And you did hear me when I told you she has active internal bleeding!?

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All I know is, there is SO much to be said about my shift last night. I am beginning to wonder if I have a personality Disorder or if it is reasonable for me to not trust the clinical judgement of most nurses, even though I have been a nurse for 13 years!?

I am beginning to realize that the severity of ignorance is rapidly growing amongst the most new population of nurses will be the cause of my "burn out" as a nurse, not patient care!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

What happened?

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What happened?

OT but that dog is hysterical. You must have a lot of fun with her.

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Took place at a free standing ER in Texas 2 days ago. Patient was a 29 year old female with complaints of unresolved, worsening Right lower abdominal pain. Patient had received eval and treatment at a local hospital approximately 20 miles away 3 days prior. She was diagnosed with an ovarian cyst. She was given a prescription for lortab upon discharge from the ER and was told the exacerbated symptoms would resolve within following 2-3 days. Before I was informed by front office staff that "a patient was needing to be brought back, I am randomly informed that "a patient is about to be ready to be brought back and that it was so obvious that she was only there to get drugs..." Keeping in mind that the patient only lived 2 miles away and had never been treated where I currently work. I started triaging the patient at approximately 8PM and was unable to bring additional patients back and manage their care due to the acuity level of my patient. Orthostatic BP and HR in a standing position was 77/32, 136. Hgb 3 days prior was 13.6 and it was 11.2 during the time I was caring for her. Translady partsl US confirmed active bleeding. Our ER physician had consulted with local hospitals for the sake of transferring her in the event more advanced care and/or surgery would become necessary. The consultations were not successful in having a local hospital accept her (she did have private Health Insurance). Our physician was not comfortable discharging her, rightfully so. I suggested that he have he admitted to our in patient side that is used for patients requiring extended obsevation time and continued medical care that is essentially basic, but that cannot be performed in a home environment. He agreed, so that was the next course of action. I gave report to the in patient nurse on staff (same nurse with preconceived idea that the patient had only come to our facility as a "drug seeker." Needless to say, she demonstrated little to no interest in my report to her. The last statement made from the receiving nurse was, "She's fine!" Additionally, shortly before I informed her that my patient would be transferring into her care, I overheard her gossiping/complaining to my ER coworker how ridiculous the decisions I had made in how I preferred to monitor my patient. I heard her say, very clearly, "I mean this is not a freakin' critical care unit!" Prior to where I currently work, I've worked in critical care for 12 years. I also have a very strong cardiac background. I spent 2 hours of my 12 hour shift 100% focused on caring for my 29 year old patient (which included all documentation). I continue to question whether or not It was reasonable for me to have been consumed for 2 hours managing and providing the care that seemed logical to me or if the care I provided was because I am having difficulty letting go of the 12 years spent caring for critical care patients. I am new to this type of work environment/dynamic so I need a non biased perspective or opinion about spending 2 hours caring for one patient in a fast track ER.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

It might be a fast track ER but you had an acutely ill patient. You based your conclusions on a careful assessment of your patient. Sounds like others based their conclusion on what kind of a shift they wanted. Scary.

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Wow...

I don't know how 29-yo lady with a possible ectopic and sbp=77/32 and an hr=136 doesn't get a code 3 trip to a hospital with an OR.

I don't care where she was, she was clearly an ICU-level acuity.

Drug seeker or not, makes no difference.

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Specializes in Emergency Department; Neonatal ICU.
I heard her say, very clearly, "I mean this is not a freakin' critical care unit!"

Response: "She is a critical care patient." If you wanted to be completely unprofessional, you could say "freakin' critical care patient" but I wouldn't recommend modeling the behavior of a moron ;)

OP, you did exactly right in my opinion. I'm curious as to why no facility would accept her.

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The biggest issue that many of the facilities "Do not have any available beds." However, I know that the patient was denied prior to the results of the orthostatic BP and HR as well as confirmation that her Hgb had obviously been dropping over the past couple days. The active bleeding that the US revealed, for some reason. Perhaps from the stand point of an OB/Gyn, ovarian cysts that result in bleeding is not a cause for concern. If it were a GI bleed instead, I certainly hope the outcome would have been different! Thank you for the support regarding the decisions I made:)

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Keep in mind the SBP of 77 and HR of 133 were the result of her standing up to obtain orthostatic vitals. Also, her significant other was a female. Not to say there might have been some infidelity that did not have a good turn out. So would you feel differently if an eptopic pregnancy had been ruled out or would your level of concern change?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
OT but that dog is hysterical. You must have a lot of fun with her.
She is my fur baby...William Wegman isn't a brilliant photographer....he has a weimaraner and a camera.....the dog does the work. LOL

She is a camera hound. She sees a camera and strikes a pose. She kills me. I love that crazy dog.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Keep in mind the SBP of 77 and HR of 133 were the result of her standing up to obtain orthostatic vitals. Also, her significant other was a female. Not to say there might have been some infidelity that did not have a good turn out. So would you feel differently if an eptopic pregnancy had been ruled out or would your level of concern change?

Wow you were on the money....Let them laugh...your behind won't be in court.

I don't like these free standing ER's. The street em and treat em mentality can be a lawsuit waiting to happen.

Ectopic or not...this patient is symptomatic of volume depletion. I don't care if she is bleeding out her ear. She is symptomatic with a systolic of 77 and a heart rate of 136..."Houston we have a problem".

I wonder as well why no one would take her. That is the problem with free standing ER's no hospital affiliation...wow.

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Our hospital affiliation in Baylor Medical center, but we always have to resort to other, non related hospitals

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