overreacting or not, that is the question!?!

[luvmyhubbybunches]

My feelings are so hurt about this, but could possibly be overreacting!

So here is what happened: I have been sick with URI since this past Friday, throat so sore I could hardly even swallow my own spit (sorry to be so graphic), coughing my head off, SOB, fever, and my lower back was hurting so bad I could not sit still. After couple of days like that, on antibiotics and getting worse I broke down and went to ER, (where I work).

First off the nurse I had ordered urine preg on me and I have had complete hysterectomy-DUH!! Then I told them I couldn't take Morphine or Lortab so doc said he wasn't sure what to give me for pain since I was allergic to so much stuff. I hardly think 2 things qualifies as so much stuff!! I see them give our frequent flyer drug seekers less of a hassle about getting something for pain as they did me! Finally after getting to point of tears, I got an IM shot for pain. Had pretty significant amount of blood in my urine so they ordered CT with stone protocal-had stone in left kidney. My nurse was one to tell me this which was no big deal, but then she added "o by the way, you have a rt sided soft tissue mass in pelvis that they are unable to identify, so here is prescription for you to come back and have another CT as outpatient with triple contrast". I asked her, "and why are you the one telling me this insead of Dr"? Her reply was "well when you first came in we only had 4 patients, now we are full". "SOOO" was my next response. Maybe I expect too much, but I would think as a nurse that works side by side with this Dr that he could have at least called radiologist and asked for some more specifics, or for sure made sure that I didn't leave ER that night freaked out! I had to hunt Dr down before I left to get him to sign my work excuse and only then did he see how upset I was and said well why don't we just go ahead and order that scan tonight so you won't have to go home worried sick. Why he didn't think enough of me to do that earlier is beyond me!! I mean I already did not feel good, was in a lot of pain and then to hear that just threw me over the edge! I thought that it was truly unprofessional and tacky of Dr to send Nurse in my room to give me that kind of abnormal test result. I had 2nd CT which was still inconclusive, so now my next stop is my OB/GYN per ER Dr suggestion.

Am I overreacting to this, expecting too much? As a nurse, I would have told Dr, I think this is news that needs to come from you and not me! Thanks for letting me vent!

[Anna Flaxis, BSN, RN]

Stargazer

I don't mind reading and entertaining your opinion! Even if I had read your opinion before hand I would not have done anything any different, given the situation at the time. I don't utilize this site to get smoke blown up my butt, I use this site to get different views on certain situations, rather I agree with them or not!

Fair enough. And do please update us on your condition when you know more. As I've already stated, I do hope it's nothing serious.

My intent has not been to offend you or hurt your feelings. In expressing my opinion, I can sometimes be quite direct, and that's something I'm working on. But it certainly does not mean I wish you any ill will.

[Anna Flaxis, BSN, RN]

Stargazer- Are you completely nuts????? An ER visit wasn't warrented???? She was in pain, and pretty severe pain according to her post. SHE HAD A KIDNEY STONE!!!

Based upon the symptom of LBP of 2 days duration and the presence of blood in the urine, a PCP is just as capable of diagnosing a stone and prescribing the appropriate medications as the ED is. I wonder how many people call their doctor when they're having symptoms of illness instead of presenting to the ED? A lot, I would guess.

I have had over 20 of them, and have had at least that many lithotripsies. I have had 2 children and let me tell you-that was a cakewalk compared to a kidney stone. I don't know how you can say an ER visit wasn't warrented. I am only assuming you have never had a kidney stone as that is one pain you can't ignore and wait to go to your PCP. Just saying....

I'm not saying to ignore anything. If the doctor can't squeeze you in, then the after hours clinic or urgent care would be appropriate. If those are closed, then obviously the ED is the last resort. I just didn't get the impression that the OP used the ED as her last resort, but rather, presented there as the first resort, expecting to be treated a certain way because she works there, and had her feelings hurt when those expectations weren't met.

I really don't mean to sound like a hard ass, I guess I just expect a little more from those who work in the field of health care. People with a 12 year old's comprehension of how the human body works present to the ED unnecessarily all the time, and it's understandable because they don't know any better. But we're nurses. We're supposed to know a little more than that, aren't we?

[Anna Flaxis, BSN, RN]

Stargazer- a complete hysterectomy is removal of the ovaries, tubes, uterus, and cervix. So the potential of a tubal pregancy is impossible-obviously. Ordering such a test on a person who has had a complete/total hysterectomy only drives up the total costs and is completely unecessary. One big reason why insurance premiums continue to skyrocket- but thats another thread.

Actually, one can have a partial hysterectomy, in which only part of the uterus is removed. A complete hysterectomy means that the entire uterus is removed. It's true that it can also mean that the tubes and ovaries have been removed, but you can't assume that.

[Butterfly0328]

Based upon the symptom of LBP of 2 days duration and the presence of blood in the urine, a PCP is just as capable of diagnosing a stone and prescribing the appropriate medications as the ED is. I wonder how many people call their doctor when they're having symptoms of illness instead of presenting to the ED? A lot, I would guess.

I'm not saying to ignore anything. If the doctor can't squeeze you in, then the after hours clinic or urgent care would be appropriate. If those are closed, then obviously the ED is the last resort. I just didn't get the impression that the OP used the ED as her last resort, but rather, presented there as the first resort, expecting to be treated a certain way because she works there, and had her feelings hurt when those expectations weren't met.

I really don't mean to sound like a hard ass, I guess I just expect a little more from those who work in the field of health care. People with a 12 year old's comprehension of how the human body works present to the ED unnecessarily all the time, and it's understandable because they don't know any better. But we're nurses. We're supposed to know a little more than that, aren't we?

Have you ever had a kidney stone?? Like I previously said, the pain is horrible and as it is moving down the ureter it gets worse. I have had a couple in which I managed the pain at home, but when it moved further down, as you obviously know the ureter gets more and more narow the closer it gets the bladder, the pain increased and there was no ignoring it. I understand what you mean about some medical professionals expecting special treatment, but I would imagine the opposite happens also where they are treated worse for the same reason. I can't say much in that regard as I am not yet a nurse. I am only speaking from experience with the kidney stone issue. Until you have experienced that horrible pain it is hard to understand. I wouldn't wish it on my worst enemy. Aside from that, you have made some very valid points and I do admire your "to the point, not sugar coating" attitude. It doesn't mean you are a hardass- it's just who you are. I personally just didn't like the comment you made about it not being warrented to go the ER. With the amount of blood she said she had in the urine my guess is it was possibly "lodged" in the ureter, possibly causing partial blockage. I am no expert in nursing, but with kidney stones I am unfortunately "the expert". I once had a stone either 9mm or 14mm (can't remember) and during a ureteroscopy was pulled out a general anesthetic and RUSHED into radiolog to have a nephrostomy tube placed. I was seconds away from kidney failure. They cut me open fully awake and no additional pain meds etc because there was no time. So, yes-a kidney stone can cause many problems and the ER is the place to go when they strike- in my opinion.

[Butterfly0328]

Actually, one can have a partial hysterectomy, in which only part of the uterus is removed. A complete hysterectomy means that the entire uterus is removed. It's true that it can also mean that the tubes and ovaries have been removed, but you can't assume that.

You may be correct, but I was going by my personal experience, as well as information found on a couple of reliable websites, I have listed below.

http://www.estrogel.com/hysterectomy.htm

http://www.hysterectomyresources.com/blog.php/Complete-Hysterectomy-Not-The-Same-as-a-Total-Hysterectomy

[Anna Flaxis, BSN, RN]

I'm sorry you had such a horrible experience with your kidney stone, and yes, they can cause big problems, but the majority pass without incident. That's why the majority of our kidney stone sufferers are sent home with Percocet, a urine strainer, and instructions to follow up with their PCP.

Of course there are are exceptional cases. I've taken care of plenty of recurrent stone sufferers whose stones decide to go on the move at midnight on a weekend. What else are they going to do but go to the ED?

I'm not speaking in absolutes and saying it's NEVER appropriate to go to the ED for a stone. Sometimes it is appropriate.

I could also point out that kidney stones are not always painful. Sometimes they are so small that the person doesn't even feel it passing.

Anyway, I've stated my piece, and thank you for not calling me heartless and lacking in compassion.

[MassED, BSN, RN]

Based upon the symptom of LBP of 2 days duration and the presence of blood in the urine, a PCP is just as capable of diagnosing a stone and prescribing the appropriate medications as the ED is. I wonder how many people call their doctor when they're having symptoms of illness instead of presenting to the ED? A lot, I would guess.

I'm not saying to ignore anything. If the doctor can't squeeze you in, then the after hours clinic or urgent care would be appropriate. If those are closed, then obviously the ED is the last resort. I just didn't get the impression that the OP used the ED as her last resort, but rather, presented there as the first resort, expecting to be treated a certain way because she works there, and had her feelings hurt when those expectations weren't met.

I really don't mean to sound like a hard ass, I guess I just expect a little more from those who work in the field of health care. People with a 12 year old's comprehension of how the human body works present to the ED unnecessarily all the time, and it's understandable because they don't know any better. But we're nurses. We're supposed to know a little more than that, aren't we?

it is professional courtesy to be seen quickly and efficiently when you work in the ED. We do that for our own.

I think you might be holding a grudge because of all the other patients who are seen in the ED who don't need to be, and god knows that is a lot and the ER's are now PCP's... but you're letting those people cloud THIS post and her experience. She works there, which as professional courtesy, we want to do our best to give the best care to our own.

Was it overkill?? Perhaps, but like I wrote, professional courtesy would dictate more or less pulling out all the stops for your own....

course none of us were there to physically SEE how she presented and if she appeared well or not.

Anyhoo, good luck, again, to the OP. Keep us posted!

[leslie :-D]

Was it overkill?? Perhaps, but like I wrote, professional courtesy would dictate more or less pulling out all the stops for your own....

when i receive a professional courtesy, i always appreciate it...i see it as a bonus...

and not an expectation.

personally, i feel awkward receiving favors, and don't like being treated w/any more advantage.

so while i won't comment on op's situation, i really would hope that she (or any nurse) would seek same tx for her patients.

we're all equal.

leslie

[Anna Flaxis, BSN, RN]

MassED,

It sounds like there is a cultural difference between our workplaces. Where I work, there is no expectation that employees will receive any different treatment than any other patient. We work hard to treat *every* patient quickly and efficiently, regardless of who you are. It doesn't matter if you are one of us, you will be triaged according to acuity, just like everyone else.

Sure, if a trauma that comes in is one of our own, it affects emotionally big time. But we work just as hard to save the lives of those we don't know as we do those who are one of us.

I don't think it's fair to say that I hold any grudges against any specific patient population. Do I think people using the ED as their PCP is a problem? Absolutely! Is it a problem that I am willing to turn a blind eye to? Absolutely not. Not only does it affect the delivery of emergency services to those who need them, but it's also symptomatic of how messed up our health care system really is.

Many of our patients who do this can't really be blamed. Unfortunate life circumstances can leave people with nowhere else to turn. Believe me, I know what hardship is. But many people *do* know better, and yet choose to do otherwise, mostly because they just don't want to wait, or to have to choose between a PCP copay and a carton of cigarettes.

I don't treat anyone with disdain over it; instead, I take the opportunity to provide information on what resources are available and why it's important to establish care with a PCP if you are able. When giving DC instructions, I take the time to elaborate on what s/s should prompt a call to their PCP, and which s/s they need to come to the ED for. I have been thanked over and over for this information, because some people just never had anyone take the time to discuss it with them in a nonjudgmental and informative kind of way. Now, I don't always have time to do this; you know how chaotic the ED can be. But I try.

I guess the mistake I made in this thread was that I didn't think I needed to pull any punches with a colleague- someone who works in the same environment and faces the same challenges. I feel like if you're not part of the solution, you're part of the problem, and that as health care professionals, we should lead by example. But, I have been told that my expectations of others are high (my expectations of myself are higher). Maybe I do expect too much.

Anyway, take care.

[luvmyhubbybunches]

isn't that what stargazer was offering...

a different view?

all educated opinions are worthy of consideration...

even if it's not what you want to hear.

leslie

Yes and I believe that is exactly what I said in my reply!

[luvmyhubbybunches]

Stargazer- a complete hysterectomy is removal of the ovaries, tubes, uterus, and cervix. So the potential of a tubal pregancy is impossible-obviously. Ordering such a test on a person who has had a complete/total hysterectomy only drives up the total costs and is completely unecessary. One big reason why insurance premiums continue to skyrocket- but thats another thread.

Exactly I have no uterus, my OB/GYN said it would be clinically impossible for me to conceive!!

[luvmyhubbybunches]

Based upon the symptom of LBP of 2 days duration and the presence of blood in the urine, a PCP is just as capable of diagnosing a stone and prescribing the appropriate medications as the ED is. I wonder how many people call their doctor when they're having symptoms of illness instead of presenting to the ED? A lot, I would guess.

I'm not saying to ignore anything. If the doctor can't squeeze you in, then the after hours clinic or urgent care would be appropriate. If those are closed, then obviously the ED is the last resort. I just didn't get the impression that the OP used the ED as her last resort, but rather, presented there as the first resort, expecting to be treated a certain way because she works there, and had her feelings hurt when those expectations weren't met.

I really don't mean to sound like a hard ass, I guess I just expect a little more from those who work in the field of health care. People with a 12 year old's comprehension of how the human body works present to the ED unnecessarily all the time, and it's understandable because they don't know any better. But we're nurses. We're supposed to know a little more than that, aren't we?

There was no other option for me at that time. Not too many options in my neck of the woods on a Sunday. I would have waited until Monday morning, but I was hurting and SOB! I have not been a patient in any ER since I was in my 20s and had MVA. I try to always use the appropriate route for my healthcare and if I had come in and all that was available was room on acute side, I would have said just put me in the hall. I would never want to keep someone with an urgent case from getting the immediate care that they needed. I was on ambulatory side, plenty of rooms available when I got there and noone waiting on room when I went back to room for second time.