Quote from Warningsign
One thing I do is I really do thorough work ups and I have overheard that some of the nurses feel what I do is over the top (ie too many tests).
What does your attending say when you discuss these cases? Are you being told that what you are doing is appropriate?
It is not appropriate for the ER to work up chronic issues. We rule out life threats. (Yes, we know that we are used as primary care, but work with me here. You know what I am saying.) I love my providers who treat and street - appropriately. This takes experience. Some patients appear toxic from the get-go, and they are almost easier because you know they are sick. The more subtle ones are scary.
Pet peeve: the add-ons. If you're going to do a workup, do it up front. Don't get two hours into the visit and add on a whole new slate of labs. Caveat: if earlier results necessitate more stuff, that's a different story. I'm talking about those "hmmm, maybe I should have ordered this earlier" things.
I can see why nurses are frustrated, such as your example with the woman with back pain. She couldn't
walk, or wouldn't
walk? Not the same thing. And why are we just finding out about this lack of mobility at discharge time? Did she walk in? How did she arrive? That's on the nurses, too - if someone has a condition that interferes with mobility, I am going to assess their mobility! But anything that delays discharge has a domino effect in the ED because you know there are already plans for that bed.
I love my ER PAs. I have worked with some that are AMAZING. Like I want to get them for a sick-sick patient before I would pull certain physicians in. I can empathize - you have a tough job. You have a lot of responsibility. You don't want to miss anything. I think time and experience are going to be your best friends. Thank you for doing what you do, and thank you for caring enough to ask!