Brain surgery last week, then coming to ED for pain. Wait 4 hours to be seen.

[happy2learn]

Nurses, I want to know your take on this situation.

I'm not a nurse, just a student. I volunteer at the ED. Families talk to me about what's going on and I listen.

This family came in and you could just see something wasn't right. They started talking to me and their son had been in the ED since last night. He had brain surgery last week. He came in because he said he felt pressure and pain in his head. They had him wait 4 hours.

Now, I know I don't know very much, but it just seemed like to me that if a person comes in with that kind of pain and they knew he had surgery, wouldn't it be more of a priority to get him seen? This guy clearly felt horrible. My immediate was reaction was well what if there was bleeding in the brain, which is exactly what the family was concerned about.

They were so polite, just the nicest people, despite what they were going through. I know the doctor and nurse didn't answer all of their questions and they did leave today, but you could tell they were not satisfied at all. I gave them the patient relations number and advised them to speak with them about the matter.

As a nurse, would you think that he should have been a higher priority, at least to make sure there wasn't any bleeding? I know I don't have any more details really to give, but based on just all of that info, what do you think?

I'm going to assume the nurses and docs did the right thing, but people do make mistakes. I'm just curious what your experience would tell you.

Thanks!

[happy2learn]

This is what you said and on which I based my response. There is no indication in your post that the patient or family complained about their care. I am aware of the purpose of a patient relations department and do not need to be schooled about it. I was just trying to keep you from getting yourself into trouble.

I wasn't meaning to "school" you on it and I'm sorry if it came across that way. I did mentioned that they weren't satisfied, which I had thought implied they were complaining.

I appreciate your advice.

[LPN_mn]

Can u say HIPPA violation. I am not sure what ur job is but if u didn't have direct care for this patient u my be setting yourself up for a big problem. If u did not have a medical need for accessing the patient records that is a HIPPA violation. Since u are not a nurse I am betting that u did not have any need to access information on this patient.

[klone, MSN, RN]

Can u say HIPPA violation. .

Hopefully not. Hopefully she would say "HIPAA" instead.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

FYI: EVERYBODYcomplains about the ER except those who are actually dying. Those actually dying get seen right away. Everybody else has to wait till the most serious patients are cared for. People come to the ER because they feel pain or ill. It's hard to wait in that condition without complaining. They also will see the triage nurse, after assessment vital signs and history, take a critical patient directly to a room. They've barely laid eyes upon the person but they decide they are sicker which makes them angry. Goes on all day, over and over. Better get used to it.

[happy2learn]

Can u say HIPPA violation. I am not sure what ur job is but if u didn't have direct care for this patient u my be setting yourself up for a big problem. If u did not have a medical need for accessing the patient records that is a HIPPA violation. Since u are not a nurse I am betting that u did not have any need to access information on this patient.

I'm not accessing their medical chart. It's in the ED log, for why they came in.

Yes, I have to access it when I escort them back or if I take a message back. I look at why they came in, and I'm allowed to, because it tells me if they have something like TB where I need to take precautions before taking a message back. It also tells me if they were an assault victim so I know to not take the visitors back, or if they've passed as well.

[LPN_mn]

It's neither. I was just curious how other nurses other look at the situation. That's it. No hidden motive to attack someone or anything. I assume they did the right thing because this is a well known hospital and the staff are quite competent.

I just like to learn different things and see different perspectives at situations. Obviously my perspective is jaded because of having contact with the family, which is why I wanted an unbiased opinion.

The system actually had him as "dizzy/nauseous/headache."

But I think everyone has brought up some really good points to think about. Thank you everyone!

athanks for the correction

[LPN_mn]

Please disregard the previous post. Thanks for the correction.

[happy2learn]

Please disregard the previous post. Thanks for the correction.

No problem. I know you're just trying to make sure I don't violate HIPAA. I appreciate it.

[Altra, BSN, RN]

Bottom line: wait time in the ED depends on what else is there at that time. Symptoms that could kill you within the next 30 minutes will always go straight back ... everything else varies.

For example: On an exceptionally good day when the planets have aligned and the sun is shining and the timing is just right, I can take straight back a screaming toddler who has taken a tumble over a toy/sibling/pet/whatever and cut his lip/forehead/whatever ... whose panicked mother is holding a bloody towel around him claiming he briefly lost consciousness ... and who looks like a horrifying mess to nonmedical staff and visitors in the waiting room. On many days however, the same child presenting with the same symptoms will wait. And everyone in the waiting room will glare at me and think how "mean", "uncaring", "cold" I am.

Another example: on a daily basis I triage patients who are post-op whatever procedure, as in your original post, complaining of increased pain, nausea, headache, etc. Could their symptoms indicate something bad happening? Yes, they could. But that's where my professional education, training and judgement come in. Also, some of these patients have already contact the surgeon who performed their procedure, and been told that their symptoms are not concerning, take xyz measures for some relief, follow up as scheduled, etc. ... but have decided that that advice was not what they wanted to hear. So they come to the ER ... where they are now being treated by medical professionals who are not familiar with them and have not been involved in their care up to this point ... and expect that evey conceivable complication be ruled out because they have some symptom they didn't expect to have. Again -- we rule out the big, bad stuff that will kill you in the short term -- everything else is between you & your surgeon/primary MD. This is what another poster was trying explain about the difference between patient expectations, and reality.

[happy2learn]

Bottom line: wait time in the ED depends on what else is there at that time. Symptoms that could kill you within the next 30 minutes will always go straight back ... everything else varies.

For example: On an exceptionally good day when the planets have aligned and the sun is shining and the timing is just right, I can take straight back a screaming toddler who has taken a tumble over a toy/sibling/pet/whatever and cut his lip/forehead/whatever ... whose panicked mother is holding a bloody towel around him claiming he briefly lost consciousness ... and who looks like a horrifying mess to nonmedical staff and visitors in the waiting room. On many days however, the same child presenting with the same symptoms will wait. And everyone in the waiting room will glare at me and think how "mean", "uncaring", "cold" I am.

Another example: on a daily basis I triage patients who are post-op whatever procedure, as in your original post, complaining of increased pain, nausea, headache, etc. Could their symptoms indicate something bad happening? Yes, they could. But that's where my professional education, training and judgement come in. Also, some of these patients have already contact the surgeon who performed their procedure, and been told that their symptoms are not concerning, take xyz measures for some relief, follow up as scheduled, etc. ... but have decided that that advice was not what they wanted to hear. So they come to the ER ... where they are now being treated by medical professionals who are not familiar with them and have not been involved in their care up to this point ... and expect that evey conceivable complication be ruled out because they have some symptom they didn't expect to have. Again -- we rule out the big, bad stuff that will kill you in the short term -- everything else is between you & your surgeon/primary MD. This is what another poster was trying explain about the difference between patient expectations, and reality.

That's a good point. Thank you.

[happy2learn]

Thank you everyone for your opinions. You've all made good points for me to think about and I've learned quite a bit from you.

Thanks again, I appreciate it.

[carolmaccas66, BSN, RN]

I worked one shift as an agency RN in a large, busy ED/ER, and hadn't worked in an ED before. When the other nurse went on her break I was supposed to do all the observations. Well, I had about 12 patients (could have been more) on my side in the section where patients had already been triaged. I was finishing off a blood transfusion, watching for adverse reactions; then someone else wanted a commode then wouldn't move as she'd come in for back pain; someone else had come in with a cut head - their daughter was freaking out cos her Mum's head was still bleeding everywhere; another patient was going psychotic & they had to get a guard for her, then the director of emergency came along to give me instructions for one of the patients - it was absolute mayhem. I didn't get any ob's done & the time just flew away. It gets very busy and I had to keep changing my priorities as to who needed what. I was told that night that if a patient is not deemed critical, they are resting in bed, ob's OK, breathing etc, basically they are not urgent and see to the urgent patients first who have been triaged. If this person had been triaged, had extremely bad head pain, was vomiting, etc as a RN, I would alert the Dr/director (who was helping us the night I was on) and get another opinion just for legal reasons and of course, to ensure the patient is taken care of. I remember I am always legally responsible as a RN as well. As long as you report any changes to your senior nurse/Dr and document it, you are covering yourself and the hospital in a legal sense.

It does get very busy in these huge EDs though, so extremely ill patients always take priority, not that I have any experience mind you, but have known a few people who have worked in EDs.

It's great that you are on here asking questions and wanting more info. As a potential nurse, you should ALWAYS query something you are unsure of, because your license is on the line and there are always legal obligations to consider, and of course you want to do the best for your patients.

Keep it up.