Advice - I'll need a meal tray too

wooh, BSN, RN · Mar 16, 2012

NewGoalRN - if you haven't worked in an ED I don't think you can really appreciate how much this grinds you down. You just never see the same concentration of these folks on inpatient floors (because they don't get admitted, because they have no acute medical problems). It can send a gal into existential despair, in my case along the lines of: "Why the **** did I have to get a master's degree to argue about bus tokens all day??"

Instead we just can't ever get rid of the ones that are sick, and the SAME DANG PATIENT wears on us day after day after day because they NEVER go home.... :)

LalaJJB · Mar 16, 2012

In my ER meal trays are only available to patients who are being admitted and who are waiting for rooms. You cannot get a tray from dietary for anyone else. .

BRILLIANT!! You gave me the answer!!! I will start saying "unless you are admitted, I cant get you a meal tray (with a smile of compassion, of course)

If they want to fluff up their symptoms to get themselves an "observation admit" then, shoot, they put in the effort for that meal tray... I am so glad I have a legit answer that cant really be argued!! :yeah:

Vespertinas · Mar 16, 2012

OK, you get one pass.
Next time though ... it won't be pretty.

Welllll...... I realized we're talking about different settings anyway. I am that way because I was raised in [sorta elective] surgery. So every patient who flew in from across the country to get this particular surgeon is truly a "customer". Those Medicare patients- whose courses are straightforward -make good payouts too.

BUT now that I'm in a different setting, I do have to try to learn where the VIP service is appropriate. Thanks for the pass!

Hagabel · Mar 16, 2012

Here in NZ we have tea/coffee bays that are supplied and stocked for pt use and family use. We also have St Johns(our ambo service) volunteers who will get tea/sandwiches for pts that cannot get up. We do not keep our chest pains NPO unless they are really sick or look like a STEMI.

I have discovered if you keep your pts happy and not hungry they are a lot more pleasant and none of us like to be hungry. I will get warm blankets if they need it but we have no tvs in our rooms and stuff is a lot more basic over here, but creature comforts are more important here.

Kids er does have TV etc and we do provide sandwiches/iceblocks for pts, and sometimes I will get water for the breastfeeding mum or a sandwich for the parent who has been up for so many hrs and has no lunch.

I think there are some pts who just take the p@#$ and those, I lay down the law as soon as they come in. I just think it is being courteous both ways.

Double-Helix, BSN, RN · Mar 16, 2012

A bit OT but I wanted to throw this out there. When I had my girls (they were born at two different hospitals) I was told by various nurses and the nurse manager to take the diapers, wipes, cooling pads, and formula every time the cart came in. I questioned it, but was told that if the products/packaging is open then they can't reuse it or bring it in/out from the room. We were told that all of that was billed to the insurance company so since we were paying for it anyway we might as well keep it. I am not sure how true that is, but that is what we were told.

If that's what you were told, then by all means, take the supplies. Our unit doesn't quite work that way. We have a linen storage cart where were keep our diapers and wipes. If a patient runs out, we bring them a new package of wipes. If they run out of diapers, we bring them some. However some of our families will frequently get into the cart when no one is watching and take whole packages of diapers and wipes back to their room and store in the closet until they go home.

Our formula is kept in the cupboards in our kitchen area. They probably should be locked, but because of how frequently they are accessed by our staff, nursing assistants, dietary, etc. they are not. Families will go into the kitchen and remove several packages of the formula to take with them. Or I'll bring in a set of 6 pre made bottles so they can feed their baby for the next four feedings. But the next feeding they are asking for more because they've hidden the bottles away for when they are home.

I'm sure the hospital bills a fee which includes these miscellaneous supplies, but it doesn't account for a stockpile of stuff. Plus, it's really annoying when we have to keep re-ordering diapers and wipes because we are emptied in a day. In the end, that falls back on our PICU's budget, and out nurse manager is not pleased.

guest464345 · Mar 17, 2012

Instead we just can't ever get rid of the ones that are sick, and the SAME DANG PATIENT wears on us day after day after day because they NEVER go home.... :)

oh man Wooh....yep, that's one reason I never ever took a job on inpatient floors (that, plus the fact that being a SW on inpatient units usually means just faxing SNF's and home care agencies all day - blech)

VICEDRN, BSN, RN · Mar 17, 2012

I work in the deep South and I have learned to smile and have an answer for everything. (For the record, I learned these clever answers from my amazing co-workers.) I also take it upon myself to talk to folks who do feed these patients and remind them gently that it creates the wrong expectation for the patient. I know they feel badly for the patient and haven't gotten over their co-dependent tendencies but that doesn't mean they have the right to create that expectation for the patient.

Here are some of my answers:

"I am sorry. All patients in the department are not allowed to eat until they have been cleared by the MD."

"I certainly wouldn't want to bring you anything to eat if it means it might delay surgery that you need. we don't the surgeon to be mad at us, do we??"

"I can't stop your family members from visiting the vending machines if you feel that strongly about it."

"There is a nearby McDonald's."

"The ATM is in the lobby near the information desk."

"We keep our sack lunches, crackers and juice for diabetic patients, fragile people like old ladies and admitted patients who were are responsible for feeding."

"We only get a limited number of lunches so we have to be judicious with them."

"No one cooks at this time of day so there are no trays. So sorry."

"If you don't have money, can someone bring you some? You can use the phone in the lobby to call."

"Unfortunately, budget cuts prevent us from doing that."

"Patients with complaints of abd pain, chest pain, etc can not eat in the department. Sorry."

"Buddhist monks fast for days at a time. I assure you it wont kill you. In fact, they say it gives you a heightened awareness."

"We checked your sugar when we drew your labs and I assure you we would feed you if it was low. Don't worry. We are keeping an eye on you."

[big ole grin]: "I am almost certain you can eat after your discharge and that should be so soon!"

"There's a food pantry/soup kitchen on blah blah blah street if you are really desperate. Should I contact the social worker? (sympathetic face) Can you feed your kids? This sounds concerning. I don't want to think you and your kids aren't eating."

If they don't shut up, I just give them a blunt, "No. I refuse to feed you." Despite my best efforts, some patients will still continue to get fed by er mds and RNs and yes, it makes me feel like a waitress and I despise it. Lectured an MD on my last shift after he initially told the patient to wait for CT results and then changed his mind because "she was waiting so long." Whatever. Her complaint is ear pain and she waited so long because there are SICK people in the house. I also found the RNs that fed her and told them they should have held the line.

LalaJJB · Mar 18, 2012

I work in the deep South and I have learned to smile and have an answer for everything. (For the record, I learned these clever answers from my amazing co-workers.) I also take it upon myself to talk to folks who do feed these patients and remind them gently that it creates the wrong expectation for the patient.
.

I am printing out this post. This is awesome because now i have a little cheat sheet to look at. Thanks sooooooo much!!!!!

allnurses Guide · Mar 18, 2012

VICEDRN :up: Love your post! Very comprehensive! :up:

Editorial Team / Moderator · Mar 18, 2012

We had a patient ask our doc for a meal tray around 2300 one night, and the doc replied to the patient, "What meal occurs at this hour?! I don't think so." HAHAHAHA

Anna Flaxis, BSN, RN · Mar 19, 2012

I love the:

"Mama's gotta eat, she's diabetic."

"Oh, okay. Is she on oral diabetes meds?"

"No..."

"Oh, well then, when was her last insulin?"

"She doesn't take insulin."

"Oh, well, is she feeling low?" Assessment: Mama is alert and oriented and keenly responsive, skin PWD. "Maybe we should check her blood sugar." It's 235. "Wow, it's high. We really shouldn't feed Mama, or it'll spike her sugar even higher. I'll go let the doctor know about that blood sugar."

brillohead, ADN, RN · Mar 19, 2012

We had a patient ask our doc for a meal tray around 2300 one night, and the doc replied to the patient, "What meal occurs at this hour?! I don't think so." HAHAHAHA

Just wait for the smart-aleck who says, "Fourth Meal -- Taco Bell said so!"