"I need to eat, I'm a diabetic!"

[Emergent]

I get a little tired of patients and their visitors demanding food because "I'm a diabetic". Last time that line was used on me by your typical overweight type 2 diabetic, I took his blood sugar. It was over 200 of course. I told him that, you only HAVE to eat when your blood sugar is low, and no, I'm not getting you a sandwich, your blood sugar is actually high. This was an ER patient with a minor complaint.

[Kooky Korky, BSN, RN]

It's definitely one of the most challenging parts of my job, I will say (working predominantly with the ininsured, homeless, mentally ill, drug addicted - our facility is a "safety net" hospital and so we see a much higher proportion of that demographic than other facilities). I have to say, I could never in a million years be an ED nurse, for that reason. I see so many people misusing the ED - calling an ambulance and going in for nausea/vomiting x 1 day, lady partsl infections, ingrown toenails, "I think I'm pregnant".

I wish the EDs could have a person who sits out in the lobby to triage the people coming in, and those who are not actually appropriate for the ED, they establish them with a PCP and set up an appointment for them with the PCP within the next 7 days.

So much of what I see that frustrates me is cultural - it's how it's always been done, and it's all they know. It's next to impossible to change 3+ generations of ingrained behaviors.

As long as I've been around (several decades), we have needed after-hours clinics. Some hospitals have a triage nurse in the ER. This nurse can determine who needs to be in the ER and who needs to go to the Clinic. I thought all ER's had a Triage nurse, but I guess not.

As for those who misuse ambulances and ER's -

There is a pretty easy way to re-train the abusers, but it would mean that ambulance crews be allowed to refuse to transport them and that ER's be allowed to triage them away to the Clinic.

The Clinic should be open 24/7 or 5 pm - 9 am every day. And 24/7 on weekends and holidays.

And I guess we could give out pregnancy tests, foot soaks, and 7 up via EMS crews.

[Kooky Korky, BSN, RN]

In the ER we are so overwhelmed with psych and social needs it's not even funny. We simply do not have time to deal with it.

Our system has encouraged socially challenged pts to seek care in ERs for minor things, expecting immediate service, then they get a survey. What it doesn't encourage is self responsibility.

In the ER, we nurses are pushed to get pts in and out quickly. We don't have social workers.

We are not miracle workers...

Emergent, it sounds like forcing yourself to be outwardly nice, per your other post, while feeling so frustrated by the lack of Social Workers or Case Managers, or other support staff is seriously getting to you.

It's probably not good for you to continue to work with irresponsible, socially-challenged people who demand immediate service for minor problems. it sounds like you work in a junk ER (seeing mostly very minor trauma and lots of sore throats and PID), as we used to call it, not a trauma ER.

Any way you can work where you are less frustrated? Or just accept that you are providing a valuable service to needy people, within the limits our society currently imposes upon you? And try to also accept that we all, including the patients, are doing the best we can at the present time. Let the world take a couple of spins, Em, it's going to be OK.

I wish you well.