ED nurses can have up to 6 patients or more per nurse that can be anything from chest pains, shortness of breath, code strokes, respiratory distress, LOC etc. In addition to having those patients we have to assist in the trauma room for cardiac or respiratory arrests. Ambulances continuously bring patients in through the back while people pile in through the front door. Our job in the ED is to treat and stabilize the patient and get them out to make room for more patients that are waiting. We can't use the excuse "Sorry we are full". If ICU beds are full we have to hold those patients and do all of the admitting orders on top of continuously seeing new ED patients. So I apologize if I don't know when their last BM was, how well they ambulate or if their grandfather is still alive. You can always look in their chart for answers to those questions that are not important to an ED nurse. Sorry I was too busy saving their life!
This is HILARIOUS! I have worked 13 years as an ER RN. Yes at times we appear as we know nothing BUT our purpose is to stabilize. IF we had all of the answers, we would not be admitting the patient. We chart by exception. We have a physician who screens each patient in detail. If we did so many details in ER, we would have ambulances backed up like McDonalds. Keep on moving!
HR in 80s? Hit him with that atropineeeee LOLOLOL "God help us all." OMG. I love the shocked pikachu meme face the ICU rabbit keeps making. Seriously though, ED nurses are badass. I don't know how they run the shit show downstairs. I floated there to watch the holds once and it was wild.
In defense of all the nursing sign outs I've witnessed, it is more like, "pt is being admitted to icu for hypoglycemia." "What is his sugar?" "120" "that's not hypoglycemic" "I realize that, he presented with a glucose of 27, treated with d50, with repeat glucose 97, but fell to 45, treated with another d50, glucagon, and started on d10 drip. To avoid hypoglycemia. No history is available, because the patient is confused, and can't relay any history, with unknown baseline. CT head negative, septic workup unremarkable, including LP. He needs to be in the icu for persistant hypoglycemia, and AMS" "What are his other medical problems""He doesn't know, and has no past visits""Did he have an Id on him?""Yes, that's how we got his name""Did you look up his name in the white pages to talk to a family member and get more history""...you mean so you don't have to?...No, we were focused on saving his life, and we have a cardiac arrest showing up in 7 minutes, with no free beds. We decided to leave you something to do""Does he smoke or drink?""I don't know, but probably given he was found on the side of the road and smells like marijuana""Tell me how he got on the side of the road""This may surprise you, but it is not my job to take your history for you and relay it in bullet point format so you don't have to sign off facebook.""I just want a proper history""When you develop a device to read the minds of altered patients, and magically obtain information that has no bearing on his immediate clinical presentation let me know, in the mean time, I will give you the pertinant info available at the time, and you will have to actually do your own assessment, and talk to family when the case manager you have tracks them down for you""You don't do assessments?""We do assessments based on limited information, focused on the patients immediate problems. Tracking down unknown family to see if the patient is a smoker was not our priority as we were saving his life, and treating his emergent condition, not to mention the perforated bowel in the next room, and preparing for the cardiac arrest that is now here.""Whatever, I guess we will just do a proper evaluation when he comes to our unit""Yeah, enjoy your 2:1, meanwhile, I will be doing my inadequate, life saving assessments on the other 5 new patients I have"
I used to get so pissed at the ER for their reports, until I started getting floated to ED Holds. Now I'm one of their favorites to give report to, "Where's the IV? Are they mobile? K cool I read the chart see you in a minute."
I have been an ICU nurse for 10 yrs, job shared with the ER for 3 of those....the outgoing RN should have called report, obviously! Berating the nurse 'covering' the pt serves no purpose!! He/she had no clue what they were getting into! The previous nurse should have given full report to the ICU chg if this occurred during shift change!
Sai Baba, basically, if I understand your response, you are confirming the cartoon video! Sounds to me like the "E.R." Is basically a first stop where (if busy) it is a "meet and greet" before a patient is sent on to ICU! I know for a fact that this is not true in all hospitals. I had a heart attack at 40, when the ambulance got to the hospital, an E.R. Nurse was with me non-stop for 10 to 12 hours! I don't remember her leaving for a break, restroom or otherwise. I would just like to say God bless each and every nurse for their efforts. Their knowledge and actions, along with their compassion and caring for their patient is as important if not more important than the doctor. I think even a doctor would be potentially worthless if not for the nurses performing their duties to compliment the doctor's assessment of the patient's status and needs. A very "heartfelt" THANK YOU to ALL Nurses for all you do! Most of which is not acknowledged or truly valued by patients, doctors, and even other Nurses!
Burn nurses receive patients directly to the unit in a burn trauma bay and remain that patient's nurse throughout the remainder of their shift. They stabilize in the trauma bay and stay with the patient as they move to an ICU-capable bed in the burn unit where they continue to provide critical care in the patient's room. This includes patients of all ages (newborn to 100+) at all acuity levels (pediatric ICU level to adult ICU and everything in between). Maybe some type of hybrid ED/ICU collaboration would help staff on both units AND increase patient outcomes. For as much as we think we know, we in medicine still have a lot to learn.
I've lived this scenario several times throughout the years....This had me in tears I was laughing so hard. I've worked both the ER and ICU's. Having worked both sides I can see both sides of this.....truly is funny
My God, people take these videos way too seriously. They are made to be comical. I'm sure that some idiotic nurses just like this one exist but people need to relax. Geez..
Trauma ER nurses generally only have 1 trauma patient, high acuity ED nurses generally only have 2. General admission ED nurses take up to 3-5 depending on the acuity and the discharge status of the patient. Now cry me a river.... rolling my eyes.....
Lenny Mastiff not true. In Detroit, I've run 2 trauma's at the same time and on the unit in the ED have had ended up to 40 pts. at the end of the night that i've provided care to myself. We generally tend to be really short staffed, ICUs are kept better staffed than the ED.
ER nurse here, I take usually 4 pts at once, 1 high acuity pt if they come in. Somtimes if we are understaffed we get 5:1. Loved the video ! Should make one for a intubated pt and have the ICU nurse ask the vent settings lmao "I'm not the resp therapist,, o2 is at 9*% right now while being ventilated"
Oh my gosh!!!!!! It's sooooo funny lol I've been worked in both ICU and ER over 2-3years. they both are telling the truth...... so it was world wide. I see now..
I hate when I get report and they say "I just started 10 minutes ago, and I'm calling report." What happens to the other nurses that KNOW the patient is being admitted, usually for several HOURS beforehand? I've stayed after shift to make sure I handoff to the ICU if I'm transferring from the floor, because the shittiest thing I could do for the patient is to allow them to be a secondhand or thirdhand report that puts them in danger of not being treated efficiently during handoff. I get it, the ER is busy, but seriously, do right by your patients. I had a patient being admitted for chest pain with a glucose of 600 that when I asked if it had been treated was told "We only treat what they came in for." But if they go into DKA on MY floor because you didn't bother treating a simple thing like a blood glucose and transferred a potentially unstable patient, I have to clean up YOUR mess, and suddenly their damn chest pain becomes secondary because you couldn't use your critical thinking skills to anticipate a secondary problem? Not. Cool.
Many times a patient will get a bed after the primary nurse has gone home. There is no way someone is going to wait for a bed to become available for their patient when they could be going home instead. Maybe in a perfect world.
MissLilRedRooster in a perfect world, if a patient in the ED has a ready bed upstairs 20 minutes before shift change, you would be able to call and give report. the problem is in that time frame the ER gets tons of ready beds upstairs, but no nurses can get reach a floor nurse to give report to that close to shift change. So the original nurse goes home, and the nurse taking over has to call report.
I don't know how I ended up here, but I'm not a nurse or anything related. Interesting to see inside another profession. Thank you to all of you nurses who take care of us when we are vulnerable (or worse)!
It's not the ICU RN's position to be making the decision to accept the patient. If they are being sent to the ICU, the ER MD and the Intensivist have already discussed the patient and the Intensivist accepted, not the RN's position. Just take the damn report.
This entire scenario is BS. Worked ICU 10 years and ER 3. Does NOT happen. Both nurses would be fired for incompetence and abusive behavior. Not even funny. This can only do harm to people who need to go to ER/ICU. This is NOT appreciated.
It’s the old joke of ICU is OCD and ER is ADHD. It might be exaggerated, but yeah, I’ve gotten ER reports like that. Patient on an insulin gtt and no blood sugar checks for 8 hours, pt on heparin gtt and the nurse has no idea why, potassium of 2 and having runs of vtach and no K+ given. After working 23 years as a nurse, I’ve seen a lot of incompetence. But sorry, this is funny. It’s meant to be a joke. In real life. I hope we give each other grace. Nursing is a hard job. We all have days where we are too busy to be the nurse we want to be.
I think the bottom line here...and I was an L&D nurse for 24 years and received reports like this a lot...from ED nurses, is that scenarios like this happen either unintentionally or intentionally (for a lot of reasons). I know you are busy, but find out who this patient is by at least talking with them or someone in their family. It takes a few very important moments to save a lot of time in the long run, and maybe a life. The point is that communication is a major reason for poor outcomes. Don't take personally what is going on here. Take time to reflect on how you communicate with each other, with other departments, with other disciplines and fix what doesn't work and improve what does work. There is ALWAYS room for improvement!!
I hate when I have to repeat "I just walked in ten minutes ago". It drives me crazy! Seriously, I walked in and was asked to do this, I haven't had time to do anything else yet!
You get report, so basic information should be passed along to you. This has happened to me I don't know how many times. "I just got here and haven't seen the patient yet, can I bring them up?" Uh, no you can't because while I can deal with an unstable patient, I'm not going to look like the moron that doesn't know anything when the physician is in the room asking me questions, because there is no excuse to "I just got the patient from ED so I don't know what happened between here and ED"
ER nurse to ICU nurse. "Patient came in with hyponatremia" his vs are 116/58 hr 97 rr 28 temp 97.1" ICU nurse " what was it?" ER nurse "what was what?" ICU nurse" ???? HE came in with hyponatremia ,what was the level?" ER nurse" hyponatremia means "low sodium" ICU nurse" I know what " hyponatremia" means ! I want to know what was the number value the lab gave you! What did you give him? What was the follow up result?!! ER nurse." We gave him IV fluids and now we are transferring the patient to ICU " ICU nurse was reprimanded for " badgering" ER nurse
This must be an exaggeration. ICU and ER are two VERY different entities. And for good reasons. ER has different priorities, focus, tasks, and concerns. Our focus is to stabilize the current system of complaint. And other systems that may be CRITICALLY affected. Then either discharge or admit for further treatment. That further treatment includes minor system issues not addressed by ER. I have never worked floor or ICU. But I have worked with many nurses who have worked ICU and ER. Every single one of them have admitted they have a better understanding after being in ER. And they no longer judge. Many of them can't do ER and return to ICU. I don't think I could handle ICU myself. Respect the differences.
I've worked in wards where this has been my handover from an ER nurse. I'm also now an ER nurse and I still find this hilarious! There is always one person you know who says 'Meh they are moving to XXX ward" during handover. It happens. It's comical - laughed my ass off! And I don't feel offended as this clearly doesn't apply to everyone!
Lol, I love how ICU nurses act like they are stooping to the ED nurse's level to receive report. Good lord, they come in as an unknown entity with no diagnosis, are lined, tubed, and scanned by the ED nurse, and sent up within a half an hour of receiving the admission orders (not to mention while having to do the STAT orders first!). I bet a lot of ICU nurses would cry if they had to deal with the workload. And then they have the gall to complain. Get over it, the rest of it (the cleaning, bathing, and labeling your lines) is your job!
mssymarie meanwhile where I've worked almost every pt comes up from the ED having received maybe 1-3 meds with several meds ordered to be given in the ED a couple of hours prior, but of course either were not given or not scanned. If it isn't documented it didn't happen. Problem is, maybe not all facilities but the ones I have worked in, ED orders are not valid on the floor. So, that heparin, lovenox, pain med, etc that wasn't given hours ago is never given until their attending actually puts in orders and realizes that they were never administered in the ED. Amazing when a pt comes up with pain of an 8 and wasn't given their one time does of morphine 2 hours ago. I get it the ED is rough, and busy. We understand you don't have time to change out field iv sites, or place ivs anywhere but in the AC. This video is meant to be comical. Heck I've laughed at the vids making fun of nurses from a doctors point of view. It's humor. However, ED nurses are still nurses. They're still supposed to assess and take care of patients. They definitely need to administer the medications that they are ordered to. They sure as hell need to know the pt before they call report to try and pass on their train wreck. You might be busy, but guess what icu and floor nurses don't have three extra hours to figure out and fix hot messes coming up from the ED. We like to go home on time also and not be stuck charting two hours late. That said I work at a level 1 trauma now and they seem to do a good job when it comes to pt care down in the ED. I imagine it is therefore possible to do the same at a level 2 trauma center.
Some of you need to grow a sense of humor... this is intended to be funny people geez! I've heard this kinda report sooo many times that's why I'm dying laughing here!! I really needed a laugh today!
That’s so skewed towards icu, sorry you didn’t get much of a report but how many patients do you see and discharge? Icu doesn’t even discharge to home, they just send them to tele or a step down. Y’all have the same patient for 1-5 shifts and we see different ones and we’re always short in staff? We do focused assessments, if you guys did such a good job, they wouldn’t be here next week so cheers to your great fabulous work 🥂
Exactly bro. I have 2 icu patients at once, alone with 2 others that need a line and meds and have the charge asking me to give report. Then I have to hear the icu nurse ask me 1000 questions she already knows the answer to and has sat there for over 10 minutes studying the pts chart she’s gonna get
A hasty generalization, yeah, but I have gotten report like this from all kinds of units. I like how this parodies an ER nurse siting on the patient until shift change. Seems to happen a lot where I work.
no, not necessarily, we also do an accucheck, obtain hx, do a primary and secondary survey, ect. Remember, often times we don't have family or even a name to go along with an "unresponsive" patient so you can't always get a history. Many other disease processes can alter pupil size and reactivity and (obviously) many processes can cause unresponsiveness. But it's commonly administered after the ABCDE's are assessed and found intact. It's cheap, fast and effective.
While this is exaggerated, a lot is on point. I have been a nurse for 5 years and love my job, but nothing makes you more frustrated than lack of attention to patient care. Regardless of the unit, there will always be crappy nurses; and every nurse has bad days. But we should also be able to laugh at ourselves. If this video is offensive to you, it's because you find truth in it. Lighten up.
Yeah they do check history, pupils and such but pushing narcan is a quick and easy way to find out if a patient has OD'd on opiods (which is VERY common, at least in the Seattle area where I practice as an ICU RN).
This is the most one-sided shit I've ever seen lol. My God go work in a level I ER for 1 shift and tell me how it goes. ER Nurses are not dumb as rocks like this video portrays. They are actually the most quick-thinking, resilient group of nurses youll ever meet. Organized chaos is our home. You walk in sometimes and your starting off with 20 patients on your team. The shift before tried to give report for 3 hours and now your trying to give report on someone you just met while the other 19 patients want your help and attention. I worked in-patient in the ICU step-down for years before coming down to the ED and it's an entirely different universe. Most people wouldn't survive the emergency room environment and are used to working in their little bubble of a unit. I respect all specialties. Most of the patients wouldn't make it to the ICU if we didn't stabilize them back from the verge of death when they first arrived.
"I don't know, I don't know this patient, I just came on shift 10 minutes ago..." THANK YOU!!! THANK YOU, this is what I hear from the ER RN every freaking time I get report from them! LOL. But that said, I do have respect for ER RNs they deal with all kinds of crap from patients and (most of the time depsite changing shift every 10 minutes), they get them up to us, relativelyclean and with a good IV, and ready for us to take over... I guess each department has their strengths and weaknesses.
As a lifelong emergency nurse, married to an intensive care nurse, I am offended and insulted by this ridiculous and one-sided piece of trash. I could quote a hundred stories of ICU nurses arguing over who will accept a patient... and have had several "codes" while waiting for the arguments to stop! No nurse I have worked with would ever have a conversation like this... if they wanted to keep their job! I call BS on this piece of one-sided fluff.
ER nurse here. First off i will start by saying that there are incompetent ICU and incompetent ER nurses. They don't represent the majority. Both ER and ICU are the most critical areas for patients and we should respect the fact that we take care of the same patients but focus on different things. A blood sugar of 600 is critical and I can only laugh at such an inflated parody. Our goal is to keep the patient alive and we construct our priorities with that in mind. We attempt solve most of the puzzle which requires rapid and focused assessments. They are definitely not as detailed as the ICU, but they give us the information we need. Sometimes we have to start solving the mystery based on little information and provide that initial intervention to save the patient or keep them alive. You think 4 IV lines, an NG tube, a foley, pt being intubated, all antibiotics given, all labs done (by the nurses mind you) pt on two drips stable and effectively sedated would be enough for some ICU nurses, but its not and thats what can frustrate us ER nurses at times. The ICU nurse has to continue that process, but since we have done a good amount of the solving their focus is on what they will have to do to keep the patient alive and get them better and hopefully home. In the ICU they can be as detailed as they want with 2:1 patient ratio, many of which they already know because they are on the unit for a while. All those answers aren't going to come from a 2 minute report. But hopefully the ICU nurse will get an accurate picture of what she can expect from the ER nurses view. Again that might mean we don't address some of the things you take as priority. Like vent settings. lol. And in reality it's ok to ask whatever questions you want. We just might not know some the answers cuz we aren't focusing on exactly the same thing.
Not true. I'm a level one ER trauma nurse and I know more about the patients and when I walk up to the unit am usually helping the icu nurses. They basically just need to do their assessments and give next round of meds when mine finish. I'm usually In icu calling the nurses who are texting to get help to come to the room And set their patients up and ask what else I can do before I go. Never a complaint. Thanks for trying to make the ones who stabilize the patient look dumb?
You are right Rana. The other thing is that the nurses don't want to take report. So, that is one reason why the other nurse will leave. We get tired of waiting on them to take report. They don't want the patient's and cry because they are receiving an admission. Ask you questions that you have already answered because they were not paying attention or ask questions before you could complete your report. I don't know what ER that is, but not in the ER that I worked in.
They'd be working in mg/dl, not mmol/L. Rough conversion: divide mg/dl by 18 (or multiply mmol/L by 18). So 17-25 mg/dl equals about 0.94 - 1.4 mmol/L.
btw did anyone else notice the conflicting statements by ER nurse? "did you get the sheet I faxed a while ago?" then says he came on 10 min ago. says patient is awake now, then says he walked past and he was asleep? Oops. what the hell kind of operation are you running down there? Are you even a nurse? Id rather die in the ambulance on the way here" hahaha
OMG so " I just came on and I don't know the patient" I assumed that was universal. as a ICCU nurse who used to float to ER back in the day I understand bother sides of the story. But that line still makes me laugh
I know some nurses sit on patients, but usually it's the floor nurse that doesn't discharge their patient till the end of their shift, therefore the bed doesn't become available to the ER patient until then. what's up with that?
That's pretty funny. The narcan.....a shot in the dark....I get that. But atropine for an normal heart rate right smack in the mean, gotta love that one! As an ICU nurse who has been floating to ER a good bit lately, I'm beginning to understand why ER reports are sometimes a bit sketchy (in lieu of lack of knowledge) and here's why: "During report, the more you tell said receiving unit about the pt, the more they fuck with you and try to find reasons not to take the pt"
I think this is hilarious! The ED and ICU RN are polar opposites. Truth is, we all just need to appreciate the different worlds we work in and not see each other as the enemy.
This happens to our ER a lot. I honestly have no idea how busy they are, or how their dept works. What puzzles me though is that they seemed to be very lost (at least where I work). They would give us a report patient sats 100%room air, then come up on the unit dyspneic, 86% sat on non rebreather. A patient that is ambulatory but with extremity contractions and total care. Hgb critical value with orders of blood, non was given since am, and troponins trending high without cardiology consult notified 😱 I don't hate them. But I advocated that they have floor experience first before going to ER. Most of them are new grads. One should establish a routine first, get the feel on how patient management is different from nursing school then go to a specialty floor. Crazy that they are allowing that with no proper preceptorship programs.. ER, ICU or MS nurses, we rock.. 😄
I worked on the MS floor and ICU prior to ER experience. The problem is less staff and higher acuity/census. I have a grip on what is happening on each of my patients when I work. Remember there is no control in the ER. Ambulances, CP, CVAs...etc come all at once. We are multi-tasking people. I get sick of nurses stating, "I didn't know I was getting an admission". Well I didn't know that I would have an acute MI or Trauma come in the door. The purpose of the ER is not to be so detailed. We trust your expertise for the continuity of care!
Synergy Sarey Well said. In my experience, it's blatantly obvious much of the nursing staff is ignorant of what other departments do- their policies, goals, and guidelines. Perhaps some of the griping lazy floor staff should ask some of these questions to the ER physicians or their own charge nurse. Stop bitching and having an attitude and do your job.
I'm an ER nurse and I've actually heard an idiot co-worker giving report such as this! However, it's not one sided! An ICU nurse asked me one night how to start an IV! And she was not a new grad! This was HILARIOUS!!!
@rebe12354 Wow, sorry, I thought this video was for ICU nurse vs ER nurse, not floor nurse vs ER nurse. if you work at a hospital who's ICU RN "floor RN" 7 to 8 each, it's either not ICU or not safe. My guess is that you are neither ICU nor ER. Sorry for the misunderstanding.
hahaha, I was getting report on a med/surg floor and received a similar report and I went into the pt's room and they were dilusional, flailing all over their bed, so I checked their blood sugar - 40!!! D50 works great!!! lol
I have to agree with @lindsycollins1 simply because her opening statement mentions she is BOTH an ER and ICU nurse. She has experience in both departments. I am sure those things you mentioned (medical mysteries) she has also experienced... Maybe even in both departments. She's clearly stating working in both departments that ICU is a breeze for her. Why argue?
Sadly this is very true of many major hospitals, but most of the stupid decisions are not made by the nurses but the IMR doctors, who couldn't tell the difference between indegestion and a MI
This made me laugh. The video is great. Don't know why there are so many nasty comments though. This video is a JOKE. Nurses in many areas work hard. It is just a different kind of work. Stop the dumb pointless competition of arguing about who works hardest. It's just dumb.
Im sorry but by "His heart rate went from 100 to 80, so we gave him atropine" "why would you do that???" I was dying in stitches. That was my exact thought before he asked "why would you do that??". Its true, the ER does a lot of un-necessary interventions (and a lack of other assessments) but like others have said, they are given scratch and have to try ANYTHING they can!
If the ICU took report 10 minutes ago, they would have known all of the details they wanted to know.
his hr dropped from 100 to 80, so we gave him atropine 😂😂😂
“He had a seizure so we gave him Narcan.” Big yikes.
Doctors order medications... So yeah!
ED nurses can have up to 6 patients or more per nurse that can be anything from chest pains, shortness of breath, code strokes, respiratory distress, LOC etc. In addition to having those patients we have to assist in the trauma room for cardiac or respiratory arrests. Ambulances continuously bring patients in through the back while people pile in through the front door. Our job in the ED is to treat and stabilize the patient and get them out to make room for more patients that are waiting. We can't use the excuse "Sorry we are full". If ICU beds are full we have to hold those patients and do all of the admitting orders on top of continuously seeing new ED patients. So I apologize if I don't know when their last BM was, how well they ambulate or if their grandfather is still alive. You can always look in their chart for answers to those questions that are not important to an ED nurse. Sorry I was too busy saving their life!
This is HILARIOUS! I have worked 13 years as an ER RN. Yes at times we appear as we know nothing BUT our purpose is to stabilize. IF we had all of the answers, we would not be admitting the patient. We chart by exception. We have a physician who screens each patient in detail. If we did so many details in ER, we would have ambulances backed up like McDonalds. Keep on moving!
Amen
So you know literally nothing about a patient and their care but think that’s ok. Cool 😂
HR in 80s? Hit him with that atropineeeee LOLOLOL "God help us all." OMG. I love the shocked pikachu meme face the ICU rabbit keeps making. Seriously though, ED nurses are badass. I don't know how they run the shit show downstairs. I floated there to watch the holds once and it was wild.
In defense of all the nursing sign outs I've witnessed, it is more like, "pt is being admitted to icu for hypoglycemia." "What is his sugar?" "120" "that's not hypoglycemic" "I realize that, he presented with a glucose of 27, treated with d50, with repeat glucose 97, but fell to 45, treated with another d50, glucagon, and started on d10 drip. To avoid hypoglycemia. No history is available, because the patient is confused, and can't relay any history, with unknown baseline. CT head negative, septic workup unremarkable, including LP. He needs to be in the icu for persistant hypoglycemia, and AMS"
"What are his other medical problems""He doesn't know, and has no past visits""Did he have an Id on him?""Yes, that's how we got his name""Did you look up his name in the white pages to talk to a family member and get more history""...you mean so you don't have to?...No, we were focused on saving his life, and we have a cardiac arrest showing up in 7 minutes, with no free beds. We decided to leave you something to do""Does he smoke or drink?""I don't know, but probably given he was found on the side of the road and smells like marijuana""Tell me how he got on the side of the road""This may surprise you, but it is not my job to take your history for you and relay it in bullet point format so you don't have to sign off facebook.""I just want a proper history""When you develop a device to read the minds of altered patients, and magically obtain information that has no bearing on his immediate clinical presentation let me know, in the mean time, I will give you the pertinant info available at the time, and you will have to actually do your own assessment, and talk to family when the case manager you have tracks them down for you""You don't do assessments?""We do assessments based on limited information, focused on the patients immediate problems. Tracking down unknown family to see if the patient is a smoker was not our priority as we were saving his life, and treating his emergent condition, not to mention the perforated bowel in the next room, and preparing for the cardiac arrest that is now here.""Whatever, I guess we will just do a proper evaluation when he comes to our unit""Yeah, enjoy your 2:1, meanwhile, I will be doing my inadequate, life saving assessments on the other 5 new patients I have"
Erik Castleberg PREACH!
I used to get so pissed at the ER for their reports, until I started getting floated to ED Holds. Now I'm one of their favorites to give report to, "Where's the IV? Are they mobile? K cool I read the chart see you in a minute."
I forgot my Accucheck code hahahaha
I have been an ICU nurse for 10 yrs, job shared with the ER for 3 of those....the outgoing RN should have called report, obviously! Berating the nurse 'covering' the pt serves no purpose!! He/she had no clue what they were getting into! The previous nurse should have given full report to the ICU chg if this occurred during shift change!
This is hilarious as I do both ICU and ER. both sides have their reasons.
ER nurse from last shift should have given report before they went home, it’s just the nice thing to do lol.
They probably tried 3 times and were told that they were busy or that it was shift change and they couldn't take report lol
They most likely tried 3 or 4 times but the ICU was "too busy" to take report!
Sai Baba, basically, if I understand your response, you are confirming the cartoon video! Sounds to me like the "E.R." Is basically a first stop where (if busy) it is a "meet and greet" before a patient is sent on to ICU! I know for a fact that this is not true in all hospitals. I had a heart attack at 40, when the ambulance got to the hospital, an E.R. Nurse was with me non-stop for 10 to 12 hours! I don't remember her leaving for a break, restroom or otherwise. I would just like to say God bless each and every nurse for their efforts. Their knowledge and actions, along with their compassion and caring for their patient is as important if not more important than the doctor. I think even a doctor would be potentially worthless if not for the nurses performing their duties to compliment the doctor's assessment of the patient's status and needs. A very "heartfelt" THANK YOU to ALL Nurses for all you do! Most of which is not acknowledged or truly valued by patients, doctors, and even other Nurses!
LOVE all the support ED nurses are getting. damn straight. y'all WISH you could handle what we handle
"Any likeness to real life people, situations, or scenarios are unintentional," - absolutely NO likeness to ANY real life ER nurse, ever!!
Burn nurses receive patients directly to the unit in a burn trauma bay and remain that patient's nurse throughout the remainder of their shift. They stabilize in the trauma bay and stay with the patient as they move to an ICU-capable bed in the burn unit where they continue to provide critical care in the patient's room. This includes patients of all ages (newborn to 100+) at all acuity levels (pediatric ICU level to adult ICU and everything in between). Maybe some type of hybrid ED/ICU collaboration would help staff on both units AND increase patient outcomes. For as much as we think we know, we in medicine still have a lot to learn.
I've lived this scenario several times throughout the years....This had me in tears I was laughing so hard. I've worked both the ER and ICU's. Having worked both sides I can see both sides of this.....truly is funny
I swear this is 80% accurate lol
My God, people take these videos way too seriously. They are made to be comical. I'm sure that some idiotic nurses just like this one exist but people need to relax. Geez..
"Are you even a nurse?" LOOOOOOL, jesus christ every time I get report from the ED.
I am an ER nurse and I love this. ICU nurses have 2 patients a shift we have 30. cry me a river
Trauma ER nurses generally only have 1 trauma patient, high acuity ED nurses generally only have 2. General admission ED nurses take up to 3-5 depending on the acuity and the discharge status of the patient. Now cry me a river.... rolling my eyes.....
Lenny Mastiff not true. In Detroit, I've run 2 trauma's at the same time and on the unit in the ED have had ended up to 40 pts. at the end of the night that i've provided care to myself. We generally tend to be really short staffed, ICUs are kept better staffed than the ED.
TheeCocoaJoJo wow, you Sinai-grace too!! (i'm guessing) what a nightmare
exactly - they have no idea - always bitching about getting another patient - they have cap - we don't!
ER nurse here, I take usually 4 pts at once, 1 high acuity pt if they come in. Somtimes if we are understaffed we get 5:1. Loved the video ! Should make one for a intubated pt and have the ICU nurse ask the vent settings lmao "I'm not the resp therapist,, o2 is at 9*% right now while being ventilated"
FWIW the ER doctor makes the decision to admit AND another doctor accepts the patient and where they go. Not the nurses job!
I'm not a Nurse, but if his sugar is that screwed up he needs a beer
Then you would drop his sugar lower.
Oh my gosh!!!!!! It's sooooo funny lol I've been worked in both ICU and ER over 2-3years. they both are telling the truth...... so it was world wide. I see now..
I'm not even in any medically related profession and this is still hilarious...
Someone's obviously never worked in the ER lol....
Ethan exactly.
This is a PARODY guys. And it's funny lol.
I hate when I get report and they say "I just started 10 minutes ago, and I'm calling report." What happens to the other nurses that KNOW the patient is being admitted, usually for several HOURS beforehand? I've stayed after shift to make sure I handoff to the ICU if I'm transferring from the floor, because the shittiest thing I could do for the patient is to allow them to be a secondhand or thirdhand report that puts them in danger of not being treated efficiently during handoff.
I get it, the ER is busy, but seriously, do right by your patients. I had a patient being admitted for chest pain with a glucose of 600 that when I asked if it had been treated was told "We only treat what they came in for." But if they go into DKA on MY floor because you didn't bother treating a simple thing like a blood glucose and transferred a potentially unstable patient, I have to clean up YOUR mess, and suddenly their damn chest pain becomes secondary because you couldn't use your critical thinking skills to anticipate a secondary problem? Not. Cool.
Many times a patient will get a bed after the primary nurse has gone home. There is no way someone is going to wait for a bed to become available for their patient when they could be going home instead. Maybe in a perfect world.
MissLilRedRooster in a perfect world, if a patient in the ED has a ready bed upstairs 20 minutes before shift change, you would be able to call and give report. the problem is in that time frame the ER gets tons of ready beds upstairs, but no nurses can get reach a floor nurse to give report to that close to shift change. So the original nurse goes home, and the nurse taking over has to call report.
I don't know how I ended up here, but I'm not a nurse or anything related. Interesting to see inside another profession. Thank you to all of you nurses who take care of us when we are vulnerable (or worse)!
This is clearly made by a salty ICU nurse lol
It's not the ICU RN's position to be making the decision to accept the patient. If they are being sent to the ICU, the ER MD and the Intensivist have already discussed the patient and the Intensivist accepted, not the RN's position. Just take the damn report.
this is my hospital I swear. its hilarious. as long as you can laugh at yourself and your situation sometimes. SO accurate
I have no idea how anyone learns anything from this. I can't get past the hilarious monotone.
"His sugar was 17" ROFLMAO.
This entire scenario is BS. Worked ICU 10 years and ER 3. Does NOT happen. Both nurses would be fired for incompetence and abusive behavior. Not even funny. This can only do harm to people who need to go to ER/ICU. This is NOT appreciated.
lol, "God help us all" and " Are you even a nurse?" had me rolling.
"He had a seizure"
"A seizure? When?"
"Here in the Emergency Room"
"Ok, that's the correct answer, had I asked you where he at it"
Lmao
It happens when the charge nurse is asking to give report b/c they need the room.
It’s the old joke of ICU is OCD and ER is ADHD. It might be exaggerated, but yeah, I’ve gotten ER reports like that.
Patient on an insulin gtt and no blood sugar checks for 8 hours, pt on heparin gtt and the nurse has no idea why, potassium of 2 and having runs of vtach and no K+ given. After working 23 years as a nurse, I’ve seen a lot of incompetence.
But sorry, this is funny. It’s meant to be a joke. In real life. I hope we give each other grace. Nursing is a hard job. We all have days where we are too busy to be the nurse we want to be.
THAT.. was enter-freakin-tainment
I think the bottom line here...and I was an L&D nurse for 24 years and received reports like this a lot...from ED nurses, is that scenarios like this happen either unintentionally or intentionally (for a lot of reasons). I know you are busy, but find out who this patient is by at least talking with them or someone in their family. It takes a few very important moments to save a lot of time in the long run, and maybe a life. The point is that communication is a major reason for poor outcomes. Don't take personally what is going on here. Take time to reflect on how you communicate with each other, with other departments, with other disciplines and fix what doesn't work and improve what does work. There is ALWAYS room for improvement!!
Every time I see this I laugh out loud! Still funny after all these years!
I hate when I have to repeat "I just walked in ten minutes ago". It drives me crazy! Seriously, I walked in and was asked to do this, I haven't had time to do anything else yet!
You get report, so basic information should be passed along to you. This has happened to me I don't know how many times. "I just got here and haven't seen the patient yet, can I bring them up?" Uh, no you can't because while I can deal with an unstable patient, I'm not going to look like the moron that doesn't know anything when the physician is in the room asking me questions, because there is no excuse to "I just got the patient from ED so I don't know what happened between here and ED"
ER nurse to ICU nurse. "Patient came in with hyponatremia" his vs are 116/58 hr 97 rr 28 temp 97.1"
ICU nurse " what was it?" ER nurse "what was what?"
ICU nurse" ???? HE came in with hyponatremia ,what was the level?"
ER nurse" hyponatremia means "low sodium"
ICU nurse" I know what " hyponatremia" means ! I want to know what was the number value the lab gave you!
What did you give him? What was the follow up result?!!
ER nurse." We gave him IV fluids and now we are transferring the patient to ICU "
ICU nurse was reprimanded for " badgering" ER nurse
This must be an exaggeration. ICU and ER are two VERY different entities. And for good reasons. ER has different priorities, focus, tasks, and concerns. Our focus is to stabilize the current system of complaint. And other systems that may be CRITICALLY affected. Then either discharge or admit for further treatment. That further treatment includes minor system issues not addressed by ER. I have never worked floor or ICU. But I have worked with many nurses who have worked ICU and ER. Every single one of them have admitted they have a better understanding after being in ER. And they no longer judge. Many of them can't do ER and return to ICU. I don't think I could handle ICU myself. Respect the differences.
I've worked in wards where this has been my handover from an ER nurse. I'm also now an ER nurse and I still find this hilarious! There is always one person you know who says 'Meh they are moving to XXX ward" during handover. It happens. It's comical - laughed my ass off! And I don't feel offended as this clearly doesn't apply to everyone!
Ha ha! I've been both an ER and ICU nurse. Yup, nailed it! LOLOLOLOL!
YES!! So true. Work ICU, ER, and PCU. This is WAY too accurate!! Love it!
Okay, this is frightening and hilarious.
wow really? how stupid are those ER nurses in your hospital? do not stereotype all ER nurses!
Lol, I love how ICU nurses act like they are stooping to the ED nurse's level to receive report. Good lord, they come in as an unknown entity with no diagnosis, are lined, tubed, and scanned by the ED nurse, and sent up within a half an hour of receiving the admission orders (not to mention while having to do the STAT orders first!). I bet a lot of ICU nurses would cry if they had to deal with the workload. And then they have the gall to complain. Get over it, the rest of it (the cleaning, bathing, and labeling your lines) is your job!
mssymarie you would cry if you er nurses actually took care of the patient.
mssymarie meanwhile where I've worked almost every pt comes up from the ED having received maybe 1-3 meds with several meds ordered to be given in the ED a couple of hours prior, but of course either were not given or not scanned. If it isn't documented it didn't happen. Problem is, maybe not all facilities but the ones I have worked in, ED orders are not valid on the floor. So, that heparin, lovenox, pain med, etc that wasn't given hours ago is never given until their attending actually puts in orders and realizes that they were never administered in the ED. Amazing when a pt comes up with pain of an 8 and wasn't given their one time does of morphine 2 hours ago. I get it the ED is rough, and busy. We understand you don't have time to change out field iv sites, or place ivs anywhere but in the AC. This video is meant to be comical. Heck I've laughed at the vids making fun of nurses from a doctors point of view. It's humor. However, ED nurses are still nurses. They're still supposed to assess and take care of patients. They definitely need to administer the medications that they are ordered to. They sure as hell need to know the pt before they call report to try and pass on their train wreck. You might be busy, but guess what icu and floor nurses don't have three extra hours to figure out and fix hot messes coming up from the ED. We like to go home on time also and not be stuck charting two hours late. That said I work at a level 1 trauma now and they seem to do a good job when it comes to pt care down in the ED. I imagine it is therefore possible to do the same at a level 2 trauma center.
Some of you need to grow a sense of humor... this is intended to be funny people geez! I've heard this kinda report sooo many times that's why I'm dying laughing here!! I really needed a laugh today!
Hilarious...nursing bloopers!😅
That’s so skewed towards icu, sorry you didn’t get much of a report but how many patients do you see and discharge? Icu doesn’t even discharge to home, they just send them to tele or a step down. Y’all have the same patient for 1-5 shifts and we see different ones and we’re always short in staff? We do focused assessments, if you guys did such a good job, they wouldn’t be here next week so cheers to your great fabulous work 🥂
Exactly bro. I have 2 icu patients at once, alone with 2 others that need a line and meds and have the charge asking me to give report. Then I have to hear the icu nurse ask me 1000 questions she already knows the answer to and has sat there for over 10 minutes studying the pts chart she’s gonna get
It’s supposed to be a joke….
Facts
A hasty generalization, yeah, but I have gotten report like this from all kinds of units. I like how this parodies an ER nurse siting on the patient until shift change. Seems to happen a lot where I work.
no, not necessarily, we also do an accucheck, obtain hx, do a primary and secondary survey, ect. Remember, often times we don't have family or even a name to go along with an "unresponsive" patient so you can't always get a history. Many other disease processes can alter pupil size and reactivity and (obviously) many processes can cause unresponsiveness. But it's commonly administered after the ABCDE's are assessed and found intact. It's cheap, fast and effective.
While this is exaggerated, a lot is on point. I have been a nurse for 5 years and love my job, but nothing makes you more frustrated than lack of attention to patient care. Regardless of the unit, there will always be crappy nurses; and every nurse has bad days. But we should also be able to laugh at ourselves. If this video is offensive to you, it's because you find truth in it. Lighten up.
I know for a fact that in my local ER the nurses aren't always the one's giving report.
This is most of my nights!!! So crazy!! Thanks for the great laugh!! So sad that this video is so much like our reports from ER nurses.. wow!
Yeah they do check history, pupils and such but pushing narcan is a quick and easy way to find out if a patient has OD'd on opiods (which is VERY common, at least in the Seattle area where I practice as an ICU RN).
Omg this is funny as hell 😭
As a former ICU nurse, I can honestly say "been there, done that."
LMAO So untrue! We are very skilled in the ER I am proud to say!
taylor8282 n
This is the most one-sided shit I've ever seen lol. My God go work in a level I ER for 1 shift and tell me how it goes. ER Nurses are not dumb as rocks like this video portrays. They are actually the most quick-thinking, resilient group of nurses youll ever meet. Organized chaos is our home. You walk in sometimes and your starting off with 20 patients on your team. The shift before tried to give report for 3 hours and now your trying to give report on someone you just met while the other 19 patients want your help and attention. I worked in-patient in the ICU step-down for years before coming down to the ED and it's an entirely different universe. Most people wouldn't survive the emergency room environment and are used to working in their little bubble of a unit. I respect all specialties. Most of the patients wouldn't make it to the ICU if we didn't stabilize them back from the verge of death when they first arrived.
You're very correct.
As and ICU RN, I could have completely written this!
I almost choked from laughing! It's 101% almost true from all the hospitals I've worked.
As an ICU nurse even I must say this video is hillarious. The nursing rivalry is like army vs navy vs airforce. We all are needed. Great Video!!!!
Omg so true! I worked ER before there are NO excuses to not know your patients. They ARE nurses too right?
"I don't know, I don't know this patient, I just came on shift 10 minutes ago..." THANK YOU!!! THANK YOU, this is what I hear from the ER RN every freaking time I get report from them! LOL. But that said, I do have respect for ER RNs they deal with all kinds of crap from patients and (most of the time depsite changing shift every 10 minutes), they get them up to us, relativelyclean and with a good IV, and ready for us to take over... I guess each department has their strengths and weaknesses.
As a lifelong emergency nurse, married to an intensive care nurse, I am offended and insulted by this ridiculous and one-sided piece of trash. I could quote a hundred stories of ICU nurses arguing over who will accept a patient... and have had several "codes" while waiting for the arguments to stop! No nurse I have worked with would ever have a conversation like this... if they wanted to keep their job! I call BS on this piece of one-sided fluff.
Agreed Michael O'Shea. I agree with your assessment. I don't find these "movies" funny. They are offensive.
ER nurse here. First off i will start by saying that there are incompetent ICU and incompetent ER nurses. They don't represent the majority. Both ER and ICU are the most critical areas for patients and we should respect the fact that we take care of the same patients but focus on different things. A blood sugar of 600 is critical and I can only laugh at such an inflated parody. Our goal is to keep the patient alive and we construct our priorities with that in mind. We attempt solve most of the puzzle which requires rapid and focused assessments. They are definitely not as detailed as the ICU, but they give us the information we need. Sometimes we have to start solving the mystery based on little information and provide that initial intervention to save the patient or keep them alive. You think 4 IV lines, an NG tube, a foley, pt being intubated, all antibiotics given, all labs done (by the nurses mind you) pt on two drips stable and effectively sedated would be enough for some ICU nurses, but its not and thats what can frustrate us ER nurses at times. The ICU nurse has to continue that process, but since we have done a good amount of the solving their focus is on what they will have to do to keep the patient alive and get them better and hopefully home. In the ICU they can be as detailed as they want with 2:1 patient ratio, many of which they already know because they are on the unit for a while. All those answers aren't going to come from a 2 minute report. But hopefully the ICU nurse will get an accurate picture of what she can expect from the ER nurses view. Again that might mean we don't address some of the things you take as priority. Like vent settings. lol. And in reality it's ok to ask whatever questions you want. We just might not know some the answers cuz we aren't focusing on exactly the same thing.
Not true. I'm a level one ER trauma nurse and I know more about the patients and when I walk up to the unit am usually helping the icu nurses. They basically just need to do their assessments and give next round of meds when mine finish. I'm usually In icu calling the nurses who are texting to get help to come to the room
And set their patients up and ask what else I can do before I go. Never a complaint. Thanks for trying to make the ones who stabilize the patient look dumb?
Dead is stable...
You are right Rana. The other thing is that the nurses don't want to take report. So, that is one reason why the other nurse will leave. We get tired of waiting on them to take report. They don't want the patient's and cry because they are receiving an admission. Ask you questions that you have already answered because they were not paying attention or ask questions before you could complete your report. I don't know what ER that is, but not in the ER that I worked in.
They'd be working in mg/dl, not mmol/L. Rough conversion: divide mg/dl by 18 (or multiply mmol/L by 18). So 17-25 mg/dl equals about 0.94 - 1.4 mmol/L.
btw did anyone else notice the conflicting statements by ER nurse? "did you get the sheet I faxed a while ago?" then says he came on 10 min ago. says patient is awake now, then says he walked past and he was asleep? Oops. what the hell kind of operation are you running down there? Are you even a nurse? Id rather die in the ambulance on the way here" hahaha
LMAO. "So we gave him the Narcan to see if it would wake him up."..........."Lemme guess, it didn't!" ahaha
OMG so " I just came on and I don't know the patient" I assumed that was universal. as a ICCU nurse who used to float to ER back in the day I understand bother sides of the story. But that line still makes me laugh
I know some nurses sit on patients, but usually it's the floor nurse that doesn't discharge their patient till the end of their shift, therefore the bed doesn't become available to the ER patient until then. what's up with that?
I am a long time ICU RN. I cant say anymore.
HAHAHAHAHAHA!!!! JC! Just what the hell kinda operation do you run down there!
That's pretty funny. The narcan.....a shot in the dark....I get that. But atropine for an normal heart rate right smack in the mean, gotta love that one! As an ICU nurse who has been floating to ER a good bit lately, I'm beginning to understand why ER reports are sometimes a bit sketchy (in lieu of lack of knowledge) and here's why: "During report, the more you tell said receiving unit about the pt, the more they fuck with you and try to find reasons not to take the pt"
I am a registered nurse. I work in the ICU and ER. This is fucking hysterical.
God bless those poor ventilator patients that are fighting and biting plastic. Heres to sedatives and pain meds.
@MsEDRN Thank you! And might I add that all of this is done while juggling multiple NEW patients from scratch! Sheesh.
I think this is hilarious! The ED and ICU RN are polar opposites. Truth is, we all just need to appreciate the different worlds we work in and not see each other as the enemy.
Totally agree. Nurses are supposed to be compassionate and caring, not bickering over which specialty does or doesn't suck. Get back to your patients!
LOOOOOOOOOL "are you even a nurse"
well at least they're both representing male nurses...lol
This happens to our ER a lot. I honestly have no idea how busy they are, or how their dept works. What puzzles me though is that they seemed to be very lost (at least where I work). They would give us a report patient sats 100%room air, then come up on the unit dyspneic, 86% sat on non rebreather. A patient that is ambulatory but with extremity contractions and total care. Hgb critical value with orders of blood, non was given since am, and troponins trending high without cardiology consult notified 😱 I don't hate them. But I advocated that they have floor experience first before going to ER. Most of them are new grads. One should establish a routine first, get the feel on how patient management is different from nursing school then go to a specialty floor. Crazy that they are allowing that with no proper preceptorship programs.. ER, ICU or MS nurses, we rock.. 😄
I worked on the MS floor and ICU prior to ER experience. The problem is less staff and higher acuity/census. I have a grip on what is happening on each of my patients when I work. Remember there is no control in the ER. Ambulances, CP, CVAs...etc come all at once. We are multi-tasking people. I get sick of nurses stating, "I didn't know I was getting an admission". Well I didn't know that I would have an acute MI or Trauma come in the door. The purpose of the ER is not to be so detailed. We trust your expertise for the continuity of care!
Synergy Sarey Well said. In my experience, it's blatantly obvious much of the nursing staff is ignorant of what other departments do- their policies, goals, and guidelines. Perhaps some of the griping lazy floor staff should ask some of these questions to the ER physicians or their own charge nurse. Stop bitching and having an attitude and do your job.
I'm an ER nurse and I've actually heard an idiot co-worker giving report such as this! However, it's not one sided! An ICU nurse asked me one night how to start an IV! And she was not a new grad! This was HILARIOUS!!!
And I thought nurses were mature professional adults. Not disrespectfully tacky like what this portrays.
So two nurses have a pissing match. Instead of taking care of business. I feel safe now.
@rebe12354 Wow, sorry, I thought this video was for ICU nurse vs ER nurse, not floor nurse vs ER nurse. if you work at a hospital who's ICU RN "floor RN" 7 to 8 each, it's either not ICU or not safe. My guess is that you are neither ICU nor ER. Sorry for the misunderstanding.
That was very skewed towards to icu nurse. Not a good representation of the er!!
I agree 100%. Some ICU nurses would shit themselves if they had to deal with some of the things that come in off the street like we do.
hahaha, I was getting report on a med/surg floor and received a similar report and I went into the pt's room and they were dilusional, flailing all over their bed, so I checked their blood sugar - 40!!! D50 works great!!! lol
I have to agree with @lindsycollins1 simply because her opening statement mentions she is BOTH an ER and ICU nurse. She has experience in both departments. I am sure those things you mentioned (medical mysteries) she has also experienced... Maybe even in both departments. She's clearly stating working in both departments that ICU is a breeze for her. Why argue?
Sadly this is very true of many major hospitals, but most of the stupid decisions are not made by the nurses but the IMR doctors, who couldn't tell the difference between indegestion and a MI
This made me laugh. The video is great. Don't know why there are so many nasty comments though. This video is a JOKE. Nurses in many areas work hard. It is just a different kind of work. Stop the dumb pointless competition of arguing about who works hardest. It's just dumb.
Im sorry but by "His heart rate went from 100 to 80, so we gave him atropine" "why would you do that???" I was dying in stitches. That was my exact thought before he asked "why would you do that??". Its true, the ER does a lot of un-necessary interventions (and a lack of other assessments) but like others have said, they are given scratch and have to try ANYTHING they can!
hey I got this same report last night haha
wow all crap I have been told by nurses... i hope i've never been guilty of this crap
This is SO true!!! LOL!!!
are you serious? who do you think you are?
ElizabethR1558 it's 100% accurate