As I said, this is something of a regular occurrence for us and people seem to think that it's our responsibility to get them home again (and to provide them food while they wait for a ride home).
It drives me bananas, especially since it's very rare that they actually have an emergency situation and that they're often frequent fliers.
Now the question: How do your facilities handle it when patients are to be discharged but state that they have no means to get home?
It could be YOU! We are all only a couple of paychecks away from being in this position. My heart goes out to patients who have nowhere to go.
It's less a matter of having nowhere to go than having a destination but expecting someone else to get you there. I feel for folks who do not have a car. But those who come in on an emergency basis when their complaint is not an emergency should not expect to be ferried home on someone else's dime.
Bus tickets, yeah. But cab fare because you decided to come after hours for something that could have waited until morning, that's just enabling. You can snooze in the nice warm ED waiting room until the buses are running again.
This isn't cruelty. It's a lesson in practicality. And planning. Adults need to start thinking like adults and understanding that their poor decision making will have an affect on them. As long as we shield people from the negative results of their mistakes, there will be no incentive for them to change their thinking or their behavior.
This isn't cruelty. It's a lesson in practicality. And planning. Adults need to start thinking like adults and understanding that their poor decision making will have an affect on them. As long as we shield people from the negative results of their mistakes, there will be no incentive for them to change their thinking or their behavior.
Expecting adults to take responsiblity for thier actions? How can we possibly do that? LOL
Our hospital (small community hospital in an 'under-served' area) has some agreement with some transportation service - we call them and a mini van arrives - they take the patients home - not sure how this service is paid for, we get lots of people (frequent flyers) who have run their Medicare into dust and crumbs - but we still take them as patients...
It could be YOU! We are all only a couple of paychecks away from being in this position. My heart goes out to patients who have nowhere to go.
You're right, it could be.
The thing is, I *wouldn't* come to the ER in the middle of the night and then expect somebody else to work out for me how to get back to whence I came.
The ER is for medical emergencies and the fact of the matter is that hunger and homelessness are not medical emergencies nor anything that we are funded to deal with. Simple as that.
It could be YOU! We are all only a couple of paychecks away from being in this position. My heart goes out to patients who have nowhere to go.
No, not really.
Sudden job loss or financial difficulty, yes, we are all vulnerable to some extent or another. But a complete lack of resourcefulness to problem-solve, no -- this is a long-term, learned behavior. One that can be modified if it doesn't continue to get reinforced.
And ... we're talking about people demanding free transportation back to wherever they came from ... they have somewhere to go. And we are NOT talking about residents of nursing homes, rehab facilities, etc.
As I'm fond of saying: "You don't go to Walmart or TGIF and then expect 'em to get you home; do you?"
- Roy
PS: What cab vouchers I have are reserved for the living-all-alone-by-herself 89 year old woman who comes in because she had chest pain. Your 20 year old butt can walk itself home for all I care...
One more thought: every, single irate patient I've ever discharged to the waiting room without a cab voucher or bus tickets did in fact leave the building sooner or later. They've all found a way home. Amazing!!
I'm happy to give out bus passes like candy if they will just not sleep all over the ED waiting room.
But you know the patient that comes by ambulance just because they think they will be seen before anyone in the waiting room? I had one that was dispatched to the triage area and then the waiting room the other day right after stepping off the ambulance stretcher. She was not happy. The minute she saw the number of people in the waiting room she called her friend to come pick her up at the hospital. Hmmm, seems like the friend could have given her a ride rather than the ambulance to start with.
They allow for some decompression sometimes. I love to vent too.
I refuse to give a voucher unless circumstances dictate like:
The patient is from out of town, trashed their car, came in by ambulance. They have absolutely NO resources to draw from...
Most recently a patient came in by ambulance (I'm NOT kidding) for cold symptoms x2 weeks. Regular vitals, no cough, no fever... in the 1st 3 minutes her demands were for something to eat, something to drink, the TV remote, "2" pillows and a warm blanket... All in one sentence.
I told her to pick up the phone and call for a ride and that I would be back in just a few minutes with the doctor and her discharge instructions. Doc checked her out and I gave her my pre-written instructions: increase fluids, lite diet, motrin & tylenol for headache or fever return if worsens. Registration was done in the lobby. Total time in department- 12 minutes!
It really makes you mad, when you see these people playing the system and wasting money as they do. I had a very NASTY girl come in for "Lower back pain x 2 weeks"- Via ambulance, of course. SHe spent the time ******** on her cell phone about how long it was taking us to dispo her. Of COURSE she demanded the turkey sandwich and juice. So the time comes to d/c her- there is an issue with her Medicaide- she gets ****** at ME for expecting her to speak with the Medicaide ppl herself-- SHe is rude and nasty to them on the phone. Then she flounces over and demands I call the nursing supervisor to get her cab money home! I told her she should probably start calling her friends in an attempt to get herself a ride- you would have thought I told her to solve world hunger on her own...so she curses at me, flounces out to the waiting room- THEN CALLS THE NURSING SUPERVISOR from the waiting room to demand money, and complain about how RUDE I am. People like this should be given 30 days, and summarily removed from the system. BTW- She was also talking to her brother on the phine- who she babysits for to get extra cig money. So glad I work overtime to support these pieces of S*^%!!!!!
It could be YOU! We are all only a couple of paychecks away from being in this position. My heart goes out to patients who have nowhere to go.
I think most of these people are talking about folks who are very obviously abusing the system. I would hope that most nurses would try to help some one who, say, is in a town they just moved to and fell out some where and was brought to the ER, or some similar situation.
...you know the patient that comes by ambulance just because they think they will be seen before anyone in the waiting room?
Someone published a book several years ago that discussed how to get over on the regular system. Explained that you should take an ambulance to the ER because you'll get seen faster. Well, I adopted a rapid triage process long ago that placed stable patients in the waiting room right from the back ambulance door. They got to sign in right behind everyone else.
"Just because you have a ride on the bus doesn't mean you have a VIP ticket to the show".
rn/writer, RN
9 Articles; 4,168 Posts
It's less a matter of having nowhere to go than having a destination but expecting someone else to get you there. I feel for folks who do not have a car. But those who come in on an emergency basis when their complaint is not an emergency should not expect to be ferried home on someone else's dime.
Bus tickets, yeah. But cab fare because you decided to come after hours for something that could have waited until morning, that's just enabling. You can snooze in the nice warm ED waiting room until the buses are running again.
This isn't cruelty. It's a lesson in practicality. And planning. Adults need to start thinking like adults and understanding that their poor decision making will have an affect on them. As long as we shield people from the negative results of their mistakes, there will be no incentive for them to change their thinking or their behavior.