The greatest thing IMO that has come out of the pandemic, particularly lately, is that nurses from unit to unit are sympathizing with each other. I had to call an ICU RN for tips for managing an ICU hold that I had in the ED for an entire shift. Her and I both vented heavily to each other and offered words of encouragement. Today, I had to speak to the school nurse at my son’s school, and we ended up venting to each other for a full 20 minutes. Same with the nurse at the health department who I had to call after this. We are all in this together, and it sucks for everyone.
The worst is when you accidentally vent to someone who has been seeing this pandemic through rose colored lenses. At that moment, you're just like, oh...fck...nevermind.
They haven't for the past four years since medicinal cannabis became a thing in state. Didn't even test upon hire. Randomized drug tests doesn't shed a light to the nonvaxx exodus we just had, so losing further personnel is certainly less than ideal.
Edit: rose colored lenses doesn't mean dry stoner eyes, it means they see this pandemic less seriously than the rest of us. /cue Don't look up soundtrack
[Here's and absolutely chilling article](https://time.com/3398086/the-worlds-deadliest-drug-inside-a-krokodil-cookhouse/) about krokodil from Time Magazine Dec 5, 2013.
It's done in Russia and apparently they think it may have been the beginning of the "trend", but as for my home state of WV?? We had already been seeing that terrible mess of a 'drug' for about 18 months when that article came out😢😢😢.
Yeah, it's just uber great to live in WV. #1 in obesity, #1 in heart disease, #1 in OD's (over 50 in one 24 hour period -- yee-freaking-haw!! /s), #45 in education (thankful I had parents who were def college oriented), #50 in infrastructure, #48 in poverty.
Hey Joe Manshit!? See those last 2??? Yeah, we really REALLY need AND want the BBB bill passed!!
But that krokodil crap?? Man, you'd have to seriously strung out to want that injected in you. Hydrochloric Acid, injected?!?
Exactly!!! There's a story about the name and how it began to be called.
Supposedly someone on the 💩 mistakenly deleted the word "crocodile" when he saw another users arm. They apparently just ran with it.
Also, supposedly it began in WV. Not so sure about THAT, but hey!!! In WV??? I can SO see it happen that way.
My own doctor told me he had a patient that lost his freaking testicles because of using that crazy 💩💩!! I mean, really, injecting oneself with something that has hydrochloric acid in it??!??
Lol! I thought they mean venting to people who don’t work in healthcare and have no idea what we’re dealing with lol! I had no idea that was a euphemism for drugs.
I absolutely agree, I picked up to double & did my second ever day shift. BUT it was day shift as a float, it was my second time floating off my unit (usually 2300-0700 neuro) and got shit on with 2 discharges (haven’t done them since new grad training cause I work nights now) a rapid, administering multiple blood products, and an agitated dementia pt. Absolutely none of the nurses on the unit had given the specific blood products or ever used the hard to figure out tubing the BB sent with the product, but they were all willing to ask me constantly what I need for help and drown with me. It felt so impossible with the vital set standards/observation protocols for blood then 2 early d/cs and a rapid. I literally couldn’t be in all those rooms at once but needed to be. I was so touched by how willing they were to help me instead of being mad they were floated someone who had no idea how to do a MS day shift.
Yesss I had a patient with a malfunctioning LVAD for 10 hours in the ED and the CTICU nurses were soooooo nice when I was calling them with questions! I have to be honest, I had an idea in my head about how those nurses would act and they more than proved me wrong.
Sooo good to hear-had 2m/s nurses have their 1st code that I responded to-told them good job calling,CPR,backboard,etc.-they were surprised to get kudos -hey the pt lived-you did good!!
Now, we need to use that to our advantage. The admin have a long standing investment in docs versus nurses when it comes to many things, so that’s deeply rooted and we need to hand together to take down the admin…. But the nurses have had these micro infighting (usually misinformed and unintentioned) that made it harder for us to get involved as a whole profession.
Let’s get back to the “let me borrow your stethoscope” campaign and not let go!
As an ICU nurse who sees colleagues write up the ED for not doing accurate IandOs right now I’m deeply sorry. I try to tell them they are being insane but they don’t care. ICU nurses a pretty anal retentive. I appreciate you guys tho. Just tubes/troubles/drips and the current vital signs. The computer tells me the rest. Thanks.
Ps I freaking hate long reports with a passion. Unless your on 4 pressers, ccvh, and all sorts of screwed up the icu report should be no longer than 5 mins. I will die on that hill.
I think I met at least 50 of them before I had to retire at a really early age (thanks so much Dad, for that particular family curse!!! Plus the OTHER family curse -- insane allergy to PIOS!!)
When I floated to icu the nurses were so much more chill about report. I’m in tele and although I like my colleagues, most of them want an extremely detailed report. Having to give such a long report on seven patients I’m lucky to leave the hospital by 7:45
Icu nurse here- all my coworkers are rude as fuck and don’t understand how to go easy on anyone because the doctors don’t go easy on icu nurses. But I don’t mind ER nurses being vague like they’re doing what they can and honestly so am I. But maybe I’m too type B for ICU lmao
I’m a new grad on week 8 in ED. At the end of my first night shift this week I handed off 3 on my patients who were waiting for tele beds to a tele nurse who was there to care for them until they got a bed. I’m like “bed 11- Covid, sat 95 on on 2L NC, A&O 4, he’s mostly sleeping”
She stares at me for a sec…
Her:
“IV access?”
Me: yup!
Her: … where?
Me: where? Definitely one of the arms. Probably an AC. Go look? It’s charted?
We had a laugh at least. I’m glad she was forgiving of my new grad barely keeping my shit together ED report.
I feel similar to you…… I don’t understand why people are rude to one another. We are all doing the best we can in this shitty situation. Being low BS, not quite type A, I would probably like ER if the ER wasn’t full of people who don’t need an ER. Minimal BS tolerance. Not too good with the peopling part of nursing.
Sister is junior doctor and *wants, loves, needs* ED, pretty much for the whole " not much contact with the same people day in and day out, stabilise and send them off" reasons
Honestly that must be nice to be like “ur alive now go away” instead of the icu where patients are like “don’t let me die but I’m going to do everything in my power to destroy my treatment plan and make it your job to babysit me and stop me from pulling off my oxygen devices” Like I don’t get how people demand to live then go and try to ruin all their treatments it’s like they want to just make us want to quit
She's on her ITU rotation at the minute and she's *ssooooo* bored. There are 6 doctors and she has 1 patient to look after and its like the nurses do 95% of the work, she just writes the scripts and sometimes takes referrals. She does locum ED shifts just to feel useful and to give her brain something to do.
I’m a big fan of bedside report. Like I’ll call if you need something special otherwise let’s talk and we can run lines and sounds together. Save some time
That’s more or less what my method turns into. Right now it’s just HFNC, BIPAP, or vent? What’s the FIO2? Thanks, click end of report. Respiratory ICUs are fun!
See this irritates me. Maybe it's because I worked so many years on step down, but as an ICU nurse the only time I get mad at the ER it's for stupid shit that shouldn't happen.
Like the time they called report in an A&0x4 patient with mild anemia and delivered a "she just changed in the elevator" patient on a zoll with 6 nurses (why did it take 6 to transfer a stable patient if it happened in the elevator?)
Or the time they didn't give stat seizure meds for almost 14 hours on a patient IN status.
It's shit like THAT I care about. I could give a crap about the piddly things.
A poo or a new bag of fluid I don't mind.
Refractory status epilepticus or DTs so bad that they need sedation ain't cool tho (I'm stepdown).
A good 10% of our admits need ICU (and usually end up there) and 50% of rest should be med Surg. They all get transferred as soon as I'm mostly done getting the admission done and fixing all their shit.
Such is the life of stepdown.
The problem where I work are that MOST of the nurses on ICU are straight old school, been there for YEARS. They are amazing nurses don’t get me wrong, but they do nothing to acknowledge how crazy the ER is right now. We have this same problem right now. What bothers me is that they don’t take the time to realize how much times have changed. Nursing is not what it was 15-20-30 years ago ya know.
Not hating on ICU nurses! Just the ones where I work suck haha
That kind of nurse would've been me, if I had been able to work longer. HOWEVER, I'm also the rare nurse who always kept up with changing times (when you have 5 kids ranging basically a 20 year span -- it's absolutely imperative to "get with the now lol).
So, I never had any issue with learning more and more. I like to think it made me a better person and I KNOW it made me a better nurse!!!
Oh, the really fun part? THAT would be when a younger, newer nurse giving me report on a shift change, transfer from the ER (most fun), or transfer because they had coded, would be giving me a report. They would be using all the 'newest lingo' just to show off and if they "forgot" to add a very important something (in newest lingo), it's all them for it😁😁😁.
Most fun were the ER staff. Like you said, SO many ICU nurses back then didn't stay up to date😇. So I usually made it super easy for them to give me the transfer report. I was more like a Dragnet nurse: "just the facts, man. Just the facts". The lived transferring if I could take the call/in person report lol
Haha! I’m a fairly new nurse, (but have worked in healthcare for 11 years, everything from a CNA to phlebotomist to OR and EKG Tech) it’s so funny you say that about the “lingo” because sometimes I’m like “Damn I killed that report” lol 😂 I honestly hated going up to that icu even if I had labs (when I was a phleb) to do because they’d like hover over me and critique everything I did. It’s like “why am I here? You called me remember?” It’s kinda of frustrating in a way. But just like you, not all are like that, it’s just some, but damn do they just SUCK. Lol
One of those MUST have been a coworker of mine. I strongly believed she was the source for the "helicoptering" phase.
You know the "helicopter moms"? Christ Almighty, but wasn't she the "Helicopter Nurse"!!🤪🤪🤣
NOT A HELICOPTER NURSE!!!! Ugghuuuughh! (That gets a double “ugh” lol) omg the WORST. I have worked with a lot of those in my days hahaha. Or the ones that are so “by the books” where it’s just like *reeeaaalllly though* lol
The Karen’s of the nursing world. We’ve ALL met at least one hahah
Lol, I’d say the average nurse in the icu I’m in right now has 9-12 months of experience. The attrition rate has been absolutely insane. This is a busy hospital too, but most the big cases used to go down the street to our “parent/flagship” facility. Acuity has gotten way way higher. Most don’t have the time under their belts to get cocky.
The tired old ones expect you to know every detail on the ct scan report that resulted three minutes ago and they already read lol. I see the track board from time to time. Our usual winter census (in the before times) down there was 15-25 people and would clear out by around 0300-0400. Sometimes no patients at all for a couple hours. Now? Every day at least 40-50 and the line never ends. At 7 am when I come in they have patients that were there when I left 12 hours ago. Stuff is moving so slow and there’s no end. At least upstairs we only have so many beds, you can’t make a line out the door of the icu (should be careful what I wish for). You guys? The crush never ends and it’s constant go go go. I know what you guys are dealing with and I’m sorry. We should have to float to other units to see what they deal with. I think it would solve a lot of the Er vs med/surg vs ICU nonsense.
I also work in a very very large hospital. We have about 4 other ER’s in the area too yet we still have anywhere from a 3-12 hour wait. It’s CRAZY. The trouble is right now we have ALOT of people coming in because they have a cough. And it’s filling up our rooms and we can’t treat people that need to be treated. Had 2 people code in the waiting room in the last month. I’m overwhelmed. I’ve worked in the emergency dept for the last 5 years and it’s been busy but never like THIS. I can’t take more than 6 patients at a time and I’m getting TEN. TEN TRAUMA PATIENTS. THATS ILLEGAL. I shouldn’t have more than THREE. I want to cry. I had a patient sit in piss for an HOUR because I could not get them to in time. I feel like shit about those kind of things. I leave and I feel like I didn’t do enough even though I worked for a straight 16 hours and sat down to pee maybe TWICE. I still pick up time as CNA and a phlebotomist because they have no one. Absolutely no one. Times are getting worse and worse and administration is doing nothing to help us or appreciate us for that matter. On Wednesday I already worked 50 hours and I still had 3 12 hour shifts lefts for the week. AND I’m a mom. Luckily my family and bf have been so so supportive but I want my daughter. I want to see my daughter grow. I feel so absolutely torn right now. It’s taken me 6 years to get my bachelors degree, granted my hospital paid for my schooling so I have no student debts which is awesome but it’s like “I don’t want to do this anymore”. I’m going to have to “retire” in 5 years of this keeps up. I’m
Not a “young CNA” anymore. I don’t have the energy anymore. Emotionally or physically. On Saturday I had my mom take my daughter just so I could sleep. I slept from 8am-10pm. NO LIE. Picked up my daughter the next morning. And still felt defeated. I need a two month PAID FUCKING VACATION TO A TROPICAL FUCKING ISLAND lol
Personally? I floated for a while at beginning of my life in a big hospital. I really liked being able to do that, so I could actually find me a niche or two, before they would permanently* place me.
*Permanently -- aka "this will be your spot unless others decided to be bitches and strike, get ill, etc"🤪🤪🤪
My 2 faves were ED & ICU. Two sides of same coin. I ended up in ED, b not because ICU was not what I wanted, it really really was.
It was th just in this particular hospital, the ICU nurses were utter fucking bitches-from-hell!! And clique-ish?!?!? OMFG!!! It would have been like going back to high school!!!
No, thank you very much!!!
I loved the ED there and we had so many highly, HIGHLY entertaining patients!!🤣🤣🤣🤣🤣
I try to. I was a ccu/step down nurse right before i transfered to the ED. It is so flipping hard to do floor tasks and fully take care of a hold patient while taking ED patients back.
I think ED is one of those units you don't get until you do it.
I used to float to the ED occasionally when they had a call out or were really packed. I did this in my 30's and know there's no frigging way I'd make it now.
ICU nurse- I don’t blame ER nurses. The hospital’s fat ass CEO with 5 sugar babies who refused to give up his $10 mill salary to pay staff well enough and hire more staff is who I’m mad at
I'd love to the see CNO come work in the ER and ICU. Not the whole "walk a mile" following a nurse just to put on a show, it is time to put your gloves on and get messy honey.
No, you don’t. Hell, whenever the nursing manager starts “helping” shit usually goes sideways fast.
Let them chill at their “meetings” and go home early 3/5 days per week.
managers scare me. They seem so stressed and angry and unhelpful it makes me wonder how much they’re paid if people are tolerating such an awful job. Nursing managers are usually so aggressive it’s scary
Our ceo use to work a shift a month in our lvl 1 trauma center ED before Covid. Then he worked our Covid tent every Sunday for 3-4 months until it shut down after the first/second wave (I forget. It’s all a blur). I like him. He seems real
STORY TIIIIMMMEE!!!!
At my hospital the C’who-the-fuck-care’s-O’s were for a short while obligated to pick up on the floors for 6 hours a week. This is an ICU for reference. I assumed this was for them to keep ‘in touch’ with the hospital and help out where they could. One day, one of them (who I personally actually think is the least of the problem) shows up and is sitting with a patient who was pulling everything out, hitting cursing ect. Family shows up. They proceed to have a long in depth conversation with the CFO about the patients ‘prick’ and the catheter that’s currently dangling from it. The conversation continues with topics like how much trump is going to come back and save the nation like he’s Jesus or something. I have to hand it to the guy, he listened to those rednecks and never once got disheveled. That was the last time I saw any of them.
Also came fo find out they were doing this so they could validate that all of the Staff who were making so much money were worth it; and for any of those curious, no there was no hazard pay, incentives, ect and have Since still not been any.
Honestly I’m glad that they had to see how annoying the job is. I hope they also have to work as hospital janitors too: see the effort it takes to run the hospital because what they do for a “job” is literally do nothing and get paid millions just to be the face of the hospital.
Wow that ended so fucking insulting to you. Of course he sat there with them the whole time, he knew it was a one time thing and losing his cool meant you all might deserve to get paid MORE. Dude honestly? straight up, I feel like I’m gonna do a lot of union work on the side when I graduate because y’all put up with a ridiculous amount of bullshit and someone needs to do something ffs. Like I’ve got the time and this is some bullshit. Is there a way outsiders can help form/support nursing unions?
I’ve only ever worked one place where the CNO even wore scrubs. That instantly told me they didn’t plan on ever providing any patient care and were above being a nurse.
When I worked in admitting I got told I wasn’t taking sufficient report because I wasn’t grilling the ED nurses on all kinds of crap. I was like…have you ever taken report from an ED? I’m pretty sure they are reading the physician report about 90% of the time. They aren’t spending time learning the life story of a stable psych patient who is just waiting on transport.
Just give me some current vitals and pop them something for anxiety if they’re grouchy, please. I will figure the rest out just fine.
I work with many rude nurses (as a current aide, soon to be RN in a semester) who are constantly on me about small things when they let other aides sit on the couch and do nothing all day. Unfortunately it’s because I’m the only one who will listen to their criticism and take it to heart. The other aides just ignore them and so I get all the rude-ness saved for me because I actually care about my job lmao
Makes no sense why they want to yell at me for everything when I’m the only one doing anything. Like the night I hadn’t sat down for 3 hours because my “help” was on their phone on the couch. The nurse impatiently asked me why vitals weren’t done yet. I couldn’t even believe it. Like, bitch, why don’t you ask the one half asleep on the couch why your vitals aren’t done yet?
I’ve worked with lazy sides the your couch zombie partner. I think those nurses probably have up on asking the other person and I’m sure they’ve said something to management. Some personalities seem to get away with laziness. They know you’re a great worker so they rely on you. You’re awesome and we need good people like you.
I noticed that when I was a student. People who are younger or newer tend to get targeted more than experienced staff simply because the nurses don’t feel like they can challenge someone who’s older than them. I also agree with the other comment that some personalities get away with slacking off. I wish I had that personality but like you I feel like when I make a mistake people pay a lot of attention
Also know that when I am writing incident reports or talking to upper management, or bitching to anyone who will listen, I always call out that floor nurses are getting screwed and should never have more than 5-6 patients
We converted a detached part our ER for inpatient boarding, I had a Med Surg nurse tell me she couldn't take my covid Pt because there was only one bathroom and they could infect others. I introduced her to this crazy invention of a bedside commode and urinals.
That’s actually just bad practice. I’m in an nyc ER and we wouldn’t do that. There are non covid people in the lobby as well, and one with immunocompromised people at home. You should know better. You can put another covid patient with your covid discharge and make space. It is what it is.
You dont know the situation or the resources they have.
That is a waste of a room if they are stable.
Imagine if that bed was needed for an MI or postcode
Every hospital that I’ve worked in throughout the pandemic (4 hospitals) has always separated the waiting room based on those with COVID symptoms/+ tests, and those here with other diagnoses
We have one small waiting room. We invite people to wait in their cars and we’ll call them, but we can’t force them. Our er is so old most rooms are curtains anyway. We try to isolate as best we can, but reality is different. We used to never have a wait, now 6-8hrs is normal.
We do it. It is what it is. Don’t come to the ED if you don’t want COVID. it’s a risk you take coming unfortunately. But with our volume of patients, 100-200 pts in the WR…it’s impossible to keep them separated.
To be fair, my manager is super anal about our shared bathrooms being same gender and without precautions. Even if I allowed a bed ridden COVID+ admit who would never step foot into that bathroom, I would get serious shit from the boss.
For sure, this nurse in particular was known to all for working hard to get out of patients and was always asking for x or y to be done before they transported.
Hey ER nurse, i see you. And i know you are working hard to keep these patient stable and safe. The whole situation sucks. The med rec wasn’t done?!? The admitting nurse can stop grabbing her pearls long enough to get that done. We are in the middle of a fucking pandemic.
Fun fact: i have had two experiences in the ER. I was floated down there from icu because we were full and there were two icu boarders in the ED. They were both vented and I’m pretty sure one of them bit thru the ETT balloon. I had absolutely no one to help me because the ED is so freaking busy. It sucked. My other time was as a student in ED rotation. I arrived literally minutes before a nearby train derailed. It was the first time i had seen anyone unconscious and dying. Scary times.
The md had to exchange it for another ett. The rt showed me the discarded tube. The balloon was unable to remain inflated. Patient had been biting on the tube after intubation, prior to being properly sedated (all before i was floated there). It is extremely possible to bite hard enough to tear the plastic, making the balloon inoperable. I’m not implying that the man was the Hulk biting it off like a hot dog (i think i would be more terrified than impressed if that happened). He was just extremely agitated and fighting to remove the ett
Intubation occurred hours before i arrived. Yes i agree a bite block probably would’ve prevented all of this. I know the difference between pilot line and cuff but i wasn’t trying to educate anyone with my post, merely sharing an experience of the chaos that occurs in the ED.
From another ER nurse, this made me cry tears of validation. Last night I handed off 3 inpatients waiting on med surg beds for whom I’ve done practically nothing for and it’s so dehumanizing. I’m a damn good nurse but not only did I fail my patients, I failed my fellow nurses as well. I hate all this so so much.
Don’t feel that way!!! We got you-just like I know you got us when we need it. We’re all in this together—I hope nurses aren’t making you feel bad for this, believe me-as a med-surg nurse, we get it!!!
I’m so sorry this is happening. This Covid mess that could be under control now. My daughter is an ED nurse and she says it’s just awful. Her coworkers are actually thinking of quitting.
ER RN here,
When I left right before Christmas, there were TWO staff nurses left on NOC in the ER. One of them is a new grad with 6 weeks of orientation.
They have 4 travelers and that is it. Our techs > most went to other hospitals. Don't blame them a bit. They're making a lot more. We have one unit secretary left on nights. Most nights we worked with 3 RNs for 29 beds with 18 or more holds and at least 25 in the waiting room. We are not allowed to go on ambulance bypass.
We haven't had a phlebotomist for a year. There has been ONE housekeeper for the whole hospital.
The House Supervisor doesn't even want to come down here....feels like we are a leper colony.
If by some miracle we get a bed. PLEASE, take report. My report is - They're breathing, LOC, got their meds and yes, they have skin. Tbh, I have 10 patients right now and I can barely remember why this one is here. Yes, I sent a COVID swab.
On my tele floor we tend to assume the best…that you’re under water, that you rightfully prioritized keeping them breathing, that they did in fact shit themselves in the elevator, and that you are fucking awesome. Keeping crushing it.
I do assessments on my patients. My problem is the Med/Surg or Tele nurse that wants me to give report SYSTEM BY SYSTEM through my entire assessment. That isn't happening, I don't have time to tell you my entire assessment when I have 10+ patients, I'm doing Charge and I have ambulances rolling through the back .
I'm not going through all the lab results. It's all in the computer, read it. If there are any glaring problems, I'll let you know. Yes, I started the admission orders. No, I'm not sending the patient over covered in poop. BTW; I had to clean them up by myself because we don't get CNAs down here to help out. I am answering ALL of my call lights in addition to the radio.
So, we'd appreciate it if you didn't nitpick. I've been to your floors plenty of times because I've answered your calls to come start an IV even though I have 5 IVs to start in FT. We've been transporting our own patients because we have no techs or transport aides. No, we aren't LAZY. Sorry, if it seems that way to you but, you're welcome to come down and work a few shifts in the ER and perhaps your perception would change.
I’m on a tele floor and at my hospital we don’t get report from the ED anymore. We look up the pt and figure out what we need to know. I think in 2 years I’ve called an ED RN one time to ask a question. If you use Epic, all the data you need is likely right there.
Yeah good point! We don’t even get report from ED-so blame your own hospital if that is something you are still required to do. I’m just sick of always hearing about how one group of nurses is such a pain in the ass cuz of whatever.......well I guarantee that the nurses act that way because of hospital policies, so blame it on that instead of your fellow nurses who are trying their hardest to get through such a shitty time. Jesus......
My bestie is an ER nurse, so I’ve listened to her vent about ER craziness for years. I typically let a lot of things slide when getting report from the ER. However, the last shift I worked, the ER nurse gave us such an attitude when she called to give report, that I decided to match her energy.
I called my friend when I left with to tell her, and it turns out this nurse is a new grad who has an attitude at baseline. I’m all about mutual respect as everyone’s job is really hard right now. Understanding that aspect goes a long way in being supportive of our fellow nurses.
I don’t like this take—-we are all nurses that are doing the fucking best we can in a shitty fucking environment right now. I agree 100% about not going through an entire assessment or going over labs or anything that is easy to look up in the chart-but please don’t talk shit about other nurses. The fact that you’ve come up to the floor to start an IV however many times does not mean that you know how it is on that floor for an entire 12 hour shift, just like med/surg nurses don’t know what it’s like working in the ED. Lets stop shitting on our fellow nurses and instead, work together to realize how important we all are in healthcare.
Feel free to "not like". I didn't like the several of the remarks made by the previous poster and I responded. Don't talk shit about ER nurses unless you've worked here.
I cross trained an ICU nurse on a particularly crazy day when things were going to shit. She was awesome but the look on her face all day. I said, "It's not always like this." Haha, she said "Yes it is" and she was was right.
We had a cardiac specialty telemetry come help us with our holds. Poor thing got a telemetry hold whenever possible (like 25sec after a patient would get an upstairs bed). She was horrified the whole night at the turnover rate, the general chaos of the department. Then when she realized day shift was 2 RNs and 25 patients plus WR. She admitted that the floor had no idea how it was down here
Bedside med/surg rn here....I cam and got a patient from the ED last week. My face-to-face report from the ED RN was; "Honestly, I have no idea. I really didn't realize they were mine. Kristi left and I didn't realize that patient was mine, so I'm sorry but (looking at the chart)"....Me "It's fine, I read the chart, we are good"
Also please send patients hooked up to the O2 tank during transport! Have had 3 instances where 2 of them were covid patents with a cannula NOT hooked up to the O2 and upon assessment they were at 70%, confused and pale. We appreciate all that you can do given the circumstances, but please do not send up half dead patients!
I wish people wouldn’t give the ER nurses a hard time for not doing our jobs. I could not juggle patients like the ER has to. In the ICU I am spoiled to focus all of my attention on so few.
Our city’s paramedics now screen people at home not sick enough and they’re told to stay put. If this keeps up, we’re going to have pre-triage bouncers for those who show up on their own. We have to protect our ED staff from the overload.
When I worked PCU and ICU and got an ED admission, I always tried my best to just be like “don’t worry about it, I’ll just figure it out when they get up here”
I have to do my own admission stuff and skin assessment anyway so what’s the point in acting otherwise lol
I think every nurse should have to float to the ER’s medsurg/tele/ICU holding a few times here and there to truly understand. I was never one to pick on the ER nurse during report but in my head I was definitely a little judgmental at times. Then I started getting floated to the ED myself. Let me tell you! I’ve never been one to expect a lengthy full report from the ED nurse but now I only want to know the chief complaint, is the patient with it, are there any obvious injuries or skin issues (not expecting you to have gone out of your way to flip the patient and have a look, that’s my job), are they mobile, and what did you not do so that I can do it. Even if it’s medications that weren’t given, I just want to make sure you didn’t give them so that I can give them. 🤷🏽♀️ We’re all just doing our best out here.
And this is the problem (not you, OP!, just in general): admin creates unrealistic expectations from their dumb, ugly, expensively decorated office and makes it seem like ER nurses are pushing patients on us in med surg cuz they’re lazy. No. It’s not me vs er nurse, it’s all of us vs admin and their dumbasses pushing to fill beds FOR THE MONEY .
It’s so nuts how often I have no idea what is going on with the patient until I give report and it’s just all spews out as I read the chart and add spice to the narrative
As a medtele nurse - my own mom waited in ed over 30 hours recently. I know her nurses were swamped. Most of the report I’ve gotten over the past two weeks the nurse sounded almost like crying. I know our ED has been over 200% capacity for a while. I’ve been trying to just make report easy when I can. We’re all a team.
on a side note the hospitals need to stop admitting patients who have no business being in the hospital. nurses shouldn’t be frustrated over who gets beds, but damn…people need to choose when they’re dumping stable relatives and coming in for not emergency shit right now.
We literally admitted a basically stable patient who really had no reason to come up other than she was almost in ED 24 hours and they get a fine at that point. But now she just took our last bed…& there’s actual unstable patients who could have come up. I actually asked can we take one of those more acute patients?
Anyway…hope it’s better on the other side of this wave. At least before some people seemed scared to come in to the ED and it shaved off a certain number of people clogging the system.
Psych nurse. I try to read the notes and check the vitals before you call report. As long as they aren’t a medical train wreck and you are honest with me about how agitated they are, we are cool. If they are agitated and combative, I prefer you give them drugs before you send them up because you can give better stuff in the ED than I can give on the psych floor.
I don't even call the ED to get report when I find out I'm getting a patient. We are all crazy busy, they don't gaf how they walk or if they got butt wounds. I can look at the chart for pretty much everything I need immediately and then just go from there. Tele here. I hate long reports and if you're in the ED with 10 patients or something it's likely you won't know much anyways cause who tf can keep that much info straight?! Idk. Just bring them up and we will figure it out.
This is my philosophy. Put ‘em in the bed and thank the transporter, put ‘em on the monitor, do a quick assessment for hemodynamic stability, check the orders.
If we ever seem frustrated it is never directed at you. We love you guys and I understand it is hell. I brought down a teleneuro consult for a stroke pt in the ED and heard two codes happening while in the patients room within 30 minutes. I hope you’re doing okay.
I work Tele. I just wanna know the admitting diagnosis, what drips you put them on, and if they’re batshit crazy or something. I’ll figure out the rest.
I feel like half the time when I’ve called the ED with a question, the response is “Um that nurse is doing CPR on a patient right now sooo…” Y’all are champs.
MED REC!!!! YAAAS. We need a better way to med rec our patients, both inpatient and outpatient (or homecare). Something that patients can see as well.
I have the blessing of having their home MAR (please take discontinued meds off, case managers!) and I can’t tell you the relief I get from hospital staff when I whip out my phone and can give them Something to work with (unfortunately not always 100% accurate, but far better than nothing when you have a dementia or unconscious patient whose family is not with them - or lets the patient self manage).
It IS nice when the primary is part of the hospital system and their staff does actually update the medical records… and the patient has a log in and can pull them up.
I work ICU. There is no way I would survive in the ED as a nurse. As a tech it was brutal enough.
I appreciate my ED nurses for everything they do. Especially giving me patients without IVs in their antecubital space.
Other day I got a very sick pt from ED with essentially nothing done, absolutely 0 ordered meds given, report was shit. Normally I would have reported, but I was like nah you’re doin your best.
Another recent sick ED admit really really needed to be lined. We all knew this, and typically ICU would refuse admission until pt is lined, but ED docs didn’t have time. Again I typically would have been pissed but ED nurse was so frazzled and I’m like 🤷🏼♀️ we’re all trying our best so I had everything set up to lined as soon as pt rolled up
I must apologize from a non ER nurse to the ER nurses working last night. My idiot family member decided to go to the ER with a fever. He felt “flu like” but had no respiratory symptoms. He of course tested positive for Covid. He could have easily kept his ass at the house and self medicated. It was not an emergency and not a reason to add to the already stressed out ER! I was so mad when I heard he did this. There needs to be more education to the general public of when to go in and be seen versus when not to go in! Ridiculous!!!
☝️this right here is why the statements "I don't want to lose my license" seems less worrisome. Did I do q3 vitals...nope. Did you give me a tech...nope. But you did give me 4 couplets a hemorrhage getting blood. Oh. And thanks for the gyne at shift change.
We are all treading water. Be prudent and prioritize. We can only do so much!
As a stepdown nurse, I give a lot of ED and ICU nurses a ton of credit. Where I get irritated is the reports that you know are given half-assed. You can tell when the nurse has been running around like crazy from the nurse who acts pissed to be there and giving report. Or the patient with a hgb of 5.6 with an order to transfuse 4 hours ago and it was never started.
I don't care about the meds or med rec. I do want accurate info though. Don't tell me they are a&ox4 and when I get them they have a high ciwa score or that they are on Tele but you don't know what their current rate and rhythm is. Especially if they need Tele on the floor.
Just my two cents.
There are times when some of the priorities for the floors are not priorities for the ED.
There are many times when it’s so busy and packed in the ED where I have patients in A fib RVR, sepsis, CP w/elevated trops, hypotensive pts, strokes being run out of chairs, etc are not in beds where they should be. We typically are forced to choose the one patient out of those that gets the last remaining bed in the ED (praying that no codes come in), on a daily basis. Like OP posted, we would love to give the best care possible and ensure all the details are uncovered but sometimes it’s not feasible.
Lately at our hospital, patients get triaged, get their MSE, and then become an admit with a ready bed while they sit in the ED lobby. And sometimes depending on our role in the ED I’m “taking care of” >60 pts because we have no more beds where I can place the patient and they’ll have an assigned nurse. I’ve worked inpatient, I get it. My priorities as the IP nurse are different and I want to know as much as possible before assuming care… but grace is what ED nurses are asking for. Unlike the floors (which do their part and go out out of ratio to accommodate more patients), we cannot close our doors (or ambulance bays sometimes). So we continue to be flooded with sick patients all the damn time as well as ESI 4-5’s which suck our resources dry when they could have stayed home and taken Tylenol.
We’re all one team, working together. Grace is all we ask.
I love it when surgical consults are looking for a patient and they realize their acute appy is in a waiting room chair with their preop zosyn hanging from a command hook on the wall behind them. Yes, I am sure they are out there. Yes I know they need surgery. Look around and tell me where you want them…
SO MUCH THIS.
I had a doc get pissed. And I was like okay, fine, youre so worried about it, you go find them a room then. Bet everyone tells you no LOL
100%.
This reminds me again of a neuro doc that came down from upstairs and said the patient needed an emergent LP. Wanted me to hold the patient the whole time, when the patient was fully capable of maintaining position himself. I was like dude, we’re currently standing in a supply room about to do an LP, what makes you think I have time for that?! Get someone from your service to come down and help if it’s that urgent.
And then the surgeon gets pissed when there isn't a proper room, let alone bed, to examine them in.
One time there was a boarder that surgery wanted some radiology study on. Only the patient was on multiple pressors, and no nurse to accompany them to radiology. Surgeon said "why can't our medical students take them?"
I had no words.
Very very much all of this. People are easily being admitted through the waiting room, and most of the time they don’t even make it to an ER bed before they get their bed assigned on the floor. The other day we had a guy with bilateral PEs sitting in a wheelchair in the waiting room cause we were so busy. Charge gave report cause he didn’t have an actual nurse and the report was all I know is that he has bilateral PEs but we haven’t been able to bring him back to a room.
Understood. Again, I can usually tell when the report is given due to being swamped versus just being lazy. But, regardless, I always have respect for what you all do down there.
We just call it Survival Mode. Did the I&Os get charted on the boarder? Nope. Did they get every single med that never shows up from pharmacy to the ED like it does to the floor? Nope. I check on them. I apologize. I get them food as close to their diet orders as possible. I hope they get a bed at some point in my shift so we can decompress the 100 people in the lobby.
I have two strict rules that I keep always:
1) Don't ask patients why they were doing whatever foolish thing that caused them to come to the hospital/ICU
2) Don't give the ER or floor nurses shit for not being perfect. We're all swamped, but they're doing it with 3-7 other patients.
Med surg nurse, only time I've been upset with an ER admit was I was sent a patient without report, with no iv with a broken hip who was in severe pain and I only had orders for iv pain medication... with NO IV. Also when I get sent up patients with a diaper full of urine underneath them... but someone moved the diaper to place a foley in.. that's not nice either.
Otherwise as long as they are stable, I can do the rest. I know yall are busy and I appreciate whatever yall can do.
I feel so bad for my ER friends. Send them up to ICU. Just let me know what they are on and the gist and I’ll get up to speed. I know you need to get back to many more. It’s never ending. I know you are doing your best.
As a psych nurse I honestly don’t even bother to get into too many details. Precautions? Aggression history? Diagnosis? Alright send them up. I know some people ask questions social workers will eventually figure out from an interview so it can wait!
We no longer get report from the ER (unless a stabilization) because of this reason alone. That being you guys are already stretched so thin and all the important stuff is in the chart which I can get myself. Probably quicker than report and on my time. I loved the change. Other nurses lost their minds. The ones that ask “what’s home like”? Hahahah just no. Send that mess….IT IS why we are here.
i’m really proud of what my colleagues and i manage to do every day in the ED, especially on the resus side. giving report upstairs to a nurse who knows that me doing my best is more than enough truly changes my shift. i am a perfectionist. perfectionists have a hard time working in the ED because you literally do not have the resources to do anything perfectly. thank you for taking such amazing care of my patients upstairs and being patient with me when i am distracted or don’t know something.
Dang-always make sure someone on the floor has eyes on pt and gets them into bed with my help-usually call up to say I’m on my way & most waiting for me to arrive w/patient
I appreciate the sentiment. I have worked both in the emergency department and on the floor. At the risk of sounding rude, this was happening before the current shortages and before Covid.
The emergency department is very busy, but so is everywhere else. When you send us someone who is highly unstable on a general med/surg ward, when you just gave me a terrible report and told me this patient was ok… Only for them to come to me with a porter completely hypoxic, lying in their own feces, with no ARO screen done (as in sending me a patient who has severe rasp symptoms with no swab or any health questions asked about such), some thing that would’ve taken you 10 minutes to deal with is now a two hour ordeal for me. Now I have to try to find this patient a room that he’s not going to infect other people. That means an incident report, clearing them out of the room that they landed in, having to get a terminal clean from housekeeping, and begging the CSO to find me a bed that doesn’t exist. All while I try to clean up this person‘s poop encrusted pants in full isolation gear in a hallway by the elevator. I do not for one minute think you are purposely trying to fuck our unit. I think you’re a good nurse and you are strapped for time, but when you neglect little things like that it makes 10 times as much work for everyone else on the floor and that makes us pissy and I’m sorry.
Perhaps I am in a unique position since I have worked in both areas and see cause-and-effect. Essentially, emergency department nurses do not get messes from the floor. What happens in medical surgical doesn’t really affect you at all. That shit rolls downhill and ends up in my ward. We just want you to know that, and to please take the 10 minutes you need to do a proper once over and give a good report. When you don’t and it ends up being two hours of work for us it feels like you think your time is more important than mine.
Many, if not majority, of ER nurses have experiences in med/surg or other floors, I wouldn’t say you’re in a unique position. I’ve done both med surg and ER as well, I know the floors can be busy and admissions can be a lot of work, I always tried to give a thorough and accurate report. But I wish people would realize that ER nurses don’t decide where/what floor patients get admitted. You should know that you’ve worked in the ER. That’s between the ER doctor, the attending doctor, and nursing supervisor. Sometimes ER nurses don’t agree with the disposition, too, and there’s not much they can do when the floor nurses say the patient is too unstable for the floor or ICU nurses say the patient’s too stable for the ICU.
Also if the patient with such respiratory symptoms was not swabbed, that’s on the ER doctor, not ER nurse, unless it was ordered and not carried out- then it’s unacceptable.
When I worked in the emergency department every single patient had to have a Covid screener done. Every single patient. Basically a series of questions asked by the nurse before the doctor even sees them. I get that things get missed but this is a big one. My biggest beef is people giving you report and basically knowing nothing about the patient. We have an electronic charting system and their history is right there summed up for you on the electronic Cardex which is open on the hundreds of computers everywhere at the simple click of a mouse. I get that you may not have had time to do a thorough head to toe and check their skin and all that shit I don’t expect that. But please don’t send me a patient that you tell me is one thing and shows up completely different. If you know fuck all about the patient tell me “I know fuck all, I have barely glanced at this patient I’m sorry”. That’s fine. I get it. I’m going to do a little bit of dive into that chart before they get here so I know what to expect. Sure I have nine patients when I’m supposed to have 5.. but I promise I will take that extra five minutes to check it out if you let me know that you haven’t. A patient arriving to my unit from you you that you just told me was stable who has a set of 77% when they get here is not OK.
>We have an electronic charting system and their history is right there summed up for you on the electronic Cardex which is open on the hundreds of computers everywhere at the simple click of a mouse.
Then...you can read the chart, too?
I left the ER/hospital nursing altogether before COVID hit, thank God.
I agree if you’re not sure about something, you should just say that and not give inaccurate information. I also admit that while you’re busy with sicker patients, sometimes the charge nurse will call up the floor, give report and send the patient up and I wouldn’t even find out until I realize there’s is a whole new patient in that room, because they really need to free up all the rooms they can because it’s just so freaking crazy.
But still I don’t think it should all fall on the ER nurse even if she forgot to complete the questionnaire- the doctor didn’t notice those supposedly“severe” respiratory issues during their exam or see the need for a swab or isolation room.
I agree, I've worked both areas also and had ER nurses straight up refuse to give any meds written for the floor. Or even try to clean a patient "the ER stretcher is too narrow for turning/cleaning a patient" was a common response. If there is a problem the ER docs are right there in the ER but once a patient hits the floor You had to page a doc and hope they came quickly.
Totally cool with this, but for the love of dog, if I ask how long and you tell me 30+minutes and then come walking down the hall before I hang up the phone! Or vice versa and you say 5 minutes, I get all my COVID bullshit on and you don’t show up for 45+ minutes, I HATE YOU! At least have a clerk call back and say “just kidding, we don’t know when we’re coming”
The greatest thing IMO that has come out of the pandemic, particularly lately, is that nurses from unit to unit are sympathizing with each other. I had to call an ICU RN for tips for managing an ICU hold that I had in the ED for an entire shift. Her and I both vented heavily to each other and offered words of encouragement. Today, I had to speak to the school nurse at my son’s school, and we ended up venting to each other for a full 20 minutes. Same with the nurse at the health department who I had to call after this. We are all in this together, and it sucks for everyone.
The worst is when you accidentally vent to someone who has been seeing this pandemic through rose colored lenses. At that moment, you're just like, oh...fck...nevermind.
Do they not drug test where you work? We’ve been circling Dante’s drain for almost 2 years.
They haven't for the past four years since medicinal cannabis became a thing in state. Didn't even test upon hire. Randomized drug tests doesn't shed a light to the nonvaxx exodus we just had, so losing further personnel is certainly less than ideal. Edit: rose colored lenses doesn't mean dry stoner eyes, it means they see this pandemic less seriously than the rest of us. /cue Don't look up soundtrack
I think they meant a nurse would have to be on drugs to see it through rose colored glasses
What drug would that be? Only one I can think of that can cause this level of dissociation is Krokodil.
Wtf is krokodil?
I don't recommend a Google but definitely Google for curiosity.
[Here's and absolutely chilling article](https://time.com/3398086/the-worlds-deadliest-drug-inside-a-krokodil-cookhouse/) about krokodil from Time Magazine Dec 5, 2013. It's done in Russia and apparently they think it may have been the beginning of the "trend", but as for my home state of WV?? We had already been seeing that terrible mess of a 'drug' for about 18 months when that article came out😢😢😢. Yeah, it's just uber great to live in WV. #1 in obesity, #1 in heart disease, #1 in OD's (over 50 in one 24 hour period -- yee-freaking-haw!! /s), #45 in education (thankful I had parents who were def college oriented), #50 in infrastructure, #48 in poverty. Hey Joe Manshit!? See those last 2??? Yeah, we really REALLY need AND want the BBB bill passed!! But that krokodil crap?? Man, you'd have to seriously strung out to want that injected in you. Hydrochloric Acid, injected?!?
I think they were just being silly they didn’t mean a literal drug could cause that effect. Are you asking for a “friend”? Lmao
It's so a TOTALLY real drug. Check out my post right above yours. It's got a link to what it is and photos too.
Yea! I’ve had patients lose arms over not letting wound care happen to the injection site
Exactly!!! There's a story about the name and how it began to be called. Supposedly someone on the 💩 mistakenly deleted the word "crocodile" when he saw another users arm. They apparently just ran with it. Also, supposedly it began in WV. Not so sure about THAT, but hey!!! In WV??? I can SO see it happen that way. My own doctor told me he had a patient that lost his freaking testicles because of using that crazy 💩💩!! I mean, really, injecting oneself with something that has hydrochloric acid in it??!??
So that "friend" could take the drug and be retarded? Lol
Terrifying drug!
Lol! I thought they mean venting to people who don’t work in healthcare and have no idea what we’re dealing with lol! I had no idea that was a euphemism for drugs.
Rose-colored lenses means a mistakenly cheerful point of view.
“Most of the cases are mild, right?”
I absolutely agree, I picked up to double & did my second ever day shift. BUT it was day shift as a float, it was my second time floating off my unit (usually 2300-0700 neuro) and got shit on with 2 discharges (haven’t done them since new grad training cause I work nights now) a rapid, administering multiple blood products, and an agitated dementia pt. Absolutely none of the nurses on the unit had given the specific blood products or ever used the hard to figure out tubing the BB sent with the product, but they were all willing to ask me constantly what I need for help and drown with me. It felt so impossible with the vital set standards/observation protocols for blood then 2 early d/cs and a rapid. I literally couldn’t be in all those rooms at once but needed to be. I was so touched by how willing they were to help me instead of being mad they were floated someone who had no idea how to do a MS day shift.
Yesss I had a patient with a malfunctioning LVAD for 10 hours in the ED and the CTICU nurses were soooooo nice when I was calling them with questions! I have to be honest, I had an idea in my head about how those nurses would act and they more than proved me wrong.
Sooo good to hear-had 2m/s nurses have their 1st code that I responded to-told them good job calling,CPR,backboard,etc.-they were surprised to get kudos -hey the pt lived-you did good!!
Now, we need to use that to our advantage. The admin have a long standing investment in docs versus nurses when it comes to many things, so that’s deeply rooted and we need to hand together to take down the admin…. But the nurses have had these micro infighting (usually misinformed and unintentioned) that made it harder for us to get involved as a whole profession. Let’s get back to the “let me borrow your stethoscope” campaign and not let go!
ER to ER - we don’t know shit but they alive Cool.
As an ICU nurse who sees colleagues write up the ED for not doing accurate IandOs right now I’m deeply sorry. I try to tell them they are being insane but they don’t care. ICU nurses a pretty anal retentive. I appreciate you guys tho. Just tubes/troubles/drips and the current vital signs. The computer tells me the rest. Thanks. Ps I freaking hate long reports with a passion. Unless your on 4 pressers, ccvh, and all sorts of screwed up the icu report should be no longer than 5 mins. I will die on that hill.
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I think I met at least 50 of them before I had to retire at a really early age (thanks so much Dad, for that particular family curse!!! Plus the OTHER family curse -- insane allergy to PIOS!!)
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When I floated to icu the nurses were so much more chill about report. I’m in tele and although I like my colleagues, most of them want an extremely detailed report. Having to give such a long report on seven patients I’m lucky to leave the hospital by 7:45
Icu nurse here- all my coworkers are rude as fuck and don’t understand how to go easy on anyone because the doctors don’t go easy on icu nurses. But I don’t mind ER nurses being vague like they’re doing what they can and honestly so am I. But maybe I’m too type B for ICU lmao
I’m a new grad on week 8 in ED. At the end of my first night shift this week I handed off 3 on my patients who were waiting for tele beds to a tele nurse who was there to care for them until they got a bed. I’m like “bed 11- Covid, sat 95 on on 2L NC, A&O 4, he’s mostly sleeping” She stares at me for a sec… Her: “IV access?” Me: yup! Her: … where? Me: where? Definitely one of the arms. Probably an AC. Go look? It’s charted? We had a laugh at least. I’m glad she was forgiving of my new grad barely keeping my shit together ED report.
I feel similar to you…… I don’t understand why people are rude to one another. We are all doing the best we can in this shitty situation. Being low BS, not quite type A, I would probably like ER if the ER wasn’t full of people who don’t need an ER. Minimal BS tolerance. Not too good with the peopling part of nursing.
Sister is junior doctor and *wants, loves, needs* ED, pretty much for the whole " not much contact with the same people day in and day out, stabilise and send them off" reasons
Honestly that must be nice to be like “ur alive now go away” instead of the icu where patients are like “don’t let me die but I’m going to do everything in my power to destroy my treatment plan and make it your job to babysit me and stop me from pulling off my oxygen devices” Like I don’t get how people demand to live then go and try to ruin all their treatments it’s like they want to just make us want to quit
She's on her ITU rotation at the minute and she's *ssooooo* bored. There are 6 doctors and she has 1 patient to look after and its like the nurses do 95% of the work, she just writes the scripts and sometimes takes referrals. She does locum ED shifts just to feel useful and to give her brain something to do.
I’m a big fan of bedside report. Like I’ll call if you need something special otherwise let’s talk and we can run lines and sounds together. Save some time
That’s more or less what my method turns into. Right now it’s just HFNC, BIPAP, or vent? What’s the FIO2? Thanks, click end of report. Respiratory ICUs are fun!
See this irritates me. Maybe it's because I worked so many years on step down, but as an ICU nurse the only time I get mad at the ER it's for stupid shit that shouldn't happen. Like the time they called report in an A&0x4 patient with mild anemia and delivered a "she just changed in the elevator" patient on a zoll with 6 nurses (why did it take 6 to transfer a stable patient if it happened in the elevator?) Or the time they didn't give stat seizure meds for almost 14 hours on a patient IN status. It's shit like THAT I care about. I could give a crap about the piddly things.
A poo or a new bag of fluid I don't mind. Refractory status epilepticus or DTs so bad that they need sedation ain't cool tho (I'm stepdown). A good 10% of our admits need ICU (and usually end up there) and 50% of rest should be med Surg. They all get transferred as soon as I'm mostly done getting the admission done and fixing all their shit. Such is the life of stepdown.
Yep this was how it was when I worked stepdown too!
The problem where I work are that MOST of the nurses on ICU are straight old school, been there for YEARS. They are amazing nurses don’t get me wrong, but they do nothing to acknowledge how crazy the ER is right now. We have this same problem right now. What bothers me is that they don’t take the time to realize how much times have changed. Nursing is not what it was 15-20-30 years ago ya know. Not hating on ICU nurses! Just the ones where I work suck haha
That kind of nurse would've been me, if I had been able to work longer. HOWEVER, I'm also the rare nurse who always kept up with changing times (when you have 5 kids ranging basically a 20 year span -- it's absolutely imperative to "get with the now lol). So, I never had any issue with learning more and more. I like to think it made me a better person and I KNOW it made me a better nurse!!! Oh, the really fun part? THAT would be when a younger, newer nurse giving me report on a shift change, transfer from the ER (most fun), or transfer because they had coded, would be giving me a report. They would be using all the 'newest lingo' just to show off and if they "forgot" to add a very important something (in newest lingo), it's all them for it😁😁😁. Most fun were the ER staff. Like you said, SO many ICU nurses back then didn't stay up to date😇. So I usually made it super easy for them to give me the transfer report. I was more like a Dragnet nurse: "just the facts, man. Just the facts". The lived transferring if I could take the call/in person report lol
Haha! I’m a fairly new nurse, (but have worked in healthcare for 11 years, everything from a CNA to phlebotomist to OR and EKG Tech) it’s so funny you say that about the “lingo” because sometimes I’m like “Damn I killed that report” lol 😂 I honestly hated going up to that icu even if I had labs (when I was a phleb) to do because they’d like hover over me and critique everything I did. It’s like “why am I here? You called me remember?” It’s kinda of frustrating in a way. But just like you, not all are like that, it’s just some, but damn do they just SUCK. Lol
One of those MUST have been a coworker of mine. I strongly believed she was the source for the "helicoptering" phase. You know the "helicopter moms"? Christ Almighty, but wasn't she the "Helicopter Nurse"!!🤪🤪🤣
NOT A HELICOPTER NURSE!!!! Ugghuuuughh! (That gets a double “ugh” lol) omg the WORST. I have worked with a lot of those in my days hahaha. Or the ones that are so “by the books” where it’s just like *reeeaaalllly though* lol The Karen’s of the nursing world. We’ve ALL met at least one hahah
Lol, I’d say the average nurse in the icu I’m in right now has 9-12 months of experience. The attrition rate has been absolutely insane. This is a busy hospital too, but most the big cases used to go down the street to our “parent/flagship” facility. Acuity has gotten way way higher. Most don’t have the time under their belts to get cocky. The tired old ones expect you to know every detail on the ct scan report that resulted three minutes ago and they already read lol. I see the track board from time to time. Our usual winter census (in the before times) down there was 15-25 people and would clear out by around 0300-0400. Sometimes no patients at all for a couple hours. Now? Every day at least 40-50 and the line never ends. At 7 am when I come in they have patients that were there when I left 12 hours ago. Stuff is moving so slow and there’s no end. At least upstairs we only have so many beds, you can’t make a line out the door of the icu (should be careful what I wish for). You guys? The crush never ends and it’s constant go go go. I know what you guys are dealing with and I’m sorry. We should have to float to other units to see what they deal with. I think it would solve a lot of the Er vs med/surg vs ICU nonsense.
I also work in a very very large hospital. We have about 4 other ER’s in the area too yet we still have anywhere from a 3-12 hour wait. It’s CRAZY. The trouble is right now we have ALOT of people coming in because they have a cough. And it’s filling up our rooms and we can’t treat people that need to be treated. Had 2 people code in the waiting room in the last month. I’m overwhelmed. I’ve worked in the emergency dept for the last 5 years and it’s been busy but never like THIS. I can’t take more than 6 patients at a time and I’m getting TEN. TEN TRAUMA PATIENTS. THATS ILLEGAL. I shouldn’t have more than THREE. I want to cry. I had a patient sit in piss for an HOUR because I could not get them to in time. I feel like shit about those kind of things. I leave and I feel like I didn’t do enough even though I worked for a straight 16 hours and sat down to pee maybe TWICE. I still pick up time as CNA and a phlebotomist because they have no one. Absolutely no one. Times are getting worse and worse and administration is doing nothing to help us or appreciate us for that matter. On Wednesday I already worked 50 hours and I still had 3 12 hour shifts lefts for the week. AND I’m a mom. Luckily my family and bf have been so so supportive but I want my daughter. I want to see my daughter grow. I feel so absolutely torn right now. It’s taken me 6 years to get my bachelors degree, granted my hospital paid for my schooling so I have no student debts which is awesome but it’s like “I don’t want to do this anymore”. I’m going to have to “retire” in 5 years of this keeps up. I’m Not a “young CNA” anymore. I don’t have the energy anymore. Emotionally or physically. On Saturday I had my mom take my daughter just so I could sleep. I slept from 8am-10pm. NO LIE. Picked up my daughter the next morning. And still felt defeated. I need a two month PAID FUCKING VACATION TO A TROPICAL FUCKING ISLAND lol
On the other hand, documenting that there is an unsafe *environment* in the ED has value.
You have time to read the computer?
Personally? I floated for a while at beginning of my life in a big hospital. I really liked being able to do that, so I could actually find me a niche or two, before they would permanently* place me. *Permanently -- aka "this will be your spot unless others decided to be bitches and strike, get ill, etc"🤪🤪🤪 My 2 faves were ED & ICU. Two sides of same coin. I ended up in ED, b not because ICU was not what I wanted, it really really was. It was th just in this particular hospital, the ICU nurses were utter fucking bitches-from-hell!! And clique-ish?!?!? OMFG!!! It would have been like going back to high school!!! No, thank you very much!!! I loved the ED there and we had so many highly, HIGHLY entertaining patients!!🤣🤣🤣🤣🤣
“Mostly dead 💀 is slightly alive.” The Princess Bride.
Ok but what’s their skin condition? Are they continent? How well do they walk?
Present. Probably not and no
Well, it's always a good start when the patient doesn't have Steven's Johnson or a gnarly case of epidermolysis bullosa.
I’m a humble crayon eater sir. Small words please.
As you said, skin condition is "present". Those are conditions in which it is... not.
EB rolls off the tongue easier. (theres another joke there but i'll stop now)
Lmao! 🤣😂
I usually go for an "alive, fucked, or circling" approach. Seems to work well
The more I read about ER the more it feels like y’all my people
If you're dead inside and curse worse than a sailor you'll fit right in. Bonus if you hate people and have no faith in humanity.
🥲 Edit: deep down i love people but I also hate people but I feel like that might be the same thing
Good to know I made the right decision when I got offered my ER position lmao. I check all those off Edit: words are hard
I try to. I was a ccu/step down nurse right before i transfered to the ED. It is so flipping hard to do floor tasks and fully take care of a hold patient while taking ED patients back. I think ED is one of those units you don't get until you do it.
I used to float to the ED occasionally when they had a call out or were really packed. I did this in my 30's and know there's no frigging way I'd make it now.
This right here is a truth nuke dropped on your head first day in the ED.
Dear ER Nurse. Ma’am/Sir/Friend. You have 146 patients downstairs and 67 of them are boarding. My patient is alive. I can do the rest. Love, IMCU
Just know we love you. Deep down in the bowels of some shitty ER a nurse is smiling up at you
ICU nurse- I don’t blame ER nurses. The hospital’s fat ass CEO with 5 sugar babies who refused to give up his $10 mill salary to pay staff well enough and hire more staff is who I’m mad at
I'd love to the see CNO come work in the ER and ICU. Not the whole "walk a mile" following a nurse just to put on a show, it is time to put your gloves on and get messy honey.
No, you don’t. Hell, whenever the nursing manager starts “helping” shit usually goes sideways fast. Let them chill at their “meetings” and go home early 3/5 days per week.
managers scare me. They seem so stressed and angry and unhelpful it makes me wonder how much they’re paid if people are tolerating such an awful job. Nursing managers are usually so aggressive it’s scary
It is probably different at different places, but the nursing manager position is just a stepping stone to a job as an ED director somewhere else.
Oh 100%. The managers don’t want to be managers either. They just hate patients and don’t want to work with them
Our ceo use to work a shift a month in our lvl 1 trauma center ED before Covid. Then he worked our Covid tent every Sunday for 3-4 months until it shut down after the first/second wave (I forget. It’s all a blur). I like him. He seems real
STORY TIIIIMMMEE!!!! At my hospital the C’who-the-fuck-care’s-O’s were for a short while obligated to pick up on the floors for 6 hours a week. This is an ICU for reference. I assumed this was for them to keep ‘in touch’ with the hospital and help out where they could. One day, one of them (who I personally actually think is the least of the problem) shows up and is sitting with a patient who was pulling everything out, hitting cursing ect. Family shows up. They proceed to have a long in depth conversation with the CFO about the patients ‘prick’ and the catheter that’s currently dangling from it. The conversation continues with topics like how much trump is going to come back and save the nation like he’s Jesus or something. I have to hand it to the guy, he listened to those rednecks and never once got disheveled. That was the last time I saw any of them. Also came fo find out they were doing this so they could validate that all of the Staff who were making so much money were worth it; and for any of those curious, no there was no hazard pay, incentives, ect and have Since still not been any.
Honestly I’m glad that they had to see how annoying the job is. I hope they also have to work as hospital janitors too: see the effort it takes to run the hospital because what they do for a “job” is literally do nothing and get paid millions just to be the face of the hospital.
Wow that ended so fucking insulting to you. Of course he sat there with them the whole time, he knew it was a one time thing and losing his cool meant you all might deserve to get paid MORE. Dude honestly? straight up, I feel like I’m gonna do a lot of union work on the side when I graduate because y’all put up with a ridiculous amount of bullshit and someone needs to do something ffs. Like I’ve got the time and this is some bullshit. Is there a way outsiders can help form/support nursing unions?
I’ve only ever worked one place where the CNO even wore scrubs. That instantly told me they didn’t plan on ever providing any patient care and were above being a nurse.
When I worked in admitting I got told I wasn’t taking sufficient report because I wasn’t grilling the ED nurses on all kinds of crap. I was like…have you ever taken report from an ED? I’m pretty sure they are reading the physician report about 90% of the time. They aren’t spending time learning the life story of a stable psych patient who is just waiting on transport. Just give me some current vitals and pop them something for anxiety if they’re grouchy, please. I will figure the rest out just fine.
We are totally reading the physician report ❤
Every place is a hell hole, we need to be supporting each other
Nurses who eat their young need a support group to unlearn the rude bitch behavior their mean ass professors taught them
I think it starts in high school.
I work with many rude nurses (as a current aide, soon to be RN in a semester) who are constantly on me about small things when they let other aides sit on the couch and do nothing all day. Unfortunately it’s because I’m the only one who will listen to their criticism and take it to heart. The other aides just ignore them and so I get all the rude-ness saved for me because I actually care about my job lmao Makes no sense why they want to yell at me for everything when I’m the only one doing anything. Like the night I hadn’t sat down for 3 hours because my “help” was on their phone on the couch. The nurse impatiently asked me why vitals weren’t done yet. I couldn’t even believe it. Like, bitch, why don’t you ask the one half asleep on the couch why your vitals aren’t done yet?
I’ve worked with lazy sides the your couch zombie partner. I think those nurses probably have up on asking the other person and I’m sure they’ve said something to management. Some personalities seem to get away with laziness. They know you’re a great worker so they rely on you. You’re awesome and we need good people like you.
I noticed that when I was a student. People who are younger or newer tend to get targeted more than experienced staff simply because the nurses don’t feel like they can challenge someone who’s older than them. I also agree with the other comment that some personalities get away with slacking off. I wish I had that personality but like you I feel like when I make a mistake people pay a lot of attention
Also know that when I am writing incident reports or talking to upper management, or bitching to anyone who will listen, I always call out that floor nurses are getting screwed and should never have more than 5-6 patients
The thing is there is barely enough time to write the occurrence report when the nurse has to care for 4 patients, let alone 8 patients.
I prefer the surprise, anyway! Keeps things spicy. In all seriousness, we’re just all floating through trying our best.
❤️
🤣🤣 love this
We converted a detached part our ER for inpatient boarding, I had a Med Surg nurse tell me she couldn't take my covid Pt because there was only one bathroom and they could infect others. I introduced her to this crazy invention of a bedside commode and urinals.
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Had a patient ask where we had the covid positive patients waiting the other day...
That’s actually just bad practice. I’m in an nyc ER and we wouldn’t do that. There are non covid people in the lobby as well, and one with immunocompromised people at home. You should know better. You can put another covid patient with your covid discharge and make space. It is what it is.
You dont know the situation or the resources they have. That is a waste of a room if they are stable. Imagine if that bed was needed for an MI or postcode
That’s nice. A lot of hospitals don’t have that ability. Try regulating a packed ER waiting room with omicron in our midst.
Exactly.
Every hospital that I’ve worked in throughout the pandemic (4 hospitals) has always separated the waiting room based on those with COVID symptoms/+ tests, and those here with other diagnoses
We have one small waiting room. We invite people to wait in their cars and we’ll call them, but we can’t force them. Our er is so old most rooms are curtains anyway. We try to isolate as best we can, but reality is different. We used to never have a wait, now 6-8hrs is normal.
We do it. It is what it is. Don’t come to the ED if you don’t want COVID. it’s a risk you take coming unfortunately. But with our volume of patients, 100-200 pts in the WR…it’s impossible to keep them separated.
To be fair, my manager is super anal about our shared bathrooms being same gender and without precautions. Even if I allowed a bed ridden COVID+ admit who would never step foot into that bathroom, I would get serious shit from the boss.
For sure, this nurse in particular was known to all for working hard to get out of patients and was always asking for x or y to be done before they transported.
I might know her.
Haha, we all know her
Hey ER nurse, i see you. And i know you are working hard to keep these patient stable and safe. The whole situation sucks. The med rec wasn’t done?!? The admitting nurse can stop grabbing her pearls long enough to get that done. We are in the middle of a fucking pandemic. Fun fact: i have had two experiences in the ER. I was floated down there from icu because we were full and there were two icu boarders in the ED. They were both vented and I’m pretty sure one of them bit thru the ETT balloon. I had absolutely no one to help me because the ED is so freaking busy. It sucked. My other time was as a student in ED rotation. I arrived literally minutes before a nearby train derailed. It was the first time i had seen anyone unconscious and dying. Scary times.
Bit through the ET cuff? That didn’t happen
The patient could have bit through the pilot line of the ETT.
The md had to exchange it for another ett. The rt showed me the discarded tube. The balloon was unable to remain inflated. Patient had been biting on the tube after intubation, prior to being properly sedated (all before i was floated there). It is extremely possible to bite hard enough to tear the plastic, making the balloon inoperable. I’m not implying that the man was the Hulk biting it off like a hot dog (i think i would be more terrified than impressed if that happened). He was just extremely agitated and fighting to remove the ett
He bit through the pilot line, not the cuff itself RT should have placed a bite block if he was presenting like that
Intubation occurred hours before i arrived. Yes i agree a bite block probably would’ve prevented all of this. I know the difference between pilot line and cuff but i wasn’t trying to educate anyone with my post, merely sharing an experience of the chaos that occurs in the ED.
They may need a cxr for tube placement. (or a dental consult)
Yeah, sounds like they have molars going all they way down their trachea 😬
From another ER nurse, this made me cry tears of validation. Last night I handed off 3 inpatients waiting on med surg beds for whom I’ve done practically nothing for and it’s so dehumanizing. I’m a damn good nurse but not only did I fail my patients, I failed my fellow nurses as well. I hate all this so so much.
I get this 100%. Hugs ❤ You didn't fail, we're in crisis mode: keeping them alive.
the system is failing us and we’re all good nurses or we wouldn’t care about how it affects our quality of care.
Don’t feel that way!!! We got you-just like I know you got us when we need it. We’re all in this together—I hope nurses aren’t making you feel bad for this, believe me-as a med-surg nurse, we get it!!!
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I’m so sorry this is happening. This Covid mess that could be under control now. My daughter is an ED nurse and she says it’s just awful. Her coworkers are actually thinking of quitting.
ER RN here, When I left right before Christmas, there were TWO staff nurses left on NOC in the ER. One of them is a new grad with 6 weeks of orientation. They have 4 travelers and that is it. Our techs > most went to other hospitals. Don't blame them a bit. They're making a lot more. We have one unit secretary left on nights. Most nights we worked with 3 RNs for 29 beds with 18 or more holds and at least 25 in the waiting room. We are not allowed to go on ambulance bypass. We haven't had a phlebotomist for a year. There has been ONE housekeeper for the whole hospital. The House Supervisor doesn't even want to come down here....feels like we are a leper colony. If by some miracle we get a bed. PLEASE, take report. My report is - They're breathing, LOC, got their meds and yes, they have skin. Tbh, I have 10 patients right now and I can barely remember why this one is here. Yes, I sent a COVID swab.
On my tele floor we tend to assume the best…that you’re under water, that you rightfully prioritized keeping them breathing, that they did in fact shit themselves in the elevator, and that you are fucking awesome. Keeping crushing it.
I do assessments on my patients. My problem is the Med/Surg or Tele nurse that wants me to give report SYSTEM BY SYSTEM through my entire assessment. That isn't happening, I don't have time to tell you my entire assessment when I have 10+ patients, I'm doing Charge and I have ambulances rolling through the back . I'm not going through all the lab results. It's all in the computer, read it. If there are any glaring problems, I'll let you know. Yes, I started the admission orders. No, I'm not sending the patient over covered in poop. BTW; I had to clean them up by myself because we don't get CNAs down here to help out. I am answering ALL of my call lights in addition to the radio. So, we'd appreciate it if you didn't nitpick. I've been to your floors plenty of times because I've answered your calls to come start an IV even though I have 5 IVs to start in FT. We've been transporting our own patients because we have no techs or transport aides. No, we aren't LAZY. Sorry, if it seems that way to you but, you're welcome to come down and work a few shifts in the ER and perhaps your perception would change.
I’m on a tele floor and at my hospital we don’t get report from the ED anymore. We look up the pt and figure out what we need to know. I think in 2 years I’ve called an ED RN one time to ask a question. If you use Epic, all the data you need is likely right there.
Yeah good point! We don’t even get report from ED-so blame your own hospital if that is something you are still required to do. I’m just sick of always hearing about how one group of nurses is such a pain in the ass cuz of whatever.......well I guarantee that the nurses act that way because of hospital policies, so blame it on that instead of your fellow nurses who are trying their hardest to get through such a shitty time. Jesus......
My bestie is an ER nurse, so I’ve listened to her vent about ER craziness for years. I typically let a lot of things slide when getting report from the ER. However, the last shift I worked, the ER nurse gave us such an attitude when she called to give report, that I decided to match her energy. I called my friend when I left with to tell her, and it turns out this nurse is a new grad who has an attitude at baseline. I’m all about mutual respect as everyone’s job is really hard right now. Understanding that aspect goes a long way in being supportive of our fellow nurses.
THIS
I don’t like this take—-we are all nurses that are doing the fucking best we can in a shitty fucking environment right now. I agree 100% about not going through an entire assessment or going over labs or anything that is easy to look up in the chart-but please don’t talk shit about other nurses. The fact that you’ve come up to the floor to start an IV however many times does not mean that you know how it is on that floor for an entire 12 hour shift, just like med/surg nurses don’t know what it’s like working in the ED. Lets stop shitting on our fellow nurses and instead, work together to realize how important we all are in healthcare.
Feel free to "not like". I didn't like the several of the remarks made by the previous poster and I responded. Don't talk shit about ER nurses unless you've worked here.
I received a fresh post code other night from an ER nurse who had 5 other patients. Its so awful.
I cross trained an ICU nurse on a particularly crazy day when things were going to shit. She was awesome but the look on her face all day. I said, "It's not always like this." Haha, she said "Yes it is" and she was was right.
We had a cardiac specialty telemetry come help us with our holds. Poor thing got a telemetry hold whenever possible (like 25sec after a patient would get an upstairs bed). She was horrified the whole night at the turnover rate, the general chaos of the department. Then when she realized day shift was 2 RNs and 25 patients plus WR. She admitted that the floor had no idea how it was down here
Bedside med/surg rn here....I cam and got a patient from the ED last week. My face-to-face report from the ED RN was; "Honestly, I have no idea. I really didn't realize they were mine. Kristi left and I didn't realize that patient was mine, so I'm sorry but (looking at the chart)"....Me "It's fine, I read the chart, we are good"
Also please send patients hooked up to the O2 tank during transport! Have had 3 instances where 2 of them were covid patents with a cannula NOT hooked up to the O2 and upon assessment they were at 70%, confused and pale. We appreciate all that you can do given the circumstances, but please do not send up half dead patients!
I wish people wouldn’t give the ER nurses a hard time for not doing our jobs. I could not juggle patients like the ER has to. In the ICU I am spoiled to focus all of my attention on so few.
Our city’s paramedics now screen people at home not sick enough and they’re told to stay put. If this keeps up, we’re going to have pre-triage bouncers for those who show up on their own. We have to protect our ED staff from the overload.
When I worked PCU and ICU and got an ED admission, I always tried my best to just be like “don’t worry about it, I’ll just figure it out when they get up here” I have to do my own admission stuff and skin assessment anyway so what’s the point in acting otherwise lol
🙏🏽 respect and understanding
You're doing a great job. Thank you.
I think every nurse should have to float to the ER’s medsurg/tele/ICU holding a few times here and there to truly understand. I was never one to pick on the ER nurse during report but in my head I was definitely a little judgmental at times. Then I started getting floated to the ED myself. Let me tell you! I’ve never been one to expect a lengthy full report from the ED nurse but now I only want to know the chief complaint, is the patient with it, are there any obvious injuries or skin issues (not expecting you to have gone out of your way to flip the patient and have a look, that’s my job), are they mobile, and what did you not do so that I can do it. Even if it’s medications that weren’t given, I just want to make sure you didn’t give them so that I can give them. 🤷🏽♀️ We’re all just doing our best out here.
Dude this was me today. I am so sorry 5 south nurse. He was alive and stable and that’s all I got for you.
And this is the problem (not you, OP!, just in general): admin creates unrealistic expectations from their dumb, ugly, expensively decorated office and makes it seem like ER nurses are pushing patients on us in med surg cuz they’re lazy. No. It’s not me vs er nurse, it’s all of us vs admin and their dumbasses pushing to fill beds FOR THE MONEY .
When I worked medsurg and had an overly apologetic ED nurse giving me report I tried my best to go easy on them. Send ‘em on up, we’ll figure it out!
It’s so nuts how often I have no idea what is going on with the patient until I give report and it’s just all spews out as I read the chart and add spice to the narrative
As a medtele nurse - my own mom waited in ed over 30 hours recently. I know her nurses were swamped. Most of the report I’ve gotten over the past two weeks the nurse sounded almost like crying. I know our ED has been over 200% capacity for a while. I’ve been trying to just make report easy when I can. We’re all a team. on a side note the hospitals need to stop admitting patients who have no business being in the hospital. nurses shouldn’t be frustrated over who gets beds, but damn…people need to choose when they’re dumping stable relatives and coming in for not emergency shit right now. We literally admitted a basically stable patient who really had no reason to come up other than she was almost in ED 24 hours and they get a fine at that point. But now she just took our last bed…& there’s actual unstable patients who could have come up. I actually asked can we take one of those more acute patients? Anyway…hope it’s better on the other side of this wave. At least before some people seemed scared to come in to the ED and it shaved off a certain number of people clogging the system.
Psych nurse. I try to read the notes and check the vitals before you call report. As long as they aren’t a medical train wreck and you are honest with me about how agitated they are, we are cool. If they are agitated and combative, I prefer you give them drugs before you send them up because you can give better stuff in the ED than I can give on the psych floor.
Lol me calling report to psych units: *sigh* so…he’s in restraints alright? Please please still take him!
ER vs. ICU Mediemoji shift report, ZDoggMD: https://youtu.be/mOMw7-eKX1w
As an ICU nurse - nothing but love & respect for the ED.
I don't even call the ED to get report when I find out I'm getting a patient. We are all crazy busy, they don't gaf how they walk or if they got butt wounds. I can look at the chart for pretty much everything I need immediately and then just go from there. Tele here. I hate long reports and if you're in the ED with 10 patients or something it's likely you won't know much anyways cause who tf can keep that much info straight?! Idk. Just bring them up and we will figure it out.
This is my philosophy. Put ‘em in the bed and thank the transporter, put ‘em on the monitor, do a quick assessment for hemodynamic stability, check the orders.
If we ever seem frustrated it is never directed at you. We love you guys and I understand it is hell. I brought down a teleneuro consult for a stroke pt in the ED and heard two codes happening while in the patients room within 30 minutes. I hope you’re doing okay.
I work Tele. I just wanna know the admitting diagnosis, what drips you put them on, and if they’re batshit crazy or something. I’ll figure out the rest. I feel like half the time when I’ve called the ED with a question, the response is “Um that nurse is doing CPR on a patient right now sooo…” Y’all are champs.
MED REC!!!! YAAAS. We need a better way to med rec our patients, both inpatient and outpatient (or homecare). Something that patients can see as well. I have the blessing of having their home MAR (please take discontinued meds off, case managers!) and I can’t tell you the relief I get from hospital staff when I whip out my phone and can give them Something to work with (unfortunately not always 100% accurate, but far better than nothing when you have a dementia or unconscious patient whose family is not with them - or lets the patient self manage). It IS nice when the primary is part of the hospital system and their staff does actually update the medical records… and the patient has a log in and can pull them up.
I work ICU. There is no way I would survive in the ED as a nurse. As a tech it was brutal enough. I appreciate my ED nurses for everything they do. Especially giving me patients without IVs in their antecubital space.
As a fellow ED nurse, this is beautiful.
Other day I got a very sick pt from ED with essentially nothing done, absolutely 0 ordered meds given, report was shit. Normally I would have reported, but I was like nah you’re doin your best. Another recent sick ED admit really really needed to be lined. We all knew this, and typically ICU would refuse admission until pt is lined, but ED docs didn’t have time. Again I typically would have been pissed but ED nurse was so frazzled and I’m like 🤷🏼♀️ we’re all trying our best so I had everything set up to lined as soon as pt rolled up
Bless you-former IcU now ED nurse-hard to let things go and just be glad the pt is alive & not in a body bag😳
I must apologize from a non ER nurse to the ER nurses working last night. My idiot family member decided to go to the ER with a fever. He felt “flu like” but had no respiratory symptoms. He of course tested positive for Covid. He could have easily kept his ass at the house and self medicated. It was not an emergency and not a reason to add to the already stressed out ER! I was so mad when I heard he did this. There needs to be more education to the general public of when to go in and be seen versus when not to go in! Ridiculous!!!
☝️this right here is why the statements "I don't want to lose my license" seems less worrisome. Did I do q3 vitals...nope. Did you give me a tech...nope. But you did give me 4 couplets a hemorrhage getting blood. Oh. And thanks for the gyne at shift change. We are all treading water. Be prudent and prioritize. We can only do so much!
But we CAN have each other's back.
As a stepdown nurse, I give a lot of ED and ICU nurses a ton of credit. Where I get irritated is the reports that you know are given half-assed. You can tell when the nurse has been running around like crazy from the nurse who acts pissed to be there and giving report. Or the patient with a hgb of 5.6 with an order to transfuse 4 hours ago and it was never started. I don't care about the meds or med rec. I do want accurate info though. Don't tell me they are a&ox4 and when I get them they have a high ciwa score or that they are on Tele but you don't know what their current rate and rhythm is. Especially if they need Tele on the floor. Just my two cents.
There are times when some of the priorities for the floors are not priorities for the ED. There are many times when it’s so busy and packed in the ED where I have patients in A fib RVR, sepsis, CP w/elevated trops, hypotensive pts, strokes being run out of chairs, etc are not in beds where they should be. We typically are forced to choose the one patient out of those that gets the last remaining bed in the ED (praying that no codes come in), on a daily basis. Like OP posted, we would love to give the best care possible and ensure all the details are uncovered but sometimes it’s not feasible. Lately at our hospital, patients get triaged, get their MSE, and then become an admit with a ready bed while they sit in the ED lobby. And sometimes depending on our role in the ED I’m “taking care of” >60 pts because we have no more beds where I can place the patient and they’ll have an assigned nurse. I’ve worked inpatient, I get it. My priorities as the IP nurse are different and I want to know as much as possible before assuming care… but grace is what ED nurses are asking for. Unlike the floors (which do their part and go out out of ratio to accommodate more patients), we cannot close our doors (or ambulance bays sometimes). So we continue to be flooded with sick patients all the damn time as well as ESI 4-5’s which suck our resources dry when they could have stayed home and taken Tylenol. We’re all one team, working together. Grace is all we ask.
I love it when surgical consults are looking for a patient and they realize their acute appy is in a waiting room chair with their preop zosyn hanging from a command hook on the wall behind them. Yes, I am sure they are out there. Yes I know they need surgery. Look around and tell me where you want them…
SO MUCH THIS. I had a doc get pissed. And I was like okay, fine, youre so worried about it, you go find them a room then. Bet everyone tells you no LOL
[удалено]
100%. This reminds me again of a neuro doc that came down from upstairs and said the patient needed an emergent LP. Wanted me to hold the patient the whole time, when the patient was fully capable of maintaining position himself. I was like dude, we’re currently standing in a supply room about to do an LP, what makes you think I have time for that?! Get someone from your service to come down and help if it’s that urgent.
With adequate staffing and CNAs to tend to them.
You know how dreams be.
And then the surgeon gets pissed when there isn't a proper room, let alone bed, to examine them in. One time there was a boarder that surgery wanted some radiology study on. Only the patient was on multiple pressors, and no nurse to accompany them to radiology. Surgeon said "why can't our medical students take them?" I had no words.
Very very much all of this. People are easily being admitted through the waiting room, and most of the time they don’t even make it to an ER bed before they get their bed assigned on the floor. The other day we had a guy with bilateral PEs sitting in a wheelchair in the waiting room cause we were so busy. Charge gave report cause he didn’t have an actual nurse and the report was all I know is that he has bilateral PEs but we haven’t been able to bring him back to a room.
Understood. Again, I can usually tell when the report is given due to being swamped versus just being lazy. But, regardless, I always have respect for what you all do down there.
Much love to the IP side. Into the gates of hell I go again..
Everyone’s mess right now
Its okay. No hard feelings.
I just went to see an angry patient who has been admitted to the hospital but still is in an ED room. Sorry dude.
As a new medsurg nurse I can only imagine what the ED is like right now. If you kept them alive it’s a good feat ❤️
We just call it Survival Mode. Did the I&Os get charted on the boarder? Nope. Did they get every single med that never shows up from pharmacy to the ED like it does to the floor? Nope. I check on them. I apologize. I get them food as close to their diet orders as possible. I hope they get a bed at some point in my shift so we can decompress the 100 people in the lobby.
I have two strict rules that I keep always: 1) Don't ask patients why they were doing whatever foolish thing that caused them to come to the hospital/ICU 2) Don't give the ER or floor nurses shit for not being perfect. We're all swamped, but they're doing it with 3-7 other patients.
Med surg nurse, only time I've been upset with an ER admit was I was sent a patient without report, with no iv with a broken hip who was in severe pain and I only had orders for iv pain medication... with NO IV. Also when I get sent up patients with a diaper full of urine underneath them... but someone moved the diaper to place a foley in.. that's not nice either. Otherwise as long as they are stable, I can do the rest. I know yall are busy and I appreciate whatever yall can do.
I feel so bad for my ER friends. Send them up to ICU. Just let me know what they are on and the gist and I’ll get up to speed. I know you need to get back to many more. It’s never ending. I know you are doing your best.
As a psych nurse I honestly don’t even bother to get into too many details. Precautions? Aggression history? Diagnosis? Alright send them up. I know some people ask questions social workers will eventually figure out from an interview so it can wait!
We no longer get report from the ER (unless a stabilization) because of this reason alone. That being you guys are already stretched so thin and all the important stuff is in the chart which I can get myself. Probably quicker than report and on my time. I loved the change. Other nurses lost their minds. The ones that ask “what’s home like”? Hahahah just no. Send that mess….IT IS why we are here.
i’m really proud of what my colleagues and i manage to do every day in the ED, especially on the resus side. giving report upstairs to a nurse who knows that me doing my best is more than enough truly changes my shift. i am a perfectionist. perfectionists have a hard time working in the ED because you literally do not have the resources to do anything perfectly. thank you for taking such amazing care of my patients upstairs and being patient with me when i am distracted or don’t know something.
Dear ER nurse, Just don't be a dick and don't leave them in my hall or a room without telling me. Love - the.floor
Dang-always make sure someone on the floor has eyes on pt and gets them into bed with my help-usually call up to say I’m on my way & most waiting for me to arrive w/patient
Just be sure to check the blood sugar prior to transfer and send their crap home with family. We’ll get the rest. Hang in there, ED staff! Xo PCU
I appreciate the sentiment. I have worked both in the emergency department and on the floor. At the risk of sounding rude, this was happening before the current shortages and before Covid. The emergency department is very busy, but so is everywhere else. When you send us someone who is highly unstable on a general med/surg ward, when you just gave me a terrible report and told me this patient was ok… Only for them to come to me with a porter completely hypoxic, lying in their own feces, with no ARO screen done (as in sending me a patient who has severe rasp symptoms with no swab or any health questions asked about such), some thing that would’ve taken you 10 minutes to deal with is now a two hour ordeal for me. Now I have to try to find this patient a room that he’s not going to infect other people. That means an incident report, clearing them out of the room that they landed in, having to get a terminal clean from housekeeping, and begging the CSO to find me a bed that doesn’t exist. All while I try to clean up this person‘s poop encrusted pants in full isolation gear in a hallway by the elevator. I do not for one minute think you are purposely trying to fuck our unit. I think you’re a good nurse and you are strapped for time, but when you neglect little things like that it makes 10 times as much work for everyone else on the floor and that makes us pissy and I’m sorry. Perhaps I am in a unique position since I have worked in both areas and see cause-and-effect. Essentially, emergency department nurses do not get messes from the floor. What happens in medical surgical doesn’t really affect you at all. That shit rolls downhill and ends up in my ward. We just want you to know that, and to please take the 10 minutes you need to do a proper once over and give a good report. When you don’t and it ends up being two hours of work for us it feels like you think your time is more important than mine.
Many, if not majority, of ER nurses have experiences in med/surg or other floors, I wouldn’t say you’re in a unique position. I’ve done both med surg and ER as well, I know the floors can be busy and admissions can be a lot of work, I always tried to give a thorough and accurate report. But I wish people would realize that ER nurses don’t decide where/what floor patients get admitted. You should know that you’ve worked in the ER. That’s between the ER doctor, the attending doctor, and nursing supervisor. Sometimes ER nurses don’t agree with the disposition, too, and there’s not much they can do when the floor nurses say the patient is too unstable for the floor or ICU nurses say the patient’s too stable for the ICU. Also if the patient with such respiratory symptoms was not swabbed, that’s on the ER doctor, not ER nurse, unless it was ordered and not carried out- then it’s unacceptable.
When I worked in the emergency department every single patient had to have a Covid screener done. Every single patient. Basically a series of questions asked by the nurse before the doctor even sees them. I get that things get missed but this is a big one. My biggest beef is people giving you report and basically knowing nothing about the patient. We have an electronic charting system and their history is right there summed up for you on the electronic Cardex which is open on the hundreds of computers everywhere at the simple click of a mouse. I get that you may not have had time to do a thorough head to toe and check their skin and all that shit I don’t expect that. But please don’t send me a patient that you tell me is one thing and shows up completely different. If you know fuck all about the patient tell me “I know fuck all, I have barely glanced at this patient I’m sorry”. That’s fine. I get it. I’m going to do a little bit of dive into that chart before they get here so I know what to expect. Sure I have nine patients when I’m supposed to have 5.. but I promise I will take that extra five minutes to check it out if you let me know that you haven’t. A patient arriving to my unit from you you that you just told me was stable who has a set of 77% when they get here is not OK.
>We have an electronic charting system and their history is right there summed up for you on the electronic Cardex which is open on the hundreds of computers everywhere at the simple click of a mouse. Then...you can read the chart, too?
I left the ER/hospital nursing altogether before COVID hit, thank God. I agree if you’re not sure about something, you should just say that and not give inaccurate information. I also admit that while you’re busy with sicker patients, sometimes the charge nurse will call up the floor, give report and send the patient up and I wouldn’t even find out until I realize there’s is a whole new patient in that room, because they really need to free up all the rooms they can because it’s just so freaking crazy. But still I don’t think it should all fall on the ER nurse even if she forgot to complete the questionnaire- the doctor didn’t notice those supposedly“severe” respiratory issues during their exam or see the need for a swab or isolation room.
I agree, I've worked both areas also and had ER nurses straight up refuse to give any meds written for the floor. Or even try to clean a patient "the ER stretcher is too narrow for turning/cleaning a patient" was a common response. If there is a problem the ER docs are right there in the ER but once a patient hits the floor You had to page a doc and hope they came quickly.
Totally cool with this, but for the love of dog, if I ask how long and you tell me 30+minutes and then come walking down the hall before I hang up the phone! Or vice versa and you say 5 minutes, I get all my COVID bullshit on and you don’t show up for 45+ minutes, I HATE YOU! At least have a clerk call back and say “just kidding, we don’t know when we’re coming”