cretin

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.

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.

We were told by our education team that even if the patient had the caps on their central lines, they still needed to be scrubbed. 15 seconds scrub and 15 seconds dry for alcohol scrub, and 5 seconds scrub and 5 seconds dry for prevantix scrub. Although in a code situation, I don't think I have ever seen anyone scrub anything for 15 seconds before injecting into the line!

For now it isn’t mandated, true. But in other areas of my facility, staff are required to pick up one extra shift per 6 week schedule due to short staffing. My unit has been pretty good about filling out own open slots. People are getting burned out. EVERYONE has been picking up extra shifts to cover the openings from staff that have left, but we aren’t able to rehire for (due to productivity). I honestly don’t think it’s my direct supervisor that the problem lies with. I think it’s the company in general. I really do like my job, and love the people I work with. Just don’t love the treatment from “above”. Every time someone complains about some ridiculous changes, we always hear “it’s not our decision, it’s coming from the mothership”. I don’t think the mothership cares much about the minions.

I appreciate the feedback thus far. Leaving isn't really an option. There isn't a lot of competition around, which is why I think things have gotten to where they have. As for productivity, I have no idea who came up with specific numbers for a quota that we have to meet. But it is what it is. I just can't fathom management staff thinking it is ok to say incentive is the same as overtime, when it clearly isn't. Then looking at me like I'm the dense one for not seeing it their way. If you want my time, pay me what you said you would. Otherwise, good luck with staff picking up extra shifts.

I was just curious if anyone else is dealing with this issue... I work in a small-medium facility that is having staffing issues. My unit is a closed unit(no one floats in or out) that is having problems with productivity and as such isn't allowed to fill positions that have been vacated. To fill core staffing, we have been picking up extra shifts and have been told that when we pick up these shifts, it will be paid at time and a half as an incentive. I picked up some extra shifts, but when I looked at my last paycheck, I didn't receive my incentive pay, just the overtime. When I brought it to my manager's attention, my director got involved and stated that we only got incentive pay, or overtime, not both. Called it "double dipping". I told her that wasn't right and if that was the case, there is no incentive to pick up the extra shifts. She said it was the overtime that was the incentive. I pointed out that in the past we had been getting paid the incentive pay, then the overtime when we were above 40 hours for the week. She discouraged me from talking to HR about it, because if I did, then finance "would look into everyone's paychecks and take back the money they shouldn't have paid." So as a full time employee, I don't get the incentive for the full shift. Roughly 4 hours of "incentive" pay, the last 7.5 hours as overtime (we won't even get into the clocking out as having had a lunch break when we didn't issue). Basically, only people that work less than 72 hrs a pay period will get the incentive pay. And as a bonus, apparently "on call" pay has been restricted as well. If a person gets flexed off for low census and expected to remain on call for the duration of the scheduled shift, they are doing so on their own dime. No more $2/hr to remain on call. Our area is not one of the approved on call areas like cath lab or OR. Not that 2 dollars is going to make or break me, but that's not the point. I don't like feeling like management doesn't value me as an employee or my time. I'm not entirely sure this is legal on either issue. Just curious what other people's take is on these issues.

I get a lot of people that tell me that their pain is over a 10. I ask if I were to kick them where it hurts, it wouldn't be any worse then? It never fails, they always say that would hurt more. I explain that the scale only goes to a 10. They look at me and say "Its a 12." There is also the lovely response, "I have a really high pain tolerance, so my 5 is like someone else's 10." Ok then!

i'm not sure it is required in all areas to give report from an urgent care to an ER. In my area, it is not even required to get bed acceptance to go from one ER to another. I think it is a curtesy to call ahead with info, but not required.

I work in a smaller ED, and have for a number of years. When I went back to school for my ADN, I decided to upgrade my ears from a classic to a cardiology 3. (My tubing was cracked after over a decade of use). I have not regretted spending the money, and I haven't had any problems with anyone walking off with it. Yes it is a little heavier than the classic, but I can hear better with it. My ED doesn't have walls and doors for the most part, just curtains blocking off a space, so it is nice to have a better quality set of ears so I can hear over the ambient noise. Just my two cents.