ER Care or lack of

dewp_63 · May 23, 2003

Sorry to hear about your tough night. I work in a small (10-15 bed, depending on who you ask) ER, and understand your frustration. A lot of what goes on after you get to a bed is dependent on how the MD works. We have some that will order all kinds of labs, IV's and meds before seeing the patient, and others who want to work through each patient at a time, and gets very upset if we try to get him to multi-task. The nurses' confidence and working relationship with the MD's will also affect your stay. I feel comfortable with some of the docs to ask for appropriate treatment (IV, labs, meds, etc), while others are not so receptive... Although I hate for anyone to get a complaint letter, I know that I'm more on my toes after someone complains - so I suggest letting someone in administration (either ER or hosp) know. Please be sure and send compliments (if any) and not just complaints... It's hard to be any nurse these days, with lowered staff/patient ratios and sicker patients. We are the only area in the hospital who cannot stop patients from coming in - and many of the ones who consume the most time are people who abuse the ER for minor/clinic complaints...

Guess the bottom line is: 1.) please let someone know. Maybe it's the doc and not the nurses....

2.)remember nurses are human too... :rolleyes:

jadednurse · May 23, 2003

I suppose one could argue that the ER doc may have wanted to assess her fully before anything was prescribed for pain or that there were more critical patients that obviously needed more immediate attention, however I don't think that either of these situations should preclude the nurse(s) from at least acknowledging mom's/patient's concerns.

I've found that even though, as a nurse, my hands may be tied b/c of a physician's style of treatment or b/c of circumstance, some good old fashioned listening and compassion can help w/ a frustrating situation for patients and their families. A little empathy can go a long way...

kiwideb · May 23, 2003

Sorry to hear you and your daughter had to experience that. I would definately write to the hospital ED and voice your concerns. The more incident reports and 'concerns' from patients alike 'should' help influence poor staffing levels and provide 'concrete' evidence that more staff is needed. Otherwise (and what usually happens) there is just lots of dissatisfaction amoungst the nurses and patients that is voiced between themselves which really has no influence on any possible changes that could be made. (however unlikely!)

Also, your daughters UTI should be followed up as she may run into urinary reflex problems which left untreated, may result in the kidney's becoming scarred and perhaps damaged. Not sure how they are treated where you are, but any child that presents with a UTI in New Zealand is followed up with further tests to determine whether there is or will be any ongoing problems.

Good luck :)

CCL"Babe", BSN, RN · May 23, 2003

Frustration about situations like your daughters is why I left ER. The comments about DR's style could be the reason your ER visit was so bad. I know a few creeps that run their shifts that way.

Write a letter to administration.

But agree that ERs are VERY tough places to work today. I still get pulled down there. I still have nightmares about not being able to give adequate care.

Hope you daughter is feeling better soon.

neneRN, BSN, RN · May 24, 2003

I'm sorry you had such a bad experience in the ER, that being said, maybe I can shed a little light on why these things happen. I'm not trying to justify poor nursing care, but with the nursing shortage and overcrowding of ERs, I see situations like this everyday.

First of all, as you said "during wait of 2.5 hours before seeing doc only offered Tylenol," well, without a doctor's order for meds, there is nothing else the nurse could have offered. And this is assuming there was a protocol in place TO give the Tylenol. At my facility, NO meds can be given before the doc sees the pt, period. Secondly, concerning the 2.5 hour wait-yes, that is a very long time, especially when a pt is so miserable. But unfortunately, every time a pt comes in with chest pain, SOB, etc, cases like your daughter's have to be pushed back to make potentially life threatening cases priority. It may seem like these more acute patients are infrequent, but in actuality, a good 50% of the pts I see are chest pains.

Regarding the pain meds after the doc's eval that were either not ordered or not given; if pain meds were ordered and not given promptly to your daughter, then yes, that is bad nursing care. However, some doctors do get caught up in "finding the problem" and neglect treating the symptoms- then it falls to the nurse to hunt the doctor down to get further orders. Not always an easy task in a busy ER.

Regarding requests for BR, to see nurse, etc. Sadly, when we are so busy, these requests must fall low on the list of priorities. For example, say pt A needs to use the bathroom. Now picture that you are caring for 5 pts total in the ER- pt B is having active CP and needs NTG, pt C is diabetic and feels "shakey", pt D is arriving to ambulance and needs to be triaged, and pt E has an empty IV bag. Now seeing the whole picture of these pt needs, how long do you think it will be before I can help pt A to the BR? This scenerio may seem exaggerated, but I can assure you it is not. This is how it is in a busy ER. Please don't think that I am minimizing your concerns, that's not my intention. Because you have every right to be angry about your daughter's treatment. I would be livid if it was my daughter.

I just feel the need to defend ER nurses because I am one. I run all day long, but it is rare that I can meet ALL of my pt's needs promptly. The cause is understaffed, overcrowded ERs with poor pt/nurse ratios, bottom line. And I'm sure that there are some nurses who give poor care, or simply don't care; but these are the minority- the rest of us are trying our hardest to give the best care we can.

Kayzee · May 24, 2003

Thank all of you who responded. I realize it is very busy, and nurs. is multi tasking. Why can't they do anything about staffing levels? This would surely help with pt care. Wish all of you the best and keep up the good work.

happystudent, RN · May 24, 2003

Originally posted by neneRN
I'm sorry you had such a bad experience in the ER, that being said, maybe I can shed a little light on why these things happen. I'm not trying to justify poor nursing care, but with the nursing shortage and overcrowding of ERs, I see situations like this everyday.
First of all, as you said "during wait of 2.5 hours before seeing doc only offered Tylenol," well, without a doctor's order for meds, there is nothing else the nurse could have offered. And this is assuming there was a protocol in place TO give the Tylenol. At my facility, NO meds can be given before the doc sees the pt, period. Secondly, concerning the 2.5 hour wait-yes, that is a very long time, especially when a pt is so miserable. But unfortunately, every time a pt comes in with chest pain, SOB, etc, cases like your daughter's have to be pushed back to make potentially life threatening cases priority. It may seem like these more acute patients are infrequent, but in actuality, a good 50% of the pts I see are chest pains.
Regarding the pain meds after the doc's eval that were either not ordered or not given; if pain meds were ordered and not given promptly to your daughter, then yes, that is bad nursing care. However, some doctors do get caught up in "finding the problem" and neglect treating the symptoms- then it falls to the nurse to hunt the doctor down to get further orders. Not always an easy task in a busy ER.
Regarding requests for BR, to see nurse, etc. Sadly, when we are so busy, these requests must fall low on the list of priorities. For example, say pt A needs to use the bathroom. Now picture that you are caring for 5 pts total in the ER- pt B is having active CP and needs NTG, pt C is diabetic and feels "shakey", pt D is arriving to ambulance and needs to be triaged, and pt E has an empty IV bag. Now seeing the whole picture of these pt needs, how long do you think it will be before I can help pt A to the BR? This scenerio may seem exaggerated, but I can assure you it is not. This is how it is in a busy ER. Please don't think that I am minimizing your concerns, that's not my intention. Because you have every right to be angry about your daughter's treatment. I would be livid if it was my daughter.
I just feel the need to defend ER nurses because I am one. I run all day long, but it is rare that I can meet ALL of my pt's needs promptly. The cause is understaffed, overcrowded ERs with poor pt/nurse ratios, bottom line. And I'm sure that there are some nurses who give poor care, or simply don't care; but these are the minority- the rest of us are trying our hardest to give the best care we can.

NICELY STATED!!!

fab4fan · May 25, 2003

^5 neneRN...as a fellow ED nurse, I get sooooo tired of being blamed for things I can't control.

ER's a pitifully overcrowded and understaffed; we do the best we can, but someone will always wind up unhappy. Any more, we just try to limit the number of unhappy people we have...making everyone happy is just not possible.

PediERRN · May 25, 2003

Please understand I am not taking sides here and I have worked in both adult and pediatric ERs - some busy some less so. I do like how the one responder "justified" the wait in waiting rooms and ERs. However, I continue to ask, how long are we as ER nurses going to have to continue to justify the poor staffing ratios and other problems plaguing ERs now. The ERs are only going to get busier and busier as it becomes the preferred method of entry into healthcare for so many of our patient populations these days - particularly populations that feel the need to take the easy way out and see someone right away. I get tired of having to justify why I cannot provide the care that I want to, that it has become very disheartening at times.

I will also tell you that right now I work in an urban setting in a pediatric healthcare facility. This facility pays attention to things like nurse patient ratios, customer satisfaction, and staff satisfaction. Unless there is an active code, the nurse patient ratio is never greater than 4:1. Between 1100 and 0300, the nurse patient ratio is typically 3:1. The organization has done a wonderful job at balbancing staff satisfaction, customer satisfaction, and cost efficiency - not just looked at the bottom dollar! That is rare in this day and time.

Sorry to ramble, but I feel that these issues are important. If we all fought to stop justifying, could we make it any better???

cab631 · May 25, 2003

I agree with Nene, I have been a night supervisor and can tell you that a 2.5 hour wait in the ER is good in this day and age. And as long as corporations run medicine, the bottom line is profit, and staffing ratios will not change much. ER docs will be hired from agencies that compete price-wise, and some of them suck. Anytime ANYONE has a problem in the hospital that is not taken care of in a reasonable period of time needs to ask for the Nursing Supervisor ASAP.

fab4fan · May 25, 2003

I didn't really think anyone was "justifying" the conditions in ED's, just trying to add perspective from the ED staff

POV.

You're lucky enough to work in a facility that takes these issues seriously; many of us are not so fortunate. You can't get admin. to listen to you if those issues are not priorities to them...you'll get the standard, "If you don't like it, leave; we can always get another nurse to replace you..."

It's not as simplistic as you make it sound. Until the public demands better care and makes admins. feel it in the pocketbook, there's little that can be done to change things.

Easy to judge others when you're not having to deal with those issues day in, day out.