RN1204

I do need to add that when I got off the phone with them, I spoke with a senior nurse who used to charge exclusively. She picked up the phone, called dispatch and requested to speak with a supervisor. The truck was soon dispatched and they transferred the client. OK, so first they MUST have half up front. Then they are dispatching a truck when someone superior calls them and they end up transferring with NO MONEY DOWN. Hmmmm? This is the honest truth. It just seems like stuff like this gets blown off where I work. Again, I am still learning and don't mind telling anyone that I have a lot to learn, but this is not right. Thanks again for the input.

"I hate family members, which is why I purposely choose to work the night shift." Sad but it's true. The family members from Hell I like to call them. Sounds like those two you mentioned should be on the Jerry Springer show with their mentality. Seriously, I have had encounters when the family didn't make it blatantly obvious, but you could tell if all they had to do was flip a switch, it would be lights out. I can sympathize with "I hate to see mother suffer" but you have to draw a line and not go around like putting dogs to sleep. Peace.

Sorry. ...patient was'nt technically stable. My bad.

Yes, they are the ones who brought them to our facility in the first place. They must bring them to the closest facility from scene as I understand it. And your right, the patient wasn't technically unstable, but was an "appropriate transfer" by EMTALA guidelines. The hospital we were transferring to is approx 70 miles from us so they could not have taken there anyway. I am still learning about EMTALA as I am now assuming a charge/leadership role alot of the time. As far as the administration goes, I don't understand it either. That is just what our house supervisor said the guidelines were? Hmmmm? Maybe I should speak with one of the administrators and defiinitely do some more EMTALA brushing up. This kind of stuff is not what you need in the middle of the night . This has happened before but not to me. Seems like there should be some resolution at this point. No doubt, this is most likely a ubiquitous problem. Thanks for any input. cheers.

I suppose i just want to vent more than anything and then listen to whatever responses I get. Just last night on shift we had a rollover MVA client we received to our ER. He was worked up and found to have had fractures on the first ribs and some spinal fractures in the thoracic area. He was stable. Our ER doc makes arrangement to transfer to a higher level of care to a level-one trauma center (that is also a charity hospital here in Lousiana). The local EMS was contacted for transport, and when dispatch found out that he was self pay and that this trip was going to be around $1600, they said that the client would be responsible for the bill and half the amount would have to be paid up front before leaving our facility. Administration at our hospital will only approve us picking up the tab for transfer if the patient request transfer (If they are self pay) but not if they are going for a higher level of care. So our hospital won't cover it and the EMS wants half up front (everyone has instant access to $800 right?) so we have a dilemma. EMS cant refuse transfer to higher level of care on the basis of ability to pay as far as I know and what our Nurse Manager over ER says. I shall do some more EMTALA studying today. What are some others input? Thank you for reading. Again this patient was not being transferred for charity reasons but rather for a higher level of care.

I think it is important what the above user said: it is "your career." Many of the nurses that claim to love their job on this board and in real life are those with few years of experience, often three or less(hardly the beginning of a career). Notice I said many -- there are exceptions. I worked with a lady who retired a couple of years ago with forty-three years of service and she still enjoyed nursing in spite of the difficulties. On the other hand I had an aquaintance whose daughter went through school, graduated, and worked for less than a year and left to never return again. All the money and time and now wasted-- not totally though. She despised nursing. It is a career and should be a lifelong affair. Just think carefully and listen to multiple people when making such a decision. As for "Burn Out," what does cause burn out''? An engine wears more quickly under adverse conditions; a horse tires faster when moving uphill; people wear mentally, physically, and emotionally under less than optimal conditions. Burn out is not a function of time, rather it is most directly related to conditions and then compounded by time. No job is perfect, but a career is more than just a job: it should be your lifelong livelihood. Choose it wisely whatever you decide. There is a sea of things to consider. Live outside the box. For the record I am going on 13 yrs of service. Not just beginning, but a long way from the end.

I have worked both sides of the fence. Receiving an admit at shift change is a pain in the backside. If possible, I will hold the patient to just after shift change (within reason and if I don't think the receiving nurse is trying to buy extra time). If we need to move the patient to make room for another waiting patient or medic patient, then I have no control over that and shall do what is profitable and safe for all parties involved. By all means, the patient must go up immediately, but as a responsible ER nurse I will be sure that the patient is stable and as much completed as possible. I have been nursing for 12 years and in ER for two years. It is sad to say this, but even though I love most of the nurses I work with in the ER, most of them are ****-poor in attitude towards the floors/units. WE ARE A TEAM --or should be. It is often times difficult to reach a resolution about certain instances, and truthfully, everyone is not going to be happy most of the time. Some on the floors are angry because they are getting admits. There are ER nurses that get angry when the floor ask them to hold when the ER is slow and there is no reason why they can't. Play safe, play as a team, and accept that things are not going to be perfect always.

Everyone has their own view. I have been nursing for about twelve years now in various settings: Prison, Med-Surg, Orthopedics, ER (currently). I can say without reservation that I would not enter this field if I had it to do over and am seriously considering re-entering college to do something else. I do genuinely enjoy helping people and interacting with them but the hypocrisy of admininstrations/corporate boards, difficult doctors, rude patients and family that will never be satisfied, legal liabilities and implications, working shorthanded often, and countless other things make it not worthwile IMO. There IS a reason why there is a huge national shortage of Nurses. There are those times when there is much gratification in what I do. However, those times pale in comparison to the endless headaches and such. Do I expect every day to be glamorous and easy, of course not. But honestly, most days are bad. You can go to any hospital (and probably other healthcare entities), at least here in the south and find numerous nursing openings. The current hospital I am at is in a serious bind with staffing. They have closed down a wing because there are not enough nurses to staff it and they can't even get agency coverage unless done in advance. A neighboring hospital is in similar shape. We hold patients in ER often because there is not enough staff to take care of them in the hospital. Why? I personally know several nurses where I work that have expressed the idea that they would like to get out of the field their in. Having worked in Louisiana and none elsewhere, it may be that work conditions are worse here than other places but I doubt it. I am not trying to be negative, but I honestly could not recommend this field to anyone who had the option of choosing.