I mean, they were when I worked on the floor. I'm just wondering, because lately, we're getting a lot of complaints about "unfinished business" after transferring a patient to the floor.
I'm not talking about sending up an unstable patient. I'm talking about busting ass on a patient who is going to a regular med/surg floor. Listen: you have most of the same training I do. You're certainly able to give meds, and put in a Foley, and page the covering resident for order clarification. Actually, you're MORE able to do those things, because your patient load gets capped off after about 6 patients. Mine doesn't; ambulances keep coming in. Also, I can have ICU and tele patients in my care, and unless you work in those units, you don't. Also, my patients are all more unstable than yours due to the nature of the emergency department. Here are my requests:
Don't complain to the nursing supervisor that a Foley wasn't placed on your patient in the ER, especially since the admitting doc was the one who ordered it six minutes before the patient went upstairs. We both were taught how to do this in nursing school. I know you haven't forgotten.
Don't call me complaining that the patient is "unstable" just because he has a blood pressure of 180/90 on arriving on your unit. His pulse is 78. He is asymptomatic. He has a history of hypertension. He's being admitted because his private doctor wants his hypertension under control. If his pressure had gone down in the ER, we would have DISCHARGED HIM. Call the covering resident and get some admitting orders. What, you can't give metoprolol or labetolol on your floor? You DO medicate your patients, do you not? I don't get excited about a BP of 180/90. I need at least 220/110 to start getting my panties in a bunch.
Look, I'll happily START a blood transfusion on your patient before he comes up. But once I've established that there is no transfusion reaction, the dude is coming up to you. I am not keeping him in an uncomfortable ED stretcher for two to four more hours just because you don't want to document the end of the transfusion. Also, I need the space for other patients who are coming in.
And speaking of which, if I call you and ask if a patient's bed is clean, and you tell me that the ROOM is clean and ready, but that there is no actual BED in it for some reason, don't get all pissy with me when I send the patient up in a stretcher to lie in that spot till YOU get building services to send a bed. If he can lie in a stretcher downstairs, he can lie in a stretcher upstairs, and don't threaten me with calling the nursing supervisor—I already called her and told her what I was doing. You won't get any sympathy from her. I need the damn space.
Seriously, folks, I'm busy. I have things to do.
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31 comments:
mwahahaha! you are reading my mind! I am glad that our hospital isnt the only one with prima dona floor nurses.
We start all of the IV's and if it goes bad they call US to come and restart it again! Without even trying..
Dont whine at me because I didnt put the NG tube in that was ordered on the FLOOR order sheet. You have only 4 patients, you have time to do it.
Lunch breaks? what is a lunch break? we eat/inhale our lunch while standing up between ambulances coming in the door.
I could go on and on. And when I was a med surg nurse we could take care of patients too. what has happened in the last 16 years?
Yeah, I work in an ICU and the floor wanted to send us a patient because they were getting 5 IV antibiotics. We just rolled our eyes.
I love being told that a pt can't be transferred because the nurse is busy/taking a break/...get the charge nurse to take report and take the pt...I don't get to tell the active laboring/pushing moms to close their legs I'm busy/taking a break!!!!
There are nurses on every unit that look for the easy way out and love to complain about something. I float around the hospital to wherever they need me and do whatever they ask, but we all get to know who the whinners are. They are not just floor nurses, I see them in critical care, ED, tele, and other float nurses.
The only place I have not heard complaining is in the morgue.
My hospital does not have an ER. That means all of our admits are direct admits. That means we have to get all orders, do all admission paper work, start an IV, draw any bloods, do our own EKGs/foleys/NGs/transfusions/whatever else, and do whatever it takes to take them from unstable to stable all on the floor. We handle it.
5 patients. Where are the aides? Who the hell knows? You are trying to call report, I'm holding pressure on the now bleeding site of a post-cath patient who is--oops, also having 9/10 chest pain, a b/p of 190/80, a serious chunk of ST elevation in the 12-lead that I got myself---in the process of using his free hand to yank out the IV that I was just about to start a nitro drip in......
One of my other patients is yelling to go to the BR but can't by herself, another has sh*t to his eyeballs, the family of the other is standing at the doorway of the first wanting to know where their nurse is.....
It is a whole lot of fun to knock other departments, but we aren't all lazy and useless, just overwhelmed as badly as you are. We have ED nurses as bad as anything you complain about, now orders written at 1600 in the ED that haven't been done at 1830 when the patient gets here.....
Fuzzy: I hear ya! Now double that load, with more coming in all the time and you'll see why the ER RNs are so anxious to get patients upstairs. And why we sometimes can't get to look at the orders for stable admitted patients as sicker, unstable patients are coming in and being doubled up in areas with admitted patients waiting to go up.
This is exactly what people talk about when they say nurses eat their own.
I would not want to work in a SNF with 20-30 pts as a nurse.
I would not want 5-7 surgical pts at a time.
I would not like fresh open heart patients starting to crash.
Everybody thinks they have it bad, grow up and be adults, the managers make sure every nurse is kept busy and stressed.
At our hospital, a tiny little place, the very things I used to care for out on the regular floor with 3-4 other patients gets sent to a higher acuity unit, or to another hospital. Yet, in the ED, we do it all. Not saying we are superheroes, but we HAVE to care for all those people. And sometimes, I go home thanking my lucky stars that one of my patients didn't die...because there are nights where you go home thinking that if you worked inpatient, an unsafe staffing form would be filled out, and complaints made, etc. But, this is the job we signed up for.
Oh, if your hospital has an electronic medical record- generally all med and lab orders default to STAT or NOW. Even if it isn't really meant to be that way. So, it may be the nurse wasn't being lazy. Just had sicker patients, or the order wasn't really intended that way. Happens all the time.
This topic bugs me! In today's crappy market, I don't think there are any departments that aren't feeling the crunch and working understaffed. That includes med/surg. To an ER nurse, I'm sure 6 patients sounds great, but ER and med/surg nurses have different responsibiilties to their patients. Everyone is running around crazy ready to quit because of the workload. It's not easier on med/surg, just different.
Misty
A self righteous ER nurse who thinks she has it worse than others, your poor patients.
Why don't you work in CCU, ICU or on the floor if you think it is easier.
I don't get these posts and there are a lot of them. I work hard to have a good relationship with the ER folks. I like them and they like me. If you need floor beds, I hustle my ass. If not everything gets done, no big deal, it's a 24/7 job. I'm just a lowly floor nurse but I bust my ass to make it work. You must work with some real divas.
I work on a med surg floor. I have a great relationship with our ER and they know, if I say we need more time, there's a really great reason for it. They also know that if they are overflowing, and transport is backed up, I'll come get the patient myself. I work in a large, inner city hospital on a busy floor with patients one foot from ICU. I love it. And my relationship with PACU? THE SAME.
There are lazy nurses. There are awesome nurses who go above and beyond with every little buttwiping. I mean, that butt shines like the top of the Chrysler building. But really, most of us are just trying to get through our shift without a patient/doctor yelling at us or killing someone with a mistake or well meant pillow therapy.
Pt needs an NG but you didn't have time? FINE. PT needs an NG but is violently vomiting quarts of bile? NOT FINE. I've never called the ER to restart their IV, but I have called other depts who sent a pt with a bad IV. That's policy. Pt needs a foley, you didn't have time? FINE. Pt has a liter of urine and is writhing? NOT FINE. But I'm assuming you know these things. You're sending a pt with a high bp to a non tele floor? We need to know we can get that BP under control and that the guy doesn't NEED tele. That's policy at my hospital, and it's not rude to ask. We need to know if it's just pain, or if they need IV beta-blockers. If not, WE hear it from the house sup and the charge about why we took the pt who should have been in tele.
It sounds like you've had a rough day, and I'm sorry about that. But please think about the floor nurses who do get the job done, don't delay, and don't complain that they JUST discharged their 6th patient, haven't had time to chart about it, JUST got another patient, who is also unstable, and wants a chocolate and turn down service, even though they are NPO.
Your job is hard. I get that. ALL OF OUR JOBS ARE HARD. We do the job, and at the end of
the day, we ALL need to have each others back. If there's a nurse that consistently delays or consistently complains, that needs to be brought up with her manager, but I bet MOST nurses are just like me, trying to get through the day without loosing my license or having someone fall/pass out/die because my HOSPITAL (not you) overloaded me so much that I didn't have time to round.
I've been on both sides of the fence and am on the "let's get along" side. We should all be working toward the same goal (patient care...we're nurses to take care of PATIENTS, right?). GrimalkinRN summarized the situation well: situations are very specific regarding when it's appropriate or not to delay tasks. Nurses really have to quit sniping at each other. Everyone is feeling the crunch lately with cuts and budgeting, and being hateful to each other just compounds the problem, IMHO.
There are a lot more hard working, knowledgable nurses than there are lazy or dumb nurses.
But the awesome nurses are not any fun to pick on or insult...
Geezum krow!
1) This is not about YOU, your skills, your floor, your hospital. This is not even about nursing, per se. This is about HER job, HER co-workers and HER workplace. And honestly, can't you assume if you're reading this blog you're probably one of the good ones? How 'bout get over yourself and shut it. Preaching to the converted, no?
2 but should actually be 1) This is not a professional Forum, and it's not even a forum. It's certainly not a magazine, newspaper or journal of any sort. There's nothing of record, no certification, no board of directors or professional association. And you should have guessed this "information" is not the result of any scientific study or research. This blog is the property of one woman venting, bitching, complaining and laughing about and even sometimes praising her job, work place and co-workers.
If she was selling shoes would you still be so damn defensive and insecure. "Well, you know, most of us shoe salespeople are awesome and even though I don't know you or your boss or your store and you're in Cedar Rapids and I'm in Dubai, well, I just know you're wrong because I'm taking this so damn personally."
When I was a resident, floor nurses used to put pillows under the sheets of empty beds to make it appear that their beds were full! The nursing supervisior had to start actually pulling down the covers to confirm a patient was there to end this scam.
To Anon: I rest my case on ERP's comment....it's a prety common theme in ER blogs that floor nurses spend their days hiding beds, etc. and aren't as competent, etc.
So, I found your blog thru Hood Nurse and I have been reading it since last night - it isn't have a good effect on my beauty sleep! Anyway - the only time I left my computer was when I had to go to the er this morning! After reading all these blogs (cuz I love to laugh at stupid people & these medical blogs are hilarious) I felt SOOOOOO bad for going to the er but my doctor had no appts available and my closest er has a fast-track area and I needed a certain medication refilled before I left for my vacation tonite. I apologized to EVERYONE for having to go - from the receptionist to the orderly! I told everyone I was sorry for coming to the er, that I knew it wasn't an emergency & I patiently waited (I was actually in and out in less than an hour - they
weren't busy at all. I was the only one there & all the other rooms that I could see were empty)in my room until the doctor came. I never asked anyone for anything or how long it would be. The nurse came in and I apologized to him too & said I didn't need anything and to just take care of his other patients (I really don't think he had any though!) Then the doctor came in & I apologized to her too! But I got my med - which was awesome cuz I REALLY needed it. Hopefully, they weren't talking about me when I left about how stupid I was to come to the er for a med refill! (no, its wasn't a narcotic or pain med of any kind). So, thanks to you & the other nurse-bloggers - my local er (hopefully) had a very nice, patient & understanding patient this morning!
I can see your point.
However, as a floor nurse, admitting a patient does take a lot of time/work. There are more papers to be filled out, orders to clarify, clinical resumes to complete, medications to be given, etc, and patient care must continue for our other patients as well.
When things such as NG tubes aren't placed on a patient who has an ileus, no IV started on a baby who hasn't kept its formula down for two days, IVs gone bad on a patient who we had to come downstairs to start because the ED nurses were too afraid to poke the baby (and has gone bad because whoever transported the patient upstairs let the pump beep so it's now clotted)...I could go on and on.
I have the same argument you do, only from the other side. The key to making an admission go smoothly is teamwork. If the physician writes the order right before transfer, ok, no problem. But it's helpful to the floor nurses if things that should have or have been ordered are completed before transport. And I will tell you that there is nothing worse than hearing, "I don't know this patient; his/her nurse went on break. I was just told to call and give report", and not knowing what times/doses/medications were given. Like I said, there's a long list...
Yeah, we need to stop turning on each other & be more supportive. We all have good shifts & bad shifts...let's try to have a bit more patience.
At the same time though, it's her blog & she is free to get her frustrations out. If you don't like what she has to say, then stop reading her blog. :)
I think the dog eat dog world of nursing is what lead me to get into healthcare IT. Nursing is a good background but there is too much bickering in this field.
-Seven year critical care nurse.
wow
Must say I am underwhelmed with your maturity guitar girl. You have an issue, take it up with your superior. Don't pull the typical passive-aggressive vent on a blog BS. If you were a being a mature professional you would realize that most RN's (whether they be floor, ICU, NH, or ER) are doing the best they can under difficult situations. Believe it or not the ER is just one part of the hospital. Not the only part of the hospital as you may think it is. If you have an issue with an RN not doing her job then go up the chain of command and call her (him) on it. Otherwise, grow up.
"wow," Anonymous! You're RIGHT!! I'm an asshole. Boo hoooooo hooooooooo you caught me. How DARE I vent on my own anonymous blog. You sure showed me! I'm "growing up" IMMEDIATELY because you said so! I'm truly ashamed that an anonymous commenter like you had to put me in my place. Because you know, I NEVER THOUGHT of calling the nursing supervisor. You are a NURSING GENIUS and I BOW to your supreme knowledge. Thank you so much for showing me the error of my ways. From now on I will only blog about the rainbows that obviously come out of your superior asshole.
Humbly,
GGRN
P.S. Uh, fuck off.
OK:
Your pathetic overtheboard saracasm aside.
Go ahead and continue your useless passive-aggressive BS moaning that you are so good at. It won't change anything.
ER RN's call floor RN's idiots for wanting everything everything done before the transfer, Floor RN's call ER RN's idiots for not being able to do anything without an ER doc 10 feet from them. Both call ICU RN's idiots for not being able to do anything without a central line, blah, blah, blah. I think even a dolt like you can see a common thread. Frankly this attitude which you are a part of is all so pathetic. Either grow up or go into another field.
Anonymous, I have a feeling that you're one of these "last word" types, so this will be the last thing I say about this issue.
It's this: why is it wrong (or "immature") of me to blog about my frustrations? I don't know if you're a nurse, but even if you are, I'm not talking about (or to) you (or about any of the other commenters, for that matter). I'm writing about some legit things that have happened to me. Where I work. None of this has anything to do with you. Or where you work. It's about me. Because it's my blog. Like it or don't. If you don't like it, you don't have to read it.
Also, just for clarification, I'm not being passive-aggressive. I'm just being plain aggressive. So there.
Ahh guitar girl passive-aggressive is whining on a blog. Aggressive (and there is nothing wrong with that word) is going up the chain of command and not taking no for an answer. MY POINT is that there are good RN's on every floor of the hospital... and bad ones. I have seen some ER RN's that I wouldn't trust with doing basic things. Not because they were "ER RN's" but rather just bad RN's. Where the person works is generally meaningless unless it is a chronic problem on a given floor/ER/etc, etc.
If you have an issue with a floor nurse then take it up with her then go up the chain. If the situation is chronic and admin is not listening, ask yourself, is this a hospital I really want to work at? I certainly would not. Otherwise then by all means continue your whining on your blog but do you honestly think that is a mature way to try to rectify a situation which may be affecting patient care? Nurses really do eat their young.
PS: Last word may be yours. goodbye.
dear anon,
every nurse has a day, a day that was perfect, a day that was a cow. so leave guitar girl alone,let her moan. we have all been there, and maybe by seeing the other side, we will try to not be a p.i.t.a. to our fellow nurses. GGRN is just saying on her blog what she would say to her bff nurse, if she wasn't too tired to talk. sometimes the feelings have to come out, and better in a blog than toward a jerk patient, co workers, or our loving families. so dear anon, if you have never ever once bitched about your co workers, i will tell you to get off welfare and get a job.
This is a HILARIOUS post because I work in an ICU and we CONSTANTLY bitch about many of the topics you covered here. It was good to see this perspective! Much appreciated, and has given me reason lighten up a bit. I especially like you because you start blood! I loooove when I get a GI bleed (among a million other issues) and no blood has been hung. I am the one getting bitched at when consulting docs find out the pt arrived in the ED at 10 am and are just NOW (sometime after 7p) getting their first unit., and the first unit. My favorite is when I ask the nurse a few basic questions about the pt, (things they should know!!!) and they say... "I just picked up this pt at shift change, so I am not really sure". Ummmm last time I checked... when the day nurse reports off to you, you now take full responsibility for this patient, and she be aware of his/her CP, diagnoses, and assessment data!!!
I love giving report to the ICU. They are the most professional, competent nurses on the floors. They don't ever ask "what's that medication for?" When a bed opens up they often call us to get report. There have been many incidents of nurses hiding beds, lying about their census, being caught by the supervisor. Never happens in the ICU.
Inner City trauma nurse
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