At what point do we realize that the ER is not all about dealing with emergencies? We constantly complain about 3 things:
People using the ER as primary care
People coming in with really stupid complaints
Drug seekers
We have a system that encourages people to use the ER as primary care. Think about the chronic ER pt's, and the care they are likely to get outside of the ER. The clinics and doc's they go to just cannot provide the standard of care we give them in the ER.
From the perspective of the chronic ER pt: Sure, I could go to a local clinic- or I could go to the ER. I will get a doc, who, by definition is at least pretty good. 50% of the docs out there graduated in the bottom half of their class, but they aren't practicing emergency medicine. Any labs, studies, etc will be done then and there. Even if I sit in triage for 6 hours, I will still get care sooner than if I got an appointment. And, it's not like I had anything really pressing on my agenda.
I have worked in 4 ER's and in all, the pt's have received top notch care. I trust the ER docs a hell of a lot more than I trust most of the family practice docs I see admitting pt's.
Let's say I am a chronic ER pt. Why should I go to anywhere but the ER? Either way it's free. (Most of the folks I am talking about pay nothing out of pocket) If I go to the ER, I will get great, immediate care.
As far as people coming in with ridiculous, micky mouse complaints: You may have noticed that these folks are not super high functioning in any aspect- work, finance, relationships, etc. It's not realistic to think that they would be any higher functioning in managing their health care.
On to drug seekers: Of course they are seeking drugs. They are addicted. If they were wealthy and addicted, they would just buy street drugs. Or shop docs till they found one to treat their fibromyalgia and anxiety. With luck, they can find a few docs willing to write Rx's. The drug seekers we complain about come to the ER because we give them drugs. Getting upset at an addict for fulfilling the needs of his/her addiction is pretty silly.
We treat every little pain with narcotics, it's no surprise how many addicts there are out there. We are part of the problem.
I am an ER nurse. I would love it if all my patients were like TV patient's: Normal people, minding their own business when all of a sudden, something out of their control happens to them. They aren't.
If I just wanted to work with sick people, I could work in the ICU. Those people are sick. Even on the floor, most of the patients are sick and in need of medical care. I choose to work in the ER. By making this choice, I know that I will be working, to a large extent, with people who really don't need an ER.
So- is there a point at which we stop being angry or frustrated at our patients? Think of it this way: If the only patient who came in were the ones who really needed emergency care, at least half of us would be out of work. Or working elsewhere.
However where I work EMS does have the ability to deem transport unnecessary(and they do), within protocols of course and under medical direction. We also have a list of physicians in the area that are accepting new patients. There is a clinic that does the followup visits, and we make the appointments right then and there(ROS,U/S results ect). We also have access to a clinic staffed with multidisciplinary professions for the chronic users that anyone can refer to. However in spite of all of that there is a large amount of the population that misuse ED. They come in for things that can seriously wait, and part of my job at triage is to make sure the ones who can safely wait...do. And the more urgent/emergent gets in sooner.In canada healthcare is "free" and people want to get their monies worth. Some of the issue is education(lack of), some is lack of appropriate access to PCP, some is the instant gratification attitude. Until there is some way of holding people accountable for their own health we will continue down this road.
being an ED nurse it is not the nonurgent patient that I have a problem with it is the non urgent patient who demands care immediately over the the trully sick ones. He/she is also the one demanding you remove his IV and give him his discharge medication now over the trully sick patient. I don't mind the non urgent, it is job security:)
We spend way too much time defending ourselves to "non-ED" nurses....there is a reason we have "specialty" boards!!!!!!!! Like Adam Sandler so profoundly said "Go to your home"! Love you all,
Larry
HAHA, I have too many homes!!! The Rural nursing board is boring:( I do ER, OB, Med-surg, some pre-and post-op.
Okay now onto the point of the thread.
I get irked often by ER pt's that come in 15 min. after the office closes for something that's been going on for a week. We also have a couple of frequenters that call the ambulance b/c they have no vehicle, they've pretty much met the ambulance at the curb a couple times.
I think many of the patients we get just have a bill at the office and know we have to seem them in the ER or they have medicaid and don't care how much it's gonna cost b/c they don't have to pay for it. I don't know that they get seen often, but we're a rural hospital and they're being seen by the same physicians that are in the Office.
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.
There's a chance the nurse was telling you "she doesn't look too sick" so that you wouldn't worry excessively. She may have known of the pneumonia and course of tx but many people with elderly family members who are sick become panicky and want to know everything before a chest xray is even done.
I quit being frustrated by this stuff years ago. I figure every patient that comes to my ED thinks they have an emergency of some sort although it might not look like an emergency to me. It might really turn out to be an emergency anyway,who am I to say? I am amazed that people will run up such an expensive bill for convenient care, but again, I'm not picking up their phone and dealing with whoever the bill collector is. I pay some of their bills for them through my tax donations but that is secondary in my mission anyway.
Drug seekers will get some drugs but we will eventually put them on a pain contract if they keep coming. It's just a politically correct and informed way of letting them know that we know what they are up to.
I have stupid patients but I figure that's what they are paying me for. I am the one with the professional judgment to help them figure it out. I do and I educate them for another time, and another time, and another time .
And you bet I make diagnosis! I had better be able to notch a patient up to the front that needs it. A busy ED doc could not function without me. No, my diagnosis is not used to code the patient visit for billing. But I know what is going on with my patients. I stay within my legal bounds and do the assessment and nursing judgment that it calls for, but I know.
Oramar tickled me a little: 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.
I know there are medical people watching me work all the time that never identify themselves. It's ok. I will tailor your visit a little better for you if you let me know! It is always good to meet a fellow medical person.
There's a chance the nurse was telling you "she doesn't look too sick" so that you wouldn't worry excessively. She may have known of the pneumonia and course of tx but many people with elderly family members who are sick become panicky and want to know everything before a chest xray is even done.
that ocured to me later on but at the time it seemed if everyone was trying to minimize the situation, somehow insinuating I had misjudged her condition, I NEVER asked how she was doing, I already knew
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back2bRN
97 Posts
There is no real solution.
However where I work EMS does have the ability to deem transport unnecessary(and they do), within protocols of course and under medical direction. We also have a list of physicians in the area that are accepting new patients. There is a clinic that does the followup visits, and we make the appointments right then and there(ROS,U/S results ect). We also have access to a clinic staffed with multidisciplinary professions for the chronic users that anyone can refer to. However in spite of all of that there is a large amount of the population that misuse ED. They come in for things that can seriously wait, and part of my job at triage is to make sure the ones who can safely wait...do. And the more urgent/emergent gets in sooner.In canada healthcare is "free" and people want to get their monies worth. Some of the issue is education(lack of), some is lack of appropriate access to PCP, some is the instant gratification attitude. Until there is some way of holding people accountable for their own health we will continue down this road.