Patient Died in ER lobby

[Kitiger, RN]

Even if I were capable of working ER, I wouldn't work here.

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This week, a local media outlet reported that a patient died in the ER lobby on June 6 after waiting for hours to be seen.

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A full day after the report first came out, the hospital disputed the details of what happened with the patient in question, but in vague terms.

“How this story has been described publicly is not how things occurred, but in respect to the family we can’t comment on a specific situation at this time. We can confirm the State has not been on site this week for any reason,” a Novant Health spokesperson said in a statement.

The full statement can be found at the end of this story.

Hospital responds to reports patient died in ER lobby waiting to be seen

[Wuzzie]

The hospital's spin on it is gross but the truth of the matter is this is going on pretty much everywhere. Not the dying in the lobby thing but EDs full of admitted patient who have no bed to be moved to due to staff shortages and threats from management if anybody speaks out about it. I wouldn't be surprised if the "dying before being seen" doesn't start happening more and more. Healthcare's dirty little secret. 

[Emergent, RN]

I don't know why anybody is shocked by this. A lot of nurses like me have left the hospital setting. It's not necessarily the hospital itself at fault, there are many many factors pushing nurses out of Nursing.

All these factors have been brewing for a while and then we got hit by the pandemic. The system got stressed to the limit. I'm so glad I am out of the hospital setting.

I don't know what the public expects. You have a waiting room stuffed to the gills, and the staff running around like chickens without a head trying to keep up with very sick people, plus they have to cater to the malingerers. They don't have time to round on every person in the waiting room who hasn't been evaluated. It's physically impossible.

[nursej22, MSN, RN]

What an tragic story but not surprising. I  visited my sister in ED last week and went in and out a few times to get her keys and fetch personal items. The same people were sitting there after 2 hours, and it was quite crowded.

Sis went in at 2 pm and got a room at 10 pm for acute congestive heart failure.

 

[Susie2310]

I think the changes in Admitting procedures that mean patients can spend many hours on Observation status have resulted in a lot of difficulties for patients/family and staff. This, combined with Covid and shortages of certain Providers.

In the ED for over 12 hours recently on Observation.  It didn't appear to me to be especially busy, and we could see staff hugging and grooming each other at shift change.  The staff that we could see appeared to be working at a comfortable, even very relaxed pace for some of the time.  

On another occasion recently in the ED  (great majority of the time spent in the waiting room) for around 3 hours.  The waiting room was very busy and the ED looked packed; patients lying on stretchers not in patient rooms.

I recently read more information about the violence/aggression nurses are subjected to from patients/family members and how nurses are active politically in trying to criminalize violence/aggression (which lacked a descriptor of just what behaviors constitute violence/aggression that is to be criminalized) by patients/family members.   After spending over 6 hours in the ED on a stretcher (on our way to over 12 hours), a staff member (possibly emboldened by the current Movement to criminalize violence/aggression by patients/family members) chose to react to our reasonably stressed under the circumstances, non-threatening, non-violent behavior, by making an unnecessarily unpleasant remark.  I read of a facility that is providing staff with de-escalation training - I think this should be standard practice along with training in treating patients/family members with empathy and kindness; I read a study that showed that the de-escalation training decreased the rates of threatening/aggressive/violent patient/family experienced by nurses. We also experienced some stressed Provider behaviors due to reasons that were out of their control.

My experience as a patient/family member recently is that the above problems/behaviors are affecting vulnerable patients/family members negatively.

[Wuzzie]

Susie, we are usually on the same page but I find it interesting that you, as a provider yourself, gave the “stressed provider” a pass but pegged the nurse as unpleasant and spoke of the need for nurses, in particular, to be trained in empathy and kindness. Seems like a double standard to me. Of course, I wasn’t there so I can’t really pass judgment on what happened and she could have been way out of line but I have been on the receiving end of non-threatening, non-violent behavior that was still beyond unreasonable, rude, demeaning and demanding. It doesn’t have to be violent to be inappropriate. 
 

As for the “grooming” in front of patients…that’s just unprofessional no matter what the situation. The hugging I have no issue with and am perplexed as to why it bothered you. 

[Emergent, RN]

I worked in the emergency room for 9 years of my career and a lot of my colleagues did get irritable with the public. It can be a very stressful environment and a lot of the customers are demanding idiots, and very trying. I never got triggered by them, but some of my very skilled colleagues did. It basically comes with the territory.

[Kitiger, RN]

It's interesting to hear about experiences on both sides. I've been hearing about ER waits of 4 to 8 hours for a room, because there are not enough nurses to fully staff the hospital. Even in home care, where I work, we don't have enough nurses. The pace is much easier, but the pay is low. I don't mind the fact that the hospital nurses make so much more because I make enough.

But I don't think I could keep my job in a hospital that muzzles its nurses. I don't know. If I HAD to have that income - a large family, for example - maybe I would have to do it? 

[toomuchbaloney]

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ER staff who have contacted the station say the overload has created a dangerous situation. They say some nurses are refusing to clock in, knowing they will be assigned nine patients when a typical patient load is closer to six. Nurses say such a high patient load makes it impossible for them to provide adequate care.

“The increased risk of jeopardizing my nursing license due to unsafe nurse-patient ratios, as well as having the feeling of complete defeat and exhaustion following every single shift,” another nurse told WECT of why she declined a full-time position at the hospital. “I told the HR manager, it is the feeling that I can’t do or be enough for these patients and their families. It’s the constant feeling of anxiety after I have left work wondering if I did everything I could to help the patients. It’s getting yelled at by both patients and their families for not being prompt enough with my attention to their needs of care. It’s trying to monitor a patient with critical vitals while 3 other patients lay in their own excrement waiting for a nurse or nurse’s aid to offer them basic hygiene.”

WECT is told other patients’ health has suffered because of the delays.

“We have recently lost several patients who have been waiting DAYS in inpatient holding for a bed only to decompensate and need intensive care and die,” a third nurse told our station. “I used to be proud to work for this hospital but now I worry for my own license and the safety of our patients.”

It sounds like the hospital is suffering the consequences of a long term staffing policy that was exacerbated by a pandemic.  They enjoyed a monopoly in acute care nursing positions in the area and used that to maintain a thread bear nursing staff that was then broken and depleted by the pandemic because there were no corporate protections in place for them.  This is a good example of what "patient centered care" actually looks like in a for profit health system. 

Their website makes some expected claims...

"Relentlessly pursuing remarkable care every day - so you can expect the compassionate, expert, personal experience you deserve."

Our principles

Human-Centered      •       Access for All

World-Class Care      •      Purposeful Innovation

Doesn't seem like their access to emergency care is world class or purposeful...

[Emergent, RN]

I have worked in nonprofit hospitals and they seem to operate very similar to the for-profit ones. Executives still get bonuses for cutting costs.

The problem is at those are short-term goals that are achieved by ignoring possible long-term outcomes and effects.

Hospitals seem to get empowered when there is no nursing shortage and people are scrambling for jobs. When the tables turn, they find themselves in a staffing pickle because nurses can pick and choose jobs. The cycle seems to repeat itself over and over again I have seen over my years as a nurse.

[Wuzzie]

3 minutes ago, Emergent said:

Hospitals seem to get empowered when there is no nursing shortage and people are scrambling for jobs. When the tables turn, they find themselves in a staffing pickle because nurses can pick and choose jobs. The cycle seems to repeat itself over and over again I have seen over my years as a nurse.

I've seen it too but unlike in the past this time it really isn't a shortage of available nurses as much as a shortage of nurses willing to continue to take the crap being dished out to them plus the myriad of alternatives to traditional bedside nursing. This "shortage" pendulum isn't likely to swing back any time soon. The sad thing is hospitals are going to continue to dig their heels in when it comes to shelling out for adequate staffing, putting patients and us at risk. 

[toomuchbaloney]

I think that minimum nursing staff is the business model for both not for profit and for profit health facilities, and has been for some time.  Nursing care is not billed in the inpatient environment, and so it is considered an expense rather than an asset.