While You Wait
A simple ER visit can become a long, ruthless, demoralizing wait game; that may even change one's perspective on the humans providing emergency care. "While you wait" delves into another perspective of the ER wait game; While you wait, you live; you wait because you can wait and still live.
You come into the ER, a lady in green sits there and asks you what your emergency is. You begin to tell her your entire medical history. She cuts you off and asks you to shorten your story and requests you to describe why you came, in 3 words. How rude! She must be burned out. She must not care. After all, you are a human being. All she does is take your information and direct you to registration and then to wait in the dreaded over flowing ER waiting room.
You came to the emergency room to be seen emergently, hence the given title “Emergency”, but it seems as though no one cares that you are waiting, and the wait time seems endless. The person to your right is snoring heavily, and his yellow hospital socks look like he spent more than one ER wait time in them. The person on your left tells you her life story, it is kind of interesting, but you just worked a long day, and you have another long day tomorrow, but now you need to play the dreaded ER wait game; so frankly, today her story just isn't that interesting.
You see 3 people come in after you, and they get taken back to be seen right away, the nurse in green with her big red glasses, even wheeled one patient back herself. That patient didn't even have to wait to get registered. It is one unfair, never ending waiting game. You wish silently that you were the one chosen to be brought in first.
What is it about the emergency room, that the people seem not care about the continuous pile of patients and their loud families filling the cracks and corners of the ever expanding waiting room? This must be the area of nursing that people choose when they don't care about compassion but just want to get the task done and make an extra buck. You take a deep breath and text your angry, frustrated thoughts to a friend who will listen. But you can breathe as you do so.
While you wait; I am that nurse in green with the big red glasses. I am the first person you see when you walk in the ER, petrified, in pain, and fearful. I made you shorten your story because there is a line of people behind you, all with a story, but their story might be life threatening, and I must work fast, sift through my pile of chief complaints and hear what they are, because some may need time-sensitive, life-saving interventions.
My job is to use my senses combined with my medical knowledge to decide how sick you are, where you will need to go, and how fast you need to be seen. Sometimes I must rush someone back because a clock is ticking to the ability to give them a medication that will help that person walk again, or to fight an infection that is racing through a person’s body like an athlete on a marathon. Every time I make the decision regarding where you will go, and how fast you need to be seen, I make a silent prayer that my knowledge and instincts are correct.There are times that a patient may begin to deteriorate, and then I reevaluate my decision and up triage that person. My hope as I leave every day from that role is that I appropriately triage each patient in the correct spot in the waiting game.
While you wait my job may vary from rushing a patient back to initiate a life-saving intervention, to giving a homeless man a sandwich and shoes, as I explain to him that getting new hospital socks is not a medical emergency.
While you wait; I get threatened by a man for reprimanding him for leaving the hospital to smoke when he said that he had chest pain.
While you wait; there is an entire other world of chaos that erupts behind the very doors through which you are aching to enter.
While you wait; there is another entrance that opens into an ambulance bay, that is constantly flooding the ER with patients that you don't see coming in as you impatiently count the minutes of your endless ER wait time.
Behind that door, more people armed in , stethoscopes and pacing pads battle the wars of the flatlines, erratic rhythms, pulseless beats and the angels of death depriving human beings of their next breath. Some of those warriors are on their 12th hour of work and have not yet taken a break.
While you wait; a bleed infests a human brain, trickling into the folds and impeding its ability to make a man speak or walk.
While you wait; a heart makes desperate attempts to feed a body with healthy circulation, but that monster clot starves the heart of its own source of circulation, and the human being holding that heart carries the weight of an elephant on his chest.
While you wait; a being only days in this world, battles his closing lungs in his fight to live onto his next breath and nurture his miniature, yet delicate brain. As he fights, 3 teams of doctors are sweating profusely because that pipe that may be the lifeline that will allow air to trickle into his little lungs, refuses to slide in and ventilate his tiny body.
While you wait; a man who thought he had a simple stomach ache; gets a life-limiting prognosis.
While you wait; another human is battling a relentless bacteria that is poisoning his blood and shutting down his organs. Multiple medical teams calculate the benefits and risks of each intervention. Soon they are prioritizing the major organs because they are his body’s emergency generators, but now, they too are threatened by the savaging infection.
While you wait; you breath on your own, you walk, and your body fights the battles of infections that threaten your serene breaths and your steady, rhythmic heartbeat.
While you wait; we haven't forgotten you, and we want to help you, we really do and we will. Eventually.
You wait, not because we don't care, but because we must prioritize those who will not live if they wait.
But, while you wait; you are breathing.
While you wait; you live.
You can wait; because you can wait and still live.
It sucks to wait, but while you wait, be grateful that you can.
(The perspective of an ER nurse after 3 consecutive shifts. It is all about perspective and an attempt to lend an understanding to what is not always apparent.)
Devorah Goldberg, BS, RN, is an Emergency Room nurse in NYC . Ms. Goldberg is a graduate student in the Adult Nurse Practitioner program at Hunter-Bellevue College of Nursing and received her baccalaureate degree in nursing from Adelphi University in 2013. Devorah has been blogging about some of her nursing adventures since she began her career in 2013. Instagram: @strivingnovice Blog:StrivingNovice.com
Joined May '14; Posts: 12; Likes: 82.Jun 14This should be posted on a screen in every ER waiting room on continuous loopback. Emergency rooms are being used too much like primary care these days and ambulances are being used as personal UBER transportation to get there. Both EMS and ER departments have "Emergency" in the name for a reason! Way too many people are using our emergency systems for "over the counter" problems. For goodness sakes, try a pain reliever or diarrhea medication for at least an hour before swamping vital services.Jun 14dpgRN, you are so spot on!
Thank you for everything you do on a daily basis!
The other side of the ER door is controlled chaos and only staff that have worked the ED know that.
I have had staff asking me to expedite them since they work in the same hospital when I worked as an ED nurse and as a hospital supervisor. Sometimes you can, but most of the days when the ED is bursting at it seams, you get a bunch of disgruntled staff commenting about the "madhouse"! The only good thing is that most of them leave with a better appreciation of what an ED nurse does.
When pushing for beds for ED pts, I tell the nurses on the floor, "Remember you can say no once you have maxed out on your census, they can't. Their doors are open 24/7, so let us work together as nurses to help each other and our patients!"Jun 14I should print this out and "accidentally" leave 100 copies in the waiting room every shift.
Maybe tape it to the back of the registration clipboards.Jun 15I could leave this in my school health office, where waiting for more than 5 minutes will send kids stomping off,,,Jun 16I've said to patients that the two best things to happen in the Emergency Department is to wait and to have only one staff member in the room with you. If you are waiting you are not dying and if only one person is in the room you are not being coded. I say this very gently of course.Jun 17What about people who don't have immediate life threatening per se but a really painful condition like a fracture or a kidney stone?
You don't find urgent care centers everywhere.Jun 17This is so touching and encouraging for me as a prospective emergency nurse. I have to share this among my peers.. Thank you so very much.Jun 17Quote from MaudKennedyWhat about people who don't have immediate life threatening per se but a really painful condition like a fracture or a kidney stone?
You don't find urgent care centers everywhere.
Life and limb is triaged ahead of severe pain, for obvious reasons. But severe pain is often life threatening, so you won't be too far behind.
My pet peeve is when we have the back chock full, and a resuscitation going on, but the waiting room is empty. People come in to triage and say "quiet night, huh?" and I'd like to brain them.Jun 17My last ER visit was the same day as outpatient surgery. (Okay, I lied ... I could only squeeze out a couple of drops, because I wanted to go home. I didn't actually pee) ...
12 hours later I regretted that decision soundly. I had to wake my exhausted husband (remember the one who snores category 5 hurricanes from a previous post?) to drive me. He was busy sawing logs and shaking the rafters when I woke him. He cracked one bleary eye and said, "Did you try running water?".
Yes, I tried running water, and every position on earth too. I couldn't quite manage a head stand yet though ...
We got to the ER, me glum, my husband glummer, and prepared for a long, long, long wait.
I was taken back so fast my head spun. Bladder drained (thaaaaaaank you!) and sent home with a foley and leg bag pretty quick.
I learned a big lesson. Bad nurse!
I brought the staff chocolate dipped strawberries when I recovered.Last edit by 3ringnursing on Jun 17Jun 17@maudkennedy; thanks for your response. In emergency, pain is actually the untold part of the ABC alogorithm in triage. Someone in visibly excrutiating pain would often be in the catagory of people brought back. Specifically something like a kidney stone; which is not life threatening, but can also be concern for torsion...or something else. Pain is often areason we up-triage patients- however someone with an acute cardiac or respiratory issue will still take priority. Triage encompasses and abc algorithm in comibantion with a good assessment and medical knowledge, and like any part of nursing or medicine, nothing is set in stone!Jun 18Quote from erogersiiThis should be posted on a screen in every ER waiting room on continuous loopback. Emergency rooms are being used too much like primary care these days and ambulances are being used as personal UBER transportation to get there. Both EMS and ER departments have "Emergency" in the name for a reason! Way too many people are using our emergency systems for "over the counter" problems. For goodness sakes, try a pain reliever or diarrhea medication for at least an hour before swamping vital services.
I had to talk a teen mom out of taking her 3 y.o. son to the ER for a rash on his arms "that's hurting him!" yesterday evening (She didn't show for a 1020 appt yesterday morning - she had to have work on her car). She was calling from driving on the freeway an route to the ER. Pull over for God's sake!
She had called telephone triage the first time at 0830 yesterday AM - she hadn't tried any home care: washing the rash off or applying cool compresses, or OTC hydrocortisone cream (in a nutshell he was playing with his toy cars inside of cinder blocks, and where he scraped his arms it blistered a bit and turned into a rash).
She was determined to bring him somewhere - I informed her the ER was for "emergencies", and UC was more appropriate for this if he must be seen. She was afraid UC wouldn't be able to Dx and treat his condition. I'm not sure if she thought he would have scans and surgery, but hopefully I deflected her from going to the ER. I did warn her they would have a long wait - while real emergencies would be seen first according to acuity, and that it wasn't first come first serve in an ER.
I also talk to several parents a week who want to take their baby to the ER for no BM in < 24 hr's.Last edit by 3ringnursing on Jun 18
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