I work in a large, urban ED. I absolutely love emergency medicine, and like many of you, cannot imagine myself doing anything else. However, I have recently been left feeling burnt out with all the non-emergent cases we see. Its as if treating and caring for a patient who is actually sick, critical or unstable just doesn't happen anymore. What happened to these patients? Where did they all go? We are so bogged down with low acuity patients, who also seem to be the most entitled, mean, and in-your-face. It is discouraging to say the least, but I'm not sure where to turn from here. Emergency nursing is my passion. Are any of you experiencing this as well? What are you doing about it? What happened to the "emergency" in "emergency medicine?"
The community clinic in town (also the only provider that accepts MediCal) constantly sends patients over to our ED because they cant fit them in..... 😅😅
All treatable at home so stock up on pepto and some immodium, gripe water and gatorade.
Hmm. My last trip to the ER for n/v/d had the physician saying NO PEPTO BISMOL OR IMMODIUM. That whole thing about stagnant viral loads in the intestines and hiding any possible bleeds from colitis.
Then of course, there is the fact that Gatorade/Powerade is very high in sugars and exacerbates diarrhea d/t the osmolarity difference.
But hey, keep on giving out that outdated advice and griping about people being sick in your ER (but not sick enough for your liking).
Hmm. My last trip to the ER for n/v/d had the physician saying NO PEPTO BISMOL OR IMMODIUM. That whole thing about stagnant viral loads in the intestines and hiding any possible bleeds from colitis.
Then of course, there is the fact that Gatorade/Powerade is very high in sugars and exacerbates diarrhea d/t the osmolarity difference.
But hey, keep on giving out that outdated advice and griping about people being sick in your ER (but not sick enough for your liking).
Thank you this is the truest thing I've heard so far
I not talking bout people who sick with stuff like colitis or with known diagnosis of abdominal diseases, we all know you dont take A/D's for.those ailments and those may require a legit trip to ER, the topic is people who come to the ER for no good reason. I've got 2 kids and never carried.either to the ER for n/v/d but hey if people got money to blow for a thousand dollar bed in an ER and wonder why health insurance rates are out of control I cant help them.
The OP makes a point here. We are seeing more and more things in the ED that can be taken care of in the doctors office. However, I wonder why patients choose to come to an ED over an office. We get tons of patients that say I didn't call my doctor I just came here or one who honestly said this was quicker to get it. Doctor's offices are getting harder and harder to get an appointment with. It really is a joke when you want to get in for a sick appointment and you have to wait four to six weeks to see a doctor. They also dont know that it is okay to say to the receptionist let me talk to the doctor or nurse because I need to come in. They just listen to them and say ok I'll wait and then come to the ED.
Since when is the ER not anywhere near as much bona fide emergencies as routine complaints? It's always been that way. Even in the late 80's during the 'crack wars' in inner city hospitals it was still 10:1 routine to emergency if not more.
Which is fine, so long as you understand that emergencies will always be the highest priority, and that if you have an appointment, have to go pick up the kids, need to get home to let the dog out or whatever, I'll do my best to get you through as quickly as I can, but that again, the true emergencies will always get my immediate attention. You may miss your appointment or have to ask someone else to go pick up the kids or go let the dog out. Your schedule is not my priority. I didn't drag you in off the street and force you to come to the ER for your minor complaint.
Also, if your doctor does send you in, you will still go through triage and wait your turn just like everybody else. You don't get to the front of the line just because your doctor called ahead.
I don't mind taking care of minor illnesses at all, so long as the people behave appropriately and respectfully. Just because you have a busy day, have somewhere else you need to be, or just hate waiting, doesn't make it an emergency.
With all respect, how do we as nurses explain that to them...
I tell patients pretty much what Anna Flaxis said - that real or potential threats to life, limb, or eyesight will always come first, and everyone else will be seen after that. I tell them that the beauty of it is that we never close, and if they wait long enough to outlast the real and potential emergencies, we'll see them - and sooner than their primary care provider, whose clinic quoted them a 2 week wait, we're much faster than 2 weeks. As a charge nurse, I am mindful of the flow and the wait time, and sometimes if an ESI level 4/5 has been waiting a long while and our fast track area is still jammed, I will get that long-waiter into a bed to be seen and discharged quickly - but this requires an open bed and a good doc to be available, too (i.e., not that doc that works everyone up no matter what just because they're in an ER core bed).
I usually (repeat, usually LOL) don't have problems taking care of non-emergent patients. For a whole gamut of reasons:
* Every once a while, I do appreciate having a non-emergent/non-critical patient. Don't get me wrong, I'm an adrenaline junkie all the way, but I do need a break to recharge from time to time.
* For the most part, most of my non-emergent patients are looking mostly for: (a) Symptom relief (N/V/D, Pain) and/or (b) Have a professional tell them that it is nothing emergent and they can go home and won't die. Which brings me to one of my favourite parts of being a nurse...
* Education - many of my non-emergent patients are sometimes embarrassed to be in the ER. They feel like they're a burden and that they're wasting everyones time with their non-emergent complaint. These are typically my patients who are worried more than they are "sick" (and WebMD doesn't help) and they just need reassurance that everything will be ok. I give them my usual spiel - "Look. I totally understand. I mean, after all - you're not the medical professional, right? How are you to know what is and what isn't an emergency? When in doubt, always get it checked out." After that we'll go over the usual stuff (while I'm putting in the IV/drawing blood, doing my assessment etc.) - try home/OTC stuff for 24-48 hours, call PMD, see UC/Minute Clinic° etc. and if no improvement or worsening symptoms to avail of next level of treatment. You'd be surprised how many patients aren't even AWARE of these other resources out there for them. And conversely, I also get a lot of patients who DID go to UC but get sent to the ED for further testing (U/S, CT etc.)
You will absolutely score bonus points with me if you atleast TRIED to help yourself/seek primary means to redress your issue before you come to the ED. You gave it a shot, didn't help - what more can you do, right?
That being said, my BIGGEST pet peeve with non-emergent complaints is the negative attitude. Usually wait times - either waiting to be taken to a room, waiting to be seen by a Doc or waiting for results.
*After triaging the pt., I tell the squad to take the pt. to the waiting room as I have no open spots:
"But I came by ambulance!"
And I drove my 8 year old car to work today. Your point?
"Why am I in the hallway?! You're not taking me to a room?!"
I'm sorry, would you rather be seen in the hallway now or go back to the waiting room to wait for a room to open?
"I've been waiting an hour! When am I going to be seen?! This is ridiculous!"
Nobody is forcing you to stay. You can always go back to your PMDs appointment 9 days from now..."
I especially love the ones who dismiss me with barely disguised contempt with a "I need to see a Doctor. You're just a nurse!"
Sooooo tempted to tell 'em "And you're neither..."
*sigh*
cheers,
° Yes, I know. I read the thread. Not all places have UC/Minute Clinics. If I worked in an area which lacked additional resources, my education would be tailored accordingly. My first job was in a semi-urban, parish supported community hospital surrounded by farmland as far as the horizon and beyond. For the next hundred or so miles (especially south) of us - there was nothing. We were it.
On another note the delays of seeing a doctor can be eased. We need to push for more ARNP's and keep pushing for atonomy in the practice so the gaps in care can be filled.
On another note the delays of seeing a doctor can be eased. We need to push for more ARNP's and keep pushing for atonomy in the practice so the gaps in care can be filled.
That will help only to a certain extant. You can have all the NPs and PAs and Docs you want and they can order all the tests and labs they wish - but at the end of the day, there are only a fixed amount of beds, nurses, techs, CTs etc. to carry out the orders.
When 42 patients sign in in under 10 minutes in a 26 bed ER, you bet your bippy some of those patients are going to wait!
'Quality, Access, Cost' - pick any two, you can't have all three.
And this might be anecdotal evidence so YMMV - but time and again I've found that the truly "sick" patients, rarely - if ever - complain of wait times.
As a charge nurse, I am mindful of the flow and the wait time, and sometimes if an ESI level 4/5 has been waiting a long while and our fast track area is still jammed, I will get that long-waiter into a bed to be seen and discharged quickly - but this requires an open bed and a good doc to be available, too (i.e., not that doc that works everyone up no matter what just because they're in an ER core bed).
ERnursebyday
38 Posts
Most people state they have abdominal pain with the N/V/D.