Does the ED stand for Emergency Department or the Everything Dumpster? - page 5
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
Jan 24, '13Quote from VICEDRNCould it simply be due to the fact that the doctor made his rounds on that day? We have been full of URI's over the past three weeks-one unit had 4 transfers in one day.All LOL's admitted with pneumonia.Doc made rounds on Wednesday-he goes to 3 local LTC's.I'm sure there were other admits -Is that abusing the ER? Most of my co-workers hate to see our folks go to acute care because we know the staffing is just not sufficient to meet their needs.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!
I imagine when you walk into the er you know you are going to be taking care of anyone that comes in-I guess those little old folks just don't give the adrenalin boost that some nurses seem to require.Last edit by ktwlpn on Jan 24, '13
Jan 24, '13Quote from ktwlpnUnfortunately, I think you might be stereotyping. I have been an adrenalin junkie. I actually kind of prefer the easy uncomplicated d/c. For example, fractures, sutures, needs a neb, insulin pump broken, etc. don't really like tons of drama as it is a lot of paper and a lot of scrutiny and patient family face time.Could it simply be due to the fact that the doctor made his rounds on that day? We have been full of URI's over the past three weeks-one unit had 4 transfers in one day.All LOL's admitted with pneumonia.Doc made rounds on Wednesday-he goes to 3 local LTC's.I'm sure there were other admits -Is that abusing the ER? Most of my co-workers hate to see our folks go to acute care because we know the staffing is just not sufficient to meet their needs.
I imagine when you walk into the er you know you are going to be taking care of anyone that comes in-I guess those little old folks just don't give the adrenalin boost that some nurses seem to require.
It isn't from the doctor visiting because the nurse will tell you in report that the doctor didn't evaluate patient in person and amazingly, the patients transferred are always the "problem children".
Again, I think folks need to move away from the idea that we take care of anyone who walks in. We screen for emergencies. It isn't our job to treat people who don't have emergent conditions and we actively turn them away.
Jan 24, '13Quote from VICEDRNYES-seems to be ALOT of that going on,doesn't there?Unfortunately, I think you might be stereotyping. .
Jan 24, '13Quote from ktwlpnI tired to explain it to you in a civil manner and you decided to respond like this. I reported your post to the moderators.YES-seems to be ALOT of that going on,doesn't there?
Jan 24, '13I'm an ER nurse (weekend option) and accepted my very first LTC assignment for PRN agency work just to try it.
I miffed and muffed the DoN when i was required to send a client to the nearest ED for a follow up cxr post abx therapy for PNA. She straight up said to me that it was what the doctor ordered and Medicaid (the patient was a young guy) was the only payer and any other method would require the facility to pick up the tab.
I was so upset and felt horrible for doing that to my ED peers
Jan 24, '13Quote from emtb2rnDisagree with what?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.
LOL with UTI is as exciting and challenging as MVA/gunshot/etc?
My friends don't enjoy trauma, drama, and intensity?
Jan 25, '13We in LTC have tried to explain our policies,procedures and the constraints we face and it seems to have fallen on deaf ears.
Ironically enough I transferred a LOL to the ER this afternoon.We gave her the best supportive care we could for several days,the doc made rounds this afternoon and out she went.I wonder of someone is saying " O here we go again! It's Friday afternoon-someone in the home just wants a break from this one" I hope she is treated with kindness and a little compassion despite the fact that she has dementia and can sometimes be difficult.
Jan 25, '13People are venting here. Just because they vent their frustrations, does not mean they treat people any less or give them horrible care.
I do find it odd that this is an emergency nursing forum, yet so many people come here not in emergency nursing.
Every aspect of nursing has it's own frustrations and stress. I'm sure if I visited a LTC forum, there would be frustrations vented on there. I guess it's safe to think other nursing peeps visit their and complain about how our elders are being vented about.
I was in LTC for years as an LPN, even did years as agency/prn. I'm well aware of the frustrations and stress. That being said, I don't recall ever being able to just call transport to come pick up a difficult patient. Even when we were trying to get a pt into geropsych, we still had to rule out uti, acute illness ect which I'm well aware gets repeated at the hospital.
That being said, I do get frustrated, with my previous experience, when I take a nh report and I can't quite make sense of why they are sending them. In the same breathe, I worked with docs who always said go to ER regardless.. The other doc would order tests and interventions.
Jan 26, '13Quote from woohDarn it, I needed an R word that expressed my feelings. Just replying to this post brings all those feelings back...sigh.Or you could just not use the word. You obviously know that some would birth a bovine by its use, yet your comment was really sooooo important to be offensive anyway?
Jan 26, '13I have been a nurse for a long time. I have worked in the Emergency Room a long time. The last few years......I have become curious as to why the definition of what an emergency department does or does not do has been re-defined. ED's have always been the safety net...the one's open when all else is closed.
I worked in the days before EMTALA and COBRA. I remember hospitals sending patients to other facilities based on the ability to pay. I remember patients coding in the back of ambulances because they were turned away based on ability to lay to pay until a hospital that would take them answered the radio. It wasn't pretty.
Why not treat a dental abscess with antibiotics? I get no narcs.... but antibiotics?
If there were more dentists that kept better hours sure send them there...but they don't AND they won't see you if you don't have cash up front or insurance...so the solution is let them suffer until they need IV antibiotics and can be charged more for revisits. You don't write prescription for HTN so it's best to let them go without because it's not emergent enough until they stroke? Many don't have the up front cash to make the appointment with their PCP. Where do we tell these people to go? So only those who have insurance deserve treatment....I disagree.
While I agree there is a misuse of emergency Departments......like teen girl wanting a "pee test" to see if they are pregnant.....an ambulance ride a hang nail.....cure the abuse of the system. Many who do call their PCP's get the go to the ED line...so when they show up in the ED and the expectation that they were sent there....who's fault is that the trusting patient? or the lazy PCP? To VICEDRN.......I am curious.....Who is doing the MSE at your facility?
I'm all about efficiency but.....Do not punish the vulnerable.
If we are deciding that they don't need the emergency room with an abscessed tooth...where do we send them? Where do these people go when you decide they aren't sick enough to be seen? That they stroke in the parking lot. This all sounds good as well.....until something is missed and you (the collective you) is sued. Someone needs to care for those who slip through the cracks.
Many times the cluster of LTC patients coming at once is because these patients have been sick and the MD just now has made their weekly/monthly rounds...these old people (amongst the most vulnerable of our society) who deserve respect and care are just an annoyance to the ED staff. They actually needed to come days ago.....but the MD just came in now....so they are sent out.....the ED staff is NOT happy...and it shows. That bothers me....A LOT.
I'm all for cutting waste....but not at the cost of good care. I signed up to be a nurse first...the ED just happens to be my area of expertise. I do believe the system is broken and I'm not so sure how to fix it. But I do believe the most vulnerable need our protection and care. It's a complex problem.
Jan 26, '13I'd just like to give a round of applause to ESME! I could not agree more- with every single thing you said.
Jan 26, '13I work LTC. I have a fairly good % of admits to send outs. One that wasn't admitted shouldn't have been sent, but covering doc wouldn't order in house xray. What was i supposed to do? Having worked as a clerk in an ED, I have a clue. Have mentioned to family on a few occasions, "do you want them in the ED for hours, for very little gain, in the middle of the noc".
Jan 26, '13I have been a nurse for many years and have worked in emergency. It is not my job to determine whether or not a patient should seek this level of care. I make my assesment and listen to the doctor. Some days I am bummed out and other days are great. This is not the patients problem. I know from personal experience that er employee prejudice can cause serious illness to go untreated. If you are not interested in treating people with problems you dont recognize or care to treat perhaps you should try working in a surgical hospital without er facilities. Everyone is admitted for surgery and nothing else.