WHAT is wrong with my ER??? Grrrr... - page 3
OK...major ranting about to go on here. PUH-LEEZE explain what is happening to my facility's ER. Here are just a few problems lately. We got an admit last night of a 51 year old male, N&V,... Read More
Oct 22, '03To go back to the original posting, I think that the ER md is really the problem in terms of admissions and treatment. I hate to say it but I've sent pt.s with kidney stones home with a RX for Motrin (and worse, but I fear to admit it). There are some mds who just fancy themselves as hard asses and they will not tolerate being challenged about their treatment or d/c decisions. Of course, I always document these failings in full (Pt reports pain at 10/10. Md informed. No further orders). On the other hand are those docs who have no diagnostic skills and can't make a decision without every test known to humankind. Then they admit the pt to top it all off. Unfortunately, I have to carry out these orders as well.
I think the hospital administration may bear some responsibility for the hard rump attitude. Medicare/medicaid will not pay any part of medical claims if the pt is a full admit and is released the following day-and other insurers are trying to follow suit. The doc may decide not to admit anyone if they've been ragged on by admin too many times. Mostly, however, I think it is a personality issue.
As for all the tales of pain and suffering and missed diagnoses and inappropriate treatment, etc., there is inadequate provision of healthcare in this nation. ERs across the country are forced to attempt to provide care for the under and uninsured, in addition to the emergent surprises. The demand is simply too great for us to meet. There are many times I feel terrible about making someone in pain wait - but I have no open bed to put them in. Every day people leave in disgust because of the wait. Pts are angry to the point of boiling over. Guess upon whom that anger is vented. This is one of the most unpleasant aspects of ER nursing: trying to placate enraged pts while explaining that the entire evaluation in the ER will also require hours. Fun, fun, fun! No one seems able to accept that someone else could be experiencing a more severe emergency than their own. I really hate trying to explain that to pts! (I'm going to move you into the hallway because I've got a CP coming in. Sorry, sorry, sorry). The missed diagnoses stem in part from this situation, and yes, some people are rushed out a bit prematurely - but heck! There are Chest painers waiting in the waiting room and though we'd like to close to EMS, all hospitals are on round robin and a GSW is on the way.
These problems need to be addressed on a fundamental level, even a cultural level. The answer does not lie with the ER but with the way medical care is funded and provided. It also lies with the willingness of nurses to stand together to fight for what we know is right on every floor.
Oct 22, '03I just reread my first post and it sounds bitter. Sorry.
Some days at work, I do make a difference.
Some days, I put toe tags on children.
Today was one of those.
Oct 28, '03Unfortunately, at my place of employment it's a quasi-hobby of floor nurses to ridicule ER nurses....(c'mon..you all know who you are!)
Of course this is misguided behavior....but some of the ER nurses i deal with deserve it! (for being rude, inconciderate, dumb, ...among other things...did i say dumb?)
Sure, you can't judge an entire department by the actions of a few....but...
I'm convinced a number of our ER nurses got into it for the wrong reasons (Awesome!..I get to work w/George Clooney..and sexy fire-police-ambulance-men...and live a soap opera-life full of tragedy and romance...and hot babes!!...YES!!)....
We can blame NBC for this i suppose....
anyway...a pompus nurse, stupid nurse, rude nurse, lazy nurse.. be he/she an ER nurse, ICU nurse, LTC, whatever...is worthy of ridicule(or to be laughed at) in my book.
(as an aside, if you REALLY want to work in a glamerous environment, full of well rounded,intelligent nurses with perfect attitudes and friendly demeanors..not to mention sexy-soap-opera-story-lines....come down to ICU! The waters perfect...c'mon in!)
Oct 29, '03AH. I see.
One of OUR favorite hobbies to to ttrash the dumb, pompous, anal-retentive (...did I say DUMB out loud?) ICU nurses. Actually, what we do is have them float to the ER for a day so we can send them back whimpering to the ICU where they belong and their idea of a huge patient load is 3 paitents.
("No toots, it never occured to me to get the patients dietary preferences. I was relaxing doing CPR and defibing his Vfib when he came in.")
Yeah. I look JUST like Clooney. And thats why we ALL became ER nurses, for the sex and glamour and I look SO FINE in blood splattered, puke splattered .
Buy a vowel, Vanna.
Nov 1, '03Whao now dude! Apparently you didnt read my post completely...
it was a slam at people who make rude comments about nurses just because they're from a particular department...( like you just did!)(with a little bash at a few nurses i know personally)..
Thats OK though...as you were probably too busy sticking your fingers into bullet holes and defibing peoples' brains out.
Sheesh...dont be so defensive.
And, as an aside..let me tell you about MY experiences being floated to ER...
-80% of ER patients are 'office' cases who're using the ED as primary care...
-15% have boo-boo's that need a stitch or a cast and some ibuprofen...and go home.
And of the other 5% (who actually need admitted)...most arent 'critically'-ill.
Oh, and as for the people who come through the ED and need CPR, defibrillation, whatever...MOST are already dead. The staff just goes through the motions...then call it. (ER nurses sometimes remind me of that kid from the 6th-sense "I see dead people...all the time...")...
And as for the trauma cases...There're about 50 people from every department waiting to 'do their thing' before the rig even arrives....makes any single nurse's job ALOT easier...not to mention the Doc's are all there and are making all the calls...nurses in these cases are 'doers' rather than 'thinkers'...
...although the nurses do get spatters of blood on their ....which reminds me: You should change your scrubs if you're constantly walking around with blood, poop, and puke on them.
In my opinion the HARDEST thing about ER is dealing with drunks, psych-pt's, and neurotic mothers trying to 'protect' their kids...the other 'bloody stuff' is hard to see at first....but the 'team' takes over...making any individual nurses job a little less difficult.
(your point about an ICU nurse asking about a persons dietary preference is well put. that nurse was a goof.)
Nov 1, '03Nope. Not defensive. Just tired of defending my position as an ER nurse. There's a difference.
Well...that's why I chose ER. Your percentages are a little off, but true in most cases...long periods of sheer boredom being an office nurse broken up by moments of sheer terror and the adrenaline rush....and I think that's why I chose ER, to be honest...I'm an adrenaline junkie.
Most of the complainers on here had cases better served by a PMD, and then *****ed because they didnt get quick, efficient service. Gee, you present with symptoms to a doc that doesnt know you or your Hx and in 15 minutes he is supposed to Dx you? Yup sure. And the ER is suposed to be an ENT, OB-GYN, PMD, opthamologist, nephroplogist, psychiatirst and whatever you have expert? The reason you got 15 minutes is all your friends and neighbors were in at the same time because amazingly, the sore throat, earache and whatever they had all day is now an emergency at 10pm. If you DO come in with an emergency, THATS what we specialize in. And there's no where near 50 people waiting to do their thing. I usually end up drawing blood off off IV lines to speed things up, bagging and intubating you, and holding your hand.
I'm tired, sometimes defensive, and sometimes a bit bitter, yup, I suppose. I dont have TIME to change scrubs, sweetie.
I learned a lesson over 30 years ago, as a medic in Vietnam:
I can't save them all.
I save some.
I'm at peace with that.
Go on and trash ER. I'll be there over top you the next time you or yours come in with an emergency and doing the best I can. Just forgive me if I defend myself sometimes when attacked. I am proud of what I do and what my co-workers do.
Actually, proud of nursing and being an RN. Even if we eat our young.
Last post. Promise
Nov 1, '03Hi. I'll introduce myself more in the general discussion forum but thought I'd share personal ER horror story here...
A few years ago I had a rather significant MOI including about a 30 ft fall onto some ice according to witnesses. I had been knocked out at least for a few seconds. Came to, unable to breath at first (talk about wind being knocked outta ya- twas frightening not being able to catch my own breath). Instead of call an ambulance (had insurance but was afraid of bill, etc. etc.) my roommate helped me into the car and drove me to a local L2 trauma center in a moderate size city we lived in at the time.
Well, the triage nurse thought nothing of it. We didn't have to wait too terribly long as it was a slow night there. a slow ER one night.. imagine that!. They took a couple x-ray's at the ER revealing at least one very obvious vertebral wedge fracture. The incompetant ER f### doc on duty gave 1 mg of Morphine and sent me home with roommate with instructions for "BACK STRAIN" Uhhhhhhhhhhhhhh okay! My roommate helped me home, me barely walking mind you, and assisted me into to be where I layed in agonizing excruciating pain from missed injuries, etc.
Two days later I was literally paining me to even breathe. My roommate came in to check on me and I just felt I was in trouble with that whole impending doom feeling. He took me back. The dumb triage nurse (i'm being too polite here) triaged me to the fast track room where I waited in excess of 6 hours. In fact, I do remember seeing a kid triaged as priority for conjunctivitis!!!!
To make a really long story short, it turns out the triage nurse wrote me down as "fell out of bed"... hmmm what ever happened to LISTENING to the patient.. I told her what happened and that I could get out of bed well. Well, fortunately a very competant doc was on duty that night, did a CT... then eventually an MRI revealing 5 fractured vertebrea, not including the wedged one, several broke ribs, cracked sternum. Woke up on a vent a few days later due to resp. distress. Some of it after going in is a blur, but after that, even now my view on ER's is very dim.
Nov 1, '03It's all about attitude, that's whats wrong with the ER (update, we're not just a room anymore, we're a department now.) I just started working in a different ED, one where the NM has the same thought process as I do and it has made a huge difference to me. I was taught in nursing school to treat each patient as if they were my family member, and I try to do that. Could we also try to think of all of our coworkers as family members? We all have family members who are not quite right, who are addicted to something, who think they hung the moon etc. Our hospital families are the same way, they are human beings. Part of the human condition is making mistakes, unfortunately some of th e people who make mistakes are in the postion where mistakes can hurt other people, perhaps even take their life. This is a quite unfortunate situation, what do we do about it? Does criticizing ER nurses change anything at your hospital? Probably just makes people mad or their feelings get hurt. How about meeting in the middle to solve the problem, it's a shared problem, should have a shared answer. I think we can all agree that we are ALL overworked, not just the ED nurse, or the floor nurse, ALL nurses have more paperwork than ever and less time to spend giving patient care. Kudos to you guys on the floors and in the ICU's, IMO you have it much harder than I do. For the most part we treat 'em and street 'em, whoever said that 80 percent of our census in the ED could be seen in their MD's office (if they had one) was right. If I have a patient who is being admitted and I can't seem to do anything to please them, usually it's the family who I can't please, they're coming to see you, they don't stay with me for hours and hours (usually). I don't know how you guys do it, deal with them for days and days. I am thankful that I love the ED, cause I could NOT do your job. If I had to do your job I would have stopped being a nurse long ago. I think I have the easiest job in the house. You probably think mine is harder because it's mostly chaos. I hear "how do you stand working in the emergency room?" from nurses all the time, easy... I'm lazy. Now before you other ED nurses have a fit, don't think I don't think you work hard cause I'm right there in the trenches with you, I know you do. Time to stop the feuding between departments and do what we were taught to do,take care of our patients, and try to care for ourselves at the same time. Here's one for you.... triaged a 6 year old last night, mom found him having a seizure with no hx of same, dad says he feels really hot to me. Temp ORALLY is 106.3, ONE HUNDRED and SIX point THREE!!! I stopped triaging him and took him into the ED immediately. The nurse that had the room where I put him got mad cause I didn't finish triaging him. They did a CBC, gave him some Motrin and sent him home?!!! Yeah some things are dumb in the ED.
Nov 1, '03In my life, I have been to ERs for many, many different complaints including, 2nd degree full thickness burns, dog attack, seizures (from epilepsy) and others. I have always had great and competent care from the nurses. Period. I love 'em so much I went and married one and hope to become one myself soon! So y'all keep on doing a great job, I am so proud of you.
Nov 1, '03Randy, i apologize for the outburst.
Also, i have ALOT of respect for you and your job.
...maybe i just need some coffee....
i suppose i was being defensive myself...
Nov 1, '03Hey, regnurse99;
You sond like you are a super nurse! You should be proud of your skills, and you are totally right: assessments are the key. I agree that we do not always do a 'complete assessment' on many pts. because it is clear that they are OK except for their main complaint. But you are correct: sometimes you have to put the whole picture together and think a bit further. All of us are very busy and stressed at times, and we all are not perfect. But keep up the good work!!
Nov 1, '03We've been having the same kinds of problems in our ER. I wish medicare would come and do a review of our admissions.......some of the docs have actually said to the patients "would you like to stay here?" before they have even done an assessment!!!