Depressed about working ER

  1. This is the situation...I work in a small hospital in a rural community. Hospital has 30 beds, ER has 5 beds, usual visits/day about 15. This time of year it is more. We have a 110 bed nursing home associated with the hospital, so several patients a day are from the nursing home. We have 4 ER docs who rotate through. One I work with every Wednesday and at least one day on my weekends. He does full court press on most patients despite their presenting complaints. For instance...if you are an old lady you need a cath urine specimen, even if your complaint is fall with hip pain. I worked with him yesterday, mainly had respiratory complaints...lots of wheezing going on. Everyone had cath UA ordered. I work solo...med/surg can be my back-up but we were admitting everyone we saw yesterday so they were way to busy to come out and help. No clerk...on day shift we have a pink-lady who mainly comes out wringing her hands and saying there is someone out here who needs to see the doctor????? Gushing blood? Blue and gasping for air? For suture removal? Oh, I didn't ask...or notice. I have to clean up each bed after each patient unless the pink-lady notices and comes out and does it for me. My shift, which should have ended at 7 pm lasted until 11 pm because several pretty critical patients came in as I was trying to catch up on my charting after the pm nurse came in. Leave with two patients getting full cardiac work-up and two peds getting IV's for dehydration...I don't think so! One cardiac was less than 50 years old and EKG showing acute MI, getting TNKase. Other one was saturating in the 80's. Peds were showing ketones in their urine. No lunch break yesterday...nurse manager came out about 4 to give me a break before she left. I am 60 years old...no chair had seen my hinny all day long. Lunch was a bite...then start an IV, another bite, then call lab, another bite, then draw blood for the lab when I started an IV, then strip the patient down to a hospital gown so they could have a chest x-ray...you get the picture. Am I too old for this? I keep my CEU's up to date, acls, pals etc. I hurt everywhere this morning. I can't afford to retire, but I am soooooooooo tired!
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    About ernurse2244

    Joined: Dec '03; Posts: 176; Likes: 2

    10 Comments

  3. by   surfer betty crocker
    [ I am 60 years old...no chair had seen my hinny all day long. Lunch was a bite...then start an IV, another bite, then call lab, another bite, then draw blood for the lab when I started an IV, then strip the patient down to a hospital gown so they could have a chest x-ray...you get the picture. Am I too old for this? I keep my CEU's up to date, acls, pals etc. I hurt everywhere this morning. I can't afford to retire, but I am soooooooooo tired![/QUOTE]
    God bless you! can you afford to look into other avenues like ambulatory care? or is the emergency room your kind of thing?
  4. by   ernurse2244
    Quote from hillflower
    [ I am 60 years old...no chair had seen my hinny all day long. Lunch was a bite...then start an IV, another bite, then call lab, another bite, then draw blood for the lab when I started an IV, then strip the patient down to a hospital gown so they could have a chest x-ray...you get the picture. Am I too old for this? I keep my CEU's up to date, acls, pals etc. I hurt everywhere this morning. I can't afford to retire, but I am soooooooooo tired!
    God bless you! can you afford to look into other avenues like ambulatory care? or is the emergency room your kind of thing?[/QUOTE]
    Hi, ambulatory care isn't really an option for me. I hate doing home nursing. The paper work is a killer for me. And, on good days, I love ER nursing...so many people say..."I am so glad you are here, I wouldn't have worried if I had known you were on duty". I have a good reputation in the community for being a good nurse. I just want some support.
  5. by   needsmore$
    Sounds like you had a day from hell!! Hopefully tomorrow will be better (the beauty of the ED is that everyday is a different day). I'm in my mid forties and have been doing this for more years than I care to remember and will probably be doing it well into my sixties (college tuition for kids). Don't get depressed- tell me it gets easier!!! PLEASE!!! I see myself (in you) in the future...
    Goodluck-
    From another 'seasoned' ( never old) ED nurse
    Anne
  6. by   errn7
    I work in a local community hospital where we have a 13 bed ER with 3 of those used for urgent care pts from 11a/11p in this hospital we draw from at least 5 counties and three states. We have our good days and our bad ones. However, last Wed. We had our worst that I can remember in our most recent past. It started by the on coming 7a/7p doc being one of those as you described so adequately as a "full press" Md on every pt. Not to mention that we are now seeing all the cough/congestion that has started now. When I arrived at 11a with the urgent care MD an the other 11/11 Rn the place was packed out with 3 waiting. So now instead of starting to clear out and see the UC pts which is what mostly comes to the ER we bog down and things go from bad to worse, the nursing homes start their daily out pouring of cough/congestion, abd pain for 3 weeks out to the ER. In the mean time we are now 10pts behind with 4 waiting to be admitted 2 of which are + for Flu. To this mess we have already seen 4 ambulances in the first hour all of which are unable to go to the lobby and be triaged....(Oh and I almost forgot 2 of the 4 dayshift nurses are working sick with the same resp. stuff every one thinks is deadly to them and decides they have to get a work excuse because of it.) Now for the blow that sunk us that day.....One of the ambulances we had just seen is on the way back in with a full arrest...now wait we have no rooms open and pts in the hall.....So the admission thats waiting to go upstairs now has to be moved out into the hallway and his room cleared for the code........After the code we now have 15pts waiting for rooms, with two more ambulances from nursing homes on the way in........Our nurse manager has been on the floor working since before I came in....as what most nurse manager's should do but dont....He tried over and over again to get the MD's to say they needed help....Finally at 5pm we were able to start seeing urgent care pts with a part time MD that picked up his phone. At 5pm The CEO n ACEO come to the ER and make the rounds asking everyone if they are ok or if they need anything......Guess what.....They bought pizza for us since no one was able to get away for dinner break...Yes it does happen....LOL
    Anyways to make a long story short. It never got any better. No other local hospital would take transfers d/t pt census and at 11pm we took the last bed available in the hospital. So the night crew had to "house" the 5 pts that were waiting to go upstairs.....2 CCU pts on dopamine....2 surg pts...one appy one free air in the belly...one nursing home pt with pneumonia.
    The total count was 102 pts registered in 24hrs 17 ambulances 20 admissions 4 transfers. I know when compared to a level one trauma ER with multiple beds and docs it doesnt sound like much but when you normally see between 60/80 aday the extra 20 and the acuity of their illnesses can smack you in the face and knock you down........but not out.... ER nursing is what I personally love and wish to do the rest of my nursing career. Just a bad day out of so many great days........
  7. by   rjflyn
    Its probably not going to get any easier with the baby boomers getting older and Americas health habits. Every ED I have been in each year seems to see a bigger patient load, and I have worked in a few.

    AS an example: The first one in 1988 use to have a doctor that worked a 24 hour shift and he was able to nap from like 1AM to 6AM, was staffed with a nurse who was helped by the ED based EMS crew when it got busy. When I left there 7 yrs ago it was a doc who now worked a 12 hour shift didnt get to sleep at all, with 2 full time night nurses, an ED tech and a unit clerk. Still had the EMS crew but most nights they/we were too busy to help.

    The next two saw about double the patients that the faucility was designed for. The last two were a little better- built for the patient load they were designed to see but that was suppose to be at least 10-15 years in the future. In fact one was just finishing a remodel and about a year later we were planning a whole new unit.

    Good luck and lets be safe out there.
    Rj


    Quote from needsmore$
    Sounds like you had a day from hell!! Hopefully tomorrow will be better (the beauty of the ED is that everyday is a different day). I'm in my mid forties and have been doing this for more years than I care to remember and will probably be doing it well into my sixties (college tuition for kids). Don't get depressed- tell me it gets easier!!! PLEASE!!! I see myself (in you) in the future...
    Goodluck-
    From another 'seasoned' ( never old) ED nurse
    Anne
  8. by   traumaRUs
    Gosh - I don't think you're too old - I think your place isn't staffed well enough. I don't work in a rural hospital - is this the norm?? If so, that's pathetic.
  9. by   teeituptom
    Quote from ernurse2244
    This is the situation...I work in a small hospital in a rural community. Hospital has 30 beds, ER has 5 beds, usual visits/day about 15. This time of year it is more. We have a 110 bed nursing home associated with the hospital, so several patients a day are from the nursing home. We have 4 ER docs who rotate through. One I work with every Wednesday and at least one day on my weekends. He does full court press on most patients despite their presenting complaints. For instance...if you are an old lady you need a cath urine specimen, even if your complaint is fall with hip pain. I worked with him yesterday, mainly had respiratory complaints...lots of wheezing going on. Everyone had cath UA ordered. I work solo...med/surg can be my back-up but we were admitting everyone we saw yesterday so they were way to busy to come out and help. No clerk...on day shift we have a pink-lady who mainly comes out wringing her hands and saying there is someone out here who needs to see the doctor????? Gushing blood? Blue and gasping for air? For suture removal? Oh, I didn't ask...or notice. I have to clean up each bed after each patient unless the pink-lady notices and comes out and does it for me. My shift, which should have ended at 7 pm lasted until 11 pm because several pretty critical patients came in as I was trying to catch up on my charting after the pm nurse came in. Leave with two patients getting full cardiac work-up and two peds getting IV's for dehydration...I don't think so! One cardiac was less than 50 years old and EKG showing acute MI, getting TNKase. Other one was saturating in the 80's. Peds were showing ketones in their urine. No lunch break yesterday...nurse manager came out about 4 to give me a break before she left. I am 60 years old...no chair had seen my hinny all day long. Lunch was a bite...then start an IV, another bite, then call lab, another bite, then draw blood for the lab when I started an IV, then strip the patient down to a hospital gown so they could have a chest x-ray...you get the picture. Am I too old for this? I keep my CEU's up to date, acls, pals etc. I hurt everywhere this morning. I can't afford to retire, but I am soooooooooo tired!

    Sounds normal to me
  10. by   stbernardclub
    Im sorry but I can't see working a job that is literally killing you. By the time you do retire, what condition will you be in? If I were you I would just tell them you need more help, or else you will have to tranfer out or leave. I commend you for your great care and dedication, but as they say, we have to take care of ourselves before we can take care of others. This is not a selfish act, this is your life.
  11. by   veetach
    LMAO Tom...

    It does sound like you had a pretty awful day. This profession of ours is not glamorous at all, is it?

    I work in a 24 bed ER, we see between 150-200 people per day, usually holding anywhere from 6-12 patients per day. We do get a lunch break though, we take care of each other, its definately not because management comes out of their office to take our team so we can go though....

    Hang in there, I would demand some help if I were you. A couple of days of the "blue flu" might drive the problem home.

    Someone out there has convinced these MD's that UA's turn up more transient disclosed problems than they can imagine. We have a doc who orders a UA on every pt too. I tell him he is flagging himself for a medicare audit! :chuckle
  12. by   CseMgr1
    Quote from hillflower
    [ I am 60 years old...no chair had seen my hinny all day long. Lunch was a bite...then start an IV, another bite, then call lab, another bite, then draw blood for the lab when I started an IV, then strip the patient down to a hospital gown so they could have a chest x-ray...you get the picture. Am I too old for this? I keep my CEU's up to date, acls, pals etc. I hurt everywhere this morning. I can't afford to retire, but I am soooooooooo tired!
    I feel for you. I had been at work for only an hour yesterday morning, when I suddenly became diaphoretic, cold and clammy, with waves of nausea. Fearing that I was having a silent MI, my supervisor called 911 and had me transported to the nearest ER. Thank goodness it only turned out to be an acute viral illness (one of my co-workers had been sick with the same thing last week). They popped me full of sedatives and then wheeled me out of the treatment room and into the hallway...to make room for another stretcher case. I lay there for the next five hours. It was FREEZING cold in that hallway, and if I hadn't had my coat with me, I guess I would have froze to death. The nurses were too busy to offer comfort measures (those were the days!), and by the time they got around to discharging me, they discovered that no vital signs had been taken on me since 11:30 that morning..and it was now 4:30 PM. A male nurse, obviously frazzled by this realization, tried to get them, as I stood by my stretcher, dizzy and nauseated, but the machine wouldn't work. Finally, at the end of his patience, he literally snatched the cuff off and flung it down and onto the floor, muttering: "Nothing in this place works!". He got a manual cuff, but it wouldn't work, either.

    I can't begin to tell you how happy I was, when a co-worker arrived to take me home. It's bad enough having to work in the conditions you guys have to work in...but being on the receiving end, is another. God bless you!

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