Question for those who work in small and/or rural hospitals. - page 3
I work in a small rural hospital. Our hospital has about 80 beds total. The med/surg floor has about 30 beds, and there is a 4 bed ICU. Our ER is staffed 24/7 by a physician. The other doctors are... Read More
Jul 2, '02Joined: May '01; Posts: 12,088; Likes: 15,955Originally posted by Y2KRN
I did not read all of the posts here, but as an ER nurse I back an ER doc not responding to anything other than a code, in a small hospital. If the surgeon was 30 minutes away he should have given you orders. Get the fluids rolling, insert the ng tube, yadda yadda. If these things didn't help and patient crashes call a code!! Sounds harsh I know but, between liability and never knowing what is going to come through the ER doors. It is safer this way.
I worked med-surg as well, at a small hospital to boot. It is frustrating not having immediate access to a doctor, one of the many reasons I love ER nursing.
TedLast edit by Ted on Jul 2, '02
Jul 2, '02Occupation: RN Joined: Aug '01; Posts: 2,276; Likes: 42In response to a previous post. No, the doctor doesn't live 30 minutes away, it just took that flippin' long for him to come to the hospital. Unlike ER's med/surg DOES NOT have standing orders for every situation. ER nurses have a lot more automony that med/surg nurses in most places. If all the ER nurses are ACLS and PALS certified, then what is the complaint about not being covered in emergent/code situations?? I am ACLS certified, have floated to ER and have been involved in emergent and/or code blues before. I wasn't even involved in the situation I described in my original post. It happened to one of my co-workers. My intent of this post was not to get anyone upset, I am genuinely seeking information about what other small facilities do in situations like this. I would like to be able to present to our DON some possible solutions to a situation that will most likely come up again at some point. I figured this board was a good place to start for information, but maybe I was wrong. I have found out one thing though through this thread. That is that most people who work ER really think their unit is the only unit in a facility and to heck with the rest of us people in the hospital.
Jul 2, '02Occupation: icu rn Joined: Jun '02; Posts: 985; Likes: 11I work in a small rural hospital,56 beds, 4 icu beds. If i have patient "crashing", our ed docs will come,if i have been unable to reach the primary doc, and IF they are not up to their ears in the ed.Also can "grab" any doc who happens to be in house,except for the ones who are feuding......Our docs seem to actually listen to us,usually, ....i know, miracles do happen.......lol.....And in the rare instance that us nurses feel that the patient isn`t being appropriately cared for we can call our icu medical director to interveen......but that isn`t very often.......And the med surg unit can move a patient to icu, if bed available, if things are going downhill...........they come crashing through those doors....lol....too bad they aren`t as efficient at getting folks moved the other way......but that`s another subject
Jul 3, '02Occupation: Hospice clinical director Joined: May '02; Posts: 2,873; Likes: 26I'm sorry you didn't get the responses you wanted; I don't think anyone was trying to criticize you. Several people gave you some suggestions on things to do when a pt is deteriorating while you wait for the doctor to arrive.
My understanding of ACLS is that ED/ICU nurses learn this so they know the appropriate interventions during a code, not for them to be running codes indep. (although that can happen, but that should only happen in an unusual situation).
I really think a lot of this has to do with malpractice/liability, not matter of ED staff not caring about other floors (if that were true, why would we be agreeable to help out the floor if they have an IV they can't get...ED nurse could say, "sorry, can't help you," but we don't...at least in my hospital).
It's not about being selfish/uncooperative; presenting it in that way just fuels contention between floors.
Jul 3, '02Specialty: Clinical Risk Management ; Joined: Aug '01; Posts: 2,345; Likes: 75I worked in a 50-bed (incl. med-surg, ICU, OB & nursery) hospital for 1 year before coming to my current position 2 years ago. I had at least one episode where I had a patient who needed immediate medical attention. ED doc wasn't contacted. I contacted the Primary Care doc. & asked for orders, giving suggestions based on my experience taking care of patients in similar situations in a teaching hospital. I acted on those orders until the doc arrived. Another doc called me from his car using his cell phone & gave me orders while in transit.
I'm wondering...why didn't the primary care doc get there sooner if, as you said deespoohbear, he didn't live 30 minutes away but took that long to get to the hospital? Is there a written policy in medical affairs that give any guidelines for repsonding to calls about their patients, especially ones who deteriorate? If not, then why not? The patients are the customers of both the hospital & the physician. Isn't it good customer service to have docs who respond promptly?
Just my 2 cents worth, such as it is.