kind of a rant

Thats all very...very... sadly true.

When I first got into ER I definately had a reality check. Half of it is hardly "EMERGENCY medicine". Its like a freakin high tech doctors office. Half...if not more than half... of the patients are just fillers in between the real emergency cases.

I don't even know where to begin to vent about our F'ed up healthcare system. And from the looks of it, things aren't getting any better. As long as the government continues to cater to freeloading system abusers, they'll continue to do it. EMTALA is a load of crap.

Taxpayers are paying the bill... millions if not more in medical costs for these peoples minor issues.

Whatever...

Like I said, I'm with you... so much so that I've had to do a real re-check in my chosen specialty, wondering if this is what I really want... but the thing is, when it really IS emergency care, I love it!

I'm very close to snapping on the next patient coming in with a freakin blister on their foot.... "but it hurts, I need pain medicine!" **** and GOMER!

its useless...:zzzzz

So you think we shouldn't be frustrated with non-emergent people filling our waiting rooms? So you think these people should be coming to us because they will get better care for their chronic problem? I disagree...

I think it is a messed up system and if these people that slap down their medical coupon stating they have insurance had to pay a co-pay as small as 5$/visit they would think twice about coming to the ED.

I do not think they get better care from better doctor's as you imply I think if they were to go to a primary care MD they would get much more complete care and have all their c/o or disease processes addressed where an ED physician will only address the primary or presenting problem.

Drug seekers will always abuse the system and I think that emergency medicine is getting better at dealing with chronic pain and/or chronic abuse of meds. They are keeping track of Rx and primary care docs are giving pain contracts, pharmacy's are even keeping track of abusers with lists that are shared with other local pharmacies.

I don't think it helps to whine or mistreat patients and I don't, but to vent on sites like this is a healthy practice that I think should continue because we are all in the same boat.

While I completely empathize with you and your complaint about the types who frequent the ER, I take umbrage at your disparaging remarks in regard to FP physicians. Bottom of their class? Do you blame FP for the overload in the ER?

It is the majority of those patients you describe as keeping us in business who prevent us from taking care of &/or recognizing the true emergency patients. With their selfishness, demanding attitude and knowing how to play the system, the quiet, really sick patients do not get the care from us they deserve.

As I frequently say to the PIAs: ...the higher the decibel level of your moaning, the lower your acuity level-because, if you really were as sick as you say you are, you would not be able to have me hear you. I will be taking care of the quiet ones before you...

Sorry, I do not consider these visitors (notice how I avoid the saying, patients?) helping to keep my job. They are a drain on the system and the resources which impedes properly treating the emergency room patient, IMO.

A young mother brings her child in because she was up crying and complaining of belly pain...(and who turns out to be constipated)

Or a person comes in with strep-throat in the middle of the night (ouch..have you had that? it's probably an emegency for him)

Or, a person comes in with a stomach-virus and barfs all over...could've stayed home (but it was an emergency for him)

These corny examples (like a bazillion others) probably sound very familiar to ER nurses. To judge these 'visitors' poorly because they're not 'really' sick (ie using ER as 'primary care', or coming in for 'stupid complaints' like the OP stated), is an insight into an ER-nurses character. Not all ER nurses...but the ones who think-it/say-it/post-it.

I think the nurse who developes this attitude is primarily the one who had an incorrect vision of what the ER is. Like theOP said, if you want to work ONLY with unstable patients then ER is the wrong place to work.

The reality of the ER is FAR from what the TV shows portray (you know that)...yet it is this very illusion that draws alot of folks to work there.

(another interesting insight into the minds of many ER nurses can be seen @allnurses...common/popular themes on the ER boards are "...what was the stupidest patient complaint..." or "lets make fun of dumb people.."...and various other silly (but entertaining) threads...)

Like it or not, ER's (by their very nature and because of the forces of the system we're all a part of) function primarily as a high-powered, 24/7 doctors office. MOst patients dont get admitted...and only a small percentage of these are unstable. Mix in the occaisional tragic stories (ie young dead people, traumatic limb amputations, splattered brain matter, etc.)...and there you have it. An office nurse who is a sporadic witness to some awful stuff (...the 'fun' stuff that the aforementioned angry-posting-patient-haters 'really' like...to hell with barf and strep-throat! :) ).

Now...let me step down from my soap box...and whisper that i agree with you...

a young mother brings her child in because she was up crying and complaining of belly pain...(and who turns out to be constipated)

"who turns out" it the key word here. belly pain in a child would be taken seriously; and, most of us would be glad to find out it was due to constipation. btw, constipation could also be an emergency. part of our job with this patient would be to properly educate the parent in regards to prevention and recognition. don't think that this is a good example of the point you are trying to make

or a person comes in with strep-throat in the middle of the night (ouch..have you had that? it's probably an emegency for him)

strep throat that results in a high fever, difficulty swallowing and possibly leading to complications could also be considered a valid emergency room visit. just because the end result turns out to be non-emergent, doesn't mean the presenting s/s doesn't warrant an emergency room visit. again, not a good example of the point you are trying to make here.

or, a person comes in with a stomach-virus and barfs all over...could've stayed home (but it was an emergency for him)

'barfing all over' could be a myriad of other possibilities that do warrant an emergency room visit (especially, regarding electrolyte imbalances). actually, most of us er nurses are relieved to find out it is a non life threatening stomach virus that was treated promptly, rather than having the person wait until they were at the point of severe dehydration and an abnormal k+ level. btw, the stomach virus patient usually gets some form of iv therapy and medication because, even that type of diagnosis can lead to a true emergency (preventive medicine in action, here).

these corny examples (like a bazillion others) probably sound very familiar to er nurses. to judge these 'visitors' poorly because they're not 'really' sick (ie using er as 'primary care', or coming in for 'stupid complaints' like the op stated), is an insight into an er-nurses character. not all er nurses...but the ones who think-it/say-it/post-it. i do not think it is for you to judge an er nurses character if you have not walked in their shoes. your very examples of what you think er nurses find to be 'stupid complants' shows ignorance of the er environment nurses are subject to.

i think the nurse who developes this attitude is primarily the one who had an incorrect vision of what the er is. like theop said, if you want to work only with unstable patients then er is the wrong place to work.

the reality of the er is far from what the tv shows portray (you know that)...yet it is this very illusion that draws alot of folks to work there.

(another interesting insight into the minds of many er nurses can be seen @allnurses...common/popular themes on the er boards are "...what was the stupidest patient complaint..." or "lets make fun of dumb people.."...and various other silly (but entertaining) threads...)

like it or not, er's (by their very nature and because of the forces of the system we're all a part of) function primarily as a high-powered, 24/7 doctors office. most patients dont get admitted...and only a small percentage of these are unstable. mix in the occaisional tragic stories (ie young dead people, traumatic limb amputations, splattered brain matter, etc.)...and there you have it. an office nurse who is a sporadic witness to some awful stuff (...the 'fun' stuff that the aforementioned angry-posting-patient-haters 'really' like...to hell with barf and strep-throat! :) ).

now...let me step down from my soap box...and whisper that i agree with you...

you have some very serious misconceptions about what it is like working in the er environment.

You have some very serious misconceptions about what it is like working in the ER environment.

Nah...you're mistaken.

The OP stated people 'using ER as primary care' was one such sub-category of ER-abusing system-ruiners. The three examples were all things that could've been seen and taken-care of by primary care.

Or...do you HONESTLY think that anyone who starts barfing needs to head to an emergency room??? Ha!

Or...do you HONESTLY think that anyone who starts barfing needs to head to an emergency room??? Ha!

A nurse who makes a medical diagnosis is practicing out of his/her scope of practice. The ER works by consideration of presenting signs and symptoms, with a medical practioner using the differential diagnosis model. The diagnosis comes last, not first. By the time the patient gets to the floor, there is usually a diagnosis (or at least a r/o)- this is probably why you are having difficulty with P & P of the ER.

As I said before, you have some serious misconceptions of the ER environment & no matter what I say you seem to be fixed minded in your opinions. If you did not understand the point I was trying to make, I guess I would be wasting my time trying to explain things further. You are entitled to your opinion; but, please, as not to mislead people into thinking your opinions are fact, voice them as opinions. To call into question others' character or make blanket determinations from limited knowledge needs to be presented in a way that does not degrade.

Actually for a rant it is pretty balanced. Sometimes I wonder though. The last visit I made to ER was with my 84 year mom. I was informed by the ER nurse that my mom didn't look to be very ill. The ER doc informed me they would most likely give her some breathing treatments and antibiotics and send her home. I just nodded and smiled. I knew she was seriously ill and I knew she was staying. I was not concerned that they would miss something. I knew that once they saw that chest x-ray no one would insinuate she was not as sick as I knew her to be. I probably have listened to more lungs in my 25 years as a med/surg nurse than the young ER nurse and ER doc put together. I knew it was a fairly serious pneumonia. She ended up being in for nine days. The lung specialist came in the second day and informed me BEFORE he exaimed my mom that she would be going home next day. I just smiled knowingly at him also. THEN he slapped the stethescope on her, his eyes got as big as saucers and he left the room. Like I said she was in for a total of nine days for a very bad pneumonia and COPD. I know all those medical professionals have much more exposure to critical care nursing than I but I know old people and their lungs like the back of my hand. On med/surg 70 to 80% of our patients are over age 70 and at least half of them have some sort of lung involvement. PS I watched all the ER staff and the med/surg staff with knowing eyes and everybody did there job and did it well. Never mentioned I was a nurse to anyone. I noticed my brother didn't either.

To call into question others' character or make blanket determinations from limited knowledge needs to be presented in a way that does not degrade.

Again, you're mistaken.

My suggestion to you (or anyone else who is reading this) is to re-read my post/posts...after re-reading the OP's.

I apologize if you felt i was degrading...that was not the point.

But...i DID get your goat...

But...i DID get your goat...

Not really. You actually got my sympathy for your ignorance on the subject and now have it for your problem with making assumptions. It takes a lot more than this to rattle an ER nurse

to my fellow er nurses-please don't waste your time debating er nursing issues with med/surg, icu, non-er nurses. they only come into this er section because they are bored and want to ruffle feathers. we er nurses know that they will never know what we are talking about, how things go, or how we handle what we handle. we know that 85% of what comes into our er are real, emergent, life-or-limb threatening illness/injuries, and that no one else could handle these cases like we do. we know we are ranting about the small percentage that are tstl (to stupid to live). please remember they only come here because of their own feelings of inadequacy. they only state opinions, not facts, because they don't get it! i know that in all of my years coming and participating on this site i have never gone to a med-surg, or ccu, etc.. forum because i not only do not specialize in that type of nursing- i also do not care about it. i personally would never want to go there because i risk maybe making myself look stupid since i don't do those things that they do everyday. we know that our assessment skills are the best because they have to be, we have to figure out what is wrong fast, often with little info from the patient or family members. we understand that they keep quiet sometimes, and try to test our skills, even when it is not in the best interest of the patient. we know that the things that we encounter in one day, on one shift, no one else could even imagine. just remember that we know, keep using the er specialty area, and if you just ignore them, they might, just maybe, quit trying to come here and poo-pooing on our space. for we also know that unfortunately one day they will find themselves or someone that they love will require our quick-thinking, and compassionate life-saving skills-and then and only then will they be forever grateful for us er staff members. i would personally like to thank you all for what you do everyday-especially for putting up with all of the drug-seeking, non-emergent, system-scamming, fd cases that impede us trying to save the really sick people. they are only trying to “get your goat” and we have more important things to do!