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waiting for provider

Posted
by Bo,RN Bo,RN Member

How do you explain to patients that even though they are in a room, they still have to wait for a doctor to see them to order medications. Many times patients can wait >3 hours in a room to be seen by a provider. I do every intervention I can: INT, labs, EKG, x ray, CT. I do notify the doctors of patient needs for example "Hey doc patient in room 7 has a known kidney stone and is in pain." Some providers will give orders for medicine, but many will not. The patient will yell, cry, and scream at me and I can do nothing. Of course these patients are non critical and CAN wait, but telling a patient that doesn't go too well.

Our satisfaction scores are awful. Even if I do EVERYTHING within my scope, I am still blamed.

How do you deal with it?

Pixie.RN, MSN, RN

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN. Has 13 years experience.

Three hours even when roomed? Wow. A lot of places have gone to a provider in triage (usually a PA or NP) and/or triage protocols to help cut wait times. That is pretty long.

I could not explain it. There is no reason that a provider can't do that unless your facility is way understaffed.

Our time to provider is supposed to be

How many beds and physicians do you have?

NurseHeart&Soul, MSN

Specializes in ED, Critical care, & Education.

Bo.RN~

Sounds like you need a serious process improvement plan in your department. There isn't much to say to a patient in that position. I have definitely been there and it's plain awful.

What do you think about making some process improvement suggestions? If you are open to that idea we can help! When your door to provider time decreases your patient satisfaction scores will increase. The selling point is that the number of patients that leave against medical advice also decreases reducing liability for the hospital while simultaneously increasing revenue. And YOU will be much happier when you don't have to try to figure out what to say to the patient. Then of course when staff are happier turnover decreases. Its's all linked together. Someone has to be unhappy with those scores and would understand the need for CHANGE!

I agree with Pixie.RN that you either need a provider in triage during peak/busy times and/or triage protocols so you can provide some level of pain relief.

We have 21 beds with plans to expand to 45 in the next 2 years. We have used a mid level provider as a PIT, but only briefly and only on days. Our problems occur between 0300-0600 when we only have one provider. Some will stop seeing new patients at 0400 and the patients have to wait for the 0600 provider to arrive. We have been told there will not be any changes to provider staffing until after the expansion. Where I live there are 3 hospitals within a small area and we are all working with these long wait times. On days there are 2 doctors and 2 mid levels. The mid levels are 0900-2100 & 1500-0300.

Pixie.RN, MSN, RN

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN. Has 13 years experience.

We have 21 beds with plans to expand to 45 in the next 2 years. We have used a mid level provider as a PIT, but only briefly and only on days. Our problems occur between 0300-0600 when we only have one provider. Some will stop seeing new patients at 0400 and the patients have to wait for the 0600 provider to arrive. We have been told there will not be any changes to provider staffing until after the expansion. Where I live there are 3 hospitals within a small area and we are all working with these long wait times. On days there are 2 doctors and 2 mid levels. The mid levels are 0900-2100 & 1500-0300.

Now I totally get it. I worked in an ED where the midshift midlevel left at midnight, and often our night docs were moonlighting internal med docs who could only manage one patient at a time. Like one patient an hour. That might work in an ED where you only get a few patients after midnight, but there? Nope. Drove us crazy. Whichever ED physician group is staffing you needs to address that problem! That's tough to deal with.

NurseHeart&Soul, MSN

Specializes in ED, Critical care, & Education.

How do you explain to patients that even though they are in a room, they still have to wait for a doctor to see them to order medications. Many times patients can wait >3 hours in a room to be seen by a provider. I do every intervention I can: INT, labs, EKG, x ray, CT. I do notify the doctors of patient needs for example "Hey doc patient in room 7 has a known kidney stone and is in pain." Some providers will give orders for medicine, but many will not. The patient will yell, cry, and scream at me and I can do nothing. Of course these patients are non critical and CAN wait, but telling a patient that doesn't go too well.

Our satisfaction scores are awful. Even if I do EVERYTHING within my scope, I am still blamed.

How do you deal with it?

Like Pixie, I totally get it now via your description. Years ago the ED I was in was identical to what you describe now. There are only so many times you can apologize to the patient. Showing empathy is about the best you can do. The fact that you are asking for ideas says it all. You've got that one covered.

nurse2033, MSN, RN

Specializes in ER, ICU.

Standing orders are a nice idea. We can order tests and medications, including narcotics. It sounds like it would be a big reach for a facility that doesn't seem to care much about patient pain though. But every challenge is an opportunity!

Thanks for the replies. I just needed to vent my frustration.

needlesmcgeeRN, ASN, RN

Specializes in Care Coordination, Care Management. Has 3 years experience.

Wondering what percentage of these patients are non-emergent?

Wondering what percentage of these patients are non-emergent?

Emergent patients are seen right away. Most patient's are non-emergent. I work in an area where the ER is used as a PCP.

All the ERs I've worked at have been like that--ER is PCP and people come in for many non-urgent dx such as UTI, URI, etc. We aren't even supposed to put in labs/tests without the provider having seen a pt! Our only new standing protocol's are for Strokes, Stemis and Sepsis. We do what we can but depending on the doctor it's not much. I do a *lot* of apologizing and explaining that while they're in pain, I can't give medication except tylenol or motrin without MD order.

A patient in pain from a kidney stone is an urgent patient. Waiting to see a doctor for 3 hours in an ER? Not acceptable. I get it that if the MDs are not regular ER docs and see 1 patient an hour, but this concern should go to administration. There is no reason an NP or PA cannot see many of those patients that are coming in. I've taken kids to the ER twice and did not see a doctor. Standing protocols for the nurses are a very good way to go. While the patient is waiting, the UA is being run. It takes a second to write an Rx.

We have 21 beds with plans to expand to 45 in the next 2 years. We have used a mid level provider as a PIT, but only briefly and only on days. Our problems occur between 0300-0600 when we only have one provider. Some will stop seeing new patients at 0400 and the patients have to wait for the 0600 provider to arrive. We have been told there will not be any changes to provider staffing until after the expansion. Where I live there are 3 hospitals within a small area and we are all working with these long wait times. On days there are 2 doctors and 2 mid levels. The mid levels are 0900-2100 & 1500-0300.

I'd like for your bosses to be patients in your ER. I hope they will be having severe pain - a good fracture, a huge kidney stone, anything extremely painful. You will definitely see change after that.

Ahh, so much for dreaming.

Meantime, just tell the patient the truth and don't feel badly.

I know it's hard when these accursed doctors won't give pain med to people who really need it, but it's not your fault.

And if they yell at you, just walk ou of their room.

Tell them to be sure to tell the doctor how unhappy they are with the ridiculously long wait and the untreated pain.

Why go to an ER for pain, like a kidney stone or whatever etiology, if no one will order the medication.