Being Rushed in the ED

[vtachy]

This is my first time posting on here so go easy on me. I have been an ED nurse for 1 year and I find myself in a strange situation in which im not sure if its normal or just crappy management. So I wanted to ask your opinion!

Recently my ED implemented this new thing in which they are not triaging patients in the front, instead they just bring them to the room and leave them there for you to triage. They refer to this method as "pull till full." It is freaking me out because when I come in at midshift they give me 4 patients (we are 4:1) all within the first hour of work and it is really stressfull to tend to all of them at once like that, especially when they havent been triaged (which adds to time youre in the room with the patient). On top of this, they are not providing medics to help us. Unfortunately, all nurses are going through this and because they are so busy, it is difficult to help your teammates. I feel that this tactic is unsafe and it threatens my license. Getting slammed with so many patients at once is really difficult because you dont seem to catch up and have lack of help. It is to the point in which many of us are struggling to take our breaks. Often times if your patient gets a bed, they rush you by putting in for transport for the patient to go upstairs without you even getting a chance to give report (often I cancel the transport but they put it right back in). Other times, they rush you by assigning the room the patient is in to a new one coming in by EMS, so that EMS stands outside of that room waiting for the bed until the patient currently in the room is out so they can put the new patient in the half assed cleaned room. Is this how your emergency department operates? this is an super busy hospital by the way. Because I have never worked ED before I am having a hard time recognizing if this is normal or if I should transfer elsewhere. Rushing and exhaustion make you prone to errors!
Thank you all!

[Kooky Korky, BSN, RN]

On 6/4/2020 at 8:21 PM, vtachy said:

This is my first time posting on here so go easy on me. I have been an ED nurse for 1 year and I find myself in a strange situation in which im not sure if its normal or just crappy management. So I wanted to ask your opinion!

Recently my ED implemented this new thing in which they are not triaging patients in the front, instead they just bring them to the room and leave them there for you to triage. They refer to this method as "pull till full." It is freaking me out because when I come in at midshift they give me 4 patients (we are 4:1) all within the first hour of work and it is really stressfull to tend to all of them at once like that, especially when they havent been triaged (which adds to time youre in the room with the patient). On top of this, they are not providing medics to help us. Unfortunately, all nurses are going through this and because they are so busy, it is difficult to help your teammates. I feel that this tactic is unsafe and it threatens my license. Getting slammed with so many patients at once is really difficult because you don't seem to catch up and have lack of help. It is to the point in which many of us are struggling to take our breaks. Often times if your patient gets a bed, they rush you by putting in for transport for the patient to go upstairs without you even getting a chance to give report (often I cancel the transport but they put it right back in). Other times, they rush you by assigning the room the patient is in to a new one coming in by EMS, so that EMS stands outside of that room waiting for the bed until the patient currently in the room is out so they can put the new patient in the half assed cleaned room. Is this how your emergency department operates? this is an super busy hospital by the way. Because I have never worked ED before I am having a hard time recognizing if this is normal or if I should transfer elsewhere. Rushing and exhaustion make you prone to errors!
Thank you all!

Take your breaks if safe to do so or you are about to wet yourself. Make them pay you for working through your unpaid lunch break. Your rest breaks are likely not mandatory for them to give you, depending on what state you are in. But pee and boop are more urgent. They don't want you peeing or booping on the floors, so you have to heed these calls of nature. And women need to tend to feminine hygiene, nursing women must relieve their breasts to avoid mastitis and bad pain and starving babies.

Let EMS wait. A lot of folks BIB EMS are not critical or even urgent. They will just have to wait.

This sounds pretty outrageous. Make it known, perhaps anonymously, to your local news outlets, senior interest groups, friends, family who can help spread the word that XYZ Hospital does this in their ER.

Of course, you can always write your reps in Congress and let the Prez know, too.

[HiddencatBSN, BSN]

Most places I’ve worked do immediate bedding and you’re just expected to find the extra time to triage patients along with your regular care. I’m so, so glad my current facility doesn’t do this: if they need to put someone in your room without triaging it the charge asks if you have time to do it or they ask someone else to triage instead.

Management likes to say that it’s not different to sit in a room than to be in the waiting room waiting for triage and that the triage part isn’t much more than you typically do, but it doesn’t allow for balancing of assignments: what happens if you get 4 untriaged patients at once who all end up being sick? If a patient passes out or codes in the waiting room, you can see it whereas if they’re dumped in a closed room....you get to them when you get to them. In room triaging also means that patients aren’t necessarily triaged by someone experienced in making triage decisions.

I think there are better ways to speed throughput. For a busy and high acuity population it’s a nightmare tho.