Thursday, April 2, 2009

Polticking at 0230

When the waiting room is holding 70 people in the middle of the night and every bed has someone in it, the ED’s priority becomes treat ‘em and street ‘em or move the freaking meat. When moving the meat means getting an admitted patient to the floor ASAP, I expect that the floor will take the patient and not bitch at me for not starting their work. Carrying out admission orders (especially those that involve giving medications that we may not keep in stock or ones that the floor keeps in adequate quantities) is the responsibility of the floor. Anything I can get started in the ER is out of professional courtesy, not obligation. While I realize that floors can get incredibly busy in their own way, they have to accept patients when a bed is assigned – it’s part of the job. This is why I don’t expect a nurse from a medicine floor telling me that he can’t accept the patient from the ER until we put in the Foley catheter and start his lasix drip because that should be done in the ER. I believe his exact words were, “we don’t do that up here”. W.T.F?? Those are very basic nursing skills! After all, we have the same nursing license so I don’t understand what rationale he was using to try to persuade me that he was incapable of putting in a Foley catheter. On top of all that, the patient was in a hallway, which is NOT an ideal place to be sticking tubes down people’s genitals! I tried to tell him this and he called me an idiot before hanging up on me. Needless to say, the ER charge nurse was mighty pissed – he and I ended up filling out a giant incident report for the floor and ER nursing manager. I ended up having to put in a foley in the hallway while two other nurses held up sheets as makeshift curtains while other (squeamish) patients looked on in horror making the poor man feel like a freak. Needless to say I received a very chilly reception when I finally transferred the patient onto the floor.

This should not have been an issue. Normally I call the floor up and let them know that I’m bringing up a patient. If they request a few minutes to get prepped then I really don’t see that as a problem unless something atrocious is happening in the ER. Refusing to accept a patient that needs some ‘work’ is completely unprofessional. The charge nurse and I should not have wasted an hour over whose responsibility it is to carry out admission orders in the middle of a very very busy shift. I later found out that the floor in question was overstaffed and had 6 empty beds.

8 comments:

therapydoc said...

Oh, boy. A lot of stuff to rant about. It'll never end, either. What did we do before blogs?

Tex said...

Hey, if they don't like their jobs, so much so as to refuse an admit or do their jobs, then quit.
Join the millions doing without!

Me, I like using the 'family' rule on them:

If it was your mother, would you have me cath them in the hall?

Emily said...

all good points...I am a "floor" nurse, and though I understand lots of admission orders can't (and shouldn't) be started till the patient leaves the ER, many a time have I received patients who have orders for units of blood, "now" labs, etc that haven't been started and the orders were written hours ago. really, it's a tough situation for all of us!

Anonymous said...

Just found your blog--great work. I relate to both ends of this story, and would have has a lot more sympathy for the floor if you had said they were working down 3 FTE's and were trying to move an unstable patient of their's to the unit. Why can't we all just do our jobs and treat our fellow employees with just a modicum of respect and the Golden Rule??

Pattie, RN

LivingDeadNurse said...

I would have really been pissed...hell its not that bad to put a cath in...lazy nurse...that just burns my britches lol

sara said...

wow, that totally sucks. some people are so lazy ... if i had been you i would have been PISSED.

DreamingTree said...

As a floor nurse, it would never even occur to me to make such a demand. I look at it as my job to get the orders going. My only complaint with ED is when my admission comes at shift change. And, even then, my concern is due to safety -- we're all in report.

Homer said...

It won't work in actual fact, that is what I suppose.
nice site