Content That Anna Flaxis Likes

Content That Anna Flaxis Likes

Anna Flaxis, ASN 20,842 Views

Joined Oct 15, '10. Posts: 2,822 (67% Liked) Likes: 8,443

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  • Jun 22

    Quote from AJJKRN
    Just think if all of the "non-emergent" cases were to stop, staffing would decrease, people could and probably would be laid off or just lose their job all together...hmmm...job stability would be one good reason for me to take a Pt with a headache and smile about it
    Yeah, no. It is actually lose-lose.

    I didn't become a nurse - especially an ED nurse - for "job stability." In as much as I didn't become a nurse to treat "customers" instead of "patients."

    This is exactly the kind of hokum peddled by un-supportive management to ensure a continuation of ED abuse and over-crowding. A few years ago at my old ED job, management tried to convince ED nursing staff that an establishment of an "Observation Unit" (monitoring admitted, stable Observation patients - usually for chest pain/ r/o ACS) was in our best interests. More "hours posted" for nurses/techs to pick up, hence bigger paycheck etc.
    NONE of the nurses/techs 'assigned' the Obs Unit liked working it - for obvious reasons (not all that different from taking care of holds/boarders!)

    And let me remind everyone - ED overcrowding is as serious as a heart attack, and can be just as deadly! How many of you would like to bring your Father or Grandmother to the ED with complaint of chest pain and be told to wait in the waiting room? Or let us assume the initial EKG shows an acute MI but the ED is so full (with emergent and 'non-emergent' complaints), the staff has to "create a bed" to accommodate an obvious emergency - would you like the nurse taking care of your Father or Grandmother, to also be responsible for 5 other patients? Or would you prefer that the nurse be able to hand off her patient load momentarily so that s/he can pay undivided attention to your loved one in their hour of crisis?

    Or let us even assume that the initial EKG at triage was normal or borderline - how many of you would want the triage nurse to send you back to the waiting room instead of a monitored bed? Be truthful!

    Quote from klone
    I saw a woman who had called the ambulance and went to the ED for "vaginal itching/yeast infection".
    I had one a few months ago.
    Very young, adult female. Came in by EMS. I triaged her out to the waiting room because I had no open beds. At 0830 in the am. She huffed and certainly appeared offended that she was going to the 'waiting room' even though "I came by ambulance."
    As the EMTs were wiping down their stretcher and getting ready to head out, I noticed that their radios were going off constantly. The EMTs looked upset. I leaned over and asked "Y'all ok?"
    "No. Not ok. That's the third call out requesting an ambulance to transport a critical patient but nobody in the township or county can respond because we're tied up with BS calls!"

    The very young, adult female that came by EMS? Her chief complaint?
    'Vaginal discharge'...
    Nope, not kidding.

    Quote from AJJKRN
    Just think if all of the "non-emergent" cases were to stop, staffing would decrease, people could and probably would be laid off or just lose their job all together...hmmm...job stability would be one good reason for me to take a Pt with a headache and smile about it
    * Have you EVER had to take a "chronic headache patient" and smile about it, when it is the patient's 240th visit in the ED in 2016? For the same "chief complaint"?
    The ones who are allergic to everything except Dilaudid and Benadryl/Phenergan? None of which are drugs recommended to treat chronic migraines or headaches?
    * The ones who refuse Imitrex (for example) because "it doesn't work. That drug what starts with the D... Dilauntin.... usually helps."
    * The ones who occupy a stretcher in the ED with their chronic, non-emergent complaint - while 80 year old gramma lies in withering pain in the waiting room!

    Not burned out - but I am certainly very frustrated!

    cheers,

  • Jun 21

    A headache is not an emergency, except for when it is

  • Jun 20

    Dehydration & rhabdomyolysis --> multi-organ failure.

  • Jun 20

    Quote from hherrn
    Well, not so much.

    ER docs regularly give medications that fall on the wrong side of the risk/benefit ratio. They give out drugs for reasons they would never allow in their own family.
    There are a number of reasons for this- Path of least resistance, as mentioned earlier. And, of course patient satisfaction.

    If you have to identical presentations dealt with in 2 different ways, who do you think is more satisfied, and takes up less time:

    1- You have ____________. (bonus points if it has a Latin name.) Here is a pill you can take, and this problem should resolve in ____________ days. (Best to put the amount of time it generally takes for self resolution.)

    2. You have ____________. This will most likely resolve on it's own. The most recent research shows that the risks of pharmacological treatment outweigh the potential benefits. This is very lucky, as there is no expense for the medicine, and your body is an amazing creation, with the ability to heal itself. And I am sorry you had to wait 3 hours to see me, I was tied up in an emergency. And yes, it does only take me 2 minutes to diagnose this- I see it all the time.
    Exactly. Just finished my FNP program. Most MDs and NPs I followed in clinicals gave out antibiotics like candy. No one wants to hear option #2 after they've been waiting for awhile. Unfortunate.

  • Jun 20

    Quote from OrganizedChaos
    I have gone to the same ER when I had an ovarian cyst, was in so much pain I could barely walk but the cyst didn't rupture & was slightly too small to take out. I was discharged with nothing, not a pain med or anything. Not that I wanted pain meds, I wanted the damn cyst out.
    That may be true for the doctors you know, but they haven't done that here. This hospital is known to do as very little as they can.
    We typically do not remove ovarian cysts. Women of child bearing age get cysts on their ovaries every month. Sometimes they are quite painful. 99% of the time they go away on their own.

  • Jun 20

    I don't work in the ED, but as part of my job of conducting the first OB appointment/history of newly pregnant patients, I would always scrub the patients' charts before their appointment. I have seen some pretty ridiculous abuses of the ED. I saw a woman who had called the ambulance and went to the ED for "vaginal itching/yeast infection". And MANY women who think it's appropriate to go to the ED because she had a +home pregnancy test and "wanted to make sure everything was all right/wanted an ultrasound". IMO people need a serious re-education on appropriate use of ED services.

  • Jun 20

    Quote from OrganizedChaos
    Well I guess since I have had the throat/ear pain for awhile & was prescribed an antibiotic, the doctor felt differently.
    Well, not so much.

    ER docs regularly give medications that fall on the wrong side of the risk/benefit ratio. They give out drugs for reasons they would never allow in their own family.
    There are a number of reasons for this- Path of least resistance, as mentioned earlier. And, of course patient satisfaction.

    If you have to identical presentations dealt with in 2 different ways, who do you think is more satisfied, and takes up less time:

    1- You have ____________. (bonus points if it has a Latin name.) Here is a pill you can take, and this problem should resolve in ____________ days. (Best to put the amount of time it generally takes for self resolution.)

    2. You have ____________. This will most likely resolve on it's own. The most recent research shows that the risks of pharmacological treatment outweigh the potential benefits. This is very lucky, as there is no expense for the medicine, and your body is an amazing creation, with the ability to heal itself. And I am sorry you had to wait 3 hours to see me, I was tied up in an emergency. And yes, it does only take me 2 minutes to diagnose this- I see it all the time.

    In the ER we regularly treat things in a way that defies current recommendations - ABX for viruses, narcotics for chronic pain, IVF for pt's who are mildly dehydrated and tolerate PO, etc. Starting to see a lot of steroids for minor inflammation- run of the mill poison ivy for example. People love being given drugs.

    So, I wouldn't read too much into the fact that a doc prescribed drugs for something in the ER. Trust me when I tell you it is often something they often wouldn't consider for themselves, friends or family.

    Oh- and as somebody pointed out- the OP was not real. First post, poorly written, inflammatory subject and factually incorrect. The hallmarks of a bored AN member creating an alias.

  • Jun 20

    Quote from OrganizedChaos
    I know they don't remove cysts in the ER, but if the OR could take walk ins I would've gone straight in.
    That actually made me LOL. Seriously. Could you imagine a world with walk-in ORs? We could open a chain, call it Jiffy OR or Speedy-ectomy.

  • Jun 19

    Quote from OrganizedChaos
    Then wait how long until I finally get seen? There aren't multiple doctors at my PCP. There is 1 NP or PA there so the next opening isn't for a little while. So no, I wouldn't be able to see my PCP on Monday.
    Sorry not sorry I go to the ER because the walk in clinic doesn't take my insurance, I can't get to see a doctor or practitioner in a timely fashion & I don't want my issues to go unresolved until I can get seen.
    Stating: "Are you telling me I should have waited until Monday to see my PCP?" Sounded as if you'd be able to see your PCP on Monday.

  • Jun 1

    Quote from Mom To 4, DNP-FNP
    It's very irresponsible but as mentioned this person knows the risk and has accepted it.
    If the student has been advised of the risk, and been directed to some resources to get a sense of what the BON's likely action is based on similar cases ... then who is being irresponsible?

  • May 19

    Quote from ERgirlynurse
    I was not referring to suing the hospital.
    The title of your thread is "Terminated. Pursue a Lawsuit?" Who, exactly, were you referring to suing, if not the hospital??

  • May 18
  • May 18

    Quote from Been there,done that
    I worked a small ICU.. if I felt the need to access any patient's chart in the unit during my shift, it is MY responsibility to do so. I was responsible for ALL the patients in the unit if and when the assigned nurse was off the unit.. or too busy to attend to their assigned patient.
    I agree with this concept. Now, I dont think that it necessarily sounds like that was what this nurse's goal was in accessing that chart. But it would be very hard to prove that he was just being nosy vs. being prepared to assist the patient if the assigned nurse wasn't available.

  • May 18

    P.S. They are not YOUR charts. They are the patient's charts. I worked a small ICU.. if I felt the need to access any patient's chart in the unit during my shift , it is MY responsibility to do so. I was responsible for ALL the patients in the unit if and when the assigned nurse was off the unit.. or too busy to attend to their assigned patient.

  • May 18

    Quote from Anna Flaxis
    I disagree. In a small department where you are each others' backup, I think it's important to be familiar with all of the patients on the unit. In the ED, while I have my assigned patients, I need to know who else is in the department and why they're there, and what the plan of care is, because we back each other up- I may or may not end up doing any care on someone else's patient, but I should be aware of what's going on in case I am needed to do so, especially since we don't have a charge nurse.

    As a House Supervisor, I don't actually provide any care (most of the time), but I do review the charts to know who is in the hospital, why they are in the hospital, what the plan of care is, any issues or concerns, that core measures are being met, and what the discharge plan is. I also review charts of ED patients to be on the lookout for potential admits.

    So, there are reasons that are perfectly legitimate and not violations of HIPAA for someone not directly providing care to be in the patient's chart.

    Maevish, rather than being passive aggressive and dropping hints, have you directly asked your co-worker why they are reviewing the chart?

    Yes I have (he's bored) and he butts out when I ask him to. There are never any breaks and the other nurses only provide care/help me when I ask them to (which is perfectly fine), but since they aren't ever providing care for my patients, I don't see any reason for any of them to be in my charts. As I said, the guy gets out of my chart when I ask him to, but that's beside the point because he (and everyone else) keeps doing it.


    As house supervisor and other areas of nursing I completely understand that. When I was a charge nurse I had to glance over charts to make sure I knew what was up if I was breaking someone or going to bed control. However, there are no charge nurses or floats nurses here and I don't go into charts where I'm not involved directly with the care and I didn't know people actually did that (supervisors, charges, etc aside).


    If they were doing audits or something like that, that would be one thing, but they're not and it just feels wrong. I'm cool with a quick report sheet that some hospitals do where you write code status, why they're here, activity, restraints, etc, but they don't do that here. I guess I've never been in an ICU where things were so slow (it really is tedious here at times) cause no one else has had the time to be nosy anywhere else I've worked

    xo


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