Waiting 7 hours for an appointment

RNBelle · Feb 15, 2008

anything could have happened to cause the delay. anything from a snafu on the staff who scheduled it in the first place or there may have been an emergency where one or more patients took precedence. i do agree 7 hrs is an extremely long time to wait and then be told to come back later. the staff should have informed you earlier on if there was a scheduling problem or an emergency. you will see once you enter nursing that there is another side to things that patient families dont see the whole picture. what keeps people from blowing their fuse, usually, is just giving them rationale explanations. or atleast it makes it a tad bit more bearable for them.

rizzle · Feb 15, 2008

That is unacceptable. If there was an emergency that took presidence over your mother's procedure, they should have been honest and told your parents. I'm glad your dad stood up for her. He could also write a letter to administration to let them know this is happening. Maybe your parents could get better care next time by going somewhere else.

Scrubby · Feb 15, 2008

I work in theatre so i see this sort of thing all the time.

Problems that can lead to this include cases that go for longer than anticipated include emergency cases being given priority, lack of staff available, a previous case going longer than anticipated. Our operating times are between 8-4 and often we have to cancel the last because the nurses and anaesthetists don't want to work the overtime, which is our right as employees, however not nice for the patients.

EricJRN, MSN, RN · Feb 15, 2008

Hard to make much of a comment since the details are minimal. We could be talking about anything from an EKG to a cardiac catheterization.

BrnEyedGirl, BSN, MSN, RN, APRN · Feb 15, 2008

Wow oh wow do you have great timming for this question!! First of all with out details obviously we can't specifically answer your question,...but let me share my last 18 hrs with you.

I am a seasoned nurse, working for the last year in ER, Trauma Center, on of two in my town. Our "region" includes about 9 counties and we have the only two Trauma Centers. Comparing our region with others with similar populations we are about 1500 in patient beds short. (for example KC, Mo has 31 hosiptals,..we have 7, 5 of which have less than 100 in pt beds).

At about noon on Valentines Day we are advised that there are NO in pt beds available in the hospital. OK,.we have a protocol for this,.a plan. We call the other hospital (the trauma center) to advise them of our diversion plan,..to divert all admits to them. This is usually done in 4 hr increments allowing for early dissmissal of pts already scheduled to be dismissed the next morning. Durring this time we also try to resechedule all non emergent surgeries and out pt procedures.

Over the next two hours, our ER recieves 8 pts from outlying hospital ER's because they have no empty in pt beds. We get a call from the other Trauma Center,.they are now full and cannot take any of our pts,..now according to federal law no one can be on "diversion".

It's now 1630,.our 35 bed ER,.has 47 pts checked in,.hall beds, chairs in the hallway and there are 29 pts in the waiting room. We have 8 pts who have been admitted but have no room to go to. We take four of these pt to the radiology recovery unit (radiology can no longer do any non emergent prodedures). The other 4 pts are in various beds in hallways (2 on vents). A "disaster alert" is called. Staff already at the hospital is not allowed to leave and the call tree is started to get every abled body in asap.

I start my shift at 1830,..am assigned 3 rooms and 3 hallbeds. I have an acute stroke,.starting TPA, an overdose that needs to be intubated,.a dialysis pt who is in fluid overload w/ a BP of 214/110, respers of 35 and O2 sats 78% on 100% NRB,. my hall beds include a drunk who fell down and is yelling and swearing about is hip pain, a 50's man with previous CABG having chest pain and a little old lady from a nursing home who fell and has an obvious hip fx. There are now 35 people in the waiting room. (they are NOT happy people)

Calls are made to out pt surgery (they have 8 beds) asking for staff to come in to take our over flow. PACU is asked to stay to take pts (they have 15 beds). GI lab has 4 beds used to recover pts from procedural sedation, they are asked to help.

We get 3 acute MI's from EMS in less than 2 hours,.need cath lab,.they are full,.no staff to open an empty cath lab. We have a trauma (MVI) pt that has been waiting for OR since noonish,..we get a call from EMS,.Level II trauma,.MVI, rollover,.non restrained driver, ejected from car, pos LOC.

8 hours into my shift we have recieved none of the rooms we requested other than the radiology recovery rooms,.their staff left at 8 so we had to send our nurses to care for these pts.

I will stop this very lengthy rant. You get my point. When things like this happen,.people who are dying go first,.period, end of discussion. While I do understand that people get frustrated because of excessive wait times,..maybe it would help if they stopped to think that because they waited a life was saved.

pyunnyhana · Feb 15, 2008

Thanks RN-Cardiac, for giving me the insight of a day like that.

I guess even though if you have an appointment, the world does not stop turning for you.

I am a person who likes to be on my feet doing something and I don't take things personally (I might get shaken up if personally attacked but that doesn't last long. I work PT at a major mall retail store so I've had some interesting customers there), so hopefully with those qualities, nursing wouldn't burn me out as much if a hectic day such as your's occurred. I'm just wondering, how do you keep your professional composure when encountering an angry family member/patients, or when all resources are taken and you are left with yourself?

banditrn · Feb 15, 2008

RN-Cardiac - :bowingpur Your patient assignment sounds horrible - bless you for being there!

justme1972 · Feb 15, 2008

I'm a student, have never worked in a hospital, but as a patient, here is what I have noticed.

(and please don't think I am ER-Nurse bashing...b/c that isn't it).

No one in the ER's (that I have visited) seems to be in a hurry. I think some workers forget that patients can here the chit chat outside the curtains of who is going where for lunch, what they did that weekend, and other nonsense stories that you don't have time for when there is 50 people in a waiting room. I have seen some carry on liesurely conversations that don't seem to be work related, leaning up against a wall, etc....patients NOTICE things like that.

Wasting seconds turns into minutes which turns into hours.

I came into the ER one night about 6 years ago...I had accidently slashed the back part of my thumb and had hit an artery and I was dripping blood everywhere...the guy working ER Registration had his back turned and was going on about some nonsense of a movie he saw over the weekend and the nurse he was talking to had to remind him that I was standing there....with an OBVIOUS towel over my hand soaked with blood.

He said without even looking, "Just sign in on the clip board", then turned BACK around (without waiting for me to answer) to finish his conversation.

You know what I did? Took my hand off the towel, and grabbed the pen with my blood-soaked hand which got blood over his clipboard, sign-in sheets, etc, and I smiled at him and said, "There you go!"

While he looked at the clipboard with a horrified look...while I went to sit down to wait for stitches.

santhony44, MSN, RN, NP · Feb 15, 2008

No one in the ER's (that I have visited) seems to be in a hurry. I think some workers forget that patients can here the chit chat outside the curtains of who is going where for lunch, what they did that weekend, and other nonsense stories that you don't have time for when there is 50 people in a waiting room. I have seen some carry on liesurely conversations that don't seem to be work related, leaning up against a wall, etc....patients NOTICE things like that.
Wasting seconds turns into minutes which turns into hours.

This reminds me a bit of the complaint that "the nurses are just sitting around playing on the computer."

If everyone is not running around like the proverbial headless chicken, then nothing is happening.

I do ER coverage for a very small hospital and spend a lot more time waiting than you'd think. Wait for the lab, wait for radiology, etc etc.

I also chat. Sometimes while I'm waiting, but also when I'm doing things like suturing someone. I had a lac not long ago and the patient and I chatted steadily about......shoes. It helps pass the time and helped get her mind off what I was doing. I'm sure anyone outside the room would have thought that nothing was happening but conversation.

As to the OP, the staff should have explained to your parents what was happening. But yes, stuff happens, from emergencies to equipment issues.

RunnerRN, BSN, RN · Feb 15, 2008

I'm a student, have never worked in a hospital, but as a patient, here is what I have noticed.
(and please don't think I am ER-Nurse bashing...b/c that isn't it).
No one in the ER's (that I have visited) seems to be in a hurry. I think some workers forget that patients can here the chit chat outside the curtains of who is going where for lunch, what they did that weekend, and other nonsense stories that you don't have time for when there is 50 people in a waiting room. I have seen some carry on liesurely conversations that don't seem to be work related, leaning up against a wall, etc....patients NOTICE things like that.
Wasting seconds turns into minutes which turns into hours.

Allow this ER nurse to give you a bit of insight here. I carried a load of 4-5 patients during my shift yesterday. Even with 5 patients, there were several times when I had drawn all my labs, given all my meds, obtained my UAs, given food/water, etc. In a nutshell, I had worked my orifice off for hours keeping these patients happy and alive, and keeping their care moving forward. At that point I am either waiting for an inpt bed to become available, for labs to come back to determine a dispo, or for the ER MD to discharge the patient. The doc may not be able to d/c a completed patient for any number of reasons (suturing a lac, intubating a pt, finishing up a more ill pt, etc).

Too many people forget that the ER RN is NOT the end all be all of patient care in the dept. I start the IV and draw the labs, but I don't run the labs - it moves on to another dept that is also probably inundated and doing its best to get work done. I order the CT, but can't help it if a CVA or trauma pt takes precedence.

Generalizing that "no ER RNs I've ever seen seem to be in a hurry" is a pretty stupid thing. This is my JOB not my life. If my work is caught up and no one needs help, there is no reason I can't ask my friend/coworker what she is doing this weekend. There is also no reason I can't ask my friend what she wants for lunch as I chart (I can do two things at once).

For the OP, I have no idea what might have been going on to make your parents wait for 7 hours. If it was a cardiac cath, it may have just been bad luck and the hospital got multiple AMIs during that time period yesterday. Either way, someone should have been up front with your family to tell them what was going on.

Blee O'Myacin, BSN, RN · Feb 15, 2008

I'm a student, have never worked in a hospital, but as a patient, here is what I have noticed.
(and please don't think I am ER-Nurse bashing...b/c that isn't it).
No one in the ER's (that I have visited) seems to be in a hurry. I think some workers forget that patients can here the chit chat outside the curtains of who is going where for lunch, what they did that weekend, and other nonsense stories that you don't have time for when there is 50 people in a waiting room. I have seen some carry on liesurely conversations that don't seem to be work related, leaning up against a wall, etc....patients NOTICE things like that.
.

I snipped some of this post because I need to stop you here. I am sorry that you had a bleeding laceration and you were asked by the greeter to sign in - perhaps he didn't notice due to the 100 other people in the waiting room. It didn't impact your care or change your outcome. You were *inconvienced* because you had to tell him that you couldn't.

I don't know how far along you are with school, but did you read the post from the ER nurse above who described her day? (The two patients requiring intubation and taking care of a hip fx patient and a chest pain patient in the hallway - not to mention the belligerent drunk screaming at her?) That's typical in the ER these days due to our "customer service" driven healthcare system and the need for many people to achieve immediate cures for their illnesses. When did 3 days of the flu suddenly become a reason for the ER (when there are no co-morbities and the patient is in their 20's with stable vital signs)? Why do I have to drop everything because someone vomited once overnight, but now "has a bad taste in mouth"?

Why do we talk about what to order for lunch and other such "non-essential" matters in front of patients? That's an easy one. We stack patients where ever we can stick a stretcher or a chair. We can't turn ambulances away when they show up seven at a time and we are packed to the gills with no relief in sight because there are no beds up on the floors. So pardon me if I see a coworker, whom I enjoy the company of, and we try to figure out who gets to eat, when and what on the fly - because we sure can't take a moment to excuse ourselves to the staff bathroom with a menu to peruse at our leisure. Besides, if I see a toilet when working, I'm opportunistic, and I don't think that is something that ought to be shared among coworkers - but the staff bathroom is just about the only place where they aren't putting patients *yet*. Just don't tell admin that the staff has their own bathroom. I'm sure a "VIP" would get a bed in there.

If your ER nurse seems rushed while dealing with you, be happy. It means that you are not dying. If there are five people on top of you and that nice red metal cart is being dragged up to your bedside, you bet we are taking our time and doing 110% to fix you.

Now to address this "wall leaning", just means that there aren't enough chairs for the staff. Sometimes "taking a load off" in the ER means that you lean against the wall. That's if the wall isn't being taken up with a stretcher.

Just because you perceive that the nurse isn't busy or the tech is being lazy and coworkers have the *nerve* to discuss personal matters (like eating?? Isn't that one of Maslow's basic needs??), doesn't mean all is as it seems.

I work my rear end off, and so do all of the other ER staff members I work with and have known through the years. It can't all be terse rapid fire medical terminology that television has perpetuated as the mythical norm.

Walk a mile in my beaten up, blood, bile and vomit stained Danskos and then tell me if I'm behaving unprofessionally because I'm telling the US (who is nice enough to walk around with a menu) that I want pizza instead of chinese when I swallow it down in under ten minutes in the nurses station. I don't get an hour for lunch with my instructor and classmates, or an hour of pre and post conference every day. Enjoy that time and get all you can from it - but don't come down on people who get barfed and pooped on for a living and still have the stomach to decide what's for dinner.

Blee