Patient Died in ER lobby

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by Kitiger Kitiger, RN Member Nurse

Specializes in Private Duty Pediatrics. Has 43 years experience.

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2BS Nurse, BSN

Has 9 years experience. 659 Posts

I recently read a job post where weekend differential was $1.50/hr. We wonder why they can't keep units staffed?

Beerman

Beerman, BSN

Has 12 years experience. 1,565 Posts

This kind of thing is going to happen more often.  The acute care health system, which in many ways wasn't great before, has been crumbling at a faster rate since covid.

My peds ED, which compared to other places I've been and other places I have friends, is a great working environment. We've lost several decades worth of experience in the last year.  And the ED and inpatient units have never been so short staffed in my 9 years there. 

I have for awhile been thinking of taking an adult ED PRN job.  Friends I have in those environments tell me to stay away.

I'm scared for my older family who may need care in the near future.

Edited by Beerman

Kitiger, RN

Specializes in Private Duty Pediatrics. Has 43 years experience. 1,698 Posts

13 hours ago, Beerman said:

I'm scared for my older family who may need care in the near future.

I am, too.

toomuchbaloney

toomuchbaloney

Specializes in NICU, PICU, Transport, L&D, Hospice. Has 43 years experience. 8,250 Posts

Hospital safety has long been a concern and topic for conversation and analysis. Part of the dialog could arguably be believed to be driven by capitalist concerns rather than patient concerns.  

Today our profit focused health system has been ravaged by a poorly controlled pandemic and years of a contrived nursing shortage that justified minimum RN presence in acute and long term "nursing" units. The collision of high demand for nurses with chronically thread bear staffing was violent and the nurses suffered. The exodus of experience and wisdom from the profession as nurses across the country leave the bedside should be of concern to all Americans. That's not to say that new graduates and young nurses aren't valuable, they just aren't enough to keep us safe in a system that was already relatively error prone inspite of being so terribly expensive. 

cretin, ADN

Specializes in Ortho, ED. Has 22 years experience. 9 Posts

On 6/19/2022 at 6:24 PM, Kooky Korky said:

Maybe a CNA could be assigned to the waiting rooms to check patients every 15 to 30 minutes and alert nurses if someone appears to be going south.

Checking patients means, to me, systematically eyeballing everyone waiting.  No yacking on the phone or watching TV or reading or doing one's nails.  Truly watching.  The aides could change posts q 1 hour or so.

Not in-depth checking but watching for changes in respiratory status or color changes,  but keeping an eye and ear open for imminent trouble so that tragedies could be avoided.

The age-old problem of people using the ER like a doc's office needs to be addressed in the community, for starters, by using the schools and  places of worship, Kiwanis, etc. to educate people about appropriate use of the ER (severe bleeding, severe pain, SOB, chest pain, strokes, and the like) and about home remedies and their appropriate usage.  Educate.  Teach.  Inform.  Perhaps once every semester.  Bring in a dentist, school nurse, other interested nurses, informed parents, (especially those who are raising kids and have encountered scrapes, cuts, etc.) nursing students, maybe PT, OT, whoever else could help educate people on simple home remedies and on when to seek ER care.  And what about using Urgent Care if one really does need some outside help?  Or calling one's doc, getting through the night or weekend and seeing the doc next biz day instead of running to the ER.

I used to see many patients brought to the ER because their pediatrician didn't prescribe a rescue inhaler.  Or maybe parents couldn't afford it?  

Not everyone knows about ice packs, OTC pain relief and other meds, Warm salt water soaks/gargles for various ailments, baking soda paste or vinegar/water application for mild burns (like sunburn) and stings, Calamine at least once or twice for itchy rashes, and the like.  My Mama was so smart.  She knew all of these things and treated most of our troubles with them.  And Granny believed in the enema for mild abd pain or constipation.  Yes, the bowels were monitored for diarrhea, gas, constipation by a vigilant, loving Granny, who kept us while parents worked.

Parish nurses, nurses who are involved in a community group or church/synagogue/mosque/etc.,  and Public Health Nurses could do much of this teaching.  If we did more of this in the community, it could help alleviate the crush in the ER's.

Meantime, nurses must not be silenced by employers, but should inform legislators and everyone they know, even if they do so anonymously.

I live and work in a smaller town ED. There are now 2 ED's, and mine is a level 2 trauma center, a few miles from the only interstate in the state. So it can get busy. we have also started holding patients indefinitely, just since last fall. And yet, we still get the people that come in for non emergent situations. when I ask them if they contacted their PCP, I usually hear either "I owe them money, and they won't see me. Plus the ER is free", or "I called the Doc and they haven't called me back". (Usually the call to the doc came after 1630, so of course they won't call back). But there does also seem to be a definite lack of common sense with some people. We get a lot of people that come in for dental issues and demand we either pull the tooth on the spot, or get a dentist to come in to see them RIGHT NOW!. (Spoiler alert... that doesn't happen!)

I think a lot of people know when to use the ED, and a lot of them just don't care. They will come in for any little thing. ("I had chest pain for a few seconds, three days ago, but its gone now. I want to know what it was", or "I have a sliver in my finger I can't get out, so I called 911"). I wish I was kidding with these examples. People will even call ahead to see what provider is working to decide if they want to come in. No we don't disclose that information, but that doesn't stop them from calling. 

HiddenAngels

HiddenAngels

Has 8 years experience. 331 Posts

On 6/16/2022 at 10:42 AM, Emergent said:

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.

Not to mention after the patient/family does finally  come up on the floor you are treated like the worst nurse in the world, yelled at, talked down to, then ignored and wants to answer the admit questions with attitude and when they feel like it, you ca t win, like it was your sole responsibility to empty beds on your floor  for ER admits

toomuchbaloney

toomuchbaloney

Specializes in NICU, PICU, Transport, L&D, Hospice. Has 43 years experience. 8,250 Posts

Isn't it sad that Americans cannot schedule a visit with their health provider because they owe them money?

LindaGracie, ADN, BSN

Specializes in geriatric, home health. Has 7 years experience. 4 Articles; 32 Posts

Many years ago before I even went to nursing school, my mother-in-law was sitting in the waiting room for migraine type symptoms. There was a gentleman there who had chest pains and N&V and had been waiting about 6 hours. That was an extremely busy ER. Needless to say, we took our mother-in-law else where to a less busy urgent care.

HiddenAngels

HiddenAngels

Has 8 years experience. 331 Posts

On 6/16/2022 at 8:20 PM, Susie2310 said:

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 

And this! I felt I was too  young to have been in two incidents where police and/or homeland security had ti follow up but I guess it’s the norm now.

HiddenAngels

HiddenAngels

Has 8 years experience. 331 Posts

On 6/19/2022 at 10:45 AM, CommunityRNBSN said:

A coworker of mine— a  competent, kind, sweet nurse— recently spent many hours in the lobby of an ER. She’s 8 months pregnant, and none of her family members were allowed to be with her. She had nothing bad to say about any of the staff; she said everyone she encountered was caring and professional. But she also said “Honestly, when I see news stories about a patient becoming aggressive, I get it. You take a person who is in pain or frightened, have them wait in a cold lobby for hours, don’t allow them any family support, don’t communicate with them at all,  and add hunger to their situation. It’s going to boil over.”  I don’t know what the solution is, other than hiring more people (and building more hospitals or something?). 

It’s not about building more hospitals and hiring more people. The mistreatment and lack of respect  that they have forced the nurse to accept is what makes nursing so unfulfilling.  Patients have all the rights and we have none

HiddenAngels

HiddenAngels

Has 8 years experience. 331 Posts

On 6/19/2022 at 10:56 AM, Emergent said:

If you don't want people to die in the lobby, you need a designated healthcare worker rounding on those people. Someone who is posted in the lobby whether it's busy or not. Someone with good people skills who can explain things to the waiting patients.

I don't know if it needs to be a nurse but there needs to be someone in the lobby keeping tabs on things. Not reception Clerk, not a security guard, but someone who has some medical knowledge and would be able to address spot potential trouble.

I would agrees with this but it has to be more than one person doing all the rounding otherwise, that poor soul 

On 6/17/2022 at 11:36 AM, toomuchbaloney said:

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.  

Yes this!

cretin, ADN

Specializes in Ortho, ED. Has 22 years experience. 9 Posts

2 hours ago, toomuchbaloney said:

Isn't it sad that Americans cannot schedule a visit with their health provider because they owe them money?

Years ago when I had multiple surgeries in 2 years, I called my provider and made a payment plan after each surgery to pay it off in a timely manner. Now a days, some people feel like $5/month for forever is suitable. But on the flip side of that coin, my employer now tells me what I can afford if I have a bill. I had some lab work done and they decided that I could either pay it all at once (which I did), or split it up over three months. What if I had a bunch of kids and lived paycheck to paycheck? I wouldn’t be able to afford the extra bill over 3 months.