ER dropping the ball?

[Birdy2]

Well, once again I've been sent a patient that is just a complete mess and I have no idea what is going on with him. This seems to happen more than a lot lately.

This patient came in because his wife found him on the floor and when he came to he was confused and weak. He had chest pain in the ambulance that was relieved by nitro.

When he got to the ER they did a lumbar puncture, EKG, CT of chest, abd, and head that were all negative except the LP. They were unable to get that because of bone spurs apparently. His vitals were stable, but white count was 23.9 and he had some respiratory acidosis. The man wears oxygen at home due to copd and smoking 3 ppd. He has sleep apnea but will not wear a cpap, so they sent him up on 2L. I ended up having to get him a mask due to him breathing through his mouth and being knocked out cold from morphine he got in the ER.

So anyways, I talk to the wife and she says he has been throwing up every morning and sometimes through out the day for 9 months, also having malaise, fevers, urinary retention, and just not feeling well. Apparently he had been confused more over the last three days. Turns out he had a pretty significant cardiac history with stents and was a recovered alcoholic. There was no mention of this by the ER nurse.

I soike to the MD and she said he was over sedated from meds he takes at home and possibly had gastroenteritis. She said she was going to order a repeat LP for the am.

First of all, I was only told that he came in confused for 3 days and had an elevated white count and unsuccessful LP. The nurse said he had no other tests done, did not mention any of his history other than HTN and COPD, and didn't say anything about fevers or vomiting. Second, he had been in the ED for 12 hours and didn't even have his EMS stick replaced, had no temperatures recorded except right before coming to the floor, and hadn't been given any fluids, just 1 dose of vanc and ceftin.

Im very confused as to how they can get away with not recording vitals. I figured she had only given me his last set because he just got there. She could've given me a range if he'd been there an entire shift already!

I had to call that nurse back when I got the patient to ask why there were orders for fluid boluses and to get the results of tests that she said he had never had. She denied he ever had a fever or that there were orders for a bolus when she had him. She was very rude and acted as if I was overreacting, but the Dr told me the patient needed to be in ICU. There were just no beds. Then the nurse finally said she thought he had meningitis and to just wear a mask. Ugh!

Also, in the doctors h/p it said nothing about any of his symptoms except for chest pain and elevated white count. I'm so confused and probably too exhausted to be thinking about this right now. All I know is this patient is sick and would be better off going somewhere else if the ER doesn't even have a clue what's wrong with him after he's been there for that long.

[Birdy2]

I really didn't mean to stir all this up, although It does help me to be more understanding because those nurses are dealing with different problems and are as busy as I am. I just wish I could be told certain info and like Libby said I do expect the big things to be done. I have experienced the EXACT same things she mentioned. Stroke with no CT, things like that shouldn't be let go.

I also think that certain things like home meds should be reviewed one ER, they're supposed to. It never gets done though. And then my patient comes and has no list because it was lost downstairs and they don't know their meds. Once a patient stayed a whole day in the ER and meds weren't reviewed. They ended up having s seizure and the family sued because the nurse didn't go over the meds, she just took the list and said she did. Maybe she got busy, forgot, lost the list by accident with all the chaos around her. I don't know, but I wish every patient I got didn't have a list that was lost. It makes things very difficult.

By the way I don't surf the Internet or all nurses at work. I posted this after the fact.

And I did stick up for this nurse when the person I gave report to wanted to file an incident report. She could've told me more and been nice enough to explain what was going on, but I know she was busy and the family could've been telling her different things, plus the doctor didn't even seem to know what was going on. The hospital was overwhelmed. i didn't just blame her.

[flyersfan88]

I would never expect them to fix the white count lol and EMS sticks are changed on arrival per protocol where I work.

Just have to say that is a ridiculously dumb policy and a waste of time. But really....it's a 24 hour job. Did you die having to start one on the floor?

[NurseOnAMotorcycle, ASN, RN]

I think it is very poor form to trash other departments- especially the ED. We are one team and all have the common goal. Just as there are bad nurses in the ED, there are bad nurses in every other department. Many of the things being mentioned are ORDERS that need to be placed by a MD- as nurses, we can't place orders, correct? We can only ask and tell the MD what needs ordered, we can't make them do it.

Seriously though- if you don't agree with the practice of another, that's fine, but be professional about it. There is no reason to trash another department- you have NO CLUE what they could have been doing it who else needed a bed. To the poster who says who cares if there are 8 ambulances lined up- I CARE! Sometimes those 8 ambulances coming in go to triage, sometimes they need a bed immediately- having a STEMI, actively seizing with no airway, a drug OD where narcan isn't working- should I send those to you instead?

It is very easy to constantly blame others- it's harder to understand what another is going through and ask questions, or God forbid, lend a helping hand! Take that patient you think "nothing" was done for- tell that nurse to hang in there and do have a good rest of the shift.

Some of you need to get outside your own department and realize each of those departments have a different approach and end game to pt care. Some of you need to stop being so jaded, and having that attitude that your way is the best way. The majority of us, in any department, want the best for our patients and do the best we can to get to that goal.

Grow up, be professional, and stop trashing your fellow nurses. Meet you fellow nurses from other departments face to face, get to know them and be appreciative of everyone. That will get you much further than playing the blame game.

THIS! Most of us have worked in more than one specialty. They are different! I worked med surg, I worked ambulatory surgery, I now work in ED. All of them are so completely different. You get what you give: especially attitude or understanding.

[ED Nurse, RN]

Med rec is not my responsibility- it either the admitting MD or the med rec person from pharmacy.

Nurses can't order CT scans without MD approval. Strokes are very big deals in the ED- if it meets stroke criteria they get a head ct- if one wasn't done then their presenting issue wasn't stroke related. If it was then the MD should have ordered the scan, not the nurse.

If you want results of tests and labs, look them up in the chart.

Med Surg is not the end all be all of medicine. The skills you have are different from the skills I have. And again, your job description is different than mine, and our end result for pts is different. We are all busy. Stop blaming the nurse for things before you know exactly what that nurse is responsible for- the nurses don't do med recs, the nurses don't put med orders in, the nurses don't order labs and tests- understand?

[Birdy2]

There are nurses that work ER that will screw you though, same as there are unit nurses that do it. I know they were slammed that night, but there have been nights when I get an admit and I'm running around giving meds,keeping people in bed, dealing with family members who are mad because their loved one hasn't been changed, starting IVs because somebody ripped theirs out and needs units of blood, insulin drips that need to be started, somebody hollering for pain meds, somebody else who can't breathe, and so on. ER will call for report, they're told we will call as soon as we get a chance, they call back in 5 minutes, are told the same thing, then they say they will wait on hold until the floor nurse is available. Well if there's time to sit and wait on hold then obviously it ain't that busy. They wait on hold because they're desperate to send us another crazy patient whose gonna climb out of the bed all night lol that's annoying

[Birdy2]

The patient was dehydrated when I tried twice, then had to just use the EMS one, because I had other patients who needed care immediately and this one to go talk to the doctor about and figure out what I needed to do. I'm not s bad stick either. I usually have no trouble, the hectic and stressful night I had could've had something to do with it though.

[Birdy2]

Where I work I have been told by my manager that it is the ER nurses job to go over home meds and present them to the doctor. It may be different where u work and I wish it were where I work. That would make sense. The doctor should be doing that.

[ED Nurse, RN]

There are nurses that work ER that will screw you though, same as there are unit nurses that do it. I know they were slammed that night, but there have been nights when I get an admit and I'm running around giving meds,keeping people in bed, dealing with family members who are mad because their loved one hasn't been changed, starting IVs because somebody ripped theirs out and needs units of blood, insulin drips that need to be started, somebody hollering for pain meds, somebody else who can't breathe, and so on. ER will call for report, they're told we will call as soon as we get a chance, they call back in 5 minutes, are told the same thing, then they say they will wait on hold until the floor nurse is available. Well if there's time to sit and wait on hold then obviously it ain't that busy. They wait on hold because they're desperate to send us another crazy patient whose gonna climb out of the bed all night lol that's annoying

I really can't continue to have the same conversation with you- you obviously don't understand, nor care to. I suggest you ask to shadow in the ED for a few hours and gain PERSPECTIVE, second, I urge you to see the whole picture and not be blinded by your job. You need to stop judging and you need to no longer be a new and novice nurse before making snap and irrational assumptions of others. If not, you are going to continue to have problems and perhaps, if you can't see outside your med Surg bubble and constantly feel the need to pass blame and criticize, then maybe the hospital setting is not for you.

When the ED sends you a pulseless pt or one who is not breathing- then they dropped the ball. Not changing out a working IV, not hanging a liter of fluid on a stable pt, or not knowing the whole history, is not dropping the ball.

[ProgressiveActivist, BSN, RN]

Ive worked med Surg. We are a level one trauma center, we cannot go on divert. Even if we did go on divert there are serious issues- pts can still request to come to us and the ambulance must bring them to us per reques

. Pts can still walk in. Lastly, and the most important, if we go on divert, the smaller hospitals around us will get overwhelmed and just go on divert, reverting us back to where we started

I don't care if you "don't buy it." This is the reality. If you think such negligence is going on then report it to the state medical

board and the BON- I mean if such negligence is continuously occurring then aren't you being negligent too?

As far as I'm concerned, you too are just part of the problem. If

you don't like the way things are, change them. Stop complaining, be proactive. If the ED is such a disaster like you claim, go work

there, make those changes. Until then, stop trashing your fellow

nurses. Gain perspective.

My perspective is that you are trying to make your problems everyone else's problems. You work there. Fix it yourself.

[ED Nurse, RN]

My perspective is that you are trying to make your problems everyone else's problems. You work there. Fix it yourself.

You seem extremely jaded- there is no I or you in nursing, we are a TEAM. I am sorry you aren't a team player and feel the need to be hateful to others. I make every effort to correct issues that I believe are harmful to my hospital and my department- not every issue is the end of the world and not every issue needs to be addressed. I work with a team though- not against other nurses. Perhaps you should try that and maybe you won't have so many issues.

[ProgressiveActivist, BSN, RN]

Maybe if we didnt have to witness negligence and be on the receiving end of some shady ER nurses high handed **** for asking for basic information that wasn't documented. Little life saving things like IV fluids blood products and stat doses of meds that are "missed" because the priority is not treatment it's disposition.

"I didnt see that order" means I never looked.

I dont trust but I do verify. I do my job. You do yours.

[RescueNinjaKy]

Med rec is not my responsibility- it either the admitting MD or the med rec person from pharmacy.

Nurses can't order CT scans without MD approval. Strokes are very big deals in the ED- if it meets stroke criteria they get a head ct- if one wasn't done then their presenting issue wasn't stroke related. If it was then the MD should have ordered the scan, not the nurse.

If you want results of tests and labs, look them up in the chart.

Med Surg is not the end all be all of medicine. The skills you have are different from the skills I have. And again, your job description is different than mine, and our end result for pts is different. We are all busy. Stop blaming the nurse for things before you know exactly what that nurse is responsible for- the nurses don't do med recs, the nurses don't put med orders in, the nurses don't order labs and tests- understand?

While I agree that the main responsibility falls upon the md, I have to say that we as nurses have a responsibility to advocate for our patients as well. If you know the patient is having stroke symptoms and there isn't a ct ordered, then ask the doctor for one. If the doctor says no or says ok and still hasn't placed one in yet then ask again and ask why. Of course you could word it nicely so that they don't get offended but if it is something that you know should be done then by all means advocate. Ive had times when a resident refused so I went to the senior resident who got the order in for me. Heck I've went to attending before if my knowledge and gut instinct tells me that I am right. If there's something that I was wrong about and it's a doctors knowledge thing then I like to ask them why so I know next time.

It's similar to when a doctor orders the wrong dosage. You don't just give it cuz the doctor said so. That's not gonna hold up in a court nor morally. You inquire about it.