We’re all in this together : The ER/Floor Nurse relationship uncovered.

A Little Background

Yall see these crazy fun girls in this picture with me? Pants up to their chest, actin a fool?? These are my friends in the ER. They are some of the funniest, coolest, smartest, and hard working nurses that I know! They are able to handle everything that walks through our ED doors, and some. They are life savers, and nothing short of amazing!

I am a floor nurse. I started on the floor and I have remained there for three years. I love bed side nursing! I love patient interaction. Don’t get me wrong, there are days where I want to send some of my patients and/or their family members off on the Hot Mess Express where they belong, but for the most part, I love what I do! I also have a really cool position. I work in the float pool at my hospital. It consists of a little under 30 nurses, and we pretty much go any where and everywhere they need us in the hospital. I recently was offered a special position in our Emergency Department. I get to help out the ER nurses, work with patient flow/expediting, and coordinate with doctors for orders and placement. Working in the ED has opened up my eyes to a lot to say the least! (I use ED AND ER interchangeably….same diff! Just FYI! Department and Room)

The Perception Is The Same Everywhere

I have worked at 3 hospitals in my short 3 years of nursing. EVERY floor that I have ever worked on (at all hospitals) have this negative perception of the ER nurses! They all make it out like the ED nurses never do anything helpful, they send patients up without a thorough report, and that they intentionally send patients up near shift change just to tick you off! I was so guilty of some of these thoughts! Especially because EVERYONE around me talked like this! It was a learned attitude! “ The ED just sent the patient up like this…..” “ They sent this patient up without verbal report….” One thing that is really a hard pill to swallow is that patients ARE allowed to come up whenever. Some hospitals have made policies or rules that don’t allow patients to transfer between a certain time frame. My hospital is between 7p and 7:30p (shift change). That does help a little, but even when the patient comes up at 7:45p, it can still be rough. Typically, we’re still getting report and introducing ourselves to our other patients, and it can get overwhelming. TOTALLY get it. Been there and done that. I complained so much about it….until I experienced first hand what it’s like to be an ED nurse.

They Are Just Doing Their Job

These nurses can be taking anywhere between 3 to 7 patients at a time! 7 patients that are going to need orders. 7 patients that are going to be sitting in the ED until a doctor sees them. 7 patients that have the potential to be admitted, needing IV’s started, labs drawn, consents signed, and STAT orders initiated. 7 patients to chart on. 7 patients to be watched without knowing much of their history or anything about them. 7 patients to either be discharged or sent to the floor. ED nursing is a different kind of crazy. What I want you to understand is, just like when we are under pressure on the floor to get patients discharged in a timely manner,  the ER nurses need to get these patients up to the floor in a timely manner.

 Back to the business of healthcare, one of the biggest complaints that hospitals get is the ED waiting time to get to the floor. “ We were down in the ED for 9 hours before we came to the floor!” Those things stick in the mind of our patients. It also puts them at higher risk for issues happening, because they don’t have that 1:4 (ideal) ratio that they would have on the floor to be safely monitored. My hospital created a special position that myself and 2 others do, to help expedite that process. Find out whats holding them up and get the ball rolling. It’s a circus down there sometimes. It’s all about getting these patients stable, and getting them to the floor with orders to be taken care of.

They Have The Pressure On Them To “MOVE” 

I stopped having expectations of a full report from the ED after about a year of nursing. I had a friend who worked there and she explained how everything worked. I totally found a new respect for those nurses and what they did. The position that I am in now, I will occasionally call report for a patient on behalf of the ED nurse just to get them to the floor. We get SO many patients through those doors, that if we don’t keep things moving, the ED gets LOCKED and thats when room control, house coordination, and the patients all start to get coo-coo! WE HAVE TO KEEP IT MOVING. It sucks. It’s hard. And it gets crazy, but thats how it works. The ED nurses don’t want to tick the floor nurses off. They are just doing their job by calling a small report and getting the patients up. The minute they hang up the phone, they are running to hang blood on their other patient or starting some kind of drip….its NUTS!

So back to me calling report. I called report to a nurse up on the floor the other night. It was 7:30pm. I felt SO bad having to do it, but we had to get these patients up. The nurse was so rude and defensive. She asked a million questions that she could literally look up in the system. I’ve been doing this long enough to be able to label questions irrelevant. Hers were knit picky….and irrelevant. She continued to tell me that it wasn’t right for me to call at that time. I told her kindly that I totally understood how hard it is to get report near shift change and that I would help get the patient settled when I brought them up! The pattern of negativity went on, even when I brought the patient to the floor.

The Nature Of The Job

This is the nature of being a nurse. It sucks sometimes. Direct admits come at the wrong times. ED admits come up at shift change. Sometimes you get 2 admits within an hour. Or you have 4 discharges before noon! THIS IS THE NATURE OF THIS JOB. I AM A FLOOR NURSE! I GET IT! Don’t hate the player, hate the game! These ER nurses do their best to give you all that they know in that short interaction and care that they gave that patient. Again, the ED gets the initial EMERGENT orders done….it’s not their job to hang heparin, send the UA, or start blood unless it is ordered STAT. I would get so mad when they would come up with a crazy amount of orders and they weren’t started. It’s because that was intentional. They were specifically written to be started on the floor. It’s not a punishment. It truly is a completely different world down there.

The pattern that I have seen is how MEAN the floor nurses can be on the phone with them. I TOTALLY have had that attitude before like “ Do you even know what’s going on with this patient?” They do! They may not know exactly everything, but that’s why these patients are getting admitted. To get worked up on. Because we don’t know exactly what’s up. I do feel it is frustrating to get a short report, but that’s how the ED works. The hospital wants them in and up. For many reasons, not all business related. Safety and care issues, among others.

Next Time, Take A Deep Breath

The next time you hear you are getting a patient from the ED, and it’s around shift change or just a bad time, I need you to do me a favor. I need you to take a deep breath. I need you to remember that those ER nurses are awesome, and they are working their tails off down there, and making time to pick up the phone to call you report. They do NOT want to tick you off. They don’t want to ruin your night by sending patients near shift change. They are literally doing their job. Just like you are doing yours. We need to be thankful these patients are coming in. It’s job security for goodness sake. Yes, it sucks the way they just pile in near shift change. Part of the reason is because they were actually all being held for an hour because of the “holding period” a lot of hospitals have at shift change, and then they all were rolled out as soon as the clock struck “time up!” Do me another favor. PLEASE don’t ask questions that you can look up. If they are admitted for cardiac issues, don’t ask what color their urine is. Don’t ask about bowel movements. Don’t ask where the IV is. It’s there. PLEASE. These are all things that you can ask when they get up. Use your brain. If they come in with chest pain, just find out about the cardiac enzymes and what they did to treat the pain, etc….

Remember. They are getting STABILIZED! Do your full assessment when they get up to the floor and honestly, treat them like a direct admit. Be an investigator. The ER nurses are your friends. They are just doing their job. Getting the patients in, stabilized, and up to the floor. Put your big girl/ big boy panties on and tell yourself it’s going to be okay. Shift change admits suck, but it’s going to happen. Quit giving the ER nurses lip. We need to be a team. I write this because I have realized the giant misconception we all have of each other! Being down in the ER has allowed them to better understand WHY we can sometimes get fussy about things when the patients gets to the floor. But I wanted yall to understand what I’ve learned about their unique position. They would be more willing to help in the little ways I bet if we were more gracious and kind about receiving report. They are just the messengers. MAD LOVE to all my ER nurses. I have a new respect for you. Please feel free to help us floor nurses out in any way! I will do my part to spread my love and respect for you! No mo’ hatin! Now put your party pants on and everyone do your job with a GOOD attitude!

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