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.
I remember someone posted their system that seems to work very well: They have a doctor do triage and the doc decides if you're emergent or not. If not, bye bye. If anyone complains, "Well, you've already been seen by a doctor! Bye!"
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??
this thread was meant as a sounding board for venting to fellow er rns who can empathize with the multitude of people who wonder into the emergency room with complaints that have no business coming to the er ,let alone getting something over the counter to treat their head lice. they act "entitled" to services that should be used in an emergency setting. they become angry when we prioritize the acuity of care designated within the system that is er medicine. we work very hard, sometimes saving a life and treating these ungrateful ignorant individuals minutes apart. do you think trying to educate someone that hemorrhoids are not considered an emergency is fun? sometimes that paient was there the week prior for an abrasion or something else minor that thought it should be looked at. we go from being chewed out by that patient to the next room as if nothing is wrong, our smile is perpetual, our dedication unwavering. so, it becomes increasingly frustrating to be judged yet again by a fellow nurse to boot. it's shameful actually. you make it sound as if we vent out loud to these people instead of talking about it in here, set up specifically in that forum. you are ignorant to what we actually do in the er and you aren't even a nurse yet. (that floors me:banghead:)
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.
I think a lot of your patients lack teaching. The mom who thought 98.6 was a fever, the post-extraction patient, for example. The latter should have called her dentist's exchange. Of course, a lot of doctors are guilty of sending people to the ER unnecessarily for liability reasons and for convenience for themselves - can't blame them, really.
Then there must not have been enough data collected or the data collection method could have been flawed.
I agree- I don't care what any research studies have shown- as an ER night-shifter, I can say that there are definitely more psych cases in the ER at or around the time of a full moon..... Even the people who don't come in for psych complaints have underlying psych issues (chest pain=anxiety, abd pain=personality disorder, etc....)- there's no way to quantify that, but that's just how it is!
OMG! these words are truly spoken. My latest ER "flyers" was a young woman notorius for oral herp. & she had a "sore throat". I thought the MD was going to go off the deep end at 2am!
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
Then there must not have been enough data collected or the data collection method could have been flawed.
....no, If you know what a meta-analysis is, then you know that (1) a substantial body of research (with adequate data) has already been done, and (2) it is looking at multiple different data collection methodologies.
So the final interpretations are a summary of what previous research has already been done - it is not one isolated research project.
My goal was to try to show that there was a relationship - but the data from the whole meta-analysis set did not support this.
What I was saying is that there is a greater amount of both psych cases AND people with underlying psych issues. Yes, it is possible to quantify visits involving patients with actual psychiatric complaints, but it is NOT possible to quantify how many visits there are from patients with complaints of things like chest pain, SOB, abd pain, etc. who have underlying psych issues (anxiety, depression, personality disorders...), especially if there was never any formal diagnosis of those underlying psych issues.
You quoted me out of context, and your condescension is inappropriate, unprofessional, and uncalled for...
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
but it is NOT possible to quantify how many visits there are from patients with complaints of things like chest pain, SOB, abd pain, etc. who have underlying psych issues (anxiety, depression, personality disorders...), especially if there was never any formal diagnosis of those underlying psych issues.
I agree, then (by your own statement) this is merely observational, anecdotal, and subject to the observer's own perception or bias and therefore "un"-scientific.
But I wouldn't say it's impossible to work up. Part of the research design (if it's prospective) would be to design a history tool that would ask a few key questions that might then be able to quantify if those "other" psych issues were/were not part of the underlying stimulus.
From a clinician's perspective; I feel that I am all too aware of the times that stress, anxiety, depression play a role in my patient's somatic complaints. From the length of time I have to talk to and interview them, AND, when I also see that their w/u is coming back negative; I can start to put the pieces together that there might be some other underlying "thing" going on.
But I think generally ED RN's generally hold three false beliefs...
1) There are more "psych" pt's during the full moon
2) There are more trauma pt's during the FM
3) There is a higher volume/acuity during the FM.
...we only formally looked at #1 and #2. #3 was left out of the analysis.
We were wanting to see if the relationship existed,and if it did then we thought that the Nurse Managers should know this so they could "up staff" during the full moon, AND, so we could have extra OR staff on standby (for those traumas)
.....we also thought that if there was truth to this, we would probably owe it to the Police, EMS, Sheriff and Highway Patrols to know also because they might be held liable too if they didn't increase their staffing when it was a fact (sarcastic here) that a FM brought more emergency business.
But I wouldn't say it's impossible to work up. Part of the research design (if it's prospective) would be to design a history tool that would ask a few key questions that might then be able to quantify if those "other" psych issues were/were not part of the underlying stimulus.
I can guarantee you that if you develop a "tool" to ask people about their underlying psych issues, it will be pretty much useless. Most people who have psych issues are not aware of them because they've never been officially diagnosed. Most people who have borderline personality disorders or histrionic personality disorders are either not aware of this, in denial of this, or will not volunteer this information. Utilizing a tool that relies on patients to provide this information would result in flawed research. For example (and this is purely hypothetical here), if I asked you if you had a little bit of a Narcissistic personality disorder, you would probably say no...
JeanettePNP, MSN, RN, NP
1 Article; 1,863 Posts
I remember someone posted their system that seems to work very well: They have a doctor do triage and the doc decides if you're emergent or not. If not, bye bye. If anyone complains, "Well, you've already been seen by a doctor! Bye!"