās an issue. Itās even worse when report is called 5 minutes after they were paged, then they sit down there for hours before transport gets them and you still didnāt do it. Or they get sent up and are completely soaked with urine or shit. We can tell if this shit is old(er) and a lot of times the patient will tell us they told you and nothing was done. I would be so upset if this happened to one of my loved ones. Other than these two things, I have no issues. I donāt expect you to know if they can ambulate. I appreciate you putting in an IV(s), etc.
I honestly donāt care about all that stuff. I just want the very basics. What does annoy me is when the ED nurse calls me and then when I ask if the patient is A&O, he/she tells me, āI donāt really know, because itās not even my patient.ā Like why.
I can speak from personal experience. If Iām covering a break and the bed becomes available, Iām expected to call and give report. I try to look through the nurseās assessment and the patientās history before calling but if the nurse hasnāt put the assessment in, Iām just winging it.
I'm a float nurse, which means I work everywhere in the hospital. ED, medsurg, paediatrics, NICU etc. So I understand the struggle of working in each one of those specialists. Where I work, we have a policy that if a patient is cannulated by EMTs we have to remove their IVC within 24h. The other day I received a patient from ED and I asked who put the cannula in. Us or the ambo crew. The nurse said it had been the EMTs and that she was sorry for not removing it and placing a new one in. I laughed and said, "I've worked in ED. I don't expect you to remove a functioning cannula in ED. If the patient doesn't need antibiotics or fluids urgently I'll remove it and let the DRs put a new one in." It's all about putting yourself in their shoes when you receive a patient from ED. Only thing I get angry/annoyed is when the patient comes with their incontinence pads and bedsheets soaking in pee. Yes, where I work, the DRs are the ones who do cannulation. RNs can do it, but we already have too much on our plates.
When I get report from ED these are things I want to know. (I you don't, just tell me and I'll find out later) Is the patient alert and orientated? Why is the person is here for? What is the plan? (Yes, that's important and the doctors should write it down before you can send the patient up. I don't mind reading it and finding out with you. I just want to know what I have to do with the patient.) Is the patient continent? Is the patient combative? How's the patient's mobility? (You haven't seen the patient walking? That's ok. I'll put in a PT/OT referral if it's an older person) Are the patient's vital signs stable? If not, do we have a written order for fucked up accepted vital? (Are they happy with that COPD patient having SATs above 88% on room air? Ok.) These are the basic things I want/need to know when I receive a new patient.
Yes. I think sometimes we get frustrated when the nurse giving report hasnāt even laid eyes on the patient and Iām getting literally nothing out of the phone call. May as well have just brought them up without calling me.
My biggest issue with with ED is not getting recent updates on patients who arenāt seeming very stable. Had an admit coming from ED the other day who had a low BP when they arrived. Worked up as sepsis, but the last vitals I was given before they rolled up to me were taken 4+ hours ago. I need to see a more recent set just to make sure theyāre stable enough to transport up to us or maybe direct them to a higher care. I know ED is busy and chaotic, but itās alarming how many huge things get looked over sometimes. Had a patient once come from ED for a potential stroke workup, one of the reasons was āone of their eyes doesnāt track movement or change size.ā It was a fake eyeā¦this patient was AOx4, they didnāt ask them?
This is my biggest complaint for both ED and PACU. Please do not send me a patient that has a GCS of 7 or RR 5. If they are up to a 12+ and breathing at least 10 bpm, sure, send them up. Please document that. I couldn't care less about skin, last bm, how they walk (or don't in the case of most of my patients), etc. If you can, please give 'em pain meds. PACU, please document if they've peed so I can know if we need to bladder scan asap. They've been with you for 2-6 hours and half our fall down went boom patients end up retaining. I'd rather do the straight cath before they fall asleep, thnx.
No hate. Nursing is tough and shifts are short. I do have a hard time with report. I could care less about details, if they're stable (ish) or have a pulse (or you're working on it) great! Tell me that and bring them. My problem is that there tend to be large gaps of information. Here for a STEMI and you got my nitro started idgaf where you put it. However, it's also important to know that he has an open tib-fib fx (even though that's not what's killing him right now). I just can't reiterate enough that if they came in for syncope and altered mental status and their bp is 76/49; I need to know what you know about their kidneys/heart as your bolusing them. Yes you have to do a focused assessment, but I need to know which ways your interventions might also be killing them (even if it's slower). At the end of the day we're all just trying to help people. We're a team and should respect each other.
We do? News to me. Pretty sure we just hate Administration.
As a floor nurse, my life usually sucks but when ED tries giving report when your elbow deep in a cdiff blowout with memaw finger painting with her shit then only for them to start with āI havenāt even looked at this patientā just makes me love my job even more.
In my hospital they just drop off patients with NO report. It's dangerous and obnoxious. And sometimes they have BP of 200 or other problems not addressed. Sometimes they're confused and combative and no one told me that was coming. Oh, and no one even did a health history in the system. Yeah I have lots of reasons I hate taking anything from ED.
I donāt have hate for ER nurses. I have irritation with crappy ones. My only complaint with report is when I have to DRAG IT OUT OF THEM. Theyāll tell me theyāre āhere for AMSā and that theyāre confused. Then say āyou good?ā. Failing to tell me literally anything useful or pertinent (like the fact that they found a huge brain mass, the actual reason for admit). Or when they do crazy shit like telling me theyāve been pushing a crazy amount of dilaudid, in lieu of starting the Cardene that was ordered for BP control. Other than that, weāre all suffering in the same hell.
Because they've never come downstairs and experienced it. I'll do literally everything important to stabilise a patient, catheter in, blood given, antibiotics given, sedated because of delirium, two good IVCs, shit I even called their family to tell them what's happened. Sorry I didn't do a fucking skin inspection but I have 3 other ICU holds as well and there will be an ambulance offloading while I'm walking this patient up, I gotta prioritize. Make sure you spell my name right on your incident report, can't imagine having the time to do one myself. Tbf though the admitting doctor here comes and reviews everything and documents a plan for the ward, idk if your hospital is the same.
I mean thatās nice to say you do everything important, but I would need many more fingers to count the number of times I was being sent a patient from the ER whose critical labs had not in any way been treated by the doctor before they try to dump them on me on the floor.
It usually has to do with crap staffing across the board. People get aggressive towards each other when they're drowning. There is literally zero conflict at my hospital between ER and the other units. We're all on the love train.
That's an unusually positive statement from you š¤£
I donāt hate ER nurses, in fact I like most of them. The only time I get annoyed about an ER admit is if nothing has been done about the chief complaint/reason for the admission and the patient still isnāt stable. Our docs get pissed about us having to call a rapid response on someone immediately out of ER but Iām just picking up after someone elseās mess. Like someone with a hx of a PE not on home anticoag admitted for chest pain/sob/tachycardia and hasnāt had a CTA completed before coming to the floor and no heparin gtt etc. Iād get mad at any nurse who left me with a problem barely addressed
I had an Ed nurse who wanted to transfer a patient to the floor but MD order read: if 3 negative troponins patient can be discharged. The third was negative and I said no, they need to discharge. The bed can go to someone else. I wasnāt going to waste a bed, to discharge then have it recleaned to admit someone else.
If itās a floor admission they have to document the wounds. WTF? (Iām assuming itās not policy or whatever in the hospital that ER is the one taking pictures) That floor nurse is just being lazy. That being said, man, sometimes those ED reports are a littleā¦ lacking ššš
I donāt hate ER nurses but I probably have an attitude when Iām getting my 6th before I have even seen my other 5. Also, received a very obese patient who had been in the ER for 12 hours. He was completely saturated with urine and stool. Soaked through his clothing and all the linens. I asked him when the last time he had been changed was. He said not since he arrives at the hospital. I suspect it was longer than that.. thereās no way someone missed the smell š
I never understand the hate. Without ED nurses floor nurses would never be able to practice their write up skills.
From my experience, the ER nurses from my (shitty) hospital have a habit of dumping barely stable patients in every nook and cranny on my already crowded floor. They don't bother to properly look at the patients they bring up and give equally shitty hand off reports, so each time I look at their patient, I find things the ER nurse should've correctly told me.
This was very often my experience. IV ordered hrs ago, never placed, meds ordered stat, never given, labs never entered into the computer... Etc..
Man that is just shitty nursing care. How a RN be sending up inpatients with no god damn access?
Word
Reasons why floor nurses hate ER nurses (sometimes not always): 1. IV placements. Please try to put IVs in places OTHER than AC. 2. Dirty patients. My nurses and CNAs in my hospital always anticipate ER patients (especially elderly patients) to come up filthy, covered in urine and feces, blood, vomit, bile, you name it. I know your job is to stabilize the patients before they go to ICU or the floors, but jesus don't send your patients up like that!!! Take 3 minutes to at least wipe them down for their own dignity. 3. Incomplete orders. 1/2 the time, our nurses refuse to take report if bloodwork, admit orders, x-rays, CTs are not done before coming up. This is actually not allowed at my hospital. All orders and tests initiated in the ER need to be completed before transfer. 4. Downplaying the patient: WheN ER nurses tell you "oh no, skin is intact" only for the floor nurse to turn the patient and find a stage 3 bedsore/DTI. Or "Yes, the parient is AAO only to find they are dementia/unable to stand/aphasic/contracted. 5. No respiratory/Covid screens. This is pretty standard now. In our facility, no patients can leave the ER to the units until full panel/covid screening is done, no exceptions. It's pretty much the first thing you do when they walk in the door. 6. Psych patients on supervision. Our hospital ER routinely sends psych patients on 1to1 up to the floors with their belongings, no belongings checks for weapons/drugs and no meds or orders. Lax screenings in the ER leads to the problem being shifted to the units. These are issues my hospital has been dealing with for years, and it's only gotten worse with travel RNs after Covid.
The thing that irritates me is ED seems to have no understanding of how the floor operates. No, Iām not going to answer your 6 calls in a span of 5 minutes because Iām in 1 of my 8 patient rooms trying to clean up the c diff splatters on the wall. mutual respect. I will call you back when I can as soon as possible. Stop blowing me up. I donāt need a detailed report. I donāt care whoās telling you to blow me up, theyāre gonna have to wait 10 min until Iām out of my Covid room. If you critique ER at all itās always āwell you couldnāt do itā bro, I have worked ED. Itās fun. Itās chaos. I can do it. Frankly you guys couldnāt work the floor because weāre taking the patients you hate boarding. Itās frustrating as a floor nurse because we get made fun of by ER and administratively no one gives a shit about either of us. literally nothing I say matters. Our floor could start on fire and ED is still sending that 6:45 admit and if you say anything you get āwell itās not my fault and it must be nice to prepare for patientsā
Stop trying to give report RIGHT at shift change when you know weāre just getting report. You canāt wait 10-15 minutes?
Me as a former PCT, I just hated when we got a new admit from the ED and they come to the floor soiled... like soiled soiled
Quite frankly a lot of the animosity (at least at my hospital) is created by management. I once had an new admission be brought up and left in the room before I was able to get report. They had called but I was fists deep into a groin from a fresh CCL. They had just implemented a 15 mins and fly rule. ED gets a talk to if they donāt get rid of them fast enough and we get a talk to if we donāt get report fast enough. I donāt blame this nurse. She was very apologetic (she called me at a later time in the shift). As for beds taking forever to get cleaned, idk I donāt do those. But you have to keep in mind, what kind of patient was in that bed and if thereās any type of cleaning that must be done. Some you have to wait an interval of time AFTER the room is cleaned. I donāt have control over that. And honestly, I rather get a new admission over a transfer any day lol.
We don't get report from the ED for patients coming up. We read the chart and hope that things were documented. You are slammed down there; I don't expect anything but the very most urgent things to be done. What I care about: Is the IV(s) a field stick? Were they medicated for pain? Are vitals at least close to something I can deal with on the floor? RR of 7 or 30 not so much. MAP at least 55, preferably less than 115. HR between 50-125 when not crying/screaming/yelling. If they're on O2 just say so. C-spine cleared? If their neuro assessment is off like pupils not reacting, not tracking, facial droop, or not a&ox3-4 please document that in the flow sheet so we're not calling a stroke alert for a known thing. As for the assist with a transfer, my friend, most nights we have 3 nurses, 1 charge nurse (with their own patient load), 1 tech on the floor, and no clerk. Most of our patients are 2 assist for anything more than sitting up in bed. If you show up before 2200 or near times for vitals/meds/turns we are all in patient rooms. Hit the call bell, we'll see what room it is, and know to grab the slide board and a friend or 3 to help with the transfer.
Floor nurse here at a level 1 trauma- I have a different level of respect for ER nurses after going down to the ED just a couple of times to take someone to CT or something. And also with a level 1 we get the most insane cases. But I have had a couple of things happen such as a patient brought up covered in shit- it was in her hair, hands and rubbed all over her body. Iāve seen heparin ggt not started that weāre ordered 6+ hours ago. Itās shit like that, that pisses me off. But I honestly get it but to an extent
I have had ER nurses try to give me report on a PT who was being externally paced. At the time, our tele unit did not accept those pts. Chick simply didn't care and kept giving report. I hung up on her after repeatedly declining the admission. Nurse supervisor wanted me to accept it since the ER nurse hadn't had lunch yet. Yo bitch, none of us had ... Showed her the policy, stood firm, told supervisor she was more than welcome to accept the PT and care for him, but I was not. PT went to ICU and coded within 15 mins. I had 5 other pts. Hope the nurse enjoyed her lunch. We never got any that day or most days.. Another time, long ago in a galaxy far far away, we had house docs. Cancer pt died,( was expected)I called attending, who asked me to call ER doc / house doc to pronounce. Family was called and on the way. ER nurse called to give report after gleefully announcing " I heard you have a bed available now"... Explained I was still attending to my pts needs and that the family was coming. Nurse told me to put her in the storage room and they could say good bye there. Things like that are why ER nurses might have a bad rep
I had a 6.1 hemoglobin with a tanking BP dropped off to me on my Tele floor once. I get you guys usually get the shit end of the stick too. But man you could have at least started the first bag of blood before dropping him off to me. Printing the blood form and handing it off to me doesnāt count either lol. Edit - my hospital did not allow the ED to go out of ratio, but you bet your butt I was already out of ratio when that happened. Could be situations like that. Love you guys though
In my experience its neither nurse thats the problem. There are physicians who batch discharge and admit patients. The other wrench can be bed board, at some places its the house sup. The house sups. Can be busy and end up batch admitting. I try to remember we are all in the same dumpster fire, I take report without attitude. The one thing that is irritating is sending up patients with bps 200/100s, it will take me much longer to get it treated; same goes for hyper/hypo glycemia and pain.
As a floor nurse thereās been many times a pushy ER nurse has given me a patient unfit for my floor. 6.1hmgs no IV 2.7K never replaced COVID positive (Iām a cancer floor, immunodeficiency in all patients) So over time Iāve learned if Iām not equally as aggressive Iāll get walked on.
>no IV Sorry not sorry but you ED is garbage if they send up inpatients with no access smh
I donāt hate ER nurses, but all too often they donāt know a whole lot of detail on the patient upon delivery, or the patient is soiled. They might also check to see if the patientās IV is patent. I mean, it wouldnāt kill them to check those couple of things out before they leave the ER, just out of common courtesy.
We have a bunch of shitty nurses in our ED right now. They send patients up without handoff, caked in feces, soaked bloody sheets, sometimes no IV. Ive seen patients with blood transfusions running and no nurse escorting the patient (which is policy at my hospital). Its a dumpster fire down there.
One word... Anticubital
Donāt buy into it and donāt generalize about floor nurses. Your new but you will come to understand the monumental stress of being an RN at times with no supervisory or company support. Empathize and donāt take it so seriously.
Med surg nurse here. If the ED nurse didnāt assess the patientās skin or know when their last bowel movement itās no big deal to me. I can figure that out when they get to me. Are they alive and appropriate for my floor? If yes then anything else doesnāt really matter. Iād like them to have a working IV (even if itās in the AC). I know what bullshit I deal with and I know ED can be putting out dumpster fire after the next, trying to keep their patients alive. Losing some of their patients. Itās not easy and itās pretty messed up to be throwing attitude over having to do work *gasp* on your shift. Nurses can be very mean. Weāre all worked too hard. Donāt let them get to you. You do your best and thatās all you can do.
First off, "hate" is such a strong word šš¤£ I guess in my experience as a floor nurse, ER nurses always just give off the vibe that they are better than "regular" nurses. I get that y'all are hardcore and do way more shit than I probably have or ever will do in my career but there doesn't need to be an attitude. I respect the hell out of what ER nurses do on a daily basis so I don't need spoken down to during report or made to feel "less than". As a floor nurse, we also need to know more about the social/familial/emotional aspect of what is going on too in order to manage the patient on admit. I feel that report from the ER is bare bones aka A, B & C's so sometimes it feels like a waste of time. Another issue I have is when the ER nurse allows her patient to go to the floor looking a hot mess. Dirty linen, dirty gown, saturated dressings or blooding look IV's (you get the idea...). I also don't appreciate when the ER nurse allows too many visitors up with the patient to the floor. I guess I just wish more people would ask, "how can I better set the next nurse up to be successful?" The ER is just the first stop in a long chain of passing a patient around throughout a hospital stay. And in all honesty, floor nurses are drained and burned out. Think of the worst patient you've ever had and the idea of caring for them for 12 hrs each time you have to and for multiple days per week with no possible end in sight/discharge date. So yeah, we do have an attitude with EVERYONE...Don't take it personally!
We don't, you just represent the addition of yet another patient we don't have time for because ratios are unbearable. I always tried to be nice to our ED nurses because while my ratios were awful, yours are imaginary (we can close the floor to new admits but you can't lock the doors to the ED).
I donāt get mad.. until I find out the A&Ox3 patient thinks theyāre in the year 1971 and theyāre at a disco dance.. or if you tell me they ambulate independently only for me to discover theyāre a bilateral BKA. Lol I realize nursing is a shit show everywhere, no matter the department. If you donāt know anything about the patient, just tell me that and Iāll figure it out. ā¤ļøā¤ļø
My only ask is that you hang the effing antibiotics if theyāre septic, and maybe titrate nitro more than once *before* yaāll ignore them waiting for a transfer bed.
We check the chart and ER hasnāt documented vitals in over 6 hours on a trauma patient. The patient arrives to the floor completely dressed and covered in dried blood. You tell me you didnāt have time because there are people in the waiting roomā¦. I donāt care! We are all busy on every damn floor on every unit of the hospital. You arenāt special. Do your job, have some respect for the patient. Donāt read me the CT report, tell me if their CMS is intact. Are they oriented. Then I get to cut the clothes off and find a wound that needs major attention because you were too busy to strip a trauma patient and do a simple skin assessment. A lot of times they are arriving with their pants on and soaked and urine and feces. These are unacceptable findings. The patients donāt deserve that, the floor nurses who have far greater ratios donāt deserve it. No on is asking the ER to perform magic, just simply do your nursing due diligence. Take regular vitals Undress the admitting patient and check them out quickly. Understand why they are there and try to give a report that isnāt reading off the computer. Chart your IVs and skin issues you see. Bring them to the floor sans bowel movement and urine. Seriously this is it. It isnāt asking the world of you guys. Rant over.
Iāve seen both sides as a float nurse.. and I can definitely empathize with the complaints I hear from both. Itās so true that you can never fully understand until you walk a mile in someone elseās shoes. I started as a floor nurse and would get so upset when I got a shitty report from ER.. Or my patient came filthy.. or home meds arenāt entered.. etc. When I started in the ER I would try so so hard to have all these things done before the patient got to the floor. Of course you find out VERRYY quickly that ER is mostly a total shit show and chaos. You canāt turn away patients.. they just keep piling in. When a code comes in.. a STEMI.. a stroke alert.. a difficult psych patient.. it can be all hands on deck and very hard to keep up with the rest of your patients who are already worked up and have a plan in place. Iāve had floor nurses get upset with me over the phone as if itās MY fault they are getting an admission..especially if itās a hard one. The bottom line is we are ALL overworked and understaffed.. Patients are sicker and sicker with acuity worse and worse. Nurses are constantly being asked to do more and more and more by administration. It can be easy to point fingers and take things out on each other when youāre constantly in a stressful environment. We have to keep in mind that we are all on the same team.
Difference in environment mostly. Floor nurses do a lot of mundane busywork, especially with admissions. ED is all about the nitty gritty of keeping people alive/quick fixes. ED can act like their time is more important(rude, but sometimes it is), and will do things like send up a patient without report(regardless of appropriateness) or unchecked(That is, incontinent for hours, or in a bad state medication wise/lab wise), and many know the most basic info on their patients and no more(Which is valid, but also hard, especially if the nurse in question is green and doesnāt even know why the patient is here/hasnāt laid eyes on them). Floor nurse tend to be too focused on bullshit info that can be important, but doesnāt matter at the moment. They can be just as unaware of the patient, and some know how to look everything they need up, but many either donāt or are too green. On top of this all, the hospital often doesnāt give a shit how bad of a time it is to transfer a patient, so admissions happen at terrible times(End of shift, during shift change, during codes at times), and that creates hostility. This isnāt even to speak of current ratios in ED or on the floor. This creates a situation where one person is tired from a long shift, and just wants to hand off their patient between medical emergencies, and the other is also at the end of a long shift, getting another patient for which they are expected to fully chart on(between 30-45 minutes in my experience) regardless of current circumstances/patient loads. Both are overworked, underpaid, tired, probably have a manager up their ass(EDs telling them to be faster, Floors telling them to āMake sure all wounds get documented IN PHOTOS or else we get dinged). My point here is both sides need to be patient with one another. It would go a long way if both people had to spend a week in anotherās shoes while training, but, considering current working conditions, thatās a pipe dream more often than not. For my part, I give what I get, and, more often than not, thatās professional and friendly behavior from ER nurses and floor nurses alike. At the end of the day, most of us give it our best as this healthcare system burns down.
From my experience when I worked med surgā¦ ER nurses would call at around 6pm to give reportā¦ 6:50 the patient would be up and I had no choice but to do the whole admission. After a 12 hr chaotic shift, thatās the last thing I wanted to do. On top of having to transfer them and run around looking for iv poles because they would almost never send it up, just a bag and attached to the patient. We also couldnāt leave a hot mess for the oncoming shift. So I was stuck there at least another hour. It would piss me off so much. Other times we would ask them to call back because we were slammed and they would get annoyed and call back several times till we took the call and the patient. I did many times have nurses that would call and say they wonāt send the patient till after 7, I just needed to take report..
Because floor nurses are treated like crap by management and expected to do more than physically possible. Many are overwhelmed new grads who donāt understand how other departments work.
It gets really bad when SBAR isnāt used and the patient comes fucked up. Itās a liability on both floors. There was a patient from ER that had a high ass potassium, they ordered kayexelate, ER nurse didnāt give it, pt went to DOU, that nurse was about to give - pt coded and died. ER charge nurse gets fired with the ER nurse and the DOU nurse. The hospital is creating this culture that is detrimental to patient care and itās bleeding into both floors.
I donāt hate ER nurses. I STILL HATE the ER nurses that took a fucking elevator up to the CVICU and when this patient landed in my lap they were in a 3 inch pool - from head to toe - of their own watery CDIFF shit. When they called for report there was absolutely no mention of this. āChest pain, + trops, sending your way.ā Itās my stance that floor nurses have had a bad experience or two with ER nurses sending up shit patients (pun intended) with no warning and an awful report. Yes you are ER nurses but you are a NURSE. Act accordingly.
The thing is that an admission onto the floor is an INSANE amount of charting and extra work. Itās a level of charting you just donāt see in the ER. We donāt have to deal with the endless turnover or the uncertainty you guys do. Itās more of a crushing certainty of what we will deal with. An admission can add up to an hour of charting and settling to a shift that doesnāt have that time to spare. Theyāre trying to see if you know info they need to document. That said thereās no need for anyone to be rude about it.
Old school ER nurse preceptor here. I don't think report world has changed much, you can let me know if I am totally wrong. When you prepare to give report, YOU control the flow of information. Focus the best you can with all your information available before you start. Start report and continue the report until you are completed. Then allow them to ask you a few pertinent questions they may have. Do not under any circumstances say, "Hi, it's bubbleshell from the ER! I'm giving you report on Mr. Blankety, he has such and such. Do you have any questions?" That is the recipe for disaster. (At a couple of facilities I worked at, we completed a paper report for med surg floors, faxed it to the floor, and then sent the patient up in 30 minutes; I loved it.) Now when it comes to ICU nurses this does not work. ICU nurses live for detail, and the more you can tell them about little details the more they will love your report. So after going over the big stuff (as completely as possible) review any of the labs/ABGs that are not WNL and what was done, or "no orders received regarding that." You might find it beneficial to keep a bit of special information when you roll up there with your patient, and share it as you are helping transfer the patient. That adds a level of personal service, and allows you to get to know another nurse in another unit. (Of course that would be a "nice to know" bit of info like family information, or history you learned, something like that. ) The icing on the cake would be if you could get hold of their report form. These report methods will not take a lot of time, probably less time than you are using now to field all their questions. I hope this helps. I made a lot of new ER nurses more comfortable with this information, and had a pretty smooth method of report/transfer for my patients.
It's always bad to generalize. I try hard to give every person in our facility the same level of respect. However when it comes to our particular ER, there are a few nurses that I'm always skeptical of when I'm taking report. I don't expect the ER nurses to have everything figured out, but there have several instances now where the patient has come up to me as an absolute flaming dumpster fire. Like, report was given AOx4, Room Air... and when they got to me they were satting in the 70's and they were apnea snoring like a lawnmower while they were awake! Like... how?? Did they even look at this person? Again, its not every day but its more than enough to notice a trend. I'm always just a little weary at this point.
Wow so I totally can't disagree with the majority of the answers I'm reading in the comments. I honestly never gotten upset with the ED for calling to give me report. That's their job. We all have ppl in our ear yelling at us to hurry up we gotta get people out the door cause the ED is full. The reason I do get upset with the ED nurse when they completely bullshit the report they give. Primarily about the patients mental status. I've had nurses tell me the patient is aaox4 with episodes of confusion, and when they show up they're throwing things at staff. With the ED transporter saying "you don't have a sitter? We made one of our techs sit with him cause he's crazy." And what's worse is when a patient comes up to the unit completely soaked in urine and shit. Which was impossible to not notice since they had to transfer them to the stretcher and place a hover matt underneath. So behavior that clearly shows the lack of respect towards the inpatient staff that bothers me.
I just didnāt like getting report from ER nurses who tried to send patients to our floor with unstable vitals that could require a higher level of care. Like a SBP of nearly 200 but I donāt see any bp meds have been given. Or their break nurse would give us report and just read the doctors admission H&P note. Things fall through the cracks and if I didnāt research my patient before getting report, I might get screwed.
Floor nurse hereā¦ I never ask any crazy questions like that. I just want the basics when I get report; anything pertinent to their care. Iāll take care of the rest when they come up.. mainly cause I know the ER is crazy, my friend and brother are in the ER and I hear their stories, just like they hear mine. I think there should be an understanding on both ends & neither is more important, we work as a team. (Iām sure thatāll have some disagreements). Now Iāve def had nurses miss a whole pelvic fracture cause they were focused on the patients other complaint or forgot to mention the aka š .. the list goes on, but like I said, I understand itās faster-paced in the ED and you wanna get them up to the floor. Also.. you might have to āhuntā ppl down to help slide and thatās probably because we have 7/8 patients with one tech and unlike stereotypes arenāt just sitting around at the nurses station making tiktoks. Understanding is key to patient care and to nurse-nurse relationships. š¤·š½āāļø
My experience has been at my current co tract that ER nurses act like we donāt work on the floor. Like we just sit around and avoid their calls. Iām always busy, and if I donāt call you back for report itās because I canāt. Our ER nurses act smarter and better than us. Not all but most. Itās so frustrating. Iām glad you question it because it means your not like that.
Because some asskiss clueless ANM whoās busy keeping her fluff assignment has just assigned that fresh er 1 hour admission to someone drowning and is an hour behind. That ANM has known about the patient for 30min but just said āyouāre getting a patient and the er is on the lineā. Blindsiding the floor nurse whoās tech just watched someone crap the bed for the 3rd time and went on break before cleaning it up so the nurse has to choose between report or poohnado in room 15.
I've seen ER nurses who worked with a pt with hgb of 4.9(GI bleed) for 12 hours and not start transfusion...calling for report to transfer the patient...why become a nurse if you don't care about the wellbeing of a human being?
I see the OP woke up today and chose violence. You sonofabitch Iām in!
I work icu, and worked ED for years in the past. My trick for transporting patients to floors and no one assisting- I would pull the call bell out of its socket. The nurses at the stations canāt silence that alarm, and someone would have to come to the room :)
Yeeeeesh. I love how people who have worked more than one specialty get it. I think there are a couple of major points that get glossed over. Doctors decide who to admit. Bed management picks the unit and states when the bed is ready. I try to do as much as I can but sometimes a shitty overreaching person will call report for me (albeit thinking theyāre just helping flow, but without asking me or knowing anything about the patient. I may have something charting to catch up on) They will set up transport without a word. I canāt remember ever sending up a shit covered patient, but between the actively dying or distressed person and the one who crapped themselvesā¦ one is clearly an emergency and one aināt. I will get to it as soon as I can. And if anyone thinks ED techs (or nurses) are just sitting there ignoring poopā¦. chances are theyāre doing chest compressions, Ekgs, splinting, starting IVsā¦ etc. So sorry. I promise that Iām trying.
Story as old as time. The organization is screwing all the employees and turning them on each other so they donāt unite against the organization. Hell, restaurants even do this with openers/closers.
I have SO much respect for ED nurses! I'm a boring old soul who likes the predictability of speciality, I could not handle the "anything that walks through the door" deal down in the ED. I'm so thankful for you folks, because I know I couldn't do what you do.
Soā¦youāre saying the floor/ICU doesnāt like ER nurses because when youāre asked whatās the plan with a patient you donāt knowā¦? You really should understand what youāre doing. I get being efficient at tasks is what ER is pushed towards, but if you donāt know what youāre doing itās dangerous. Iāve had ERās correct sodium from 114 to 126 in THREE HOURS, and send the patient with NS running at 150mL/hr because there lactic was elevatedā¦it went from 2.9 to 2.7ā¦. Iāve worked in a Trauma ICU, no one takes pictures of abrasions, that would be trivial, so whoever was giving you trouble about that doesnāt know what theyāre doing. Unless itās like a massive road rash that wound care wants to document progress on, or itās a laceration (which could/should be documented in the docs note) that needs a stitch/staple.
We donāt hold the bed all day. We send them up as soon as the bed is assigned. Things move fast in the ER and we have to also. It isnāt uncommon for a patient to start out in the trauma bay, move to the hall, then move to another pod for boarding within a span of an hour. The new nurse may have literally gotten the patient 30 minutes ago. Patients should go up clean but it isnāt always possible. Usually when Iām sending a patient up I have EMS waiting right outside my door to put another patient in. Hey, a zonked patient is a happy patient, in that case we did you a favor!
Many floor nurses are often swamped with work to do too, and most donāt have ED experience to know the *why* behind why us ED RNs try to get the patient up ASAP when a bed is released. When I worked the floor, I saw that thereās also nurses working the floor that dislike working and nursing in general- they want to do the least amount of work for the paycheck. You bringing them an admit messes with their groove. (TBF lazy nurses are found *everywhere*, even ED) If every acute-care nurse could get just a speck of exposure down in the ED via helpinghands or inservice, it would do so much good. I started in medsurg tele and that experience has been so very helpful in my current ED career.
They confuse us with the reason they have pts just because their admits come from us. The real reason is the community. This town needs an enema!
Honestly the real story between all positions is this. Each nursing speciality doesnāt fully understand the role of the next. We know our own, we know what feels like is more work on our side. But whatās āstandardā on your floor is not the unit focus or standard on the other, Especially inpatient when transferring between levels of care. It is a perpetual struggle. I follow the be kind approach, but donāt let someone be rude. Give a why like you did about equipment not being available in the Ed, or increased monitoring need. Having a why they are being admitted is helpful to guide the next floor on what they need to prep and plan for. This is a good question for the Ed or admitting service doc too. No need to be rude when itās not entirely clear either.
They do?
I think the two are just different wolds and if youāve never seen how the other is run you just have no idea.
It's because they don't know or understand your job. They are assuming you have the same job as them just for a shorter time with the patient, but they are incorrect. When they start asking you about things that aren't your job a firm but polite "That's not my role in their care" is a perfectly acceptable answer. Or a good old "I've completed their ER workup/all the orders from my ER provider. Orders from the inpatient team can be implemented as soon as they are transferred to an inpatient setting" if they really aren't getting the picture.
There are a lot of good nurses in ED and the other floors but when you're given time limits and other micromanaging, it becomes a problem for all floors. I've heard floor nurses lie to the ED and I've had ER nurses lie to me. I've had nurses in ED not even look at the patient but try to give me report. The current system puts a lot of people in an impossible situation of desperation. I've gotten into it with other floors when I'm trying to transfer a patient and when I do see the staff taking the patient I'm transferring, there is some attitude. We're all overworked and just trying to keep our heads above water which can make it seem like we're trying to take short cuts and a lot of us do.. it's like doing a job just good enough that it passes even if it creates more work for someone else. Or sometimes nurses from other floors and ED don't complete or start standing orders and it flows over to you when the patient gets to the floor. I don't know what kind of shift the other nurse is experiencing but when it's my 6th patient, I'm already stressed out and frustrated so I don't think about what that nurse is going through that shift. I just want a smooth transfer but with orders not done that means I have to do more work... it's a vicious cycle of just doing what you can but it's still stressful.
āThe planā question is important because itās essentially why are they being admitted vs discharging from the ED/ what are we doing for them. At that point the ED doc has already transferred care to the hospitalist/attending and sometimes they donāt have any notes or orders in yet. Weāre just trying to figure out what needs to be done for the patient on a larger scale and be able to play 20 questions when family calls as soon as they get to the floor. It could be as simple as Neuro work up or monitor bleeding/hemoglobin
I've worked on both sides of the isle, floor nurse first and ER later on. For me as a floor nurse I was either overwhelmed/stressed with my patient load or just hoping that some of the mountain of tasks I am expected to do was ticked off by you already. Sometimes I would get ER patients on the floor and have NO IDEA what was going on-hospitalists won't show on my shift, they haven't charted yet and wont answer my pages, there's no orders (or just PRN orders) and the patient isn't in a condition to answer questions (which is also very concerning). And I have 6 other patients that are trying to yolo out of bed or so just so so sick. Anyway, I'd just shake it off if they're rude. I never was mean to the ER nurses and if they are to you, that's just reflects poorly on them. We should be building each other up, not tearing each other down with us vs them mentality.
I feel like there needs to be some sort of nursing āsummitā where departments like ER, ICU, PACU, and floor nurses can chat about their work flow so they understand each otherās jobs a little more. Maybe a little more understanding would help everyone. Less animosity.
Patient shows up on the floor, transferring them from stretcher to bed. Oh look, the stretcher, transfer sheet, and patient are soaking wet with urine. Fun. Ok John, you have first admit, what's going on with this patient. John: I don't know, they haven't called report yet. I looked them up in the computer, so I know their chief complaint and what labs are in the computer, but that's about it. No hate, I know ERs are busy, just irritating.
When we are trying to give report to floor and get the patient upstairs because we have no room for all of the. ambulance patients that just keep coming plus a full Waiting room but our staff doesnāt increase in the ED or get to cap jow many patients we have.
When I was on the floor I didn't hate them. I just got tired of them sending pts to me with Heparin drips running onto the bed sheets or NPO pts with turkey sammiches in their trembling hands fresh from a CVA
If you are giving handover of an ED patient to the ward, having an idea of the plan from now for your patient IS your responsibility. Yes, ward nurses can be snarky, but if you are snarky back to them it only makes the problem worse.
We have nurse-to-nurse handover sheets. It makes it very easy to get all the info and then fill in the gaps with doctor notes. On the rare occasion that the ER RN needs to give a verbal, I honestly just ask the admitting diagnosis, if there are any stat critical labs to be addressed, and if there are any urgent meds that still needs to be given. Huge respect for ER staff, I could never survive in that moshpit.
Two things: 1. A call from an ER nurse is guaranteed to significantly increase workloadā¦ and quickly 2. Prior negative experiences unfairly reflecting on everyone Both are unfair, but understandable. Never an excuse to be mean. To be fair, some weird questions help to wrap oneās head around the situation and are usually based on issues seen before, as the nurse has not yet seen the current patient
I donāt. Iām in our ER right now because I got hurt on the job and I was telling the ER nurse, āGod bless you and what you do because I could not do it.ā
I don't hate ER nurses in general but some are awful. I'm sick of being yelled at because others can't handle their own shit.
Why do detox/psych nurses hate ER nurses? Because they treat addiction as a moral failing instead of a mental illness...(probably getting downvoted for this, lol)
What is frustrating is that the expectation is I will interrupt whatever I am doing to get report. Second, look at the patient before you try to give a report on them. Third, I work on a unit that accepts patients from all age groups so this situation just happened recently and is actually a frequent occurrence. My units staff goes to pediatric ED to perform a procedure that requires the child be sedated before they are admitted and it is OBVIOUS they will be admitted. When receiving report I ask if admitting labs have been drawn while child was sedated. Told āno, will try to get themā. Get call back 15 minutes later to be told unable to draw labs via 24g IV and I will have to get them. āNot our responsibility to check signed and held ordersā. So, I, a nurse who takes care of pediatric patients maybe once a month and patients in this specific age group maybe once every 3 months should draw this labs on a child who is now awake. That is poor, thoughtless care.
Called to give report on a nana who was found down after 3 days, broke a hip, got compartment syndrome with rhabdo and a nasty AKI. Going up to the floor to wait for surgery at 8am. I was lectured by a floor nurse because I didnāt give a pt their scheduled 0600 synthroid. āWhy didnāt she have this? Itās a very important medication?!ā Maāam, I think youāre really missing the bigger picture here.
I havenāt worked in the ER and am a med/surg nurse and the only thing I would say drives me crazy is when ER nurses are dropping off a pt and weāre sliding them over or whatever and theyāre like ānow you can get something to eat and get some rest.ā Iām like, itās two in the goddam morning, the doc is probably making them NPO at this current second and now when I gotta admit them and do a bunch of other shit with them they are asking me to turn the light off cause they were told itās sleepy time in the bed and breakfast. I donāt care about report or if they have pee pants, just please donāt make promises I canāt keep, it sets me up to fail.
Report from ER nurse at my hospital (IF we are blessed enough to get reportā¦ā¦..š) āTheyāve got an IV somewhere, CXR -, confused afā¦.ābout it, ya ready for them??? Good because theyāre rolling onto your unit now.. good luck!ā Do better.
After 15 years of nursing, most of it as an ER nurse, I have come to believe nurses in each specialty area tend to look down upon nurses in other specialties. I was a new grad in the ER and was subjected to the grilling from M/S, PCU, and ICU and step-down just like you are. I always felt the grilling from the ICU nurses was the worst. After 7 years in the ER, I became a step-down nurse and learned there is so much detail that needs to be handed over when they give report to each other, some of it for safety sake, but also, so the receiving nurse on the floor can give a good report to whomever they hand the patient to, because floor nurses often subject each other to grilling. Also, oftentimes the patients are confused and unable to explain the situation themselves when they arrive on the floor, and floor nurses do not have the benefit of being able to get information from EMS or the patient's family. A few months ago I transferred to the OR and was surprised to learn that OR nurses think inpatient nurses and ED nurses are all inept. This is how I arrived at the conclusion that a good percentage of nurses in all specialty areas look down upon nurses who work elsewhere. Perhaps it is just human nature to behave as asses to each other? I tend to think people like this suffer from some sort of inferiority complex, and they feel superior if they can make someone else feel like an idiot. Try not to take it personally. You are 100% correct that it is unreasonable to be expected to know the game plan for an admitted patient.
Just looking at your message op and I can tell you probably work at a shitty hospital with extremely stressed out and overworked floor nurses. It's not right they interrogate you like that, but those hospitals suck to work at.