My new "Urgent Care" job is like ER lite--anyone with the same experience?

vashtee, RN · Mar 28, 2009

I haven't really heard about urgent care facilities in your situation on a regular basis, but I sure have heard a lot of ER people complain about people using them instead of urgent care!

Sorry you are so feaked out... your job sounds scary!

Displaced · Mar 28, 2009

We recently coded a patient on the ground in our entrance. We transfer 10+ to the main hospital ER daily, it is only 5 min away. We have a public education campaign that both advertises the urgent care centers and mentions what should be seen there. The public must see the ads since the urgent care centers are seeing increases in patients, but we can't get everyone to the proper location.

Either way, they still get seen by ER staff anywhere they go, so even if they are having an MI there is no real waste of time. The urgent care center calls 911, then the ER to notify them of the patient and to activate the cath lab, and if the cath lab is ready before the patient gets there, they go straight there.

rebelgal · Mar 28, 2009

I work urgent care also. We send people to the hospital all the time. They come to us for everything because we are cheaper than the hospital. The big problem is that the only RN in our urgent care is the supervisor. We as LPN are not allowed to assess people so we have to room them and then the provider will determine what there needs are and if we can handle it. It is very frustrating for people to come to urgent care and when you tell they need to go to the hospital they get mad because we can't help them.

Larry77, RN · Mar 28, 2009

Sounds like this system would work better if you were attached to the main ED...

Smokey9283 · Mar 28, 2009

The Urgent Care that I work at is attached to the ER and we have problems as well. The triage nurses will sometimes triage a patient to Urgent care because they refuse to go to ER even if the triage nurse feels that they are more appropriate for ER. We also have problems with patient flow. Our patients are seen by emergency certified physicians and often times will have to wait for 2+ hours to be seen depending on what's going on in ER. There is no perfect system, so we try to make due as best we can. I wonder what happens with patients that are having chest pain and schedule a appointment in the clinic. I would assume that those nurses also need to call 911.

rjflyn, ASN, RN · Mar 28, 2009

5 a day is probably not many. It though depends on what they are. Being an urgent care you generally are not hindered by EMTLA, so doing what you do ie calling 911 is probably appropriate.

As to some of the other comments one should not have to wait for an RN or a provider to see someone to determine if UC cant handle the pt. Your protocols should tell you that. If the pt does not then the call should be made. I give the example of CVA pts that we could have given TPA to but due to the delays we cant't.

That said the biggest problem is that most UC's one dont take insurance, only take X insurance, only take cash. Worse yet most don't take Medicaid. And close way too early.

expo4u · Mar 28, 2009

Many patients go to urgent care because they have a lower co-pay when they go to urgent care vs ER.

Prettyladie · Mar 28, 2009

My new job in our local urgent care (2 minutes away from a LARGE major medical center) is turning out to be a lot more like an ER. We are calling 911 a few times a day and transporting at least 5 a day. The local (older) community doesn't want to go to the "other" hospital because of the wait so they start with us even though it's clear within 5 minutes that they are going to get transfered. YIKES. It's very stressful. Anyone else have a similar experience and how do I get rid of this sinking feeling in my stomach before I go to work? I've been a nurse for 22 years and have done a little bit of everything. Nothing freaks me out too much but this time it's very different!

what urgent care is this. what city or state are you in.

beccarner · Mar 31, 2009

Not to mention in a small rural hospital, we also, put orders in computer, start IV's, draw blood, mop floor, order tray's for IDDM pt's, if no cafateria open, nuke tv dinner. Clean-up various fluids, drop NG tube, suture pts, salt ambulance bays, clean bottoms, Mix and dispense meds when pharmacy is closed. Wish we had a system to educate the public on where to go when and for what!

pennyg1 · Mar 31, 2009

Thanks for the thoughts. Sounds like you're busy, too. After day 7 of orientation I'm feeling much better. I was just surprised at the acuity of patients. Luckily the existing staff is amazing and very helpful. I know in 6 months I'll feel even better.

beccarner · Apr 1, 2009

Penneyg, Here's hoping if you get a chest pain complaint that before truck gets there you are allowed to put pt on monitor, assess if vf, defib if neccessary, O2 pt, get a line, administer asa, and nitro? All within ACLS guidelines. Two minutes is two minutes, what if truck can't be there for longer time? Here's hoping your facility is up to standards! Some folks think progressive chest pain is not an emergency and do go to urgent care. How is it at your place??