County ER Issues....

[EmBeMap]

I am a CCT in a level 3 ER. CCT is like a unit clerk combined with CNA and phlebotomy duties. I love my job and my patients, I like the workload, I like to busy all the time as it makes my shift seems shorter. But I am having a HUGE problem with apathy of some of my co-workers towards patients, I recently sent the following to management and they seem to be behind me recognizing improvements need to be made.. My question is ... Is it always this bad ? Am I making a bad choice as I plan on being an ER RN when I finish nursing school as well. I tried to sanitize for personal or patient info...

Pain Management:

I have seen this repeatedly and it tends to be more of an issue with non-english speaking patients.

The case today is as follows,,

Patient is an amputee with colostomy, had severe infection had 3 different antibiotics hung (I checked because I'm nosey). The patient only spoke spanish and complained 3 times that I know of (told me in spanish) that he was having chills. I kept relaying this to nurse and she said " he has a severe infection I gave him some tylenol earlier and he has to deal with it ". Theses complaints are over a 3 hour period. Then the same patient (who I placed on a monitor becomes tachy (HR 114) and the nurse is not present he is also visibly in pain and grabbing his remaining leg. I can't find his nurse but since I translated for his resident (doctor) I go tell her and she comes to assess. Resident writes order for morphine and within 10 mins I see the nurse back and relay to her the patient HR and that he complains of a 9/10 pain in remaining leg, also tell her that I already told resident and if she checks chart there is an order for morphine for his pain and fever of 101.1 which I had reported to her the first time he complained of chills to me. Nurse says ok I will check chart and get it... I check with patient periodically over the next 4 hours and he still states he is in pain and has not had meds. He still had HR of 104 and grabbing his leg between bouts of falling in and out of sleep .... I have a high standard for working in the EC as I believe that these people are entitled to timely and compassionate care which includes timely pain management. There are so many things that happen back there that nurse's can't address quickly because of lack of Dr's Orders. I hold myself to this standard in everything my CNA allows me to do for them. If the nurses are not up to delivering care in a timely manner shouldn't they consider moving to a different dept with a slower pace... (again my opinion)

Apathy..... is a killer....

My CNA training is not a highlevel training but they did explain that consistently high BP 201/187 (especially in a patient who has already had one CVA) puts them at risk for additional problems and should not be disregarded (my nurse replied it's no big deal she has already had one CVA) now to me that's awful.

Auditing: TBS (to be seen) Patients

Today was very slow for patients, we cleared similiar patient loads in EC2 on Wednesday with Dr. **** (other attending) and we didn't have any patients who went all day as TBS patients. It's seemed extremely disorganized and chaotic and we had several patients who had not been seen since the am. I understand delays but having patients with no orders and no labs for more than 5 hours to me is excessive. These patients weren't even assigned docs when I left at 7pm.

Safety:

What's the protocol of cleaning up large amounts of body fluid in the EC... in restaurants and grocery stores we have to use a powder that absorbs the liquid and then we sweep up powder and disinfect. Our nurses just put blanks and towels down and swept up glass. This was from broken glass bottles of paracentesis fluid.

Translators

Usage has been to call them down for h/p and then wait for docs to write orders, they don't call them down to discuss any treatment details example ( to tell them your are going to CT for this test or blood draws to test this or this ) this consideration is giving to english speaking patients. The problem is that the patient cannot make any contributions to their care because most of the time they are not sure of even what is going on. I have tried to work with as many as possible to have them clarify and issues or questions or doubts regarding their treatment by asking for interpreters (or myself) as much as possible. If the patient cannot relate their concerns or complaints of pain in a timely manner because of the language barrier then patient care can be compromised. (maybe we need a translator to rotate in only adult and pedi EC) We do this with consults right ? Some surgeon is regularly assigned to EC right ? Why not a interpreter, we are the front end to the hospital for most people I don't feel we can afford to have a compromised care to language and apathetic staff as in the long run it makes the organization as a hole look bad. Also I have seen nurses do discharges by just printing out micromedex info in spanish making them sign it and going about their business, I have witnessed this at least 3 pt's in pedi EC with pregnancy related abdominal pains.

I admit that I have stars in my eyes and hope for miracles. But I believe that both you and **** (other anm) have the patients best interest at heart, and I keep seeing concerned caring nurses among the apathetic ones. So we have people to work with. How do we make it better? Do we do discharge interviews in english/spanish to spot holes in care. Are there any incentives we can reward people with who do value the patient no matter what their situation. Good example (**** EC RN) gave me a lecture making sure that I didn't assume or generalize patients so that I wouldn't let assumptions affect how I provided care (example prisoners) I felt good hearing that from her and feel confident in how she would handle patients no mattter what the case.

Am I nuts for feeling this way ? Is county a bad match for me... I don't mind the amount of work or the patients we get (I like being able to help the non-english speakers especially) I like being busy from the time I get there until I leave. I see people in pain, dying (cancer patients) and people with many different needs. I don't have any emotional issues dealing with any of that, I go home nightly feeling good about the people I helped that day. But as I get more exposed to the apathy in other techs and even RN's I get so disappointed. In your honest opinion will it improve? If not should I tough it out until RN so that at least I can make a difference for my patients.. ? Can I survive even if my co-workers complain?

Any input from you guys would be appreciated..

RN 2 BE

[gonzo1, ASN, RN]

The only input I have is keep up the good/caring job you are doing. I wish I worked with you. County needs people like you to advocate for the patients that have no one else.

I have worked in cushy hospitals with no need for interpreters and I have worked in dumps. I prefer the dumps. You are there for the people that really need you. Thanks for caring for the ones no one else does.

[mom2michael, MSN, RN, NP]

You'll be great at your role, wherever that takes you in life. Keep up the always caring, always compassionate attitude. That will get your farther in life that your unsympthitic co-workers.

[bollweevil]

I have worked with lots of nurses in numerous settings,

[bollweevil]

I have worked in numerous settings with lots of nurses, government and non-government. Apathy and cruelty are not limited to gov settings.

What in God's name was that nurse doing for 4 hours that she couldn't give MSo4?

Understand that most people work to pay their bills, not please God or their fellow man. They satisfy their own consciences, therefore hold to a pretty high standard, as most people are pretty okay. But you will always some who answer to a higher authority (God) and some who answer only to that need for a paycheck.

Pray for everyone, strive to be a good example, take to task the really horrible, abusive ones. The rest you won't have time or strength to deal with. They outnumber you.

Keep your beautiful outlook as long as you can. you might inspire someone to emulate you.

[locolorenzo22, BSN, RN]

I agree....the image that we strive to uphold in ourselves is one that we can look square in the face when we wake up every morning (or afternoon). Some people only want the money, some people only want to put in the time and go home. those of us who truely try to serve the patient are sometimes the minority. We do because we care. keep the faith, and maybe others will pick up on it....(but don't hold your breath. Do it for you, not for others.)