Difficult night, heavy trauma/high acuity... vent/insight - page 2

Hi All, very busy time of year in a level 1 ER. Being summer, huge volumes of tourists = a tough time for all. As per typical, I have changed some scenarios/events to protect privacy. I would... Read More

  1. by   MassED
    Quote from opossum
    These posts sound like my night last week in the ED - I'm a per diem "float" (don't get me started...) who is now cross-training for the ED after doing mostly ICU and Med-Surg. I've been working as a nurse for a little over a year and I always thought I wanted to do ED nursing. Now...I'm not so sure.

    One night last week was just too much for me - we went on ambulance diversion, we were simply packed. Most of the patients in my zone were not critical, just urgent - painful gout attack, broken nose, CP w/normal EKG and troponins....I felt like I was doing damage control the whole night and just got it from both ends. How do we advocate for patients who haven't seen in a doc in 4hrs because there is a cardiac arrest that just came in?

    How do we explain the concept of triage to less-critical patients in the Almighty Customer Service mindset? I just don't think it's possible, and I'm not sure I want to be a part of it anymore
    That's just it. We DO educate on how we triage (or I do, anyway), and when our trauma rooms are full tilt, I tell my patients WHY they are waiting. I explain that there's an emergency that is requiring ALL of our doctors right now, and that is why the wait. Of course, you always get the "how long?" I tell them, that's just it, it's an emergency room, and if an ambulance comes in, or somebody comes in that is emergent, everyone else is bumped. That's just how it works. People may get mad, and they do, but I don't have patience for those that don't understand, even after I have painfully explained in simple terms. Some people never do understand (or want to understand), and it's usually those that have urgent care type complaints who could be seen by their PCP or urgent care and chose not to. I make sure I have AMA or LWOBS forms for them to sign, should they choose, and always explain that to them that they don't have to stay, that they are not being held against their will. Those that are truly sick and need to see a doctor OFTEN (not always, well the family may not be understanding) are the most understanding.
  2. by   Dixielee
    Quoted MassED: You've been in the ED for 38 years? Geeez, I know I won't last that long at this pace. No way. I don't think anyone could. I think for some, leaving the ER would bring a fear of boredom, perhaps? I think, "Boredom? Bring it on!" I can deal with that, so can my feet, my knees, and my BACK. Most of all, my brain and psyche can deal with that. Boredom doesn't lead to burnout, but verbal/physical/emotional abuse, lack of pee breaks and food breaks sure do!!

    I think working ED has actually kept me healthier because I am sure I have been exposed to everything in the book! It is now to the point where I fear for my patient's safety because of the workload and I fear for my own safety because of the increase in violent behavior of patients.

    As far as lunch.....I can't tell you how many meals on the run have consisted of chicken strips and tater tots because they are portable and fit in your pocket!! I know, gross, but you do what you have to

    Best of luck to all of us as we carry on, doing the best we can.