ER. A Clinic?

[JSlice.]

I have been working in a 15 bed ER in a rural area for 5 months. To me, emergencies involve life or death. More pt's come with minor complaints such as pain meds, toothache, or sore throat. When we actually have a true EMERGENCY, we scramble for an available bed.

I have been told that the people are coming into the ER for minor complaints more often because of the new health insurance law.

Anybody have this issue?

Perhaps somebody can explain this healthcare law better.

[oregonmom]

I live in a small rural town and after 7pm pretty much your only option is the ED. I have kids and they tend to get hurt after the urgent care clinic closes. Thankfully our hospital just opened an urgent care clinic. You go to the ED and if you aren't an Emergency they send you there.

[GreyGull]

Many who are uninsured would probably love to have a book of doctors to choose from like most of us instead of getting the luck of the draw at the ED. They might also enjoy having a scheduled appointment and complaining if the the doctor keeps them waiting 15 minutes past that instead of the 8 - 24 hour wait in the ED. For some, their families may never have been in the financial position with insurance to have a primary care doctor and the ED is all they have known to use for the past few generations. Breaking the cycle can be hard and it is not isolated to the inner city areas.

The homeless is another issue that has grown since many of our shelters, mental health facilities and clinics including those roaming the neighborhoods in mobile vans have disappeared. Can we really blame those that could legally be declared incompetent to make a legal decision for themselves? Yet, we've closed most of the facilities that helped with their decisions for shelter and medical care.

Sometimes those who are in the group of the "have", including most of us, may not know the side of the "have not" and hopefully will never have to be in that position. I do know many health care professionals that got their homes foreclosed and felt like they were heading deep into the "have not" category.

[Lunah, MSN, RN]

I've definitely seen an increase in visits from people who have lost their insurance and literally have nowhere else to go -- even the urgent care/clinics want some payment up front, and some of these folks literally have two nickels to rub together, and that's it. We do have a high number of paying, insured patients in our county (it's a fairly affluent place), but we also have a lot of patients for whom we are the last resort.

There are no easy answers. I just try to be compassionate as best I can.

[AprilRNurse]

I had a friend recently vent to me that she had to wait 10 hours in the ER when she was there for heavy menstrual bleeding. It's very hard to tell your friend that if the nurse didn't feel her life was in danger...than it wasn't an emergency. She kept saying they didn't know- didn't run tests etc for so many hours... again I expained that lack of dizziness (asked during triage) and her skin color told the nurse a LOT. She was still upset, even with her nurse friend trying to explain. The random patient's definately don't get it.

I had a favorite ER dr at my last job. He'd look the patient straight in the eye (the obvious "clinic" type visits) and say " Hello, my name is Dr. XXX, what exactly is your EMERGENCY at three AM today" and would emphasize EMERGENCY and the time lol.

Honestly- even then they never got it...but it always gave us nurses a chuckle when the young mom started rambling about her 3 year old who wouldn't sleep because of the bilat ear infection she saw the dr for yesterday and started antibiotics but no..she hasn't given anything for the discomfort....

[ROBR]

seems to be the normal; I know an ER doc that has mentioned several times how people come in the ER with a cold....etc....minor things that are NOT emergencies.

[Altra, BSN, RN]

This has definitely been the norm for the 6 years that I have been an ER nurse. If there was a specific point in time when it became the norm, it was probably after the implementation of EMTALA in the 1980s.

And I'd like to point out ... it has been the norm at both the inner city ERs I've worked in, with large populations of uninsured/indigent/homeless ... and at the "nice" suburban ER with a more affluent population as well.

Same stuff, different day.

[Altra, BSN, RN]

To you the emergency room is for emergencies. The public just didn't read the same textbooks you did. To them, the ER is a place where they can get all their health care without an appointment 24/7. The ER is great, you don't have to shop around, get directions, find out their hours, schedule an appointment, or spend a lot of time filling out forms. They might even give you a snack. And by law we can't say no.

This deserves a standing ovation ...

[Not_A_Hat_Person, RN]

I volunteered at an ER in Boston for 2 years. Boston has a huge shortage of doctors. Until 2008, the city had no urgent care centers. Community Health Centers have very limited walk-in hours. If you had no insurance, no PCP, didn't want to wait 3 weeks for an appointment, or needed medical care outside of 9 am-5 pm Monday-Friday, your only option was the ER. We saw a lot of tourists, UTIs, and script refills.

I needed a strep test when I was between PCPs, and my only options were a community health center near school, that saw walk-ins from 10-11 am and 2-3 pm (and you had to arrive an hour beforehand) or the ER.

People also go to the ER because they're sent there. Quite a few patients were sent to my ER for MRIs and CAT scans. When I fell down the stairs and sprained my foot, my doctor sent me to the ER for X-rays. Last time Hubby and I went to Boston, Hubby had some symptoms that suggested a stroke. Our insurance's nurse triage line told him to go to the ER. A few weeks later, after unrelated surgery, he had problems with an indwelling catheter. We went to the local hospital's walk-in center. It was Sunday, and they had no urologist on duty, so they sent us tp the ER.

The best way to get people to see doctors is to offer some options outside of banker's hours. If it was possible to see a doctor on the weekend or at night, without waiting 3 weeks for an appointment, fewer people would use the ER for non-emergency care.

[SBarn]

Most of the guys that work with my husband go to the county ER for everything. They have great insurance but don't want to pay a copay and the county ER is completely free. So, those with no insurance are stuck waiting behind those who could have just made an appointment with a doc but won't. No surprise, the county hospital is expected to be the first thing on the chopping block when the new county commission gets going.

[kcmylorn]

I am personally happy about and anxiously await the new healthcare reform. I would like to see the federal government take over the hospitals in this country- I feel it would take the COMMERCIALISM out of healthcare/sick people- we all remember them even if the CEOs and Nursing Executives don't. I think the new healthcare reform is going to creat more nursing jobs just not in the acute care setting. I have been a hospital acute care nurse for over 30yrs. If the new healthcare reform does what I think and hope it will do- nurses shouldn't care about getting hospital jobs/experience. There isn't ever going to be another increase in acute care positions. With the new healthcare reform- nurses are going to be needed by the thousands for urgent care and primary care- people will have insurance and be managed in the outpatient Arena. Tere is no nursing shortage, never was- nursing jobs were cut so the hospital and nursing executives didn't have to cut their greed- salaries. Nursing schools kept pumping out new grads who couldn't find jobs beause there were none, the nursing money powers didn't want to put nursing educators out of work and close schools/colleges. There were no jobs even for us seasoned/experienced nurses-because we would have to be paid what we were worth/ earned with our years of seniority and expertise. This is also why there is so much firing, terminating nurses for reasons that should make the leagal community and labor depts stand up on their ears. Granted, if you are diverting drugs or so incompetent or crazy you kill people -that deserves to be fired but personality issues, clocking in issues, don't fit in, you have a second job issues, crappy documentation and needing a documentation course?????? I think those reasons that I have been reading so much of on these blogs for 3(three) YEARS, say it all.

[EmerNurse, BSN, RN]

Yep same in our ER, both pedi and adults. I finally decided that people seriously don't think of going to "the EMERGENCY room". What they think of with vomiting x1 at 0300 is "hmm I should go to THE DOCTOR". And who's the doctor at 0300? The ER. Doesn't matter if they're insured or not. We're the 24 hour clinic, that's all.

[Trekfan]

What new Health Bill? What is it ? Can it get any worse? I payed out $700.00 in my reg.meds (about what I make working) this month alone . Then I was I would need a $ $600.00 antibiotic and a $100.00 antibiotic only was to get around that was to get them in the ER where they be covered (200.00 copayment per visit / dose so no help there) or to get the in the hospital (1000.00) copayment . It's just to bad I work or I could get it for free by Medicaid .

Sorry venting

Ps I was able to get one that was olney $130.00 so hope it works