Ridiculous? Or not?

[LilgirlRN]

I'm in Alabama very near Birmingham. I work in a very busy ER (30 beds, 200-275 pts q 24) After a year of no wage increases the hospital decided that they had enough money to give us all merit raises. I now get an extra 75 whole cents an hour. What they didn't tell us was that in order to get the merit increases they were cutting staffing in both the RN and tech roles. Needless to say tensions run high in the ER anyway but now patients are having to wait longer periods of time before their "stuff" gets done. Patients and families are upset, yell at us and some of us are finding it hard not to fire back.

We've had so many complaints that the bigwigs did a survey and all the charge nurses go to this meeting. The survey was done in the general area that we serve. People were asked things like... how long do you think you should have to wait after the call light is pushed for an answer... less than one minute was the answer. If there is something that you needed like pain medication, help to the toilet how long do you think you should have to wait? FIVE minutes!?! Do you think expectations run a little high?

I'm usually in triage so when people are having to wait up to two hours just to get to me they are usually rather upset. I try to do a little patient education on average wait times etc. But what I'd really like to do is to step into the waiting room and say something like... Seriously people, if your belly has been hurting for 3 years then it really can probably wait till tomorrow when you can see your own doctor!

Oh, I forgot to mention this... the same bigwigs will no longer allow the ER to go on diversion. I've got 16 people waiting to get to a bed and 10 ambulances have shown up in the past hour alone, anyone besides me see a problem here? We recently had an EMTALA violation, the doc got canned and a nurse was demoted, can no longer be in charge. We all had to reaquaint ourslves with EMTALA via the computer. My personal opinion is that not being able to go on diversion can be an EMTALA violation. You have to be able to provide "adequate" care of the patients you have and with our numbers being up while staffing is down, I don't think we can. What do you think?

[greenfiremajick]

I don't think she was posting from work, just giving an example.

If I were stating something as an example, I think I would have used past tense and not present tense as if it were happening right now.....But that's just me......

My warning still stands though...If she was doing this from work, I wouldn't want her to get called out for posting on the internet while trying to convince them there wasn't enough time to do what she says is best for the patients, etc....

[snoopy29]

I am in the UK so things are different here primarily because we are measured on government targets and more importantly financially penalised if we fail to meet targets so for example:

Triage has to be done within 15minutes

MI's have to be seen assessed and thrombolysed or gone to the cath lab in an hour

Strokes have to be seen have a CT and thrombolysed within 2 hours

And the big one every patient has to be seen assessed and either referred to a specialist team and gone to the ward or discharged. No-one stays in the department more than four hours (in theory!!!)

Because of this if we do not have sufficient nurses then we constantly escalate up to hospital management who undertake risk assessments. If it looks like we will miss targets on the basis of not enough doctors or nurses then its funny how they can be found.

I am not saying the UK situation is ideal but it does bounce some of the pressure for ensuring we have sufficient numbers back to higher management.

[LilgirlRN, ADN, RN]

Originally Posted by canoehead

"I don't think she was posting from work, just giving an example."

Yes, what canoe said.

We also do fast track, but a PA subs for the doc. PA has a nurse (we're all RN's). But still have to wait on the doc to approve some things for the PA. Unfortunately fast track is physically in the ER, just another hall with 6 rooms. Sometimes if we're full and we have someone who needs a bed now, they are put in fast track supposedly with the thought of moving them when a one in the ER becomes available. That rarely happens however.

Four years ago we got a new hospital president. He requested that people from different departments in all job capacities have lunch with him on different days, he just wanted to get a feel for the place. One of the charge nurses was supposed to go but called in sick and I was off so they asked if I would do it. He asked me what I thought the ER needed, I told him we need an indigent clinic. This would keep so many people from using us as primary care. I even told him how to do it because we did it at another hospital I worked in. ER's lose money. Staff it with medical interns. Patients are hand picked after they fill out an application. Patients have to meet indigent requirements and some have to actually have medical probs so the interns can learn.

At some point administration will have to decide what kind of hospital we should be. One that gives quality care, safe care or one that is only about the numbers, btw, we're a non-profit organization. When I went to nursing school back in the dark ages we were taught that we were to give the care that we would like our loved ones to have. I still try to fulfill that goal. I just want to work at a hospital that does too.

Hmmm... put a disguise on the president and have him come work as a tech for a day ot two, just like the show on TV?

[LilgirlRN, ADN, RN]

Thanks Snoopy for the info for how you do it across the pond. We have some of the same goals. Chest pain pts must have an EKG within 5 minutes of arrival. Average times for door to balloon is falling. I usually work in the afternoon to wee morning hours so cath lab has to be called in and we still manage to get the pts there within an hour or so.

We do have standing orders on a variety of things so the nurses can get the ball rolling on several types of pts even before the MD or PA sees them.

[Christy1019, ASN, RN]

From this sentence she included with her post:

"I've got 16 people waiting to get to a bed and 10 ambulances have shown up in the past hour alone, anyone besides me see a problem here?"

umm maybe its just how I read it but i see that as an obvious hypothetical "for example" type statement.. i never got the impression she was at work..

[bonestAx]

Lilgirl, the more you talk the more I think you work at my hospital, lol. Same things happen here, same president with same promises, and tactics. I'm interested to know how they took you ideas for your clinic? It's a good idea we have tossed that around also just would have to do some building to accommodate it.

[LilgirlRN, ADN, RN]

How did they take my idea for the clinic? We have no clinic, went in one ear and out the other. Healthcare is just so screwed up. I really wish someone would ask "us" the people who give care daily what needs to be done. Look out! I'm getting out the soapbox!

Here in the US our government has just chosen healthcare insurance for everyone for us. Many, many people fall thru the cracks here. Don't make enough money to buy insurance themselves and make too much to qualify for government assistance ( I think the plan goes into effect in 2014?) I think a much simpler solution and a less costly solution would have been to have catastrophic insurance for those who don't get insurance thru work or don't make enough to buy it for themselves. I also like this idea.... allow health professionals to volunteer to staff clinics and then take it off their taxes. Let's just say you make 25 bucks an hour, you volunteer 8 hours at the clinic, take 200 bucks off whoat you have to report as income.

OK, I feel better now, sorry went WAY off topic. I suppose I can b*tch and moan about stuff but nothing really gets accomplished by my doing that. Sure, I feel better. Just wonder what it'll take to get the people in administration to listen.

Yeah I whine and whine... been sent home early the past two shifts I've worked cause the load was too light. I'll have to whine here more often if that's the effect it's going to have!