Does the ED stand for Emergency Department or the Everything Dumpster? - pg.4 | allnurses

Does the ED stand for Emergency Department or the Everything Dumpster? - page 4

Why, why, why does it seem like we are the dumping ground for the whole medical community? From primary care providers offices, to nursing homes, to the urgent care it just seems like no one wants to... Read More

  1. Visit  sirI profile page
    3
    One last warning. (note, posts have been removed since last staff redirect)

    Stop the one-on-one attacks and divisive replies.

    Future replies will result in points against member account.

    Final warning.
    JBudd, Nascar nurse, and Esme12 like this.
  2. Visit  ktwlpn profile page
    2
    Obviously if you are in the middle of a code you'll activate EMS first and then call the doc. after the dust settles,that's a no -brainer.IMHO I have just never seen a nurse decide on her own to just send someone out
    Things to know about LTC-most don't have lab or radiology services on site so a stat eval calls for transfer to the ED.
    A resident with late stages of Alzheimer's disease CAN have AMS-we know these people and we KNOW when something is going on and DNR does NOT mean do not treat.We have to deal with family members pushing for what we may consider to be futile care,often you see the results.It's what we do-the plan of care is NOT driven by us.
    Why so much anger at LTC? What about all of the other groups that have gotten stereotyped together and bashed on here over the years? Is the prevailing attitude that these elders don't deserve our resources? How many frequent flying drug seekers were in your ED ruining the day when this LTC resident was dumped ?
    If this crap really is occurring frequently in your local nursing homes it needs to be reported it-it's neglectful and maybe abusive.
    jrwest and wooh like this.
  3. Visit  emtb2rn profile page
    2
    It "feels" like we're being dumped on when the multiple pts from the same nh show up on friday afternoon for ams. And we can't figure out what's different because we don't know them. And there's a list of meds from the doctors orders but no mar.
    VICEDRN and redhead_NURSE98! like this.
  4. Visit  Esme12 profile page
    3
    Quote from nhnursie
    Sorry Disagree with the idea completely..... that we send them out for a break
    I was not referring to anyone in particular. My response is based on YEARS of experience with many different facilities in multiple states....unfortunately the behavior occurs...but is by no means a reflection on NH and nurses who work in nursing homes.

    It is my personal observation...nothing more.
    Susie2310, VICEDRN, and tewdles like this.
  5. Visit  billyboblewis profile page
    3
    The unfortunate thing about er personnel is that they feel they should be able to pick and choose their clients. People go there because they have no where else to go and feel their health is in immediate danger. The er is suppose to have personnel and equipment to figure out what is wrong. Insurance companies put other providers responsible for the cost of ambulances if a client is moblle. They of course cannot afford to pay these fees. if you cannot deal with these things perhaps it is time for you to move out of emergency services and find another specialty. As far as drug seekers, it is unfortunate their physicians did not properly address the problem and that is why they are in emergency. Addicts can get there medicine much easier from a dealer. It is unfortunate that er personnel cannot deal with each patient in as well as possible and move on to the next one. If you are understaffed it is managements fault not the patient.
    Susie2310, DeirdreG, and Nascar nurse like this.
  6. Visit  wildboo profile page
    0
    I'm sorry, but that's just too funny to not say something!
  7. Visit  DeirdreG profile page
    5
    Quote from whichone'spink
    Why, why, why does it seem like we are the dumping ground for the whole medical community? From primary care providers offices, to nursing homes, to the urgent care it just seems like no one wants to be accountable for taking care of patients, so they dump patients in the ED. It's just very frustrating. It's even going to the extreme where nursing homes are sending dying patients by the transport van, instead of by ambulance. Just a couple of days ago, I had a patient that was sent over to the ED from a local nursing home by a local transport service, for altered mental status. Now why was the patient having altered mental status? Because the patient was in third degree heart block. When this patient was hooked up to the cardiac monitor, it showed that the patient's heart rate was nearly asystole. Now why this nursing home chose to send this patient by a transport van instead of by ambulance is beyond me. What if this patient died while in the transport van? The drivers are not even trained in CPR. And apparently this nursing home has sent very sick patients by transport van many times before. This is just a rant, with no particular focus at all. Just frustration with how the medical establishment sees the emergency department as a dumping ground.
    The people that you state are "dumped" are people who who deserve to be cared for. If a nursing home cannot safely care for a patient, they do not have a lot of options. They can "let the person die in place" or "send them to hospital for diagnosis and/ or treatment." Most (thankfully) will opt for sending them. They need your assistance in managing the illness. The nursing home may not have the skills or resources to properly assess and manage the current situation.
    The problem, as I see it, is in the system that does not facilitate appropriate options for diagnostic services for the elderly. When a "new" problem arises (particularly a sudden change), there is no back up plan to manage the person. If they do not send them to the ER, they would be negligent if the person died of something minor and treatable.
    As I see it, the current system expects that the ER's will manage these situations. It is disappointing to read that nurses view certain patients as unworthy of their knowledge and skills. These patients deserve to be treated with dignity.
    Susie2310, NRSKarenRN, tewdles, and 2 others like this.
  8. Visit  tewdles profile page
    2
    Nh patients transported to the ED likely do not provide the same level of excitement, activity, and challenge as say; a big trauma. My friends in ED prefer trauma, drama, and intensity.
    workingharder and morte like this.
  9. Visit  emtb2rn profile page
    5
    Quote from tewdles
    Nh patients transported to the ED likely do not provide the same level of excitement, activity, and challenge as say; a big trauma. My friends in ED prefer trauma, drama, and intensity.
    Disagree. I have no issue working up any pt from anywhere who needs help. I think my real issue with nh pts who seem to come in for no real reason is lazy docs who respond to calls from the ltc rn by saying "send them to the er".

    I understand the ltc staff has no choice when the doc says ship 'em out.
    Esme12, canoehead, VICEDRN, and 2 others like this.
  10. Visit  NurseOnAMotorcycle profile page
    1
    In the last few months:

    Guy came in by ambulance for a 2 inch by 3 inch rash.
    Girl came by ambulance because she poked her thumb with a needle while hand sewing.
    Old lady came from home by ambulance because "My family won't pay attention to me." (This one kind of sad but still...)
    Leg cramp, resolved.
    A cough after drinking "down the wrong way", resolved. (male, 30s)


    Sigh.

    I think this is going to turn into the "Triage complaints-good, bad, ugly" thread.
    VICEDRN likes this.
  11. Visit  Mulan profile page
    0
    Is insomnia an emergency?
  12. Visit  VICEDRN profile page
    0
    Quote from billyboblewis
    The unfortunate thing about er personnel is that they feel they should be able to pick and choose their clients. People go there because they have no where else to go and feel their health is in immediate danger. The er is suppose to have personnel and equipment to figure out what is wrong. Insurance companies put other providers responsible for the cost of ambulances if a client is moblle. They of course cannot afford to pay these fees. if you cannot deal with these things perhaps it is time for you to move out of emergency services and find another specialty. As far as drug seekers, it is unfortunate their physicians did not properly address the problem and that is why they are in emergency. Addicts can get there medicine much easier from a dealer. It is unfortunate that er personnel cannot deal with each patient in as well as possible and move on to the next one. If you are understaffed it is managements fault not the patient.
    Just as a point of education, I do not believe that the role of the emergency room is to identify the cause of any patients complaint and treat it. Rather, it is our job to identify, stabilize emergent conditions and move patients to the appropriate level of care. We would end a lot of frustration if folks would realize that we have no intentions of identifying the condition once we have identified that no emergency tExists and no plan to cure it either. Some examples: we no longer treat dental abscesses with antibiotics unless you need iv antibiotics as this encourages revisits. We do not write scripts for hypertension in our er.We would love to help identify a stroke in you ltc/nursing home patient but if they were acting like this last time and act like it again today, we have nothing to go on.We do in fact pick and choose. It's called medical screening and hospitals are becoming more anymore aggressive about it.
    Last edit by NRSKarenRN on Jan 25, '13 : Reason: fixed quote
  13. Visit  VICEDRN profile page
    1
    Quote from ktwlpn
    Why so much anger at LTC? What about all of the other groups that have gotten stereotyped together and bashed on here over the years? Is the prevailing attitude that these elders don't deserve our resources? How many frequent flying drug seekers were in your ED ruining the day when this LTC resident was dumped ? If this crap really is occurring frequently in your local nursing homes it needs to be reported it-it's neglectful and maybe abusive.
    There were and are very few seekers in our er because we refuse to give them what they want so they go other places that cater to them. I don't think there is a thought that the ltc patients don't deserve emergent care but rather that they don't deserve to be in the er. It is disruptive to them, exposes them to infection and frankly,rarelyq results in an improved outcome for these patients. I agree that we should be reporting some facilities but there isn't much to report when someone dumps five pts on you at once from one place. As for why that causes resentment, well, I signed up to work in the er today, not the ltc. I am sorry you are short staffed ( the ltc that does the dumping of five at once) but we are not volunteering a nurse to you.

    Have a good story: have a friend that works in an er eight blocks up from mine. One day, I got a few ltc patients from this one place and when I was complaining to her about my day in triage, she said she had a similar problem. Same place sent her er a few too! Now don't tell me that's not about abusing the er!
    Believe it or not, we prefer to help the emergent patients!
    scrubsandasmile likes this.


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