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Cooler weather and homeless "patients"

Emergency   (6,913 Views | 23 Replies)

NurseOnAMotorcycle has 10 years experience as a ASN, RN and specializes in Med-Surg, Emergency, CEN.

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Funny/sad story..

We had one of our regular homeless come in quite a lot recently (a lot even for him), for stuff like back pain, knee pain, a fall, etc. It was so excessive, I wanted to explode. One day, I see he had arrived once again by EMS, to our main trauma room. I laughed and couldn't believe he was taking up our trauma room. And then I walked in and saw a man who was having a STEMI and AAA rupture.

Every once in a while you have to get put in your place. Even though they use and abuse you, every now and then they actually are sick, so you must always treat them as such.

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JBudd has 38 years experience as a MSN and specializes in Trauma, Teaching.

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Ours are usually under the influence of something or other, which makes them incompetent and therefore not streetable. Police won't take them into protective custody anymore, so they sleep in our hallways.

Very few get the whole workup anymore, most don't even get labs. As long as they are maintaining a sat, keeping their own airway open and fairly normal range of vitals, they sleep until they've been in long enough to "sober" and walk straight but before they get the shakes, then we send them out with the dawn.

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55 Posts; 2,630 Profile Views

So give them a blanket and let them sleep inside...better than getting them back via ems for hypothermia. Have some compassion, geez, these people have many problems.

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VICEDRN has 5 years experience as a BSN, RN and specializes in ER.

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So give them a blanket and let them sleep inside...better than getting them back via ems for hypothermia. Have some compassion, geez, these people have many problems.

I would love it if the answer was that simple but the waiting room was not intended for people to pull up three chairs and sleep. It scares decent paying "customers" out of our facility and gives them them the impression that we are a dangerous scary place that reeks of foods, urine and body odor. When the homeless patient collapses from the too much booze that warms them, we end up looking bad. again. Not to mention the bills they are running up from the pretend triage.

My public/critical access hospital needs to stay open in a big way for the trauma patients/burn patients and the needy. We can not afford these problems in our waiting room.

For the record, i have discharged a patient who bounced back hypothermic with a heart rate of 35. Wish I had a better answer for this problem.

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That Guy has 6 years experience as a BSN, RN, EMT-B and specializes in Emergency/Cath Lab.

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Ours learned the trick. Say chest pain, or I want to kill myself and it buys them an overnight stay. ****** me off to no end.

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sandyfeet has 5 years experience and specializes in Emergency Nursing.

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Ours learned the trick. Say chest pain, or I want to kill myself and it buys them an overnight stay. ****** me off to no end.

I was going to reply the exact same thing. Info being passed through the network?

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VICEDRN has 5 years experience as a BSN, RN and specializes in ER.

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No reason to keep them overnight with chest pain. Do you keep all chest pain patients? Crazy.

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55 Posts; 2,630 Profile Views

Well, if a pt is that booze soaked it needs an admission, sorry but etoh does kill. There are many out of the way places in the hospital at night, not just the waiting room...although its not my responsibility to find it...nor to pass judgement on a homeless seeking shelter, nor to worry about offending the rest of the 'clients' getting a glimpse of societies real problems. This is a management problem, not a nursing issue, but if you are willing to try to step outside your roll as homeless police and do securities job for them...well, I say your in for early burnout. Sorry, but, I have compassion for them, even if they don't seem human, they still are. Like I said before...when did it become the nurses job to boot people into the street? Discharge them, and your role is over....let admin come up with a solution so I don't have to be the bad cop. Not my job.

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VICEDRN has 5 years experience as a BSN, RN and specializes in ER.

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Well, if a pt is that booze soaked it needs an admission, sorry but etoh does kill. There are many out of the way places in the hospital at night, not just the waiting room...although its not my responsibility to find it...nor to pass judgement on a homeless seeking shelter, nor to worry about offending the rest of the 'clients' getting a glimpse of societies real problems. This is a management problem, not a nursing issue, but if you are willing to try to step outside your roll as homeless police and do securities job for them...well, I say your in for early burnout. Sorry, but, I have compassion for them, even if they don't seem human, they still are. Like I said before...when did it become the nurses job to boot people into the street? Discharge them, and your role is over....let admin come up with a solution so I don't have to be the bad cop. Not my job.
I came back to this thread to respond specifically to you. I was thinking of your post yesterday when we began a spontaneous discussion about our regulars early yesterday morning. A couple of thoughts for you: 1) you only "need a bed upstairs," if you are so intoxicated you cant ambulate without falling over or worse; 2) if I am in triage, it is my responsibility to care for the people in the waiting room. I assure you the manager will not care that they weren't in the system when they collapse; 3) they are discharged or...checked in but not willing to go see the doctor when their turn comes; 4) it is my job to provide for the safety and well being for the people in the waiting room. One day, two discharged homeless patients got into a fight about a half cigarette and a dollar bill in our waiting. We had to clear the waiting room and get security to resolve it. They broke several chairs and finally...as we talked, I wondered how well you know the homeless patients you pity? Most of these folks have places they could stay but choose not to. I know this because I know them and their story. I do pity them but I also respect them as human beings enough that I refuse to act as though their hard existences are a reason to indulge inappropriate behavior. They are grown ups, they are endangering their well being and bankrupting the hospital!

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uRNmyway is a ASN, RN and specializes in Med-Surg.

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I think for those frequent flyers who don't pay for their own care there should be some kind of limit. For instance, if you show up in the ER more than X number of times for non-emergent situations, we won't pay for it, and you will have to. I guess then it becomes a problem of collecting on the debts though...

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DC Collins has 7 years experience as a ASN and specializes in ED.

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I don't know about most other EDs but we contract our ED docs. They don't get paid unless they see patients. None of ours would let someone like this just hang out *unless* it isn't taking up resources. Those resources include the nurses and techs, since we need to get our work done on the other pts so they can be discharged.

DC :)

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