Welcome to the ER. Please observe the following rules. (mild rant)

tonchitoRN · Oct 27, 2003

i am not sure you meant this in jest or venting or what. unfortunately the nurse is on the front line to receive the public's complaints. the er's in this country are bursting at the seams. the public feels they have a right to health care no matter where it is from and they are going to demand it. last week nightline with ted koppel did a series about health care that shows the problems this country is facing. on friday they profiled an er in colorado that refuses to treat pt's w/o the ability to pay with the exception of life threatening illness. doesn't really sound ethical but they get away with it. their reasoning is they would prefer to treat the patient with life threatening pneumonia rather that treat it when it was bronchitis. patients who cannot pay are referred to community sources who the patients say many times have one month long waiting lists to be seen. now put yourself in the shoes of the financially poor patient. you have a child with an earache and high fever. you have no insurance and do not have the $100 to be seen in a private office. the er turns you away and the local community center says it will be one month to be seen. that person will certainly feel desperate. where is the compassion people?

MICU RN · Oct 27, 2003

Yes, many times. I was told when I was being taught how to triage that it is one of the hardest jobs in the hospital for a nurse. And they were totally right. Now, I was working in a level one trauma center, inner city teaching hospital that was always in the top three in the nation for volume. But, I am sure it is like that at other busy ER's too.

I concluded that 20.00 bucks an hour to submit yourself to that kind of stress and sometimes physical abuse just was not worth it. So after three years, I went back to ICU to get some more critical care experience so that I could try to get into anesthesia school.

An important lesson I learned in the ER was that knowledge is power, especially in the form of more education and training in the medical field. Those who taught me that were mostly the residents and staff doctors. I watched how much harder we, the nurses, usually had to work and then realized the staff ER doctors were making on average 4-5 times as much. While, hospitals could not function without us, we certainlly don't get paid or respected as if we are that important and that is sad.

NYCRN16 · Oct 27, 2003

AMEN Nightinggale!!!

MrsWampthang, BSN, RN · Oct 27, 2003

For those of us who work in the ER, we have all BTDT and got the supersize T-shirt! With ERs bursting at the seems these days, I imagine it will only get worse so you can either laugh at it or cry. Our ER would never turn anyone away based on the ability to pay, however, since our hospital wrote off in excess of 64 million dollars last year in uncompensated care, I could almost see it coming to that. We see a lot of patients in our ER that could have seen their family doctor, or treated themselves with OTC meds. We also see a lot of patients who have no FMD or are "between" doctors because of being on medicaid. And it seems like these are the patients that will hollar the loudest about the long wait, etc. Some are truly drug seekers who yell at everyone when they don't get the drugs that they want. I have had to have security escort them out of the ED when they got too abusive. The doctors and all the staff gets so frustrated with this so like I said, you can either laugh about it or get mad and cry. And you might as well laugh, because after all, laughter is the best medicine!:chuckle

Please don't think think that ER nurses are burned out or heartless if we get frustrated at the patients we see, sometimes we just have to let off some steam!

Pam

Todd SPN · Oct 27, 2003

Originally posted by Pamela_g_c
Please don't think think that ER nurses are burned out or heartless if we get frustrated at the patients we see, sometimes we just have to let off some steam!Pam

Frankly, I do. The common thread in the majority of these ED posts tend to demean the stupid public who are underfoot and should have stayed home and made an appt with their PCP for sometime like 3 days down the road.

I really don't think the public is there just to piss you off. For some reason they feel it is proper for them to visit your ER. With so many being incorrect, how can you educate them to the inappropriateness?

NYCRN16 · Oct 27, 2003

Todd,

I can see why you would take Pam's post this way, but unless you have ever worked in the ER, its hard to understand. When we come in and take report for 5 patients who are all sick with real problems (not earaches and sore throats), and then we are recieving new patients and notifications on top of that, you are already overwhelmed. Than to top it all off, you get someone that comes in for something that could have waited until the clinic opened in the morning, or because they know if they come to the ER they dont have to pay for the Rx. Working up this patient takes up a lot of your precious time, and you are spending less time with the patients that really need your observation. You know that the MD is not getting to this patient anytime soon, so now you keep adding up the # of patients you are getting. Before you know it, you have 13 patients, many of them are there for BS reasons. Now you spend more and more time documenting, drawing blood, ect on these patients that dont need to be there. This is the part that is frustrating. JMO

pepperbark · Oct 27, 2003

I wish we could send this to our patients.

ESG RN

Todd SPN · Oct 27, 2003

Originally posted by imagin916
Todd,

I can see why you would take Pam's post this way, but unless you have ever worked in the ER, its hard to understand. frustrating. JMO

Reading these posts, I understand it is a frustrating job. I would never want to do it as I think I would turn into someone I would not like. I used to work retail and I have eaten my share of crapola. My point is how do you educate the public what is a proper visit? Frankly, I don't know and wish someone would address this. Obviously, they don't understand and it is frustrating the ED staff making them look like crabby uncaring professionals. It also makes for longer waits for those who truly need the services. Unless people are educated otherwise, it will always be the same.

So, in the spirit of being constructive, if you ER personel come up with a way for the public to determine if a trip to the ED is appropriate, I will submit it to the local paper via letters to the editor. I know it isin't much, but if everyone was to do it...

flashpoint · Oct 27, 2003

LOL...Yesterday, I worked ER for the first time in six months. We're a small rural hospital and we don't have a pharmacist to get out drugs, etc. I'd like to add a few things to your list...

1. Don't stand at the nurse's desk asking if we're working on your dismissal instructions...it's distracting and it violates the other patient's privacy to have you leaning over the desk trying to see what we are doing.

2. You have to wait to get instructions before you leave. Please listen to what the dismissal nurse says to you and please read the instructions before calling back and asking questions. The doctor really means it when he says, "No gym for one week." Take one pill every eight hours means take one pill every eight hours.

3. Please don't return for further treatment unless you have actually tried to do what we recommended the first time. Yes, we want you to take the medicine that was prescribed. It's unfair to the staff, the other patients, and to your insurance company to return and complain that you're not getting any better before you take your first pain pill or dose of antibiotics. We are doctors and nurses, not miracle workers...the fact that you came to see us will not cure your infection...that's what drugs are for.

4. Don't come into another patient's room to ask me a question, unless you are on fire or in full arrest. It's rude and you're likely to be pushed out of the room. And, yes, you do have to stop breathing to get five nurses and three doctor and lab and x-ray at your bedside. A sore throat or an earache or a stubbed toe can wait a while, a code blue cannot.

Maybe this does sound a little demeaning, but a lot of it is simply common sense and the good old-fashioned golden rule. Being sick does not give you the right to yell, swear, hit, kick, or act like a spoiled brat. If you are fixing to die, we will drop whatever we are doing to help you...if you are stable, you'll have to wait along with everyone else.

momoftriplets · Oct 27, 2003

Todd, you are assuming that patients actually want to be educated!!! Most people just want their problem fixed immediately. If they vomit once, they come into the ER to have it stopped. People don't care about taking care of themselves and preventing illness. They don't want to learn what is an emergency or not. People want the quick fix, like most American's do. I think the rules posted are quite appropriate. ER nurses, and frankly all nurses, are hard working and want to help the sick. We just get tired of taking care of people who could take care of themselves but won't!!! The ER forum is a place where other ER nurses can support one another and be validated. This is not the place for people to judge others, especially people who are not nurses and don't work in the real world. I have read your posts and they are most critical of other nurses. How are you going to work with others when you already have a dim view of the nursing world? Hopefully, you can become more understanding and openminded, as that is a skill that nurses must have.

Medic946RN · Oct 27, 2003

I'd like to add one:

Please don't expect sympathy if you've done something really stupid, like do-it-yourself dental work, but we will refrain from laughing at you and hold the snide remarks down to a minimum.