They left my love one in the E.R. for....

fab4fan · Oct 27, 2003

moonshadeau: I'm not referring to a problem with the floors not taking admits quickly...I am talking about when there are no beds and we have to hold pts for hours-days.

memphis: This is one of those problems that until you've had to deal with it for a while, you really can't appreciate how frustrating it is. And it's not like we deliberately put people in a well-lit noisy hallway...it was either that, or they would still be out at triage, waiting for a bed in a cubicle to open up (then they yell at you because they don't get brought back soon enough).

Damned if you do, damned if you don't.

memphispanda, RN · Oct 27, 2003

Please don't think I'm saying anyone does it on purpose! I just can understand that it's a bad situation for both parties. And goodness knows at least 1/3 of the people in the ER the majority of the time don't have a real emergency...they have a hangnail or a stuffy nose.

Erin RN · Oct 27, 2003

I agree with SJoe..it is called triage and the sickest or most at risk go first..that is why it is called an emergency room....too many people use it like either their friendly drug dealer or the family GP. But since you can't turn em away you have to deal with them and again, as SJoe said they do clog up the works!!..

wayover20 · Oct 27, 2003

There sure seem to be alot of "bash ER" threads on this BB. And no....threadstarter is not whining. I swear, some folks just don't like it when the truth is spoken...IMHO.

Tweety, BSN, RN · Oct 27, 2003

It's not whining it's the reality. It's not ER bashing because it's not their fault there are no rooms available when it's time to admit.

Here in the height of our "season" which is Winter. Critical care beds are full, the floors are busy, and waiting in the ER to be admitted is the normal. Waits can be 2 to 24 hours. If you you need a private room, or isolation it can be longer.

Sure patients are going to complain to the first person and everyone they see. I don't get overly apologetic and defensive. But I can be empathetic. Yeah, it sucks being in the ER for 24 hours waiting for a room.

sjoe · Oct 27, 2003

3rd writes: "It's not whining it's the reality."

Exactly. And if "consumers" want to change the reality, they need to start supporting and funding these facilities rather than simply appearing at the door and demanding services RIGHT NOW that they all too frequently are NOT willing to pay for.

ERs have been closing all over the country. How many trauma centers are left? These kinds of operations require MONEY and political will.

Shouted demands and self-righteous expressions of entitlement are NOT enough.

IMHO (as always)

NYCRN16 · Oct 27, 2003

I agree that there are things going on on the floors that are beyond the control of the nurses that hold up patients from the ER recieving beds. It is not always the nurse on the floor that holds up the patient going up, but from what I notice in my hospital, frequently it is.

I tend to notice that certain med/surg floors in my hospital as compared to others tend to come up with many excuses not to take the patient up, and even more frequently, it tends to be the same few nurses that you are calling report to that are never available or are never ready to take the patient. I just dont have time to call for report all night long which I sometimes wind up doing, my patient has a bed at 0000 and the patient is still here when I am giving report off at 0730. I dont send report faxed or call at 6 am because I know that is a bad time, but if I faxed you the report at 1 am, there is no reason why that patient cant get up there in enough time before the end of your shift.

More times than not, these same nurses that I can never reach to give report to, are telling the families that its the "ER nurse's fault" that thier mother/father/whatever cant get into their bed because they havent recieved report yet. I understand the nurse is busy, but so am I. I have called 5 times to give report and I am hung up on, the nurse is on break, the nurse cant take report, ect. I dont care what the reason is, either take report, or dont tell the family anything. Just as we dont know what is going on up on your floor, you dont know what is going on in the ER, so dont say to the family that we are trying to hold them up. We want them out of there just as much as they want out.

Home Health Columnist / Guide · Oct 29, 2003

Attended an inservice on Physican Satisfaction (2 hrs was spent on ER service) 2 weeks ago...

Novel idea was to call a "Code Purple" when ER volume = 150% of capacity. All department heads arrive in ER to help with logistics of moving patients to floors. Surprise, suprise beds open up.

Another idea was the creation of Patient discharge room where discharged patients could sit, watch TV, get snack till loved one arrived to pick em up--staffed it with volunteers.

My homecare agency has estabilished an "ER to home" program. All ER patients needing homecare or just a follow-up phone call to review ER instructions can be referred 24hrs a day. Intake RN or oibcall staff call patient within 3 hrs of discharge with purpose to reinforce discharge instruction, arrange time for homecare visit, see if family got injectable meds etc. This is seen as a way of decreasing ER admits and helping pt get needed homecre services, making sure meds/supplies in home before staff visit and offering reasurrance, followup visit to PCP arranged. etc.

ER nurses get my full support as get to visit my area ER's about every 2-3 months with one of my family members.

Tweety, BSN, RN · Oct 29, 2003

Originally posted by imagin916
I. I just dont have time to call for report all night long which I sometimes wind up doing, my patient has a bed at 0000 and the patient is still here when I am giving report off at 0730. IB]

That is totally rediculous. Wouldn't fly at my hospital. If the ER calls someone on the unit has to take report. No exceptions. Now, most ER nurses are kind enough to call back if need be, but they can insist report be taken and we are not permitted to refuse. Our ER is too busy for floors to play around like that. They need to get together as a TEAM and help with admits.

The only time ERs are held is when there are no beds whatsoever. Sometimes, we're allowed to keep ERs until the next shift if the bed is not staffed. But sometimes the charge nurse or someone has to take the patient.

But we are not allowed ever to obstruct ER transfers. We don't have that much power. The ER does. Because if they have to divert patients to other ERs, it's $$$$$.

bluesky, BSN, RN · Oct 29, 2003

teamwork between departments was a huge problem at my old ER too. Now that I'm taking the management class, I realize that facilitating teamwork between departments is actually management responsibility.

askater11 · Oct 29, 2003

Yesterday was a crazy day--I came into work--we each had 5 patients which is our max. We are down on aides. (as usual) And down on a secretary

The bed coordinator's up at the desk--we have 12 pt. in the E.R. that need beds here. She was checking potential d/c. I felt so sorry for the charge nurse--she was calling every 1/2 hour--are any beds open. (I wish she'd trust us--we never not tell right away--though I did work at one hospital that worked like that)

One of my patients---the nurse said she'd be going home. One hour later up from the E.R. there came the admitting Dr. to D/C the patient.

The worse part was when the bed coordinator came up to our unit--our patient was coding. She pulled our floor charge nurse from the patients room. She said, "okay we need that bed for another patient" (her statement sounded like good now with that shift in patient she'd get more patients up) The patients condition was very grim...I think another bed in the unit would open up soon in PCU.

I don't know what the answer is. The problem they always say is staffing--there's not enough help. So the E.R.'s over busy with pt. lying in stretcher's in the hall. Unable to keep up with the workload.

Then they come up to the floor--everyone's running their behinds off. I just see the staffing problem getting worse and worse. Everyone's getting so burned out. If it wasn't so busy and nursing was actually a "safe" profession I'd work more often....but I need a couple day break in between each day I work.

I wrote the initial thread--

On the way home--all I could see was my g.f.'s face--her disgust at hospitals. I thought ..."maybe that's why they didn't have your dh's dad in a bed"(lack of staff)--I used to work at the hospital he went to --nurse ratios weren't the greatest--they had a hard time staffing units--even with poor nurse patient ratios. (though there are hospitals around her with even WORSE nurse patient ratios) But then again--I thought of the E.R. nurses they are over worked....with stretchers all over the place. Where ever the patient is the "conditions" are not good.

I wonder if things ran better when their was a "surplus" of nurses? (part of me says it ran a little better but never as well as it should've)

E.R./Floor nurses keep up the good work--and continue to voice your concerns to management--and maybe---just maybe someone will listen to us.

---

Okay I read some of the threads. Please no one make this E.R. vs. Floor nurses thread--that is not why I started this thread.

Okay this is what we do. I work 3 different units--everyone is excellent at getting report from E.R. (that I've seen)

Management made out a board--the reason why was at the end of shifts we'd get all our patients. (literally 6 patients at once) Now we get them all spread out.

The E.R. nurse calls the unit and books a time slot. The E.R. can book 2 patients per hour to our unit. No more then that. There's a gray area between 6:30 and 7:30 that no report or pt. can be sent up on the floor. There's also time slots where they can only send 1 pt. up that hour--I think it was around lunch time. So we can get our break--we're so understaffed we never get breaks anyways--but I think that's their point.

It's working very well. At least for the floor nurses.

I must say our hospital works wonderful between units. My 1st hospital was not like that at all. (2nd was another great hospital too==they worked wonderful together)

Yesterday 2 time slots--within 1 hour were filled up by my E.R. patients. The 1st 1/2 of the time I didn't hear a word. Then I got report on one. 10 minutes later they called report on the 2nd patient. I honestly couldn't take it--I was passed staffing Matrix--but I had a patient just put in bed--another requesting to be d/c. (etc) (it was a long d/c--not simple at all) The E.R. nurse was wonderful--she let me call back 45 minutes later. I swear she needs a star!!! We work together--that's what I love.

berry · Oct 29, 2003

looks like most of us are in the same boat and man 6-8 pgs of people down on the er in several different threads. IMHO if you dont want to wait or just sit and complain "i am hungry why did i only get 50mg of demerol, iwant something to drink"GO THE F HOME i love handing out ama forms just makes my life easier and for all the nurse complaining about er nurses come follow me for a day doubt most of you can not trying to be rude but facts are facts. There is not a floor in the hospital where a rn load can be a ICU pt on vent titrating a couple of gtts, a 2month old in for sz, 2 pts couh, cold (by the way these are the 2 loudest complainers of the pt list)and an active chest pain on a nitro dripp waiting to go to the cath lab, and get a overhead pg that rescue is 5 out with an OD. Does sitting in a room all day suck hell yes and i hate it for you but fact is you came here and about 75% of you could have gone to the drug store or you PCP in a few days but you chose to come see me. We all know MDs, RN, admin that time is clooged up in the er and it is only gonna get worse in hte coming years. The er is abused by the public, clinics, private docs, and nursing homes we are a dumping ground pts people dont want to deal with.