A Headache is not an emergency

Roy Fokker, BSN, RN · Jul 8, 2016

My clients do tell me that they avoid emergency rooms, even in an emergency because they are often labeled as drug seeking or not requiring emergent care.

Have your clients with sickle cell disease had over 400 visits for this year alone (come July) for sickle cell pain? Especially when they have resources available to them to help manage their sickle cell pain? When some of the doctors/nurses you work with also work at different area hospitals and see those same patients there too (for the same complaint)? Have your clients verbally and/or physically abused nurses and doctors for following patient treatment protocol for sickle cell pain as proscribed by pain management? Have your clients unhooked their Heparin infusion (for a PE) whence they got the Dilaudid they wanted and walked out of the ED without telling anyone? Has your client ever told you "You either give me Dilaudid or I'll just go someplace else. I'll just go to XYZ Hospital (a local rival) and you'll never know." ? Have you ever caught a client behind the curtain as they are being discharged, ranting on the phone that "Well the ****ing Doctor just prescribed 4 pills. I couldn't get more. Can you tell him that I get him 4 for now but Imma try for more later today?"

If your answer to any of these questions is a resolute "NO" - YOU are truly 'gifted' that you've never had to deal with such examples of chronic patients!

Going back to other chronic conditions. Every condition had signs of am emergency. As an example, I have chiari I malformation.

I'm truly sorry to hear that. A colleague was diagnosed with Chiari Malformation (rumor. Don't know the stage) and kinda retired from nursing. She was awfully young! :-(

I am well managed, and not yet a candidate for surgery. However, I know that if I experience certain symptoms such as severe headache with stiff neck, hemiparesis and new symptoms, it could be a sign of an acute herniation.

In other words - a change in your condition from your baseline. Which is something ER nurses look for and also what I mentioned in my comment:

"Both my Mother and her Sister suffer from horrific migraines and headaches. My best friend was almost hospitalised because of intractable pain from migraines. His wife takes a bucket of medication everyday to try and avoid a flare-up of her debilitating migraines. I've ordered a stat head CT by protocol on a young male patient who came in with c/o "headache" against the judgement of the charge nurse and the attending ER doc who didn't think the patient was "that sick" - who ended up being a bleed from a ruptured AVM.

So yeah, I know that "headaches can be serious!""

I understand that emergency nurses are stressed and often have too many patients too deal with. In a past job I was often floated to the emergency room.

I appreciate the support but 'floating' ain't the same as 'living'. It would be akin to me 'floating' to your unit every once a while and then telling you how to treat your patients.

I just want to remind you that individuals with chronic conditions may or may not seem to need emergent care, but oftenthey are following a treatment plan. Also, remember that providers who see clients on an outpatient basis need to send individuals to emergency rooms because of the nature of office hours. Lastly, some clients go to am emergency room because they have poor health management.

What does this have to do with the price of tea in China?!!

NONE of the reasons mentioned here - yes, including those who go to the ER for 'poor health management' - is a problem of the ER! It is an "EMERGENCY ROOM". Not "chonic condition room". Not "after hours room". Not "pain clinic room". Not "I have no health insurance" room!

People think I'm callous for mentioning this but it is reality - no-one who has not worked in the ED on a regular basis has any ***ing idea of ED overcrowding because of non-emergent complaints!!

And last I checked - pain did not kill anyone.

Finally, I will agree that not everyone who goes to the emergency room needs to go, but please don't take it out on those with legitimate chronic diagnoses. Why should sickle cell and migraines be treated any differently than diabetes and hypertension. All for can be managed in an outpatient basis but may have specific symptoms that necessitate emergency room visits.

Nobody is "taking it out on" anyone.

ALL my sickle cell patients and migraineurs are offered non-narcotic, alternative treatments backed up by evidence based medicine (as I pointed out in the link.)

More than half refuse, because "that s*** don't work!"

It would help their case if they stopped lying though (about other ER visits, narcotic prescriptions from other providers, pain management contracts they don't disclose) - because we can track most of 'em (especially prescriptions.)

Again: not saying that everyone lies...

As a matter of fact, it would be helpful if the patients didn't keep complaining/threatening the nurse as to "what's taking so long?" "I've been here for 45 minutes" "I ain't going back to the waiting room ***** you better find me a Doctor now!" "How the *** he went back now but my girl gotta wait?! That's ***ed up man!"

Et cetera

Myself and the nurses I've worked with in triage have routinely called security to keep the peace. Do you think that is appropriate behavior?

She had been vomiting for over 12 hours due to the headache and couldn't keep any medications down. She arrived actively vomiting, pale, diaphoretic.

That sounds very much like an ED appropriate patient.

Emergency Department overcrowding is a serious problem!

Emergency Department staff SUCK at treating chronic conditions. We are neither equipped nor trained to deal with them!

Just because Primary Care sucks in our country, doesn't make it an Emergency Department problem!

For the rest of the mill - everyone would like to see me as a callous monster. That I don't care about people and their pain.

I reiterate the point I made in my original post - "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?"

Almost NOBODY thinks about the ER and wait times - until they have a loved one who needs to be "seen NOW!"

PS: "clients"???

*** happened to "patients"??!!! Yes, it is why I highlighted the term!

BrnEyedGirl, BSN, MSN, RN, APRN · Jul 8, 2016

This HA was an emergency

wowohwow · Jul 11, 2016

The OP needs to take a chill pill. If the ER stresses you as much as it comes across in your comments maybe it's time to retire or find a less stressful job.

Editorial Team / Moderator · Jul 11, 2016

The OP needs to take a chill pill. If the ER stresses you as much as it comes across in your comments maybe it's time to retire or find a less stressful job.

The OP is not a nurse, and I suspect he won't be returning.

A&Ox6, MSN, RN · Jul 11, 2016

Have your clients with sickle cell disease had over 400 visits for this year alone (come July) for sickle cell pain? Especially when they have resources available to them to help manage their sickle cell pain? When some of the doctors/nurses you work with also work at different area hospitals and see those same patients there too (for the same complaint)? Have your clients verbally and/or physically abused nurses and doctors for following patient treatment protocol for sickle cell pain as proscribed by pain management? Have your clients unhooked their Heparin infusion (for a PE) whence they got the Dilaudid they wanted and walked out of the ED without telling anyone? Has your client ever told you "You either give me Dilaudid or I'll just go someplace else. I'll just go to XYZ Hospital (a local rival) and you'll never know." ? Have you ever caught a client behind the curtain as they are being discharged, ranting on the phone that "Well the ****ing Doctor just prescribed 4 pills. I couldn't get more. Can you tell him that I get him 4 for now but Imma try for more later today?"
If your answer to any of these questions is a resolute "NO" - YOU are truly 'gifted' that you've never had to deal with such examples of chronic patients!
I'm truly sorry to hear that. A colleague was diagnosed with Chiari Malformation (rumor. Don't know the stage) and kinda retired from nursing. She was awfully young! :-(
In other words - a change in your condition from your baseline. Which is something ER nurses look for and also what I mentioned in my comment:
"Both my Mother and her Sister suffer from horrific migraines and headaches. My best friend was almost hospitalised because of intractable pain from migraines. His wife takes a bucket of medication everyday to try and avoid a flare-up of her debilitating migraines. I've ordered a stat head CT by protocol on a young male patient who came in with c/o "headache" against the judgement of the charge nurse and the attending ER doc who didn't think the patient was "that sick" - who ended up being a bleed from a ruptured AVM.
So yeah, I know that "headaches can be serious!""
I appreciate the support but 'floating' ain't the same as 'living'. It would be akin to me 'floating' to your unit every once a while and then telling you how to treat your patients.
What does this have to do with the price of tea in China?!!
NONE of the reasons mentioned here - yes, including those who go to the ER for 'poor health management' - is a problem of the ER! It is an "EMERGENCY ROOM". Not "chonic condition room". Not "after hours room". Not "pain clinic room". Not "I have no health insurance" room!
People think I'm callous for mentioning this but it is reality - no-one who has not worked in the ED on a regular basis has any ***ing idea of ED overcrowding because of non-emergent complaints!!
And last I checked - pain did not kill anyone.
Nobody is "taking it out on" anyone.
ALL my sickle cell patients and migraineurs are offered non-narcotic, alternative treatments backed up by evidence based medicine (as I pointed out in the link.)
More than half refuse, because "that s*** don't work!"
It would help their case if they stopped lying though (about other ER visits, narcotic prescriptions from other providers, pain management contracts they don't disclose) - because we can track most of 'em (especially prescriptions.)
Again: not saying that everyone lies...
As a matter of fact, it would be helpful if the patients didn't keep complaining/threatening the nurse as to "what's taking so long?" "I've been here for 45 minutes" "I ain't going back to the waiting room ***** you better find me a Doctor now!" "How the *** he went back now but my girl gotta wait?! That's ***ed up man!"
Et cetera
Myself and the nurses I've worked with in triage have routinely called security to keep the peace. Do you think that is appropriate behavior?
That sounds very much like an ED appropriate patient.
Emergency Department overcrowding is a serious problem!
Emergency Department staff SUCK at treating chronic conditions. We are neither equipped nor trained to deal with them!
Just because Primary Care sucks in our country, doesn't make it an Emergency Department problem!
For the rest of the mill - everyone would like to see me as a callous monster. That I don't care about people and their pain.
I reiterate the point I made in my original post - "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?"
Almost NOBODY thinks about the ER and wait times - until they have a loved one who needs to be "seen NOW!"
PS: "clients"???
*** happened to "patients"??!!! Yes, it is why I highlighted the term!

I will be completely honest, I cannot even understand this post because of the unconcealed animosity. In my line of work (foster care) I have clients And not patients.

Secondly, I am not saying that ED is not overwhelming and difficult. I am saying that you may be misjudging some of my clients' actions. I am also saying that your frustration with the system only works to alienate those who truly need care.

Lastly, just I only mentioned floating to the ED because I have seen and experienced some of what you deal with and I have the utmost respect for you. However, as a nurse who has worked in a number of second-class nursing positions (school nurse, psychiatric nurse, and foster care) I am really frustrated by the opinion that ED/ICU/other specialty are the ultimate in nursing. Just like I could never do what you do, I would wager that you would have a very hard time with any of my positions.

If you would like to rewrite your response to me in a less inflammatory and condesce so f manner, I would be glad to respond in kind.

Nalon1 RN/EMT-P, BSN, RN · Jul 11, 2016

I will be completely honest, I cannot even understand this post because of the unconcealed animosity. In my line of work (foster care) I have clients And not patients.
Secondly, I am not saying that ED is not overwhelming and difficult. I am saying that you may be misjudging some of my clients' actions. I am also saying that your frustration with the system only works to alienate those who truly need care.
Lastly, just I only mentioned floating to the ED because I have seen and experienced some of what you deal with and I have the utmost respect for you. However, as a nurse who has worked in a number of second-class nursing positions (school nurse, psychiatric nurse, and foster care) I am really frustrated by the opinion that ED/ICU/other specialty are the ultimate in nursing. Just like I could never do what you do, I would wager that you would have a very hard time with any of my positions.
If you would like to rewrite your response to me in a less inflammatory and condesce so f manner, I would be glad to respond in kind.

They are not dealing with your clients, they are dealing with their patients.

So you're foster care? All your clients are under 18? All are wards of the state? Not what is being talked about. These kids do not come into the ER ranting and raving that they are in pain and need Dilaudid now. They are minors and need consent to treat, so they will have an adult with them and will be treated as they need to be. They will not refuse treatment. They will not leave one ER and go to another to get more meds. They will be treated appropriately for their condition.

Your taking personal offense to something that is not directed at you or your clients. I do not see anyone saying the ED/ICU is better than any other area of nursing, you brought that up. No, I probably could not do (do not want) your job, and you state you float to the ER but can't do it? Why accept that assignment?

As for this entire post, some people can't read a simple sentence. Tho OP (probably a troll) said a simple headache. Not a migraine, not a bleed, not a six month long headache, not the worst headache they ever had, just a headache. If you work in the ER you have had these patients. The patient that comes in saying "I have a headache that started an hour ago". No nausea or vomiting. No weakness or deficit. No visual problems. No speech problems. Just a regular headache that they have not taken anything for and just wants something for the pain, but for whatever reason has not even attempted OTC self treatment.

Not every headache is an emergency.

The x-ray above, we have no information about. The migraine sufferers, nothing to do with simple headache. Still trying to figure out how sickle cell got into this discussion.

A&Ox6, MSN, RN · Jul 11, 2016

They are not dealing with your clients, they are dealing with their patients.
So you're foster care? All your clients are under 18? All are wards of the state? Not what is being talked about. These kids do not come into the ER ranting and raving that they are in pain and need Dilaudid now. They are minors and need consent to treat, so they will have an adult with them and will be treated as they need to be. They will not refuse treatment. They will not leave one ER and go to another to get more meds. They will be treated appropriately for their condition.
Your taking personal offense to something that is not directed at you or your clients. I do not see anyone saying the ED/ICU is better than any other area of nursing, you brought that up. No, I probably could not do (do not want) your job, and you state you float to the ER but can't do it? Why accept that assignment?
As for this entire post, some people can't read a simple sentence. Tho OP (probably a troll) said a simple headache. Not a migraine, not a bleed, not a six month long headache, not the worst headache they ever had, just a headache. If you work in the ER you have had these patients. The patient that comes in saying "I have a headache that started an hour ago". No nausea or vomiting. No weakness or deficit. No visual problems. No speech problems. Just a regular headache that they have not taken anything for and just wants something for the pain, but for whatever reason has not even attempted OTC self treatment.
Not every headache is an emergency.
The x-ray above, we have no information about. The migraine sufferers, nothing to do with simple headache. Still trying to figure out how sickle cell got into this discussion.

I am not really sure why you are upset about my post. I responded to a poster who bolded my use of client stating that she doesn't have clients. I responded stating that she may not have clients, but I do because of my work.

While I currently work in foster care for medically and emotionally fragile persons, I have had experience in school, acute psych, and urgent care. I also was crosstrained to ED and med surg so that I could float. Therefore, I have worked with adult patients and individuals who come to the ED on a nightly basis for the turkey sandwich. I stated that I cannot do what ED/ICU nurses do as a way of recognizing that this is not my area of expertise. There has bewn a long history of elitism of some "designer" specialties in nursing. My statement was a preemptive attempt at explaining that just like I don't do what you do (because I don't) you don't do what I do.

I don't really understand your statement regarding foster kids and ED. I understand that foster care is different in every state, but my clients are not all "wards of the state" from a medical perspective. Some biological parents remain as medical consenters. As such, a child in foster care is not always brought by a guardian to the ED. In fact, some of our foster parents are also ineffective in this manner. It may not be good, but it is reality.

While I know that this OP referred to a simple headache, this thread has evolved, and many other examples have been addressed. Some of those examples included migraines, back pain and sickle cell. In general, many clients with SCD are labeled in EDs as med seeking. this actually does affect my child and adolescent clients because they receive mixed messages regarding treatment of a vasooclusive crisis.

Regarding you not wanting to work in foster care, I will just say that very few nurses like to work in foster care for many reasons including low pay, limited appreciation and sometimes stigmata that rub off on us. However, I truly believe that I am doing important work, which can potentially improve the outcomes for our clients. Therefore I am glad I do what I do.

Nalon1 RN/EMT-P, BSN, RN · Jul 12, 2016

I am not really sure why you are upset about my post. I responded to a poster who bolded my use of client stating that she doesn't have clients. I responded stating that she may not have clients, but I do because of my work.
While I currently work in foster care for medically and emotionally fragile persons, I have had experience in school, acute psych, and urgent care. I also was crosstrained to ED and med surg so that I could float. Therefore, I have worked with adult patients and individuals who come to the ED on a nightly basis for the turkey sandwich. I stated that I cannot do what ED/ICU nurses do as a way of recognizing that this is not my area of expertise. There has bewn a long history of elitism of some "designer" specialties in nursing. My statement was a preemptive attempt at explaining that just like I don't do what you do (because I don't) you don't do what I do.
I don't really understand your statement regarding foster kids and ED. I understand that foster care is different in every state, but my clients are not all "wards of the state" from a medical perspective. Some biological parents remain as medical consenters. As such, a child in foster care is not always brought by a guardian to the ED. In fact, some of our foster parents are also ineffective in this manner. It may not be good, but it is reality.
While I know that this OP referred to a simple headache, this thread has evolved, and many other examples have been addressed. Some of those examples included migraines, back pain and sickle cell. In general, many clients with SCD are labeled in EDs as med seeking. this actually does affect my child and adolescent clients because they receive mixed messages regarding treatment of a vasooclusive crisis.
Regarding you not wanting to work in foster care, I will just say that very few nurses like to work in foster care for many reasons including low pay, limited appreciation and sometimes stigmata that rub off on us. However, I truly believe that I am doing important work, which can potentially improve the outcomes for our clients. Therefore I am glad I do what I do.

Who said I was upset?

As for the foster care job, it was not a slam, I have the utmost respect for those that do it, it is a hard and thankless job. My dad was adopted, and his adoptive parents were foster parents for many years. So was my aunt. It takes a special person to work with many of these kids day in and day out, only see them returned to the ones that caused the problem in the first place.

amandakay24 · Jul 19, 2016

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.
Yes, assuming that you are not immune suppressed, you could have waited until Monday to see your PCP. Treating uncomplicated ear infections with antibiotics right away is no longer the standard of care, and a wait and see approach is reasonable. If, after 48 hours, there is no improvement or there is a worsening of symptoms, it would be reasonable to call your family doctor.
As a person who suffers migraines and as an ED nurse, my opinion is that a person with chronic migraines should be under the care of a primary doctor who can prescribe medication for their condition, and they should try this before seeking further treatment. An Urgent Care clinic is capable of providing effective treatment for a migraine headache. While it's understandable that there may be issues with insurance or hours of operation that drive people who have migraine headaches to the ED, the ED should be the last resort. Unfortunately, many use it as a first resort, before they've explored other reasonable alternatives. I think, for some of us, that is where the frustration lies. It's like the person who has a PCP, who vomits one time and comes to the ED without even calling their doctor's office - calling your PCP and trying simple home care measures for the first 24-48 hours is appropriate for most simple and non-life threatening illnesses.

Pain doesnt wait for a convient time to show up migranes are hell and when a person who has one wakes up at two am with blurred vision 10/10 pain and vomiting they are not required to wait until a walkin clinic opens just because some snotty ass nurse doesnt want to deal with a "simple" headache

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Anna Flaxis, BSN, RN · Jul 19, 2016

Pain doesnt wait for a convient time to show up migranes are hell and when a person who has one wakes up at two am with blurred vision 10/10 pain and vomiting they are not required to wait until a walkin clinic opens just because some snotty ass nurse doesnt want to deal with a "simple" headache
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Did you even read my post that you quoted?

amandakay24 · Jul 19, 2016

Did you even read my post that you quoted?

Quoted on accident thanks buhbye

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Anna Flaxis, BSN, RN · Jul 19, 2016

Quoted on accident thanks buhbye
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Alrighty then!