ER Pet Peeves

**canoehead, BSN, RN** · Nov 5, 2005

They have to do a pregnancy test on anyone of chidbearing age for quality control reasons. Also because an untold number of people will lie about having sex and actually be pregnant (some of them deliver and deny sex).

You went to the ER for a lump on your labia??? You got in quickly by most hospital standards. Hope all was OK.

anothermadhatter · Nov 5, 2005

Wow...this could go on and on and on.

As for kids with fevers...could you put another blanket on them?

A personal favorite is the 2AM head injury (kid fell down from a standing position 3 hours earlier) and he's sleepy. Of course he is...it's 2AM.

The stumped toe with...oh yeah...chest pain!

Hope to add more to this thread later, but I'm actually in triage at the moment and have another scholar to triage.

As for the rebuttals...work here a while...then we'll see!

kea6783 · Nov 7, 2005

They have to do a pregnancy test on anyone of chidbearing age for quality control reasons. Also because an untold number of people will lie about having sex and actually be pregnant (some of them deliver and deny sex).
You went to the ER for a lump on your labia??? You got in quickly by most hospital standards. Hope all was OK.

I know policies regarding pregnancy tests. I was saying that they were unprofessional and didn't acknowledge any of my concerns. Their remarks were innappropriate and do not warrant any sort of defense.

I didn't go into detail on the other issue but I assure you it justified an ER trip... and there were three patients in the waiting room and staff just sitting around.. for every negative ER experience, (I HOPE) there are ten good ones.

errn7 · Nov 7, 2005

About 75% of the public that enter the doors on any given day would fall into the category of "pet peeves".

One of the biggest that seems to be growing larger is Doctor's offices telling their own pts that they wont be able to see them until two weeks from this coming Thursday..."if its an emergency, please hang up and call 911" thus planting the seeds of going on to the ER for whatever the need.

This just happened last Tues. night....LCF sent in a pt at 11pm who the night med tech said..." he wont stay awake"...Pt was sitting in the day room asleep when transport arrived...Pt aroused to verbal command and got up and got onto cot...Pt was transported to ER with the above C/O from the LCF's astute med tech.....upon arrival Pt moved from stretcher to ER bed. After triage and going through his med list it was noted he had been given Ambien 10mg at 9:30pm also Seroquel 100mg at 8:00pm..wonder why he wouldnt "stay awake".......The biggest waste of tax payer $$ of the day, and the most ridiculous reason to have a resident of a LCF sent to the ER.

Bipley · Nov 7, 2005

I know policies regarding pregnancy tests. I was saying that they were unprofessional and didn't acknowledge any of my concerns. Their remarks were innappropriate and do not warrant any sort of defense.
I didn't go into detail on the other issue but I assure you it justified an ER trip... and there were three patients in the waiting room and staff just sitting around.. for every negative ER experience, (I HOPE) there are ten good ones.

Even though you deleted your post I am going to respond anyway.

You asked if we felt better since you were billed for services you never paid for and it ruined your credit. No, that doesn't make me feel better at all. I hate to see anyone's credit ruined but there are a couple of things you really need to realize before you assume we are all jumping on you.

Just because you didn't pay for your medical care doesn't mean nobody else did. Lots of people that really can't afford it still pay anyway, they make monthly payments or something they can manage. So THOSE people are paying for your medical care while they have a hard time affording their own.

You explained in the post that you deleted that you went there BECAUSE you couldn't afford to go to a private doctor. NOW you claim it really was an emergency. ????

If there were only three patients in the ER waiting to be seen it's likely you didn't go to a county facility but a private facility instead. County is for folks that can't afford their own medical care. Sorry, I don't mean to sound blunt but it's true.

When you use a private facility just please remember, just because you aren't paying for your medical care, that doesn't mean others who can't afford to pay for your medical care aren't paying for it anyway.

The main hospital chain here in Phoenix has adopted a new policy to deal with issues like this. They won't refuse anyone a diagnosis, but they will refuse them treatment. They will be triaged, seen in order of severity, seen by a medical provider and if it is not life threatening they are sent to county for treatment. Even if that just means an Rx for abx, the docs will not give it to them. They are referred to county to get their Rx. So they really didn't save any time at all in going to a private facility. Instead they are having to wait in two ERs.

This practice has saved the private facility from bankruptcy.

kea6783 · Nov 7, 2005

Even though you deleted your post I am going to respond anyway.
You asked if we felt better since you were billed for services you never paid for and it ruined your credit. No, that doesn't make me feel better at all. I hate to see anyone's credit ruined but there are a couple of things you really need to realize before you assume we are all jumping on you.
Just because you didn't pay for your medical care doesn't mean nobody else did. Lots of people that really can't afford it still pay anyway, they make monthly payments or something they can manage. So THOSE people are paying for your medical care while they have a hard time affording their own.
You explained in the post that you deleted that you went there BECAUSE you couldn't afford to go to a private doctor. NOW you claim it really was an emergency. ????
If there were only three patients in the ER waiting to be seen it's likely you didn't go to a county facility but a private facility instead. County is for folks that can't afford their own medical care. Sorry, I don't mean to sound blunt but it's true.
When you use a private facility just please remember, just because you aren't paying for your medical care, that doesn't mean others who can't afford to pay for your medical care aren't paying for it anyway.
The main hospital chain here in Phoenix has adopted a new policy to deal with issues like this. They won't refuse anyone a diagnosis, but they will refuse them treatment. They will be triaged, seen in order of severity, seen by a medical provider and if it is not life threatening they are sent to county for treatment. Even if that just means an Rx for abx, the docs will not give it to them. They are referred to county to get their Rx. So they really didn't save any time at all in going to a private facility. Instead they are having to wait in two ERs.
This practice has saved the private facility from bankruptcy.

I didn't say either of those things.. that I didn't pay my bill nor that I went because I couldn't afford the regular doctor. I was making a point that there should be a little empathy for uninsured pts because there are a million different circumstances for why they are uninsured, and also- if they were on government assistance, they would recieve criticism for that.

Can't please everyone.

Ok, return the the pet peeves, some of these are really good. :coollook:

Bipley · Nov 7, 2005

I didn't say either of those things.. that I didn't pay my bill nor that I went because I couldn't afford the regular doctor. I was making a point that there should be a little empathy for uninsured pts because there are a million different circumstances for why they are uninsured, and also- if they were on government assistance, they would recieve criticism for that.
Can't please everyone.
Ok, return the the pet peeves, some of these are really good.

Hmmm.. Perhaps I am thinking of another post. Problem is, the post went away so I can't provide quotes. However, if it is still there and written by another, and I'm just not finding it, my apologies.

Edit to add: You are correct, empathy should be given for uninsured patients. That's why we pay taxes for county facilities. That's what they are for, people who can't afford to pay their bills. Going to a private facility knowing one isn't going to pay for their own medical care is no less than stealing. It is no different from writing a check off of the hospital's checking account and stealing the money.

As for knocking Medicaid patients, that's just not true. The issue of frustration is watching medicaid patients abuse services because they can. BIG HUGE difference between those folks and the sincere folks. Just because someone is on Medicaid isn't a right to abuse the system, it just isn't.

kea6783 · Nov 7, 2005

Hmmm.. Perhaps I am thinking of another post. Problem is, the post went away so I can't provide quotes. However, if it is still there and written by another, and I'm just not finding it, my apologies.
Edit to add: You are correct, empathy should be given for uninsured patients. That's why we pay taxes for county facilities. That's what they are for, people who can't afford to pay their bills. Going to a private facility knowing one isn't going to pay for their own medical care is no less than stealing. It is no different from writing a check off of the hospital's checking account and stealing the money.
As for knocking Medicaid patients, that's just not true. The issue of frustration is watching medicaid patients abuse services because they can. BIG HUGE difference between those folks and the sincere folks. Just because someone is on Medicaid isn't a right to abuse the system, it just isn't.

I agree with you and you probably read my post correctly, I might have not explained it clearly!

Bipley · Nov 7, 2005

I agree with you and you probably read my post correctly, I might have not explained it clearly!

You were very clear. But that doesn't matter anymore. On to more amusing topics.

TennNurse · Dec 1, 2005

I forgot one I had a while back re: preg test. Girl comes in and says whe wants a preg test. I said, ok.. what makes you think you're pregnant? Answer: I don't.. I'm a day late and I want to go out drinking tonight, but I thought I better make sure I'm not pregnant first. On Medicaid.. big surprise.

I have had this!! :angryfire :angryfire :angryfire It requires all my restraint to keep from looking her in the eye and marveling, "Why, how very responsible of you."

Also, people who drive themselves to the ER, check in with their complaints, then don't want us to treat them appropriately. One pt checked in for the 2nd time in 2 days with chest pain. Although all cardiac labs were normal yesterday, we did them again. When she also mentioned that she had been taking Xanax and clonopin EVERY OTHER HOUR since she left the night before, we decided to address that, too, much to her discontent. She kept hitting her call light to ask why we were ignoring her chest pain and "obsessing" over her med misuse. Another pt last night checked in c/o c-spine tenderness following MVA. Not only did she fish out her ringing cell phone from her purse and answer it as I was trying to listen to lung sounds, when I said X ray would be along for her shortly, she whined, "An X ray? Do I have to? I don't want an X ray!"

WHY, WHY, WHY do people come see us if they don't want to do anything we recommend? I long to ask them, "Where is the person who dragged you here at gunpoint against your will?"

It irritates me to ask a pt, "Please take some deep breaths so I can listen to your lungs", pt takes maybe one or two, then resumes conversation while I'm still assessing lungs. Is there a nice way to say, "Please shut up for 2 seconds and breathe so I can do my job"?

Last week I had a couple leave their 6-year-old, a heart transplant recipient, alone in the ER without telling anyone they were leaving. They both returned an hour later and said, "We were so hungry, we had to go to McDonalds" Then they wanted to leave again later to go get nightclothes for themselves b/c mom "just could NOT wear no hospital gown" It was good enough for her daughter, though...

And just one more... the ones with all the special problems that make them different and difficult. Just off the top of my head:

"My veins are horrible. You have to use a butterfly" (Veins look fine to me, perfectly capable of housing a 20g, minimum)

"I'm immunosuppressed. I can't use your phone, I need to use my cell phone. In fact, I shouldn't be here" (At last, we agree on something)

"I can't swallow pills" (Pt never tiny and slim, clearly manages to swallow most everything else put in front of him/her)

"My temperature is always low. If your thermometer says 98, I have a VERY HIGH fever. I usually stay at 94" (As do some cadavers)

"I'm hypoglycemic and have to eat every 2 hours. How long will this take?"

That's all for now.

EMS · Dec 6, 2005

I work in a Planetree hospital that lives and dies by the Press-Ganey survey.
Of course we get it for them!
Chip

I second that one right now the hospital I work for is 98% Employee and 99% ER pt scores. So every thing is all about our score and how we can WOW the pts. and familys. What happened to taking care of the sick pts!!!! If they are really sick then they don't care if you offer something to drink or the fact that I for got to tell them my name as I put in the IV. I love my job and all but sometimes it is to much.

Simba&NalasMom, LPN · Dec 6, 2005

Typically, these patients need to be restrained at the hospital because they're so loopy with infection and illness that they're always pulling the IVs out. And as you're aware, NHs are "restraint-free"--no exceptions. NH nurses simply can't be everywhere at once, and realizing how time-consuming the med pass is, with accuchecks, tube feedings, crushed meds for about 30 people, and it's easy to realize that there is no time to stick Ms. Susie for the fourteenth time to keep some D5NS running. Plus, NH nurses don't do IV starts very often, and to have to do repeated sticks to a frail, dehydrated resident who doesn't want the thing anyway, and you'll understand the frustration.

Thank you, Angie!!! :) I'm in my first year, and the last facility I worked for had me scheduled to "orient" on the LTC side but they had nobody to orient me so I hit the ground running on an unfamiliar unit. One of the residents spiked a temp about an hour after I got there and had already been given Tylenol within the last two hours and she was very lethargic. The CNA told me that she was not usually that lethargic, etc. so I called the doc, told him what was going on, and HE ordered me to send her out. An hour later, I got a call from BOTH the ER RN and MD asking me why I had sent her out...ummmmm "Because I had an order to?!?! If you have a problem with it, why don't you call Dr. so-and-so and asked why HE decided to send her out?" :angryfire