Different Teams On The Same Side

My hospital has a New Grad program that requires that new nurses do a few shifts in departments other than the one they were hired in.

When I went through, they were a little vague on the reasons behind it, and I wasn’t exactly sure of its purpose. I observed that it had a few positive outcomes, of which the three primary ones were empathy, inter-departmental cohesion, and facilitating lateral movement. While healthcare is divided up into various specialties, we all are on the same side, caring for people’s health when they are unable of doing it themselves, so I understood that anything to aid in our working together would be extremely beneficial.

I personally had started my career as a Long-Term/Transitional Care Nurse at a couple nursing homes and was hired on in the ED as a New Grad, even though I had been out of school for a few years, in order to get adequate training to function as an ER nurse. Nurses tend to often feel that other types of nurses have no idea what they go through and often avoid working in other types of nursing because they either feel inadequate, overly-qualified, or just hate dealing with a certain bodily fluid or type of patient.

When I started working in a nursing home, I found that many nurses in that field felt that hospital nurses looked down on them. We had limited resources, especially when management left, and most calls to our patient’s primary care providers ended in them ordering the patient be sent to the ER for evaluation. Of course, this usually meant that ER nurses would be exasperated at us for sending them a patient with increased confusion that turned out to be simply a UTI or a ground level fall, just because the patient was on warfarin and we were unable to determine if they had hit their head because their dementia prevented them from answering our questions appropriately. Of course, once we sent these patients to the ER, they would have to deal with those patients trying to climb out of bed without the aid of “sitters” or bed alarms. Their exasperation often bled through when they were receiving report, or giving report. You could hear it in their voice.

Many long-term care nurses, my past self and those I’ve worked with, feel that they lack what it takes to work in a hospital. Depending on the facility, they may never do tasks that were considered basic nursing skills in Nursing School, like starting IVs. One facility didn’t even want nurses using regular IV bags and pumps, but had their out-of-town pharmacy send us “Balloon Pumps” (Technically they are Elastomeric IV Pumps) which we, maybe just I, called Baby Bottles; because that is what they resembled. Of course, these could only be used on patients that came back with a PICC line in place, because we didn’t start IVs.

I worked in the ER for 6 months as an ED Tech, because the facility was a bit unsure of hiring a nurse with my work history. I observed how in the busiest of times when an ER nurse was trying to move patients “upstairs” (MedSurg or ICU), they would often feel a palpable amount of cultural tension. Not only did other departments appear to work at different speeds, but had very different goals and ways of doing things. The ER would need to move a patient out to make room for another critical patient as the waiting room filled up, and the nurse upstairs would be asking about the geriatric patient’s mother’s gravida para when the patient was born…or so it appeared.

When I finished the classroom portion of the New Grad program, many of my ER coworkers asked me why I wasn’t going to immediately begin working in the ER, where I was hired. I had a hard time explaining exactly why I’d be going “upstairs” for a couple weeks. I usually ended up telling them that it was probably to help us understand what was going on in other departments so that we could work better together, while I secretly had another theory.

I ended up doing a couple shifts with an ICU nurse before I went to MedSurg. I had worked where my patient load was between 15 and 38, one to two patients seemed like it should be easy. I learned very quickly, that a critical patient often would become a “one-to-one”, meaning pretty much all your time was spent on one unstable patient, while other nurses helped out on your less critical patient. It came down to minute details in the interaction between a host of medications and lab values that were ever changing while trying to not get tangled up in all the wires and tubes. I learned that while ER deaths are often quick, the ICU often has to keep a patient “alive” until family members can fly in from out of state. I saw all the care and compassion bestowed on the family as they prepared to take a patient off the vent. While I still appreciate the ICU nurses that don’t give me the third degree, and see the halos of the angels upstairs that say “Sounds like you’re busy down there, I’ve read the chart and only have a couple questions…”, I learned to be a little more patient with those ICU nurses that seemed to be throwing questions from left field.

My short time in MedSurg started out with me feeling a bit lost, or rather abandoned. The nurse that I was theoretically supposed to work with, backed out last minute. I ended up with a couple other nurses during that time, and really enjoyed myself. I learned how big of a headache it was to take patients in the middle of report, during a med pass, or when they were doing their assessments that left no box unchecked. The number of medications they passed seemed reminiscent of my days in long-term care. As patients often commented, it was like “another whole meal”. But, while their patient load was much smaller, the amount of assessment and charting was much greater. They also could do nothing without an order, and getting an order often was a fully-fledged side-quest.

I also learned that many MedSurg nurses were baby nurses as well, since MedSurg hires the most new grads of any department in the hospital. I could see why sometimes the “nurses upstairs” were asking all sorts of questions during report. They were just trying to get a handle on a complex patient or if they were a baby nurse, try to learn something from an experienced nurse. ER nurses, due to the work environment, are often forced to stop patients in their long list of complaints and ask them for “the one reason you are here today”. In fact, we may not even be aware of much of a patient’s medical history because we are dealing with primary complaints and sending them elsewhere for follow-up care. Our main patient education mantra is, “Come back if you have changing or worsening symptoms, or other concerns”. While we may enjoy teaching other nurses some of the things we know, we often don’t have the time to teach while tied to the phone. In the chaos of the ER, we might have to say “walk with me” during a conversation or end a conversation to do a time sensitive task.

While I did my rotations upstairs during dayshift, occasionally I’ll give report to someone I know, and it really is a completely different experience. I believe that nurses need to work together for best results, both patient outcomes, and staff morale. MedSurg nurses that have come down and worked in the trenches are much revered by ER nurses. Sometimes these nurses can feel abandoned, due to a combination of patient load, uncertainty as to their skill set while working in an unfamiliar department with a different mix of patients, and sadly, because of interdepartmental tensions.

As I mentioned earlier, I secretly held another theory as to why new grad nurses were sent to other departments as part of their program. I had noticed that there were a couple new nurses working in the ER that really “didn’t fit”. After a few months, they ended up being invited to work in other departments and seemed to excel in their new specialties. I figured that it was a way for other departments to feel out new nurses, to see if they wanted to work with them, if the new nurse found their current placement not fitting them well. This made a lot of sense. When a nurse is recruited to a “rural” hospital, while it may seem like they can easily hire another, the reality is that not everyone wants to live so far away from the amenities they are used to having. A lateral transfer not only has the ability to improve that nurse’s fit in the system, but allows that nurse to aid in the cohesion between departments. They end up acting like ambassadors, explaining how other departments work or why they do things a certain way, and they have connections with their old departments which opens up dialog.

In an earlier article, I mentioned how ER nurses can be a bit frustrated by flight nurses because our goal is to keep our patients alive until someone else takes over. Nurse specialties allow nurses to gain a high proficiency in their specific line of work, but we need to realize that we are not better or worse than other specialties and we are all working for the same goal: Patient Satisfaction…I mean to care for others and help them with their illness, injury, or comfort them and their family as their life ebbs away. I write this from the perspective of a nurse, but each and every person that assists in this goal, whether they be the Emergency Dispatcher that takes the first call, the first responders, ambulance crew, CNAs, EMTs, techs, nurses, doctors, ER, MedSurg, ICU, surgery, etc., while we may be on different teams, we all are on the same side and need to know that we cannot do it all alone.