Anna Flaxis, ASN 20,859 Views
Joined Oct 15, '10.
Posts: 2,822 (67% Liked)
CSnyder823, a ruptured eardrum isn't an emergency. But, I can understand how a person might not know that, and think something seriously wrong is happening, and be scared, and go to the ED. I'm guessing the doctor was being kind to you and didn't want to make you feel badly or stupid. Regardless of whether a person comes to the ED for something that can wait to be handled by their PCP, there is no reason to be unkind. :-)
Having said this, ED overcrowding is a serious issue. There are all kinds of ramifications from putting a strain on resources, increasing costs, and the safety of those truly emergently ill who are stuck waiting for a bed that is being occupied by someone who is not emergently ill. The reason so many EDs have "Fast Track" areas is for the sole purpose of off-loading stable patients with minor complaints off of the main ED where you have people actually trying to die.
I have had a patient with a minor complaint that could have waited for an office visit with their family doctor come out of the room to complain about the wait, while the doctor was in another room trying to resuscitate a baby. And yet, I was still kind and professional toward the person.
But back to the original topic, again I will state that most of the time, a headache is not an emergency; however, it could be. This is why we have the triage process.
Here is a good article that I think sums up the situation from an ED staff member's point of view nicely:
ER misuse in our instant gratification society
This may be slightly off topic, but you seem a bit surprised that the patient walked in, and did not come by ambulance.
Some of the sickest people I've seen have been walk-ins. The sickest don't always come by ambulance. They can be walking and talking one moment, and coding the next.
To answer your question, yes, heat stroke can lead to rhabdomyolysis, of which DIC is a late complication. It sounds to me like, for whatever reason, your patient waited too long before seeking treatment.
This is unacceptable and needs to stop now. This type of behavior undermines the primary nurse, reinforces attempts to split staff, and can result in medication errors or other mistakes because the nurse who is trying to "help" does not know the patient.
The first step is for you to talk to this nurse face to face. Tell her that you appreciate her willingness to help, but that in the future, she needs to check in with you first. If speaking with her does not result in the desired change in behavior, then take it up the food chain to the charge nurse next time it happens, at the time that it happens. If the episode is repeated again, then take it to your manager in the form of a formal, written complaint documenting each episode using objective language and leaving any emotion out of of it.
It's one thing to help one another as part of working as a team, and this is appropriate behavior. It's an entirely different thing to insert oneself into a situation without knowledge of the patient situation and without checking in with the primary nurse first to see if they even want/need assistance.
Well I guess since I have had the throat/ear pain for awhile & was prescribed an antibiotic, the doctor felt differently.
A headache certainly can be an emergency, although I do agree that most of the time, it is not. But this is what the triage process is for - to use the tools at our disposal to determine whether we suspect an emergency condition exists and get that patient in front of a doctor sooner, or if it is less likely that an emergency condition exists and the patient can wait.
I went to the ER last night & was diagnosed with an ear infection. Are you telling me that I should've waited until Monday to see my PCP? I think we both know that, that's a bad idea.
Migraine sufferers need help right away. It's not a life threatening emergency, but their suffering is profound.
Disclaimer: I am chiming in late, and I have not read any of the previous responses. I am replying to the original post.
All I will say is you are spot on!
No, I don't think this is a case of under-medicating. It is reasonable to start at the low end of the dosing range, and it's true that he should be thinking ahead to his post-operative pain management situation.
In a word, no.
You can ask anything you want. Whether you get it is a whole other question.
Unacceptable: looking in every patient's chart on your unit as a floor nurse when there is no reasonable expectation that you will be providing some sort of care...
I think you need to get *all* the nurses trained in NIHSS, but start with the Charge Nurses. This way, you can transfer the pt to the gen med floor, freeing up the tele bed, and at least the CN can do the NIHSS until it is DCd.
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 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, aside from getting what legal assistance you are able, were I in your situation, I would change my name, move to a different location, and eschew social media. Sorry you're going through this!
This is actually very puzzling to me. First, where in the world the nurse found 15 pillows, and second, what the rationale for this action could possibly be? The only thing I can think is that perhaps the nurse thought that the sensory perception of the pillows around the patient might help calm them, like swaddling a baby sort of? Just a thought.
You're being thrown under the bus.
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