You hate us. We know you hate us. My goal here is to see things from your side, and tell you how it is on our side. Everyone has those stories "One time the ER sent me up this patient and it was a TRAIN WRECK." I ask you to put aside that, and read with an open mind. I accept that floorbies and ERs will never walk hand in hand to get coffee together, but if one person reads this and isn't as sassy in their next patient handoff, I'll consider myself a success.
We give you patients at change of shift.
This complaint irks my soul. I'm sorry kids, but it does. I know it sucks to get a patient at change of shift. But if you're getting a patient from me then I'm getting a brand new one as well. Believe me, I'd much rather hang on to this admission that I finally have settled in bed then ship them off for a new one. Just as its unacceptable to tell your night shift "I got this patient at 1830 so I didn't do the admission stuff", I cant tell my relief that I didn't complete any orders on my brand new one either. And it is completely untrue that we hang on to the patient for the day, and send them up at the last minute. As soon as the bed shows up as ready, the secretary is calling transport and the patient is going to their bed. The timing sucks. And we really can't help it.
Plus, imagine it from the patient's point of view. They've sat in an uncomfortable stretcher for hours, waiting for CT results and admitting MD evals, while watching a psych patient running down the hallway. They come to the desk every hour asking when their bed is going to be ready. They are miserable, and the family members are about ready to walk upstairs and clean the rooms themselves. Please, don't bring any irritation onto them when they get wheeled into their room at 1845, because they've probably been waiting ALL day for this.
We put IVs in the AC
So when a patient comes in, sometimes they're really sick, sometimes they're putting on a really good show. You could be getting a nice, stable patient that looked completely different when they walked in. Either way, we have to get an IV in, fast, and a nice big one is optimal. Certain medications require that placement. CT scan prefers 18G or larger above the wrist for any imaging with contrast, so if they have any type of trauma or we think they're getting imaging, that's the spot. Sometimes they're so dehydrated on arrival, that's all that's popping up. Sometimes they REFUSE to let us go in the hand. It's annoying to us too..."Mrs. Jones, remember leave your arm flat so the fluids can drip in!" If I have time to search around for a different spot, and if the patient doesn't require a large bore IV, I try my best to go somewhere else, otherwise I'm going to be happy with what I've got.
We don't start admission orders.
Y'all have to understand that our job, and our mentality is to stablize the patient, then get therm where they're going. We fix things pertinent to the issue at hand, then send them away. If the ER nurse isn't giving antihypertensive medications and the blood pressure is out of control, that unacceptable. If the PCA or the heparin gtt or the blood transfusion was ordered hours ago but never given? Unacceptable. But the NSS 80mL/hr, the subq lovenox and the colace? It's not our priority. Personally, I try to at least draw any due labs I can before my patient goes upstairs because I can draw from the line and the floor nurses at my hospital can't. Half the time the pharmacy takes hours to send us the medications. Flowtrons? Forget it. Good luck trying to find a pair. But if an ER nurse is feeding the patient and not covering with their sliding scale insulin, or giving their needed blood pressure medications that's unacceptable.
We give incomplete reports
Our report/patient hand off is very different from yours. Mostly "Mr Johnson is here for L sided CP on and off today. We gave him 2 sublingual nitro and that decreased his pain. He has an IV, I sent labs. HR has been SR 80s, blood pressure has been on the high side, 150s systolic, but the docs are just watching it for now. He'll probably be a tele-admit." We don't do a systems run through or delve into the past medical hx unless, like mentioned before, its pertinent to the issue at hand. I know it's frustrating to get half the story, but it's just not our priority. We operate to focus on the problem in front of us, not to plan care for their entire hospital stay. It's two totally different approaches to patient care.
That being said, it's inappropriate for the nurse not to know what hip is fractured, what the vent settings are, what heart rhythm the patient is in, etc. That is bad nursing practice, and should not reflect the department as a whole.
We get irritated when the floor won't take our call
Eh, yeah, guilty. We aren't required to give report to med-surg or tele floors in my hospital, just ICU and stepdown units. So when I give a courtesy call to the floor and they won't come to the phone I get irked. And I shouldn't. I am sorry for rolling my eyes over the phone. You guys are just as busy as us, and I understand that. However. If you do take my call, please don't use this as the opportunity to get out of taking the patient. The patient has already been accepted and approved by the doctors and the nursing supervisor, take it up with them and not me please?
We don't pay attention to skin care
Eh, yeah, not as much as I should, I'll admit to that. Anyone coming from a nursing home or incontinent at baseline I turn them, get a look at their back/sacrum and document. In my department, we don't carry all the fancy wound care dressings that the floors have, so its usually just an abd pad and some tape. The floors also take pictures of the wounds, so I'm hesitant to do a baller dressing that's taped down like cement when it's just going to get ripped off during the admission assessment. I will say that I'm really bad at remembering to take off their socks to check for pressure ulcers on their heels. Sorry yall, I'll do better I promise!
In conclusion, I realize there are some things I need to work on from my end. I hope this didn't come off as pompous, I just wanted to give things from my perspective. I give you floorbies a TON of credit, I could never do your job. Everyone fits a different specialty, and we each have a different job to do. And like I said before, if one floor-ER interaction is a bit less sassy after reading this, I'll be a happy nursey.
-K
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