Try these tips to ease tensions with floor nurses

Do you bear the wrath of frustrated floor nurses due to factors beyond your control, such as crowded waiting rooms and hallways filled with admitted patients?

"The ED is the department that causes the most unrest to other hospital units," says Carla Schneider, RN, director of the emergency care unit at Hoag Memorial Hospital Presbyterian in Newport Beach, CA. Just when caregivers become comfortable, have an empty bed, and stabilize their critical patients, it all changes, Schneider says. "The empty bed is filled lickety-split, and the critical patient has to be transferred out for the new admit," she says.

To resolve conflicts, implement these strategies:

  • Ask other departments for input before making changes.

Since ED nurses were frustrated with constant excuses about why beds weren’t ready, a decision was made to fax report and send the patient up immediately, says Schneider. But before making this change, ED nurses met with the hospital’s clinical practice council. "Other departments gave us input on what specific information they would need and asked us to call 100% of the time before we faxed reports."

  • Invite nurses from other departments to observe triage in the ED.

To understand the need to move patients out of the ED as soon as possible, floor nurses are invited to sit in triage for 30 minutes and decide which of the patients will go to the one empty bed first, says Schneider. "We remind them that this decision is based only on a three- to five-minute triage without any monitoring or testing," she says.

  • Have ED nurses spend time in other departments.

An "ambassador" program is being developed at Hoag Memorial that will allow nurses to work for a few hours in another department, says Schneider. For instance, if ED nurses want to know more about X-ray procedures, they can work with a radiology nurse for a few hours, or if a neonatal intensive care unit (ICU) nurse wants to sharpen her intravenous line skills with newborns that arrive in the ED, she can spend time there.

"We will build bridges by putting a face with the voice on the telephone," Schneider says. This will allow frontline staff to resolve issues between departments, she says. "When you see what they do, it all makes sense," Schneider says.

  • Collaborate with other departments to find solutions.

At Methodist Hospital in Indianapolis, ED nurses participate in a monthly clinical practice council with staff from pharmacy, lab, dietary, administration, and environmental services. "There is a structure for voicing concerns and a process for resolution, fact finding, and intervention," says Kathy Hendershot, RN, MSN, CS, director of clinical operations for the emergency medicine and trauma center. "It is amazing when one nurse will speak up and several others chime in with their own experience."

Working together, ED and ICU nurses have come up with the following solutions: If there are four critical care patients and only one available ICU bed, the ICU nurse comes down to the ED to evaluate each patient jointly with the ED nurse. "They decide who goes first, then the ICU nurse helps place the others as quick as possible," says Hendershot.

Also, ED nurses often accompany the patient to arteriogram prior to transport to the inpatient bed, and now they call the ICU to ask for help. "If they can, the ICU nurses will meet us there and get a face-to-face report, and the ICU nurse assumes care of the patient," says Hendershot. "This allows the ED nurse to return to the ED, and the ICU nurse transfers the patient when the procedure is complete."

At Mecosta County General Hospital, a 78-bed hospital in Big Rapids, MI, there was an ongoing problem with admitted ED patients during change of shift, says Kathleen M. Walter, RN, BSN, the ED’s clinical support nurse.

"The ED nurse wanted to give report and not have the next shift give report secondhand," she says. "Inpatient staff weren’t always available for report because they may have had a crisis going on or had gotten slammed with direct admits."

To address this problem, ED and floor nurses formed a committee, including nurses who had worked on both units and nurses who were resistant to change. The following changes were made:

— The process of calling report was changed so that if the floor nurse is busy, ED nurses calling report can leave a voicemail message and send up patients immediately;
— ED nurses agreed not to hold patients to finish charting;
— Nurses agreed that occasionally an emergency on either unit may need to take priority.

"The goals have been met, and there is better understanding and patience on both sides," says Walter. "Members are proud of the changes they helped make."

[Editor’s note: Do you have an idea for resolving conflicts with floor nurses to share with ED Nursing readers? If so, please contact Staci Kusterbeck, Editor, ED Nursing, 280 Nassau Road, Huntington, NY 11743. Telephone: (631) 425-9760. Fax: (631) 271-1603. E-mail: StaciKusterbeck@aol.com.]

Sources

For more information on reducing conflicts, contact:

  • Kathy Hendershot, RN, MSN, CS, Director of Clinical Operations, Emergency Medicine and Trauma Center, Methodist Hospital, I-65 at 21st St., P.O. Box 1367, Indianapolis, IN 46206-1367. Telephone: (317) 962-8939. Fax: (317) 962-2306. E-mail: KHendershot@clarian.org.
  • Carla E. Schneider, RN, Director, Emergency Care Unit, Hoag Memorial Hospital Presbyterian, One Hoag Drive, P.O. Box 6100, Newport Beach, CA 92658-6100. Telephone: (949) 764-5926. E-mail: CSchneider@HoagHospital.org.
  • Kathleen M. Walter, RN, BSN, Clinical Support Nurse, Emergency and Cardiopulmonary Departments, Mecosta County General Hospital, 405 Winter Ave., Big Rapids, MI 49307. Telephone: (231) 796-8691, ext. 4131. Fax: (231) 592-4421. E-mail: kwalter@mcghhospital.com.