I have been an ER nurse for several years. I've always been very proud to be an ER nurse, but see some pretty sad trending in the field. I have a family member that works in the ICU, so I often hear that end of patients that have received some poor care in the ER.
I had a family report to the ER. After some issues, we reviewed medical charts to find that the nurses and the doctors filled out complete physical assessments, when there were no hands on AT ALL. The pt was literally untouched by anyone in the ER, with serious complaints. But according to the EMR, the patient had not 1, but 3, hands on physicals.
My questions were - have we become so reliant on machines that we no longer touch? Are we too hung up on real time computer charting that we can't take our eyes off of a keyboard to look at a patient during a conversation? Are we becoming dependant on smart pumps, so we don't even know how to do drug calculations anymore? Are we too worried about positive ratings and "excellent" referrels that we are falling away from the very basic care - listening to lungs or an abdomen? Is it a nursing problem? Is it a management problem? Is it just a sign of the times?
I would like to hear how other ER nurses unit's do the triage process, from the minute the patient walks through the door. Are there instances that you send a patient to a waiting room without a brief assessment and VS? Do you feel that your protocols are used reasonably or as a way to make the shift a bit easier for the doc? In relation to the last question - an example I'll give is a 34 year old presenting with chest pain, cough, heavy smoker, recent history of bronchitis, non compliant with meds. The triage nor primary nurse did an assessment prior to protocol orders and it was expected by the docs (without a verbal report or doc exam) to do a complete "chest pain" work up. IV,EKG, labs, so on. Protocol orders were ordered immediately by the triage nurse, however the PA saw the pt shortly after and had her discharged before the EKG could even be done, but after an IV and labs were drawn. Are we not using common sense, nursing judgement and critical thinking skills to do appropriate care, not which is easiest?
I'd just like to hear some other opinions and thoughts.
