ER: The dumping place

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Specializes in Emergency.

This is a cynical rant...

This week I worked 3 12's, I only had 2 patients who were actually sick, even out of the dozens who were admitted, basically because we have to watch them even though we know nothing is wrong for fear of being sued by the one who really does have something wrong.

It seems like half of my patients this week said they called thier PCP and they told them to come to the ED (with BS complaints).

It seems like the vast majority of my patients are seeking drugs or attention or a combination, or they can't see a doctor because they don't have insurance, so our taxes will pay for a $14,000 work up for the WORST HEADACHE OF THEIR LIVES, when they just drank too much last night and ate too many tacos for breakfast (not that I have anything against tacos).

If there has to be a place for these people to go, why does it have to be the emergency room, and why do we have to be so afraid of a law suit that we do a $14,000 work up on everyone when we all know that there is nothing wrong with them. How is that the greedy have taken away all of the power that Doctors have to make a financially intelligent decision. How many tests do we do on a daily basis based purely off of fear of being sued, really think about it. Is there a way to fix it? We have these great facilities in place in order to save lives, but we rarely ever actually do that, all or our resources are spent on the "others." Sometimes it feels like a fruitless waste of effort, and like I am contributing to the further degradation of society as people become more helpless and pathetic every day. It's not that I don't love being a part of the times when we really do help someone that is sick, I just don't understand why we have to spend so much time, energy, effort, and money on people who are NOT SICK.

Sorry to be so negative, bad week.:o

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Specializes in LTC, assisted living, med-surg, psych.

I'm sorry you're having such a rough time.:icon_hug:

I'm going to be very honest with you here. You sound to me like you're suffering from a classic case of burnout........and believe me, I've been there, done that, got the battle scars to prove it. A year ago, I was a Med/Surg nurse who was almost afraid to breathe; every moment of every shift, I was terrified of making some horrible mistake because I felt so overwhelmed. The workloads were impossible; patients, families and management were unappreciative and sometimes downright hostile; and no matter how tightly you were stretched, some manager (who NEVER helped out on the floor even when things were insane) would come down and tell you that you had to take still another admission.

I was constantly frustrated and angry, and I was becoming cynical. My blood pressure was in the danger zone; I was depressed and anxious; I kept coming down with one illness or another and found MYSELF hospitalized on more than one occasion. Finally, my nerves just gave way, and I walked out of that hospital nine days before Christmas without even the prospect of another job.

I'm wondering if you have an employee-assistance program (EAP) where you work?? It's totally confidential, it's free, and it can help you recover your enthusiasm for your job (or steer you in the direction of a new one). My counselor helped me to see that I needed to get out of that toxic environment and to stop being so hard on myself for not being the perfect nurse/employee/wife/mother/grandmother/friend/fill in the blank.

Now I work at a job that provides me with the right amount of challenge and opportunity, and I've gotten my groove back. I've rediscovered my passion for nursing and even recovered my faith in humanity. I wouldn't have believed such a thing were possible eight short months ago. But it IS possible, and I know it's not just possible for me---I've met a number of nurses who have been in the same position and made it back. I also think you are too good a nurse to waste.

I hope you are able to get the assistance you need to deal with your feelings and decide what, if anything, to do about checking into another field of nursing. Good luck to you, and please keep us posted.

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Specializes in ICU,ER.

I'm not so sure that Happy is really burned out. I mean, I am an ER nurse and I will tell you.....unless you are a grinning idiot on 80mg of Prozac a day..... you WILL get frustrated with all of the BS. She has a point.... something needs to change. It is insane to work up all the crap and spend so much for fear of liability. Long workups on bull crap leads to long waits which lead to high tensions. And lets face it, most of the people we see are a little less than informed and educated individuals. (the abusers) ....which means that their interpersonal and social graces may not be well tuned. And I'll tell ya, to be continuously chastised and looked upon with disdain by the dregs of society kinda gets to ya after a while.

I am frustrated....but I am not burned out. For every 20 idiots I see...there is that grateful family for the AMI we just saved or the sweet child I just helped through getting sutures.

Our job is tough mentally, physically, and emotionally..... but we are rewarded. I would hate to see us lose good tough ER nurses that chalk it up to "burn out" when it is human to be frustrated.

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Specializes in NA - 100 years ago.

DUPE (See below.)

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Specializes in NA - 100 years ago.

I don't know, I'm not a nurse, but maybe all the "unsick" are just practice patients for the "real sick." You have to be there anyway, right? I'm sure getting a break would be nice, and not being treated rudely would be great. I'm not knocking your frustration, put just trying to think of a way to put a positive spin on it.

I don't know too many people, dregs of society, or not, who really enjoy sitting around the ER all day. I'm sure there are a few who just want some attention, but gawd, what a horrible way to have to get it. I have four sons and I can say, I've been to the ER a few times for stitches and such. (After hours.) One of my sons had a motorcycle accident. That was the most serious ER visit. I just don't know how anybody would want to go through that. It's hell. Probably because of all the tests and crap you have to go through. I don't know...

I hope you feel better.

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Specializes in CT ,ICU,CCU,Tele,ED,Hospice.

leahjet i couldn't agree with you more .well said.happy hang in there.

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Specializes in Emergency & Trauma/Adult ICU.

I also agree w/LeahJet ... is it necessarily "burn out" when you look at and identify the reality?

Some days there's just a little too much reality ...

((Hugs)) to the OP.

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Specializes in Emergency/Trauma/Education.
I don't know, I'm not a nurse, but maybe all the "unsick" are just practice patients for the "real sick." You have to be there anyway, right? I'm sure getting a break would be nice, and not being treated rudely would be great. I'm not knocking your frustration, put just trying to think of a way to put a positive spin on it.

That's certainly a different way to look at it. I like the way you think!

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Specializes in Cardiac, Acute/Subacute Rehab.
If there has to be a place for these people to go, why does it have to be the emergency room

My husband and I were talking about this recently. Not to disagree with you...I'm just offering this. Some of the people that come in with non-emergent complaints are the ones that don't see the value in a Family Doctor or even a Doctor's Care. Why? Because, at those places, you have to have money in hand. Granted, in the end, they will spend much more on an ER visit. But, that's part of the reason WHY it's the ER they go to. Because they don't have to have money in hand. It's sad, it's not right and it's frustrating for the people like you that are there to treat EMERGENT issues.

My nursing student opinion is that there is HUGE need for public education about this. A local hospital is doing a really good job, even if not directly saying "Don't go to the ER if it's not life or death." They are putting up billboards with sayings like "Hey, watch this!!!" and "It's not THAT heavy" and the only other thing on the billboard is the name of the hospital's URGENT CARE Clinic.

My question for you, Happy ER RN...What can be done in the way of patient education while the patient is there? Or is it an issue of not wanting to mess up "customer service" feedback?

(For whatever its worth, I've started to speak up when peoplearound me complain about ER wait times...i.e. Your cough that won't go away is not life or death. The reason you had to wait is likely because someone else's condition/problem needed more attention than your two week old cough.)

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Specializes in Utilization Management.

I only had 2 patients who were actually sick, even out of the dozens who were admitted, basically because we have to watch them even though we know nothing is wrong for fear of being sued by the one who really does have something wrong.

I have to add my two cents.

Working the floor, I see plenty of people come from ER with basically no treatment, just monitoring. I'm sure that the ER staff thinks nothing was wrong, but that was when THEY had the patient.

In just the past two weeks, I've had three patients who spent hours in the ER, got basically nothing for pain, and only a few basic tests--and they then were found to be much sicker than anyone knew. One is still in ICU, one died, and one went to surgery before transfer to ICU.

Please understand, I'm not knocking ER, all I'm saying is that you might've felt there was nothing wrong with these patients, and could not know any different because you were unable to follow them through their hospitalization.

So I just thought you needed to be aware that quite a lot of these patients get admitted and then we figure out that there really IS something wrong. Even malingerers and druggies can get really really sick.

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I don't think that the above poster is really referring to pts who actually are admitted to the hospital- its the pts that come in with "vomiting one time" by ambulance and then demand a free taxi ride home that are over taxing the system.

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I have to add my two cents.

Working the floor, I see plenty of people come from ER with basically no treatment, just monitoring. I'm sure that the ER staff thinks nothing was wrong, but that was when THEY had the patient.

In just the past two weeks, I've had three patients who spent hours in the ER, got basically nothing for pain, and only a few basic tests--and they then were found to be much sicker than anyone knew. One is still in ICU, one died, and one went to surgery before transfer to ICU.

Please understand, I'm not knocking ER, all I'm saying is that you might've felt there was nothing wrong with these patients, and could not know any different because you were unable to follow them through their hospitalization.

So I just thought you needed to be aware that quite a lot of these patients get admitted and then we figure out that there really IS something wrong. Even malingerers and druggies can get really really sick.

i understand your point angio, but really there are dozens of people who do come to the ed with nothing wrong with them other than :

they have no a/c

they want food

they had a fight at home

they want pain meds

in the er we experience the poor system we have daily. the insurance companies and lawyers run health care now. if you have insurance, they decide what tests you can have and the lawyers sue for anything under the sun anymore.

i recently had the opportunity to speak in person to 1 of my state's legislators on how desparate the situation is. the state is paying for a very abused, and very expensive system.

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