ER Pet Peeves

You were very clear. But that doesn't matter anymore. On to more amusing topics.

I have had this!! It requires all my restraint to keep from looking her in the eye and marveling, "Why, how very responsible of you."

Also, people who drive themselves to the ER, check in with their complaints, then don't want us to treat them appropriately. One pt checked in for the 2nd time in 2 days with chest pain. Although all cardiac labs were normal yesterday, we did them again. When she also mentioned that she had been taking Xanax and clonopin EVERY OTHER HOUR since she left the night before, we decided to address that, too, much to her discontent. She kept hitting her call light to ask why we were ignoring her chest pain and "obsessing" over her med misuse. Another pt last night checked in c/o c-spine tenderness following MVA. Not only did she fish out her ringing cell phone from her purse and answer it as I was trying to listen to lung sounds, when I said X ray would be along for her shortly, she whined, "An X ray? Do I have to? I don't want an X ray!"

WHY, WHY, WHY do people come see us if they don't want to do anything we recommend? I long to ask them, "Where is the person who dragged you here at gunpoint against your will?"

It irritates me to ask a pt, "Please take some deep breaths so I can listen to your lungs", pt takes maybe one or two, then resumes conversation while I'm still assessing lungs. Is there a nice way to say, "Please shut up for 2 seconds and breathe so I can do my job"?

Last week I had a couple leave their 6-year-old, a heart transplant recipient, alone in the ER without telling anyone they were leaving. They both returned an hour later and said, "We were so hungry, we had to go to McDonalds" Then they wanted to leave again later to go get nightclothes for themselves b/c mom "just could NOT wear no hospital gown" It was good enough for her daughter, though...

And just one more... the ones with all the special problems that make them different and difficult. Just off the top of my head:
"My veins are horrible. You have to use a butterfly" (Veins look fine to me, perfectly capable of housing a 20g, minimum)
"I'm immunosuppressed. I can't use your phone, I need to use my cell phone. In fact, I shouldn't be here" (At last, we agree on something)
"I can't swallow pills" (Pt never tiny and slim, clearly manages to swallow most everything else put in front of him/her)
"My temperature is always low. If your thermometer says 98, I have a VERY HIGH fever. I usually stay at 94" (As do some cadavers)
"I'm hypoglycemic and have to eat every 2 hours. How long will this take?"

That's all for now.

I second that one right now the hospital I work for is 98% Employee and 99% ER pt scores. So every thing is all about our score and how we can WOW the pts. and familys. What happened to taking care of the sick pts!!!! If they are really sick then they don't care if you offer something to drink or the fact that I for got to tell them my name as I put in the IV. I love my job and all but sometimes it is to much.

Typically, these patients need to be restrained at the hospital because they're so loopy with infection and illness that they're always pulling the IVs out. And as you're aware, NHs are "restraint-free"--no exceptions. NH nurses simply can't be everywhere at once, and realizing how time-consuming the med pass is, with accuchecks, tube feedings, crushed meds for about 30 people, and it's easy to realize that there is no time to stick Ms. Susie for the fourteenth time to keep some D5NS running. Plus, NH nurses don't do IV starts very often, and to have to do repeated sticks to a frail, dehydrated resident who doesn't want the thing anyway, and you'll understand the frustration.

Thank you, Angie!!! I'm in my first year, and the last facility I worked for had me scheduled to "orient" on the LTC side but they had nobody to orient me so I hit the ground running on an unfamiliar unit. One of the residents spiked a temp about an hour after I got there and had already been given Tylenol within the last two hours and she was very lethargic. The CNA told me that she was not usually that lethargic, etc. so I called the doc, told him what was going on, and HE ordered me to send her out. An hour later, I got a call from BOTH the ER RN and MD asking me why I had sent her out...ummmmm "Because I had an order to?!?! If you have a problem with it, why don't you call Dr. so-and-so and asked why HE decided to send her out?"

Thank you, Angie!!! I'm in my first year, and the last facility I worked for had me scheduled to "orient" on the LTC side but they had nobody to orient me so I hit the ground running on an unfamiliar unit. One of the residents spiked a temp about an hour after I got there and had already been given Tylenol within the last two hours and she was very lethargic. The CNA told me that she was not usually that lethargic, etc. so I called the doc, told him what was going on, and HE ordered me to send her out. An hour later, I got a call from BOTH the ER RN and MD asking me why I had sent her out...ummmmm "Because I had an order to?!?! If you have a problem with it, why don't you call Dr. so-and-so and asked why HE decided to send her out?"

i may be dumb but.. why does taking shoes off bother u..

Have you ever smelled 2 week old fish bait left in an ice chest in 95+ degree temps? I would liken that to some of the people I have taken care of feet. Think someone who drinks listerine to the point that they urinate and defacate on themselves but are still capable of standing so it all runs down. Add this to the fact that they do not change socks until they rot off. (usually the socks not the feet) Now think of this next time you are tempted to remove someones shoes. You will only have to do it once.

Hi Y'all. How about the patient with fibromyalgia?!! I actually had one husband tell me w/a very somber tone of voice that his wife had "end-stage fibromyalgia". Hello? And you know they are all allergic to motrin, toradol, percocet, vicodin, etc. etc. Also, how about the patient that tells you exactly where he/she does and does not want the IV!!

FYI if you've ever had a migraine so bad that it requires medical attention, you'd know that it's impossible to drive yourself to the ER or urgent care. You need someone else to bring you (ie. a spouse or relative).

And someone to bring you home once you're pumped full of phenergan and that ED Doc's pain med of choice.