How long is the wait??? - page 2

How do you answer this question? It seems to be the triage nurses job to keep everyone posted about the "wait time" I got so irritated at that question yesterday! I had a lady with a "toe... Read More

  1. by   TrudyRN
    [quote=critterlover;2001839]we're not allowed to give time estimates. someone in risk management thinks it could potentially be construed as an emtala violation if we do.

    (i think they are afraid we would be accused of telling the uninsured that the wait is longer to get them to leave.)

    so, whenever i'm asked, be it a patient i have triaged or a phone call, i just tell them "there is no way to tell. that changes from minute to minute."

    you'd think the people in the wr would get it after getting that answer a few times, but it doesn't keep them from coming to the window every 10 min. i feel your pain. it is one of the things that i hate about triage.

    it always amuses me when they get really upset, and say (threateningly) in a huff "well, i've been waiting for hours. i guess i'll just have to go home and see my doctor in the morning."

    i always want to answer "sounds like a great idea to me!" (quote)

    why does it amuse you? and why don't you answer the way you want to?
  2. by   TrudyRN
    [quote=RunnerRN;2001736]I also work in an Urgent Care every once in a while, and the day after Christmas I had a girl go postal on me because I couldn't answer how long the wait would be (the waiting room was full and people were sitting out in the hall.) I was completely shocked! She said "Well if you can't tell me, I'm going to go to the ER" And I just replied that it was her choice, but we would most likely get her seen in less than an hour
    [quote]

    I don't get it. First, you "couldn't" tell her how long but then you all of a sudden "could"? :uhoh21:
  3. by   CritterLover
    Quote from trudyrn
    why lie and why be judgemental? maybe you've never had to go to an er. just say you really can't answer that with any certainty because even though it's quiet now, it could get busy the instant you hang up. maybe you could even do a little screening and try to help the person figure out how to avoid the er. you could suggest that the person call the private doc, if the person has one.

    and don't forget - doctors often tell their patients to go to the er. it isn't necessarily the patient's choice.

    actually, we can't suggest that a patient call their private doc. maybe they could be done in the past, but not anymore. emtala has changed that.
    [color=#483d8b]
    [color=#483d8b]basically, the emtala law states that if a person shows up on hospital property requesting to be seen by a doctor, that person cannot be directed elsewhere by staff until seen by a physician, or a physician's designee (such as an np or pa) and screened for an emergency medical condition.
    [color=#483d8b]
    [color=#483d8b]once it is determined that an emergency medical condition does not exist, the patient can be directed to their primary care physician for further treatment.
    [color=#483d8b]
    [color=#483d8b]since rns are not usually considedred to be physician's designees, we cannot suggest that a patient just see their private doctor, rather than waiting in the er for hours, even if it seems like the obvious thing to do at the end of triage.
    [color=#483d8b]
    [color=#483d8b]i triaged a girl one night who was c/o cellulitis to her back. she even used the word "cellulitis." she actually had a pimple. and not even a big one. we were pretty busy that night, and she must have waited over four hours to be seen. well, she got seen about six am or so, and when the doctor told her it was a pimple, boy was she ticked at me. kept going on and on about how i should have told her it was just a pimple. sorry, not allowed.
    [color=#483d8b]
    [color=#483d8b]now, different facilities interpert emtala slightly differently, and my understanding is that emtala doesn't exclude the possibility of an rn being the physician designee. however, i haven't heard of a facility that used the rn in that role.
  4. by   CritterLover
    [quote=trudyrn;2003907]
    Quote from critterlover
    we're not allowed to give time estimates. someone in risk management thinks it could potentially be construed as an emtala violation if we do.

    (i think they are afraid we would be accused of telling the uninsured that the wait is longer to get them to leave.)

    so, whenever i'm asked, be it a patient i have triaged or a phone call, i just tell them "there is no way to tell. that changes from minute to minute."

    you'd think the people in the wr would get it after getting that answer a few times, but it doesn't keep them from coming to the window every 10 min. i feel your pain. it is one of the things that i hate about triage.

    it always amuses me when they get really upset, and say (threateningly) in a huff "well, i've been waiting for hours. i guess i'll just have to go home and see my doctor in the morning."

    i always want to answer "sounds like a great idea to me!" (quote)

    why does it amuse you? and why don't you answer the way you want to?
    why does it amuse me? because they say it as a threat as though i'm going to rush them to the back just because they tell me they are going to leave if i don't. because they should have thought of their regular doctor earlier, before coming to the er. becuase if it can wait until morning, then it isn't an emergency. and that is what emergency rooms are for -- emergencies. we are not after hours clinics for those who don't want to take off work. we are not their for the convenience of people who are going to ingore a situation (toe pain) for weeks or months, only decide that they "have" to be seen one night, becaue it starts throbbing. we will take care of you promptly if you ignore your chf for months and then come in unable to breathe. but toe pain? you are going to have to wait your turn. and if you want to leave because the wait is too long, it doesn't bother us any.

    as for why i don't tell them, see my post from earlier tonight. emtala fines are quite expensive.
  5. by   russ11
    in our er you are almost never waiting on the nurse. most people are triaged by a nurse with in 20 minutes even during the busiest times. then you wait for a room to open up. when a room is available you are taken to the room by your primary nurse and reassessed. this nurse starts your iv, and can order labs , xrays, ekg's and in some cases ultrasounds or cat scans before you are seen by the doctor. now you are waiting to be seen by the doctor and for everything to result. during this time the staff may not appear to be doing anything from a patients perspective. often we give pain meds and antibiotics during this time (after consulting with md). the nurse is also monitoring results as they come back and is caring for 2-4 other patients. if you are waiting your nurse should be updating you on exactly what you are waiting on. we have 63 beds in all departments with 6 md's , 6 pa/np's , and 21 rn's working most of time so its not a staffing issue. often in a trauma center critical patients take up a lot of resources and time and patients who are not in that part of the er are not exposed to the flurry of activity that is going on in that area. nurses in the less critical areas of the er are often less busy and may have "down time" while waiting for their patients to be seen. from 3am to 7am the minor er is closed so if you have a minor complaint during these hours you are at the bottom of the "see next list" and you will wait. best advice in any er. come early on the day shift for minor complaints... most hospitals have a minor er during these hours and more resources in all departments. don't wait until you are at "the end of your rope" before you do come...just because you "can't take it anymore" doesn't mean you have a true emergency in the big picture of the er. sundays and mondays are always bad because a lot of people try to "wait it out" so they can see their md on monday and either can't take it anymore or find out they can't be worked in. and finally, during flu season remember in most cases you should stay in bed, drink lots of water, gatorade and juice. take tylenol every 4 hours (if you have a fever )around the clock. if you are not having nausea, vomiting or diarrhea also take advil for the aches...most er doctors do not prescribe antivirals for the flu unless you have underlying medical problems. if you have fever in spite of an aggressive tylenol/advil routine or can't keep even water down, or are old, young, or have complicating medical problems we need to see you ...otherwise there is not much we can do for you in the er that can't be done at home. last but not least: be nice...i know it is hard when you don't feel well. being sick is no excuse for bad manners. right or wrong it's human nature... grumpy demanding people are often avoided. no one will go out of their way for you...you will still be cared for according to good nursing practice but there is a huge difference between what ena requires and what will be done to expedite your treatment and make you less miserable during your stay.
  6. by   scrmblr
    Quote from 33-weeker
    I know there are busy ERs and even busy days in the slower ones... but there have been times when I've been in an ER on a Sunday morning or the like. The staff were smiling & chatting, some sitting around, and it still took a couple hours or more to get through and get out. What's up with that?
    Were you at my ER last week?

    We only have one doc from 0800-1200. Usually the nurses have everything done by the time the doc can get in to see the pt. Last week our poor doc was completely slammed. We really didn't have a tremendous number of pt's--we had one really complicated one(our doc was on the phone trying to get this pt transfered out) and a few minor things going on. We were all taking advantage of the "downtime" But, I know it probably looked bad:uhoh21:
  7. by   babynurselsa
    Again I will say that there is no way to forecast wait times. Things may be fine when the person calls or checks in, but that does not mwan in 3 minutes you are not going to get a code, or an AMI, or a CVA in 3 minutes. When that happens it does not matter if you have made it to a room or are still in the waitng room. Your pimple, sore toe, or flu-like symptoms just fell even lower on the priority list.
    You are not going to get your butt kissed or rushed to a room just because you get up in my face and "threaten me" that you are going to leave. I persoannly do find it somewhat amusing in a sarcastic sort of a way that someone percieves that they are going to change things by tossing that out there. Much in the same way I think it is funny when my 5 year old say "If you won't buy me this toy then I won't be your friend." Does it change the fact she still isn't going to get the toy? Nope.
    Would you rather that I jumped across the desk and throttled the offender? Maybe we could designate a "time out" corner in the waiting room......
    When people say that maybe they will leave and call their PMD in the am I tell them that is their right to do so, I have them sign the AMA whenever possible, I also encourage them that if anything changes and they need to return that they are welcome to do so.
    I know that sometimes it appears that things are not moving when folks are witing but as said above, I may have all MY orders complete but that does not mean that the doc is ready to dispo you yet, we have lab/radiology results or that the doc isn't busy with another pt, etc. Somelimes things just knid of hit a log jam.
  8. by   Altra
    Quote from babynurselsa
    You are not going to get your butt kissed or rushed to a room just because you get up in my face and "threaten me" that you are going to leave. I persoannly do find it somewhat amusing in a sarcastic sort of a way that someone percieves that they are going to change things by tossing that out there. Much in the same way I think it is funny when my 5 year old say "If you won't buy me this toy then I won't be your friend."
    Amen...

    Same principle applies to the ever-popular "you only get one shot at this IV ..."

    Or ... what? What do they think they're threatening you with, exactly? You/your family member won't get the IV, won't get labs drawn, won't get meds?

    I actually had that conversation with a parent of a 6-year old recently ... as I was putting in the IV. By the time she figured out what an asinine thing that was to say, I was done, and her kiddo tolerated it well.
  9. by   PANurseRN1
    Quote from 33-weeker
    I know there are busy ERs and even busy days in the slower ones... but there have been times when I've been in an ER on a Sunday morning or the like. The staff were smiling & chatting, some sitting around, and it still took a couple hours or more to get through and get out. What's up with that?
    God forbid staff should smile, chat or even sit.
  10. by   EmerNurse
    Triage and waiting times are an ongoing irritant. Last night I walked in to triage with a backlog of 15 people to be triaged, and they just kept coming and coming. To top it off, in the back they were full to the gills, backlogged from days, and trying to get folks up to the floor or dispo'd, which took longer than usual for some reason.

    I got 1.5 smoke breaks (of 2 minutes each) right outside the ER doors where the smoking area is and where I could see if anyone came in, one bathroom break that was beyond necessary, regardless of who was waiting, and that was IT. And when I went into the back to check a chart, I was then asked to triage and set up the next rescue rolling through the doors because the nurse was still on break and everyone else was busy. Did I do it? Of course - the poor old gent was severely SOB.

    And to top it off, at 0645, we get a cocain cowbow who still had the damn EKG leads on from the day before in our ER for being in for coke use... he'd been discharged, went out the ER door and got coked up again - now he's BACK in my ER, right before I'm leaving, throwing up on my FLOOR and being uncooperative but slurring that he needs to be seen.

    Such an awful night I nearly cried on the way home and I never cry. The RN who was charge is normally unflappable and runs a good show - even she was at the end of her rope. I go back in 3 hours. God help me.

    Wait times my butt! By the time I got out of there this morning, I just had nothing left and couldn't care LESS how long your wait was. MY wait for 13 seconds of sanity is going on.... let me see... 6 months or so I think?
  11. by   NicoleRN07
    I hate that question, and usually my response is "I don't know how much longer it's going to be, but if you don't feel like waiting, I be glad to let you sign the Left without treatment form".

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