Why don't the big boys understand?? - page 2

I work in a rural hospital. 6 beds in the ER and the town has one stop light. If you blink while driving you're through town without realizing it. We send most of our transfer pts up the road to the... Read More

  1. by   kate1114
    Quote from TazziRN
    I work in a rural hospital. 6 beds in the ER and the town has one stop light. If you blink while driving you're through town without realizing it. We send most of our transfer pts up the road to the next hospital, but sometimes (like today) every hospital within a 90-mile radius is full. Then we try the cities up north. Almost always the doc there will get snooty and ask "Why can't you keep him? Aren't you a hospital?"
    How frustrating! I see two major problems with his logic:

    1. A lot of larger hospitals in larger areas have problems with running out of beds (or staff to work the beds). Many ICUs in large cities go on diversion because of these reasons. It wasn't unusual in the large city I used to live in, but they tried everything they could to NOT go on diversion because of potential lost revenue and bad PR for not accepting patients.

    2. Um... transfers are usually a source of revenue? Also it's really bad PR for them to not accept.

    I've never worked in a rural hospital, but I've worked in many hospitals that took patients from more rural areas. Many of them had contracts to try our hospital first. It helped us staff beds and it helped them to become more familiar with what they offered. Sounds like the doc you dealt with had a personality issue and possibly a laziness issue. If they were too full (like the others), they'd tell you. It seems like a very strange situation.
  2. by   General E. Speaking, RN
    Memories of my rural hospital experiences are resurfacing! My first job was in a rural hospital 17 yrs ago. I recall doing my own neb tx, EKGs, peds, med-surg, and helping with births and then coming out to take care of the baby and mother.

    Is there a forum for rural nursing? If not, there should be. It has it's own set of unique issues.

    Didn't mean to get off topic...
  3. by   TazziRN
    We don't have a contract with any facility, but the policy is to try hospitals in order of distance and ability. There are three higher levels in the county for people who don't need a place like Stanford. If there are beds in any of the three they will take the pts, usually without complaint. When there is a complaint it's never from the house supe or the ER doc, but the on call doc who tries to get out of accepting a transfer.....almost always ortho. The case that frustrated me so badly yesterday......the place I'm talking about was the fifteenth place I'd called....of the previous 14, 13 were full and the 14th ran around the bush long enough that I gave up and went up the line.

    Stevie, in our county we call the house supe to make sure a bed is available and she contacts the on call specialist. If the specialist accepts based on what she tells them, she calls back and tells us to send the pt. If the doc refuses, he has to call personally and talk to my ER doc to make sure he's refusing for the right reasons and not violating EMTALA.

    If we have to send to Stanford we call LifeFlight dispatch and they set up the transfer for us and almost always will come get the pt by air or ground. Same with UCSF. It's the hospitals in San Jose that keep giving us trouble, two in particular.
  4. by   Spidey's mom
    Quote from kriso
    Memories of my rural hospital experiences are resurfacing! My first job was in a rural hospital 17 yrs ago. I recall doing my own neb tx, EKGs, peds, med-surg, and helping with births and then coming out to take care of the baby and mother.

    Is there a forum for rural nursing? If not, there should be. It has it's own set of unique issues.

    Didn't mean to get off topic...
    You are talking about MY job. Plus the ER for those nurses who get their MICN.

    There is a rural nursing forum but it isn't very busy.

    steph
  5. by   Spidey's mom
    Quote from TazziRN

    Stevie, in our county we call the house supe to make sure a bed is available and she contacts the on call specialist. If the specialist accepts based on what she tells them, she calls back and tells us to send the pt. If the doc refuses, he has to call personally and talk to my ER doc to make sure he's refusing for the right reasons and not violating EMTALA.
    Wow, I'd hate that. Our doc must talk to another doc who then accepts the patient . . .THEN the nurses get involved.

    steph
  6. by   TazziRN
    Usually it's the cardios who tell the house supe to accept on their behalf, because they know time is of the essence and that we can't handle cardiacs. They're really good about it.
  7. by   snowfreeze
    They may not understand because any nurse with that experience is way too busy to socialize at all during their work week with any of their co-workers. Give us an appropriate work load and everyone will be happier. Nursing socializing is usually sharing skills and experience, give us that time. Give us a proper break room without doctors using it also for their daily rounds reviews. Give us a couch and a few chairs, a microwave that works and a small table and a bathroom. We will take shorter breaks and be more eager in our jobs. Make that break room close to the unit we work on, we are willing to share with a few other units but just nurses please. Amazingly with these few cheap options, nurses can share a wide variety of experiences which become knowledge for other nurses.
  8. by   TazziRN
    Whaa.......?
  9. by   ERERER
    Here's a cheer for working in a small ER.... I hear the same crap that you do while giving report to a hospital that I am transferring a pt. too. Little does that snippy nurse know that I have 30+ years of critical care exp, teach, and keep up with what's new. I have worked in teaching, magnet, trauma, etc centers and you know what? I think it takes more "smarts" to work in a small non-specialized hospital. We don't have the luxury of lots of other nurses to bounce things off of, residents and interns to hover over our pts, round the clock clinical coordinators (we're lucky to have a house supv). Only one doc, and hope he knows his stuff. many's a day that the nurse diagnoses the pt from her "gut feeling". In my opinion, it is MUCH harder to work in these small ER's, and it seems like the sickest patients come in private vehicles.
  10. by   TazziRN
    Quote from ERERER
    Here's a cheer for working in a small ER.... I hear the same crap that you do while giving report to a hospital that I am transferring a pt. too. Little does that snippy nurse know that I have 30+ years of critical care exp, teach, and keep up with what's new. I have worked in teaching, magnet, trauma, etc centers and you know what? I think it takes more "smarts" to work in a small non-specialized hospital. We don't have the luxury of lots of other nurses to bounce things off of, residents and interns to hover over our pts, round the clock clinical coordinators (we're lucky to have a house supv). Only one doc, and hope he knows his stuff. many's a day that the nurse diagnoses the pt from her "gut feeling". In my opinion, it is MUCH harder to work in these small ER's, and it seems like the sickest patients come in private vehicles.
    Hear, hear!!!! Those big city nurses probably don't even know what it's like to thrombolyze an MI pt, yet I can do it without thinking about it.
  11. by   TazziRN
    Something else I heard that I couldn't believe......one house supe lamented to me about how she was holding pts in the ER because there were no beds, and that we might have to do the same. I told her "We can't hold him in the ER, we can't take care of him here."

    Her: "You have a doctor, don't you?"

    Me (after mentally banging phone on desk): "He's not a specialist. The pt needs a specialist. We don't have them here."

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