ER Care or lack of - page 2

1. 
   May 25, '03

   Last night we were so busym there was a 2 to 3 hour wait just to get taken back to a bed. pt overload, sensory overload, Just too many and too few
2. 
   May 25, '03

   This experience you report is pretty much what everyone is experiencing. Matter of fact it might be better than average. A lot of reports are coming in about patients dying in waiting room without ever being triaged.
3. 
   May 26, '03

   We ED nurses feel tremendous frustration at treating "clinic" patients. Their constant bombardment clogs the ED, and postpones of the treatment for patients with truly emergent conditions for outrageous amounts of time.
   
   The "clinic" patients don't visit the clinics for 2 main reasons....
   
   1) They don't want to wait for an appointment...they want to be seen NOW. The ED cannot turn them away if they request to be seen.
   
   2) The ED does not require money up front for treatment as the clinics do.
   
   Both of these factors, set in place to insure care for patients with emergencies, have made the ED very attractive to clinic patients.
   
   One possible solution would be to place a PA-C in triage to either provide clinic care up front, if lab, x-ray or other dx tests are not required, (do an exam/provide a precription) or to simply inform the person requesting to be seen, that this is NOTan emergency, and redirecting such a patient to a clinic (this CAN wait until tomorrow).
   
   Sound realistic?

   Last edit by AngelGirl on May 26, '03
4. 
   May 26, '03

   Originally posted by Kayzee
   Thank all of you who responded. I realize it is very busy, and nurs. is multi tasking. Why can't they do anything about staffing levels? This would surely help with pt care. Wish all of you the best and keep up the good work.

   What an innovative thought.
   
   I assure you that the nurses would love it.
   
   Management for some silly reason doesn't think it appropriate though and wouldn't do it, even if they could find the nurses. it might require them to work for their bonuses.
5. 
   May 26, '03

   HI! I think all ED have the same problem. Just wanted to get your opinion on something I had heard about. We are a small hospital with 8 ED beds and a fast track with 4 beds that is only open from 3-11 when we have the staff. We were considering on making this a triage room with a nurse and a doctor and the minor things treated immediately and sent home and the emergent patients sent over to the ER. Sounds like it may work. Just wanted some input.
6. 
   May 28, '03

   Nene about covered it except to say in our area a 2 1/2 hour wait is actually very good. During peak hours if you are not triaged Emergent (in danger of dying within the next few minutes) the waits may be as long as 6-7 hours.
   
   ER nurses as a whole wish this could be different but as long as the "paper pushers" think a 5-1 nursing ratio and a 20-1 doctor ratio is sufficent, the situation will only get worse.
   
   In our facility the only medication that can be given before a patient has seen a physician is Tylenol for a temp greated than 101. We do have "standards" which allow us to draw labs and order x-rays based of presenting complaints and in most cases these results are back before the physician even sees the patient. Most of our doc's will order pain medicine on a nurses request but there are still some that refuse until they see the patient. All you can do is explain that to the patient and document it. ("1830 Patient complain of severe headache 10/10. Dr. Smith informed of complaint and request for pain medication. No orders received at this time. CAT Scan of head ordered per unit standards. Lights in room dimmed, patient given pillow and blanket in attempt to provide comfort. Call light within reach with instructions to patient and family to notify nurse of any changes.")
7. 
   Jun 11, '03

   Kaycee: Sorry for your experience, although, sadly, it is now the norm in most ER's. Why the problem staffing? Well one reason is the frustration of ER nurses like myself who run and work their butts off trying to do proper/safe care, and constantly being confronted by family members complaining that we are neglecting their patient. A good ER nurse is well-aware of the acuity levels of the patients in their care, and, although anytime someone you love is in pain you feel frustrated and want to make them feel better quickly, this is not always possible in the scheme of things in a busy ER. Although family thinks their member is the most emergent/urgent sick person, this is usually not true. Traumas, heart attacks, strokes in progress, respiratory distress/arrests, etc. are all REAL emergencies that need to be tended to immediately. Taking patients to the bathroom when family members are there to do it themselves is NOT something an ER nurse can be expected to do! Not in this day and age. Patients must realize, the nurses are performing more of the physical life/death patient care techniques than even the docs. You would not ask/expect an MD to take your family member to the bathroom would you? Just a thought, I'm sure not well-received, but true. The nursing shortage is so extreme (and going to get worse) because no one wants to work so hard and get as little respect from patients and families as nurses do. Also, you should realize, when the docs see the patient, they promise the family member pain meds, etc. then may get busy and either not tell the nurse, not write it down, get onto another patient, etc.
   Again, sorry for your experience, but give the nurses the benefit of the doubt! Remember, when you complain to management, they were not there, they were home asleep, and I am sure they were not dreaming of the poor staffing they left to care for the patients! They will, however, be quick to find fault with the ER nurses for any problem that occurred! Patty
8. 
   Jun 11, '03

   Was there a nurse doing triage? Given those symptoms there was a possibility it may have been meningitis. While I agree that a long ER wait is normal....seems like this child should have been a higher priority.
9. 
   Jul 2, '03

   Your experience unfortunately is repeated daily
   
   You should complain to the hospital adminstration. I see this care too often at work and its healthcare provider oriented. A nurses job is to advocate and communicate. Many times we hold meds for tests or because it effects assessment but science is great there's plenty of meds and treatments to TREAT people while preserving caution. When people complain the heat comes down if you complain to the top dog. You should of had a nurse say i'll ask the doctor to tell you why you can't give a med or what there impression is. I even give my name and ER# is if a difficult discharge needs help I can answer basic info even when policy says no. I look at it as extended d/c follow-up. I can pull a chart 3 hrs after d/c and note vomiting continues advise use of meds, fluids or return to ed. its called giving care. Your right to feel upset I would and no excuse is acceptible

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