Potential safety issue

[amzyRN]

Just wondering if many hospitals do this, initiating care in the lobby? We triage patients then there is an internal lobby area where they wait for a bed if it becomes available, but care is initiated in the lobby-IVs, Meds, diagnostic tests. Sometimes there will be one nurse with 20 or more patients in the lobby. Some of these folks are sick. some folks have walked out with their IVs.

Is this common practice. If so, maybe this is the wrong specialty for me.

[CX_EDRN]

No care is initiated in our lobby, but people are seen in triage and either wait in the triage chairs (if they are lined/labbed) or are sent back to the lobby until there is a bed.

[Medic/Nurse, BSN, RN]

Starting care (labs pulled, excluded 12 lead, sent for X-ray and back to lobby) by a MLP or MD in triage and "reseating" the patient in a triage chair or lobby isn't inherently risky on its own.

Tho, I DO NOT think the practice of placing a saline lock when pulling labs in patients in the lobby that have elope potential is worth the downside to save them another needlestick "just in case" meds/fluids/CT. Just too risky from every angle.

Are you now covering triage and the front of the "house"? I ask this question respectfully because you had a post about not getting any variety and only crappy assignments a few weeks ago.

amzyRN — I am going to gently give you some advice. I took the time a couple weeks ago to go back through your posts (tho I can't find them now) and your seem to have been taken off orientation in early Summer. So you've been "on you're own" about 3 months as a RN in the ER. Congrats, that's tough. You seem to be having some ups and downs and that's kinda normal. I do legit wonder if you have a good clinical educator — a good educator supports you after you transition to practice, not just off orientation. You may be in a bad ER, I don't know. Some ER's are not good places to work, they just aren't. ER may not be for you. But as a new ER nurse, I think you need to take more of a head down "I'm just going to master my universe whatever it may be, then I'll expand my universe approach". Who knows yet? I can't decide that I really love a certain paint color for my walls in 90 days. And I truly thought I had no business being a nurse as the 1st 3 months I was a nurse and I went from being really good at something (paramedic) to being so slow, inept, bumbling that it was frightening.

You may just be having a case where what you "expected" of being a ER NURSE and what the "reality is" are just very different things — and since you are a new ER nurse, that should really be okay. It's okay to be a little disappointed at all the "not emergent" things you deal with. It's okay to think "I want to see some action" and have trauma/resus room envy. Here's the thing — until your assessment skills are speedy and can pick up the slightest hint of impending badness before it starts and you can hit IV's 100% of the time, and know major meds indication/contraindications/issues/interactions, have ACLS committed not to "parrot memory" but working knowledge of WHY — it's not in your or the vulnerable patient's best interest to have you as the primary in the resus/trauma room. You will get there, I promise.

It's okay to feel like some days you can't find you a$$ with both hands, a map, compass and GPS. It's okay to think that some things just feel risky and wrong (maybe they are and that's your spidey sense) or unknown and feel foreign (maybe you need more information to understand). But, before I "surrendered" I would really take some time and carefully think this over. Just because something is familiar doesn't make it better. Do you want to go back to step-down? Go back.

You have several years experience in nursing. That should make it easy on you really. You also noted that "new grads" are being on boarded into the ED and given trauma/resus room experience as part of their orientation while you are being assigned less interesting patients. big deal, it really shouldn't effect you. My global advice is just worry about your assignment. Do not meddle in things that aren't your business. Do not complain about your lot vs other nurse's lot at this stage in the game (you're 3 months in!). Believe me, tho you are not a "new nurse" you are being viewed as an unproven quantity and new ER nurse to the ER leadership and management. The way you prove yourself is through deed and dependability. Head down. Do your job. Do it well. Master it. Help those nurses in proximity to you if you find you can. Ask for assistance if you need it.

Unless you are doing triage and covering the lobby, do not worry about what goes on in the lobby. If you are triaging as a ER nurse with 3 months of experience — STOP — TODAY. You are headed for the danger zone.

[Lev, MSN, RN, NP]

Yes it happens and yes it is not safe but this is reality of the overpopulated ER and over-utilization of emergency services.

Patients are triaged, IVs are started, and labs sent, EKGs done and patients are sent back to the waiting room of 50+ people to wait (it happens). If a patient is ordered IV fluids in triage they are sat down in one of the triage rooms with other patients (an area visible to the triage nurse) and given their IV fluids or IV antibiotics and then sent back to the waiting room to wait some more. Patients who need vital signs monitoring may be sat in triage with a pulse ox on til a room opens up. The fall risks and psychs sit in triage.

It can get very dangerous out there. However, we do go out to the waiting room aka "the jungle" to get patients back and a quick scan of the waiting room for the previously unnoticed sick patient is always in order.

[amzyRN]

Thanks for the information. I greatly appreciate the input. Sounds like my ED is not that different than other high volume EDs. It makes me very nervous to initiate care in the lobby because I can't monitor for side effects. I worry about an adverse reaction and not being able to catch it.