Better Glimpse into the ED "Chaos"

  1. This past year during my CNA training, I had to shadow a nurse for a few days for three weeks. (Senior in High School, was in my schools CNA preparation class called Allied Health II). I shadowed in thed ICU and ER. I really came to more of an understanding of what the staff, especially the nurses go through back there. In the ED lobby everyone is seeing people go out, but "no one go in". I used to be one of those who wondered why the staff took so long to admit and see the patients in the lobby. I quickly found out why. I realized that many people that come to the ED are those with minor emrgencies that can go to urgent care or solve the problem at hom or calling a nursing hotline. It was during my shadowing experience that I was truly introduced to Triage and how those with the more life threatening ailments have precedence. Which explains why sometimes the staff will take someine who can't breathe back before they will take back someone with small laceration that has controlled bleeding, even though the laceration patient was there first. Many don't understand that. I also learned that there could be a slight stall in admissions because of lack of staff and beds and the arrival of a level 1 trauma patient come in on the ambulance and many staff are needed in the room to help stabilize the dying patient.

    We had a someone come in that fell of a 25 foot roof while working, and my nurse that I was shadowing put me, a a health occupations student who just completed his CNA training, to work. She told me to count the patients respirations and encourage the patient not to move excessivelywhile she documented and got his hx and got a foley cath set and another nurse began stabilizing the patients sacral/hip area. I thought i would just be observing but she really utilized me for whatever skills I had learned. I enjoyed it, We finally stabilized the patient and he was sent to another hospital where they could help more efficiently. There were so many people in the room for that one man that it was like the mall during the holidays.

    I have a new respect for the ER staff, especially the nurses who have to manage a level 1 trauama patient, a laboring woman, and 2 other psych patients at one time. Great job guys!!!
    YOu inspire me to work harder to be half the nurse that you guys are.
    Hopefully I will be a certified Nurse's Aide on July 17th, but until then I am still moving closer to my first step to becoming a Registered Nurse.
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    About PatMac10,RN

    Joined: Mar '10; Posts: 1,172; Likes: 553


  3. by   arabianeyez83
    That was nice! Unfortunately some patients do not understand priority, of course the whole ER revolves around them lol.....when I work the pediatric section of the ER, that's where I get bombarded the most...."I was here first, my chart was in front of theirs" well ya that's because you put it in front..ahhhhh..also working triage makes me crazy..worst part of the ER...I prefer to be the resuscitation nurse or working in Category 1 (higest acuity after resus)..the patients are really sick and really need to be there.
    Well good luck with everything!
  4. by   PatMac10,RN
    If only people really new what went on the other side of the lobby door. Thanks for your experience and reply. Keep them coming guys!!!!
  5. by   coolpeach
    I worked at a level 2 trauma center that was also in a well to do suburb. Two of our trauma rooms are semi private, and contain two beds. When we are not really busy we will put a non trauma in one of these rooms. I remember one night we had a patient with an ingrown toe nail who literally watched us bring in a level two MVC. We drew the curtain, but she could hear everything from the paramedics report to CPR. She saw all the doctors and nurses flood into the room, and heard us as we were trying to save this mans life. She was on the side close to the door so I had to walk past her to leave the room. I was walking out to send his urine to the lab in a frantic hurry, and this woman was saying ...Hey hey. After I sent the urine I came back and see what she wanted. She was ticked because I hadnt stopped before when she called, and she had been in our ER with her poor toe for an hour with eating. I explained that we had a trauma next door, and this made her even more upset. She then explained to me that she was important even if she wasn't dying, and she was paying us, and she hadn't eaten since lunch (it was 3pm), and I needed to get her something to eat. She also threw in that next time she would make sure she was dying before coming to our ER so she could get some service.

  6. by   PatMac10,RN
    It's sad they act and feel like that. The thing is when you try to explain it to them, they don't want to hear it. I wish they could imagine how much pressure you guys have on you. I remember someone fussing on my way back after calling the next patients name to come to their room. They get so angry, but we have to do it that way to save lives and if a few people get mad, we will have to say we're sorry and keep on rolling.
  7. by   dthfytr
    Career ER/Trauma nurse, everything from 3 bed rural ER to 5 years level 1 experience. Thanks for understanding and complimenting. It's rare. A very wise doctor once told me "sometimes the hardest part of the job is to forgive the patients." It's taken some years and hard work, but has led to an inner peace, and made the job easier.
  8. by   whichone'spink
    I work as a scribe in the ED, and I've been at it for more than a year. It has opened my eyes to how people abuse the system and the entitlement mentality that some patients have. I hope other people are just as cognizant of the controlled chaos of the ED, just as the OP is. I know I am. I will never go to the ED for small things. Since I've been working in the ED, I've made a note of where the nearest urgent care centers are, because that is where I'll go for minor complaints.
  9. by   KimGau
    I do have to say I recently had a bad ED experience where I was that person getting mad and I have not worked in an ER yet so maybe I was wrong. My father was in a bad auto accident (he hit an 18 wheeler). I rode in the ambulance with him to the hospital where they wheeled him into an empty hallway and literally left him there for 3 hours unattended while employees hung out joking and talking literally one foot from the gurney that he was strapped to (still in the neck brace and restraints) His shoulder was broken in 3 places, bruised ribs etc. He was having trouble breathing and even passed out quite a few times. When I asked the nurse who was joking with her friends about the passing out she told me "atleast hes lying down". My dad begged me for 3 hours to "help him" needless to say when my mom arrived I was so angry I had to leave the hospital. Their excuse was they had a bunch of LTC patients come in (none of which were injured). The hospital is known for this behavior and I will never go there again. In conclusion they finally got him in xray and the machine wouldnt work so they left him by himself in another hallway for almost two more hours before FINALLY giving him pain meds and saying "our MRI machine isnt working so your going to need to go to another hospital in the near future" Am I wrong to have been outraged??
  10. by   PatMac10,RN
    I think you werejustified in your anger. It seems like the triage nurse would have given your father a hirer priority than ltc clients that are fine. If you were hit by an 18 wheeler and your in a C-collar it's seems like something to pay attention too. I don't know the specifics of your case, but from what you've said it seems that you and your father were not treated with the optimal level of care. I'm sorry for you bad experience.
  11. by   RaziRN
    OP, thank you for sharing your experience! I'm glad to hear that you had a good clinical rotation shadowing. It sounds like the nurse you were working with is a wonderful teacher. I wish you the best of luck in becoming a nurse. It's a hard journey but totally worth it.

    Kim, I'd have been furious. I don't know the whole story but it sounds like your father was a priority pt and he didn't receive the care that his condition warranted.
  12. by   KimGau
    Thanks..I definatly think that in most cases people abuse the emergency room. I have seen so many people in the ER complaining about the amount of time they are waiting when all they have is a cough. Do people not know what urgent care offices are for? The lady with the ingrown toenail blows my mind, I dont understand how any human being coulde be so selfish and behave that way when they just witnessed someone dying.....
  13. by   canoehead
    Quote from KimGau
    ... they wheeled him into an empty hallway and literally left him there for 3 hours unattended while employees hung out joking and talking literally one foot from the gurney that he was strapped to (still in the neck brace and restraints)

    If they were one foot from the gurney he was not unattended.

    Three hours is too long to be on a backboard by anyone's standards.

    At some hospitals where I live ambulance patients are waiting for up to 6 hours in hallways with the crew until a bed becomes free in the ER. There is nothing the ambulance crew can do, and the staff at the receiving hospital is out straight 24/7. It's not right, and staff becomes hardened just to survive the shift. Write a letter to the administrator and complain, you'll be doing everyone a favor.
  14. by   PatMac10,RN
    Thank You So much RaziRN I really enjoyed shadowing.