Is this common? The new face of the ED

Specialties Emergency

Published

I have worked in the ED for 4 years. Anyone who works in an ED knows the current situation with ED care. Too many patients (esp with non-urgent complaints) and we are incredibly understaffed. The turnover is so high, like I said I have been there 4 years and I figure I am in the group of 10% of RNs who have been there the longest. I have seen waves of nurses come and go. Recently it has gotten even worse.

Our management obviously is lacking. Many of the patients are "entitled". The services at our hospital keep decreasing to cut costs. I have not had a raise since I started, they always find a way out of it on a technicality. I love taking care of most of my patients ;-P and of course we are supposed to rate high on surveys for reimbursement reasons. On the other hand we are supposed to be fast and turn over the rooms quickly. It is an impossible situation. Either "too slow" for management and the patients love you, or too fast for patients and they feel neglected, "treated and streeted".

I spend time educating my patients, making them feel comfortable understanding the care they receive, etc. Normally I do this while I am inserting and IV or some other task where I would already be in the room. To be honest, I can't keep up with 4 critical patients at once - literally as soon as a patient is out of a room they bring another one down the hall while someone is cleaning the room. I don't feel like I can give good care this way.

Maybe it is just me - doesn't seem like it based on the number of nurses who have quit working at my ED, I've talked to them of course. And it seems to be getting worse - we never have adequate staffing (I think it is a danger to the patients) - we are not "rewarded" - a 1/2 hour uninterrupted break in a 12 hour shift is supposed to be reward enough, if we ever get it!

I am wondering what your experience is like. The good parts of my job are that I love most of my coworkers, I get to chose my own schedule - hours and days worked. And it is close to home.

Is my experience common? I feel like with the current situation in healthcare it will not get any better and probably worse. Thinking of making a change.

Specializes in ER - trauma/cardiac/burns. IV start spec.
Sorry ER nurses.

As with many units there are problem nurses but that is no reason to generalize. I assure you that I have been on both ends in my own ER, both as RN and patient, and it can be difficult. I do not know the size of your city but here on an average night 100+ patients in 8 hours was average. I would make it a point to do patient education every time I went into a room. I cannot tell you how many times I arrived at work to find that we were 20 to 30 charts behind overflowing from evenings. I am truly sorry that your subdural was missed, that is why I really liked having treatment protocols in place. Once a RN started a protocol the flow had to be completed - the Doc on that night could not short-cut the path.

ER's will always be treated as if it is a clinic by many patients and that abuse of the system will have unintended consequences for the truly sick or emergent patients. The ability of the hospital to cover any shortage of nurses in an ER that gets slammed would be not only helpful but it would be safer. Safer for the patients, safer for the nurses but it means the costs of care go up and management is all about keeping the costs down. But despite all the negatives I would have never left the ER - I never burned out but I knew nurses that did and I was glad to see them go.

(And Yes I am allergic to latex, severely allergic - anaphylaxis level and I cannot have Epi so avoidance is my best option. A hospital can go "latex free" but that does not make it safe for the severely allergic. Short of demolishing the existing buildings and rebuilding with no latex containing products the buildings are already contaminated and therefore unsafe. I have not been to a movie since 2005, cannot go out to eat at a dine in restaurant, cannot buy new furniture, cannot find a safe bathing suit, (just to name a few obstacles) and shopping is a nightmare as my battery for my filter system only lasts for 2 hours and people tend to stare and make rude comments. I am on Social Security disability as a result.)

Our ER is latex free.

@redhead_NURSE98!

We do not clock out for lunch, they automatically deduct it from our pay, and the two 15 minute breaks? Have never happened.

@billy bob

I have no idea what ER you went to. But that is a way overgeneralization. If you came in our ER with a HA that wouldn't go away, first thing we could do is a head CT, before meds or anything. It is our protocol. Doctors and Nurses lazy? I just had to laugh at that.

as for people coming to ER vs urgent care or clinic, we are just at the fringe of seeing a greater influx of these patients. the flip side, hospitals don't recieve a great amount of reimbursement so staffing may continue to be a nightmare at times. Clinics charge for first visits (even with medicaid), urgent care has a co pay, and some people just don't want to bother making an appointment and further more don't wish to sit in a clinic for an hour so the ER seems to them the answer

Specializes in Med/surg, Quality & Risk.
@redhead_NURSE98!

W

e do not clock out for lunch, they automatically deduct it from our pay, and the two 15 minute breaks? Have never happened.

You don't have a manner in which to edit and show that you did not take a lunch?

You have even better grounds for a fair wage lawsuit, because all of your employees are being shown as taking a lunch when they may not be. Again, the reason companies get away with this is because we let them.

Specializes in Dialysis/Nephrology.
I have worked in the ED almost 4 years and there are many times that I don't get any breaks let alone 30 miutes for lunch. We aren't required to clock out for lunch; the time is automatically deducted and you have to remember to write it in a time book to get paid if you don't get your lunch. Even if I am getting paid when I don't get to take time for lunch, I would rather have the much needed break than the extra few dollars.

I work in Dialysis and even if we are not able to take our 30min lunch break, they dock our pay anyways. I have went on break before, clocked out, 15mins later I'm called back to the floor for whatever reason, clock back in, then get called in the office to get grilled because I ONLY clocked out for 15mins... :confused:

Specializes in ER/Trauma.
@redhead_NURSE98!

W

e do not clock out for lunch, they automatically deduct it from our pay, and the two 15 minute breaks? Have never happened.

@billy bob

I have no idea what ER you went to. But that is a way overgeneralization. If you came in our ER with a HA that wouldn't go away, first thing we could do is a head CT, before meds or anything. It is our protocol. Doctors and Nurses lazy? I just had to laugh at that.

Same here. The situation at the ER that I work in sounds eerily similar to the original posters' note. We work hard, and the vast majority do actually care and have great bedside manner, even with the most minor of complaints. Yet, it is quite clear that @billyboblewis has no earthly idea of the actual state of things or he would not have made such an egregious remark, I hope. He had a bad experience, it seems, and has chosen to paint all ER nurses with the same brush. Typical and sad.

Also, I have never seen an ER that had a "light" workload. That has to be the funniest thing I've read today.

Having been an RN for 40 years I have more experience in ER's than most of the people who have sent letters. Every nurse has bad days and misses meals from time to time. We all have good and bad days. If you survey people who have used the services of ER's you will find that there are many more dissatisfied people than you think. I am not alone and actually feel quite qualified to judge er service.

Having been an RN for 40 years I have more experience in ER's than most of the people who have sent letters. Every nurse has bad days and misses meals from time to time. We all have good and bad days. If you survey people who have used the services of ER's you will find that there are many more dissatisfied people than you think. I am not alone and actually feel quite qualified to judge er service.

billyboblewis, I don't understand the offended reactions to your post. It didn't occur to me to think that you were saying you really believe that all ER nurses are incompetent prejudiced slackers. I know there is such a thing as professional pride, but such strong reactions to a stranger's (a stranger who is an RN with ER nursing experience) opinion on an internet forum when he says he nearly died through lack of appropriate care in the ER, and then goes on to direct some comments to ER nurses, just seems a little excessive to me.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

The face pf the ED and ED nursing has changed ove rthe years somewhat...but the ED has always been the safety net for the needy. As hospitals close and over crowding continues this will lead to futher stressing of the ED deaprtment resources.

ED nursing is a demanding career choice for you cannot stem the flow through those doors.

The OP's intention was to talk about these changes and conditions of working in the department and not personal stories of actual visits.

Allnurses supports the idea of lively debate. This means you are free to disagree with anyone on any type of subject matter as long as your criticism is constructive and polite. PLease stick to the subject matter of the psot.

Additionally, please refrain from name-calling. This is divisive, rude, and derails the thread.

Our first priority is to the members that have come here because of the flame-free atmosphere we provide. There is a zero-tolerance policy here against personal attacks. We will not tolerate anyone insulting other's opinion nor name calling.

Our call is to be supportive, not divisive. Several posts have been removed from this thread as as non contributory and off topic. Please stick to the subject of the post or the thread will be closed.

Well shucks, sign me up for this amazing ER with the light workload and people going out to buy lunches for everyone's 30 minute breaks! Why am I suffering through saving lives when I could be doing that?

Exactly if anyone really worked in a real ED they would no that light work and someone leaving for lunch would be unrealistic. What if they call a trauma, stemi or stroke alert along with taking care of the yellow medicals, baker acts and drug seekers. ED doctors and nurses might seem short because we have a time frame to get patients in and out. As far as lazy you have never been in my ED. I work in the busiest ED in Florida and we are not gonna stand for lazy.
o btw I am an RN and have been for the last 36 years of my career. I have worked in all types and sizes of hospitals and will tell you that the majority of er nurses are fantastic and I believe the ones complaining may be a very small minority!

First their lazy then their amazing. No possible way you worked in a ED and can use light work and ED in the same sentence.

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