"But for me, 98.4 means I have a fever...."

MinnieMomRN · Mar 18, 2012

sounds like my middle school students... they think a temp of 99.0 means they have a raging fever

And need to be dismissed. ;-)

Christy1019, ASN, RN · Mar 18, 2012

[color=#333366] i always try to make it my practice to acknowledge pt's complaints and educate when necessary, however some things annoy me, such as the patient coming in saying they've had "a real high fever all day", when i ask what their temp was they say "well i don't have a thermometer but the oven was on and i touched it and touched my head and it felt about the same so i think it was like 375".. umm... let me go get my turkey thermometer.... :confused: [color=#333366] or the parent that brings their toddler in at 3a.m. who looks exhausted, c/o the kid having a fever x 3 days, vomiting/diarrhea, and won't stop crying. me: did you give him any tylenol/motrin at home? mom: no, i just brought him here! or that they "gave em benadryl a few times so they'd stop crying and go to sleep", or "i didn't have any and i can't afford it" yet they reek of marijuana and brought in $10 worth of mcdonalds! :mad: [color=#333366]me: why did you just now come in? mom: cuz i had stuff to do (as she's on her cellphone cussing and complaining about having to bring the kid to the er, while eating and yelling at the sick kid b/c they are crying, then saying they are gonna need a work note b/c they're supposed to work the next day), and proceed to tell me that she also wants the other 4 kids she dragged out of bed to be checked too even though the only thing wrong with them is that they are in the er in the middle of the night and have a parent who isn't responsible enough to be reproducing :idea: [color=#333366].

now granted that was a pretty specific example but i encounter similar situations almost every shift i work and no matter how aware i am of the need for teaching as well as being respectful, i generally will end up with 1 out of 10 encounters that end with any sense of satisfaction that they will now understand what to do in the future or see any signs that they actually were listening to me.

for those ready to preach about not being considerate of under educated/lower socioeconomic situations of patients, i agree that some rns don't always consider the big picture when dealing with similar patient encounters, and consider myself a very compassionate/understanding person that will go out of my way to advocate for my patients. however, working in a large inner city er where the homicide and substance abuse rates far outnumber those with higher than 8th grade education, i've come to realize that our society's values and beliefs are so negative and centered on self entitlement that we've become comfortable with ignorance and resistant to personal growth and accountability which has drastically impacted our nursing profession r/t nurse-patient encounters and relationship, as well as personal satisfaction with role as pt. advocate. as a result we see threads similar to this that are venting about negative personal experiences and our frustrations that we all encounter the same issues day after day and nothing changes, there is no accountability anymore yet patient care has now become "customer satisfaction".

as for the previous posts, i agree with the reasons and need to vent, as well as the importance of listening to the patient and acknowledging what they say because the very fundamentals of nursing are to provide holistic care for our patients and at the very least treat them as you would want and expect to be treated. so when i encounter situations like i described above, you can bet it will frustrate me and cause me to vent, however to the patient and/or family members i will remain professional and treat them with respect and compassion b/c it's the right thing to do.

hopefully my long-winded, rant didn't bore most of you to tears lol, and offered a different perspective about this type of issue in our profession. it's taken the 5yrs i've been an rn and working in my er to be come to the understanding that there are many things that happen that irritate me about patient care and that sometimes no matter what you do, you can't always fix the problems, but if you don't find a way to adapt and develop good coping skills, you will find yourself burnt out with negative effects on your day to day life. i see far too many coworkers who have forgotten what it means to be a nurse and why they decided to pursue nursing. it not only negatively affects the patient but also affects the entire work environment and relationships with coworkers, further feeding into the problem.

one more thing.. i think if we were allowed to pass out thermometers, tylenol/motrin, pregnancy tests, and band aids at the er door that we would prevent so many unnecessary er visits, because obviously noone outside of the healthcare field has gotten the memo that all of those things can be bought at the dollar store! lol, eh who am i kidding, we'd still get the ones who called ems for papercuts and std checks @ 4am lol. .. gotta find the humor in it sometimes :clown:

NurseLoveJoy88, ASN, RN · Mar 18, 2012

I worry with anything 100.4 or over. At my job that is considered a fever.

wooh, BSN, RN · Mar 18, 2012

38.5 is the magic number at my job. But if a mom says she wants a temperature check, I take tylenol or ibuprofen with me and give it regardless of the number on the thermometer (unless we're observing and will get to go home if we remain fever free.) If the kid is miserable with a low grade, or we're just catching it on it's way up or down, I see no reason to keep the kid miserable just because of the number we got. (Again, unless we're observing for fever, I'm not going to be the one that delays a discharge so that a kid can catch something while they're at the hospital!)

RNMom2010 · Mar 18, 2012

Who cares about a thermometer? A mom can tell if a kid is feverish.

I don't use a thermometer on my son unless I am planning to try and get him into Dr. Then I grab a quick temp/pulse/resp to give to the nurse. I also do not treat fever for him unless he looks like he really feels poorly.

I know when I run 99.0 I feel like CRAP. Aches, chills, swimmy head.

Vespertinas · Mar 19, 2012

I often don't even treat my patients' fever unless they're feeling poorly (or they're unstable or have very high temp). Let me tell you how much next shift RNs love me after an instance of that...

prinsessa · Mar 19, 2012

I work with the elderly so I get nervous when I see a temp of 99. Most of our patient's seem to run in the 96-97 range. I have called our medical director and told him about a temp of 99 on one of our patient's and he took my concerns seriously. Especially with elderly patients vital signs are usually the last to go. I had a patient whose vital signs were normal but just seemed "off". I told the doctor and he ordered some tests. It turns out she had a very serious UTI.

TopazLover, BSN, RN · Mar 19, 2012

I recognize that I am either opening a can of worms or offering something that will most probably be ignored..

Why do ERs, part of huge hospital complexes, not have some form of urgent care for sick kiddos in the middle of the night? A place where the ear aches, strep throats, etc. can be treated away from the gun shots, MVAs, stabbings, full and near code folks?

Many of you work in ERs. You probably have to go to staff meetings where you are placed on some quality improvement committee that is tasked with something. On these committees do you find any upper management who is willing to look at things differently? ER nurses are expensive, ER beds are expensive to maintain because you need all the bells and whistles for codes and near codes. Kids high temps, ear aches, and strep throats need none of these. Why do we not see a dividing line done by someone when the family shows up? Instead we bog down an ER bed and nurse to do no emergent but urgent care. This is not a new concept. "Doc in a Box" storefronts have been around for years. They are a good place to take these families. I think any times they do not do insurance and other third party payers well.

Another situation came to my attention clearly recently when talking about trying to get a 15 yr old girl into a gyn office. She was not a pt. (mom was). The girl had to be seen in the ER, where they could do little except a CBC. After this the girl would get into the gyn's office. Bottom line for this girl was 3 months of bleeding continuously, a crit of about 7 by the time anyone took it seriously. It was a total waste of resources to not get her definitive treatment when her mother determined there was a huge problem. Perhaps it is because we see so many parents that are not schooled as well. Certainly the gyn knew the mom and knew she does not freak out.

Bottom line for me is that our health care system is broken in so many places. Nurses take a lot of the flack and the other stuff flying around but the problem is a corporate mindset. Unfortunately our patients do not carry the same numbers or respond in the same way with similar numbers. If we treat our patients with that same mind set we are in danger of only looking at numbers like the rest of the bean counters. At that point we fail to be nurses. I am not sure what the proper name would be, but it cannot be considered nursing.

brillohead, ADN, RN · Mar 19, 2012

Why do ERs, part of huge hospital complexes, not have some form of urgent care for sick kiddos in the middle of the night? A place where the ear aches, strep throats, etc. can be treated away from the gun shots, MVAs, stabbings, full and near code folks?

Both of the hospitals in my area have a "fast track" section of their emergency department -- everyone goes to the central triage, then they get assigned to either the "urgent" or "emergent" section accordingly. In both hospitals (which are both Level 1 Trauma Centers also), the "urgent care clinic" is in a completely different room from the "emergency department", with separately assigned doctors, nurses, and clerks.

The urgent section is usually only open until about 11pm (due to lack of demand after hours), so after that time everyone gets placed in the emergency section after triage, but we're fortunate in our area that staffing and space are both sufficient so that nobody ends up waiting twelve hours for strep throat.

Anna Flaxis, BSN, RN · Mar 19, 2012

Okay, we're veering off topic, but here goes.

There are several urgent cares in my area, including one right on the hospital campus. Problem is, our urgent care is so poorly managed, they can barely keep their doors open. Several docs have left because of this, and now they're short doctors, and so they close at 8pm.

There is also an after hours pediatric clinic in my area, open for limited hours on weekends.

There is an indigent clinic, but their resources are so limited, they can only operate three days of the week, and people have to get there really early in the morning and line up to be seen, and often the clinic cannot fit everyone in. These are poor people who take the bus, walk, ride their bike, etc. super early in the morning, stand in line all day, and may not even be seen.

There are low-cost clinics for uninsured/underinsured, but again, these require appointments that are hard to get, especially on short notice when a person feels like they have something urgent going on.

I won't even mention the VA clinic, except to say it's shameful how we treat our veterans.

Many of our non-emergent patients are insured and have PCPs, but when something non-emergent but urgent comes up, such as an upper respiratory infection or viral gastroenteritis, they cannot get an appointment for weeks at a time.

Any mention of chest discomfort (as in pneumonia, not cardiac) or abdominal pain (as in viral gastroenteritis, not a ruptured appy), and the urgent care will not see them. Won't even assess them to determine whether the urgent care can provide the services needed. They just punt them.

Like the above poster, our ED also has a Fast Track area, but sometimes we cannot staff it (because our hospital administration keeps us understaffed to save money), so our non-emergent 4s and 5s have to sit and wait, and get merged into the flow with the rest of the patients.

I don't blame the patients for all of this. This is how messed up our health care system is. I completely understand why people just come to the ED when they feel sick, even if it's not an emergency. In my mind, the problem is lack of access to primary care. When you're experiencing abdominal pain, or you've had a fever and cough for a week and it's not getting any better, and you can't get in to see your PCP for three weeks, what the heck are you supposed to do?

Not only do we need more PCPs, but we need more PCPs who can see their patients on short notice for those little things in life that come up. What ever happened to the family doctor that you could call in the middle of the night because little Johnny has an ear ache?

Part of the problem is that medical school is so expensive that new doctors come out with a gigantic debt, so they specialize because it's more lucrative than primary care. Also, the way reimbursement works, it necessitates that PCPs run on the assembly line model, with no time left in their day to squeeze in someone with the sniffles or who just doesn't feel right. They have to think about whether it's going to be billable or not. Reimbursement dictates practice.

I'll do it. Pay me to go to medical school so I don't come out of it with a mountain of debt that I'll never repay, and so that my home isn't repossessed while I immerse myself in school for the next ten years, and I'll do it. I'll happily open up a clinic in my area and see my patients on short notice instead of punting them to the ED unnecessarily.

Oh wait, there I go dreaming again. Nobody wants to pay for doctors. Nobody wants to pay for education. Yet we expect to have access to health care when we need it.

Woodenpug, BSN · Mar 20, 2012

A recent experience.

I had a pt. who was legitametily knowledgeable, as in the pt had "been there, done that." I "lit a fire," because I felt that his pulsatile bleed was, possibly, over my head. The pt informed me that the bleed was not important, I should be concerned about the contralateral pain. pt. may well have been correct, but, for me active visible bleeding is more significant. The point for my patient was that we were addressing that problem well, however, we were not addressing another problem.

Yes, I'm omnipotent, I'm dealing with your truly significant, high temp., pain, etc., but what you see is my concern over what you perceive as a lessor problem. No sarcasm, your perceptions of what is my priority, is meaningful.

tech1000 · Mar 20, 2012

Never?! I've seen a few doctors do it in the last 2 years in the ER. They'll just pop on the cuff while talking if they don't like the number currently glaring at them on the monitor.