I'm really getting burned out very quickly with the life sucking force of non-urgent patients in the ER. I've been in ER for 3 years now (2 nursing NS as a tech, 1 as an RN). I'm not new to the obvious abuse of the system but lately I would rather hear nails down a chalkboard that listen to these people in triage with their c/o they've had for 6-7 months.
It seemed to plauge us Wed night something awful. Our entire ER filled up in 15 mins. with things that obviously could've been addressed at a PCP or Urgent Care. Which, BTW, those are abudent in our area. And, you don't have to wait to get into a PCP, most have same day appts. We even have a great Urgent Care that sees patients until midnight down the road from the ER.
How do others deal with this?
Let me give you examples of Wed night. URI s/s for 30+ days. It hurts when I insert a tampon. Back pain for 6 months. I hit a wall 3 weeks ago and I just now think it needs to be checked depite the fact I have full ROM and no swelling and/or pain right now. My child has a "fever" of 98.6. My child was exposed to chicken pox 3 days ago. A man with totally vague s/s during triage and later we find out, he just wants a physical and a work note. A woman with chronic dental pain, on ATB already, the tooth has been pulled AND she already had pain meds at home.
Our Urgent Care and PCP can all order labs/X-rays from their office and people can come to hospital for OUTPATIENT stuff. Our Urgent Care is open until midnight 7 days a week. Our lab and/or X-ray will see patients until midnight as well. We even have 2 PCP's that see patients until 7p.m. at night. Obviously they have bent over backwards to address the needs of working people here.
Usually I don't even mind people who come in with minor c/o and not really emergencies,. But for the last couple of months I find myself having this urge to just scream whenever I hear WEEKS or MONTHS in their sentences during triage. I can't even begin to describe the feeling I get when I hear "nothing" when I ask what they've done for the said complaint that has plauged them for WEEKS or MONTHS.
Then we have a staff meeting about the stupid PG and how we are slacking and how we need to improve customer satisfaction. I could come up with the ways, but I don't think the hospital would find my ways very funny.
I'm at my wits end I really am.
I need some great words of wisdom or some humor or something to continue this madness.
rn2ben2008: as an rn for 11 years in the ed and 14 as a respiratory therapist, i have laughed long and hard through the years with the sick humor that is ed nursing. even as an rrt we used to make crude comments in our break rooms about putting loogies on ritz crackers. (you know the saying, anything goes good on a ritz)....sick joke, sure....but it is said in every rt department across the nation i bet. we are not overtly offending our patients when we vent in these rooms. you have to realize that right?????? we are venting through humor....did you learn that is a good way to deal with stress in nursing school? do you honestly think we let people rot in the triage area...i mean literally rot. no.....but since they shouldn't have abused the system, there's no reason they can't wait out there alittle longer then they would choose to, while the mds and rns treat life and death situations every minute of every day. if you ever want to grace the ed as an rn, i would be curious to chat with you.......1 week after you start, then 1 month and so on. let us have our sick humor, and we'll let you try to keep your "i'll be a better nurse than you" attitude.
it floors me how many non er nurses judge the sick humor that allows us to laugh rather than cry....
i am soon to be a grad nurse, switching careers in midlife, and i wouldn't ever want your attitude. "let them rot"? good god almighty, you need to switch departments or careers. i can't believe there are nurses out there with this attitude. i certainly would not want you, or anyone with this attitude touching any of my family members.
until your family has an emergency.....then you wish the guy with the wart on his member was made to sit out in the triage area while your child cries with a broken arm waiting for an open room
Honestly I would never want to sit in an ER if it wasn't an absolute necessity. Whenever I've had to take one of my kids for stitches or X-rays (not often fortunately) I always tried first at a clinic or outpatient center. Generally the wait is MUCH shorter and more pleasant. Our primary doc also does stitches in his office on occasion if he isn't too busy. I don't get people who go to the ER when there are other options available.
Honestly I would never want to sit in an ER if it wasn't an absolute necessity. Whenever I've had to take one of my kids for stitches or X-rays (not often fortunately) I always tried first at a clinic or outpatient center. Generally the wait is MUCH shorter and more pleasant. Our primary doc also does stitches in his office on occasion if he isn't too busy. I don't get people who go to the ER when there are other options available.
Maybe I've mentioned this in this thread (I know it's somewhere on the board), but I have a distant relative who got divorced some years back, and part of the agreement was that he had to pay the kids' medical bills. Lots of couples do this, and I think it's a perfectly legitimate way to support your children, but guess what? She would take the kids to the ER, instead of a regular doctor, just to soak him. She would even take them there when they weren't sick, so he would get a bill. This was in addition to taking them to all kinds of specialists, once again, to soak him with medical bills.
Thing is, the kids want nothing to do with HIM and nobody who knows why will tell me.
I should add that when they were married, she would find a way to have surgery every year or two as a "getaway", instead of a spa or a resort like a lot of other women do. I once asked our mutual relative if her ex-husband was a pervert and she did this so she could have a legitimate excuse not to fulfill his demands (I have heard of women doing this) and he said no, she just needs attention and doesn't care where she gets it.
I don't get people who go to the ER when there are other options available.
Several reasons ...
1. The World Revolves Around Me Syndrome: a lack of understanding that an EMERGENCY DEPARTMENT is not empty with a full staff just waiting for you to have an "emergency" of n/v x 1 day. Forget bird flu - I believe it is this syndrome which will spell the end of civilization as we know it.
2. Reinforcement of this concept by PCPs who are either truly overbooked with more patients than they could ever hope to manage well or are just lazy. I have the utmost respect for good family practice practitioners and nothing but loathing for lazy ones whose mantra is, "just go to the ER."
3. TSTL: see the acronym thread if you need an explanation of this one.
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
I believe (although it is not the way an ED should be used) that we have to accept that this is the "way it is for now"...I feel sorry for all the "new" ED nurses (less than 5 years experience) who are disillusioned about this. They believe they will all be working in a place like Cook Co. ED (see NBC TV ER). When they get the ED job that actually exsits in (just guessing here) 95% of all ED's...they become disenhearted and gradually develop a ****-poor attitude because "this is not what I signed up for"....
For whatever the reasons, today's ED is not what it was perceived as 10-15-20 years ago.
INTERESTING SIDE NOTE: Next time you see a pediatric pt come to your ED with a minor complaint (regardless of having a PCP or insurance), just think what that parent is teaching their child; think what they are telling their friends ("Oh I had to go to the ER").... and then think what that child will do someday when they are an adult or when they have kids of their won...They will have learned that the ED is an okay place to go for minor illness/injury....
Again, regardless of the causes (social, economical, educational etc) one thing we all can do is educate. I propose that the first thing any of us ED folks can do is to get involved. The ENA is an awesome professional group for networking and seeing national level policy/position developments and peer support on the same topics.
So In answer to the original poster who asks how to deal with these, I say get involved in something; a work team at work, a committee or council at your hospital, recruit your managers to be aware of the problem and maybe get an initiative started by your hospital, get professionally involved and support your local group, heck, even volunteer at a free clinic (this makes sure they don't have to turn away pt's due to inadequate volunteer nurses), also consider educating your doctor - tell him/her that you are an ED nurse and how many doctors "send" their pt's to ED's rather than "work them in" etc.....
But remember, until even our nation's top leadership get's it right - we're caught in a crux....."America has access to health care, just go to an ER"...George Bush...
rn2ben2008: as an rn for 11 years in the ed and 14 as a respiratory therapist, i have laughed long and hard through the years with the sick humor that is ed nursing. even as an rrt we used to make crude comments in our break rooms about putting loogies on ritz crackers. (you know the saying, anything goes good on a ritz)....sick joke, sure....but it is said in every rt department across the nation i bet. we are not overtly offending our patients when we vent in these rooms. you have to realize that right?????? we are venting through humor....did you learn that is a good way to deal with stress in nursing school? do you honestly think we let people rot in the triage area...i mean literally rot. no.....but since they shouldn't have abused the system, there's no reason they can't wait out there alittle longer then they would choose to, while the mds and rns treat life and death situations every minute of every day. if you ever want to grace the ed as an rn, i would be curious to chat with you.......1 week after you start, then 1 month and so on. let us have our sick humor, and we'll let you try to keep your "i'll be a better nurse than you" attitude.
it floors me how many non er nurses judge the sick humor that allows us to laugh rather than cry....
i do not have a "i'll be a better nurse than you" attitude, and i understand humor and dealing with stress, and no, i do not believe anyone literally let's a patient "rot" in the waiting area. i was floored by the comment, that is all.
i live outside of detroit, and at our local community hospital, everyone has been so kind and nice, when i have had to take a family member to the er. sometimes, i think people forget how many americans are without health insurance, last i heard it was around 50 million??
i do not have a "i'll be a better nurse than you" attitude, and i understand humor and dealing with stress, and no, i do not believe anyone literally let's a patient "rot" in the waiting area. i was floored by the comment, that is all.
i live outside of detroit, and at our local community hospital, everyone has been so kind and nice, when i have had to take a family member to the er. sometimes, i think people forget how many americans are without health insurance, last i heard it was around 50 million??
the lyrics to an old song from the sixties leaps to mind:
come back, when you grow up, girl
you're still living in a paper-doll world
livin' ain't easy, but lovin's twice as tough
so come back, baby
when you grow up...
in other words---it's very easy to be an armchair quarter-back, until you are the one on the field..
Specializes in cardiology, psychiatry, corrections.
Oh my goodness!!!
I am soon to be a Grad Nurse, switching careers in midlife, and I wouldn't ever want your attitude. "Let them rot"? good God almighty, you need to switch departments or careers. I can't believe there are nurses out there with this attitude. I certainly would NOT want you, or anyone with this attitude touching any of my family members.
You have a lot to learn, chickie. :trout: If you plan to work in the ER, you will learn that while bad things can happen to good people, some ER visits are the result of one's own stupidity or ignorance, or doing something he or she had no business doing. There is an EMS rule out there: "About 80% of assault patients most likely deserved it."
EMS and the ER staff see the worst of the worst. Using humor helps us cope with everyday issues and sometimes helps us forget about the things we'd like to forget about, such as the fatal motor vehicle crash I ran on several days ago. The patient was dead on the scene with a near decapitation. Without humor the job will eat you alive.
What we've started doing at our ER is.... we screen them out. If they do not meet emergent requirements, they are asked to pay their copay if they have insurance, 110 bucks if they don't. Word has gotten out and we don't see nearly as many non-emergent patients as we used to.
I have had patients who are asked to pay a 5 collar co-pay and because they cant afford it are not forced to. Of course these patients all have a pack of cigarettes, fake nails and a cell phone, yet cant afford a 5$ co-pay nor Tylenol for their kids fever. Any why should they when they can get an RX for the same. (medical patients of course)
I have had patients who C/O rectal bleed, who have a hemorrhoid who bring 5 family members who all insist on being at bedside. Who fight the rule of 1 visitor stating they want a new RN because their RN doesn't want 5 people in their way. I truly believe there was nothing on TV that night. They hate me BTW and I don't care either.
I have tried to explain to patients till I'm blue in the face that their URI doesn't constitute they are dying and doesn't come before the 87 yr old with chest pain with a + cardiac history. Instead I get, "How do you know I'm not dying with out an X-ray?" This coming from a 22 yr old with URI symptoms x 3 weeks. I have tried to explain how I'm sure they would be happy if their grandma came in with symptoms of a heart attack and how they would be priority. This doesn't fade them. "well how do you know I'm not dying???" You have stable vitals and are 22 yrs old. Which means you will wait a long time. "feeling like your dying doesn't mean you get straight back." If thats the case the guy with the "scratch" with 10/10 pain trumps you.
The back pain or "insert complaint x 6 mo -4 yrs here" is due to the fact we don't make them pay a co-pay. People will continue to abuse the ER until someone finally steps up and refuses to see a non-urgent complaint. We say we will "refer you to your PMD" if you have a non-urgent complaint, but truth be told...we never do. Not really. Sure they may D/C with motrin. But still they see everyone. Because bottom line is they want "numbers" and to keep everyone happy.
So I continue to beat my head on the desk, and try no to roll my eyes.
I also want to say I have sereral patients who come in every time their kids have a bruised knee. They can ambulate fine. And these people state they cant go to a PMD due to the fact they are working those hrs. Yet they are in all hours of the day. simple fact is, if they have medi-cal or no insurance and no plans on ever paying, they will abuse they system. And will put one of your ER doctors as their PMD on the sign in. Because really, your ER doc is their PMD.
TraumaNurseRN
497 Posts
rn2ben2008: as an rn for 11 years in the ed and 14 as a respiratory therapist, i have laughed long and hard through the years with the sick humor that is ed nursing. even as an rrt we used to make crude comments in our break rooms about putting loogies on ritz crackers. (you know the saying, anything goes good on a ritz)....sick joke, sure....but it is said in every rt department across the nation i bet. we are not overtly offending our patients when we vent in these rooms. you have to realize that right?????? we are venting through humor....did you learn that is a good way to deal with stress in nursing school? do you honestly think we let people rot in the triage area...i mean literally rot. no.....but since they shouldn't have abused the system, there's no reason they can't wait out there alittle longer then they would choose to, while the mds and rns treat life and death situations every minute of every day. if you ever want to grace the ed as an rn, i would be curious to chat with you.......1 week after you start, then 1 month and so on. let us have our sick humor, and we'll let you try to keep your "i'll be a better nurse than you" attitude.
it floors me how many non er nurses judge the sick humor that allows us to laugh rather than cry....