There has been quite a few times where pts complain over the waiting period due to a code. There was a pt just the other day who had been out in the WR for 3 hrs due to a code-and when I went out to call the pt back, the pt gave me such an attitude, stating "what in the h#ll took you so long! Dont you know I AM IN PAIN!" Pt c/o of ear pain times 2 weeks. As I explained to the pt, sorry it took so long, but we were in code situation, the pt interrupted me stating, "I dont care, What about my pain! My ear hurts!" The pt then had the nerve to demand a nursing supervisor to then tell her how rude I was to her, and how long she had to wait! And how she was "going to do something about this!" And how we didnt care about her pain!
Pts complain all the time about the waiting period, but seriously? We all know they can hear the code blue emergency room call. What is that about! How absolutely mind blowing someone would even THINK ear pain TRUMPS a CODE!
Then our VP came in just the other day, stating how our customer service scores were low, blah blah blah. Insane. There are so many clinics around, urgent cares, yet for some reason the ED is a clinic, and is getting customer service scores! Press Ganey, who thought of that anyway?
but we weren't talking about the unresponisive pt with meningitis-they get first priority, the post was not about missing strange diagnoses, it was about a whiny guy with ear pain who should have went to his pcp 2 weeks ago-it was about him suddenly thinking his problem was my problem and that he gets my undivided attention because he is loud and annoying. The lady with meningitis belongs in my er, the guy with ear pain needs to GOMER now!! he takes up space for the people who need it!
Yes, you are right we weren't talking, but with an open forum I felt putting my experience in about the earache gave a different perspective.
Yes, you are right we weren't talking, but with an open forum I felt putting my experience in about the earache gave a different perspective.
A different perspective,...but also a way different presentation. Unresponsive trumps pain everytime. An adult with a temp of 104 trumps a 2wk, afebrile ear pain with normal VS. It's all relative in the ER. A three yr old screaming with an earache and a temp of 101 might get seen in 30 min IF we don't have anyone with chest pain, SOB, facial droop, etc walk in the door,...and IF we don't have 3 class I traumas, 2 MI's waiting for the cath lab and 3 GI bleeds we're trying to dump blood into! It isn't that we don't want this child to be comfortable, or that we don't care about his pain,..it is our job to decide if his illness is severe enough that 30 min will change the out come. Will an hour or two make any difference?
So many people seem to forget that the ER really does see emergencies. We see people who would die if we didn't intervene NOW. It isn't an occasional occurrence for us to have several people in the department who are critically ill or injured. It is an every shift occurrence. I worked 14hrs last night and sent 4 pts directly to the OR, 2 to the cath lab and started t-PA on one, and I didn't have any trauma beds! All of these people walked in through triage, and I'm sure to many waiting, looked just fine! I started my shift with 37 people in the waiting room, many had been there for over 3 hrs. I'm sure people were upset to see the 47yr old healthy looking woman walk in and get taken ahead of them. They didn't hear about the right sided weakness, the very subtle facial droop or the hx of multiple DVT's and DM. They didn't understand that leaving her in the waiting room for 3 hours could significantly change her way of life forever!
Do I feel bad for the guy with the ear ache, or the woman who tripped down her stairs and twisted her ankle? Sure I do. If there is an open bed, and nothing more serious ahead of her she goes back. It is very rare for us to have open rooms when someone walks in the door and some people act like they just don't believe us! There have been soooooo many times I've wanted to take people by the hand and walk them through the department,..show them the CPR in progress in RM4, the GI bleed in 7 and the 18mo asthmatic who is turning blue, and then ask them if they could patiently wait in the waiting room.
A different perspective,...but also a way different presentation. Unresponsive trumps pain everytime. An adult with a temp of 104 trumps a 2wk, afebrile ear pain with normal VS. It's all relative in the ER. A three yr old screaming with an earache and a temp of 101 might get seen in 30 min IF we don't have anyone with chest pain, SOB, facial droop, etc walk in the door,...and IF we don't have 3 class I traumas, 2 MI's waiting for the cath lab and 3 GI bleeds we're trying to dump blood into! It isn't that we don't want this child to be comfortable, or that we don't care about his pain,..it is our job to decide if his illness is severe enough that 30 min will change the out come. Will an hour or two made any difference?
So many people seem to forget that the ER really does see emergencies. We see people who would die if we didn't intervene NOW. It isn't an occasional occurrence for us to have several people in the department who are critically ill or injured. It is an every shift occurrence. I worked 14hrs last night and sent 4 pts directly to the OR, 2 to the cath lab and started t-PA on one, and I didn't have any trauma beds! All of these people walked in through triage, and I'm sure to many waiting, looked just fine! I started my shift with 37 people in the waiting room, many had been there for over 3 hrs. I'm sure people were upset to see the 47yr old healthy looking woman walk in and get taken ahead of them. They didn't hear about the right sided weakness, the very subtle facial droop or the hx of multiple DVT's and DM. They didn't understand that leaving her in the waiting room for 3 hours could significantly change her way of life forever!
Do I feel bad for the guy with the ear ache, or the woman who tripped down her stairs and twisted her ankle? Sure I do. If there is an open bed, and nothing more serious ahead of her she goes back. It is very rare for us to have open rooms when someone walks in the door and some people act like they just don't believe us! There have been soooooo many times I've wanted to take people by the hand and walk them through the department,..show them the CPR in progress in RM4, the GI bleed in 7 and the 18mo asthmatic who is turning blue, and then ask them if they could patiently wait in the waiting room.
As a seasoned ER nurse I know that my post wasn't remotely the same as some goof who comes into the ER with a ear ache and proceeds to yell, scream whatever. I made a comment,that's all....
My post was really intended for those who were reading.
BTW it's strange that you mention your case. A few months ago I got a 37yr female, stayed home from work "under the weather". Husband came home she was "in bed asleep". He decided to wake her for some dinner and couldn't wake her. Of course she came EMS, unresponsive, but we then found out that she had had a "sinus infection" and it had abscessed into her brain! She ended up ok, after a week on some powerful antibiotics, but wow. I guess I've heard about this happening. I've seen some homeless people with this, but would never have expected it from a young, professional Mom of two with adequate shelter, diet and great health insurance!
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
major snippage here:
do i feel bad for the guy with the ear ache, or the woman who tripped down her stairs and twisted her ankle? sure i do. if there is an open bed, and nothing more serious ahead of her she goes back. it is very rare for us to have open rooms when someone walks in the door and some people act like they just don't believe us! there have been soooooo many times i've wanted to take people by the hand and walk them through the department,..show them the cpr in progress in rm4, the gi bleed in 7 and the 18mo asthmatic who is turning blue, and then ask them if they could patiently wait in the waiting room.
i've never worked in the er, although i've been there a few times both as a patient and as the family member of a patient. the waiting is excrutiating . . . especially when the waiting room is full of those loud, obnoxious and often stinky folks who have exulted drama to an art form. but i'm a nurse and i understand the difference between an excrutiating wait because i'm miserable and a life or limb-threatening emergency. i also understand that the triage nurse and most of the other er staff are doing their best to get everyone seen as quickly as possible.
i work in the icu -- most of our post cardiac surgery patients wake up demanding water and very few of them understand the reason it isn't immediately forthcoming on demand. even some of you who work l & d, nicu, ltc, home health etc. probably don't understand the very good reasons we don't give someone the great big glass of ice water that is their fondest desire the moment we've extubated someone. but -- and here's my point, although i'm taking a long time getting to it -- i expect fellow nurses (whatever your specialty) to understand that we icu nurses have a very good reason for not giving your father, grandmother or uncle exactly what he wants when he wants it. you may not understand the reason (even when i explain it to the best of my ability) but i'd hope that you would trust that i have one. i'm doing my very best for your loved one, and i'd hope that you'd trust that, too. i know that the general public doesn't understand a lot of what happens or doesn't happen in the er, but i would hope that we as nurses would give our colleagues in the er the benefit of every doubt. it irritates the fecal matter right out of me to see fellow nurses trashing er nurses, trying to argue that their pain is special or that the er nurse isn't treating their loved one as specially as they deserve.
i've never worked in the er, although i've been there a few times both as a patient and as the family member of a patient. the waiting is excrutiating . . . especially when the waiting room is full of those loud, obnoxious and often stinky folks who have exulted drama to an art form. but i'm a nurse and i understand the difference between an excrutiating wait because i'm miserable and a life or limb-threatening emergency. i also understand that the triage nurse and most of the other er staff are doing their best to get everyone seen as quickly as possible.
i work in the icu -- most of our post cardiac surgery patients wake up demanding water and very few of them understand the reason it isn't immediately forthcoming on demand. even some of you who work l & d, nicu, ltc, home health etc. probably don't understand the very good reasons we don't give someone the great big glass of ice water that is their fondest desire the moment we've extubated someone. but -- and here's my point, although i'm taking a long time getting to it -- i expect fellow nurses (whatever your specialty) to understand that we icu nurses have a very good reason for not giving your father, grandmother or uncle exactly what he wants when he wants it. you may not understand the reason (even when i explain it to the best of my ability) but i'd hope that you would trust that i have one. i'm doing my very best for your loved one, and i'd hope that you'd trust that, too. i know that the general public doesn't understand a lot of what happens or doesn't happen in the er, but i would hope that we as nurses would give our colleagues in the er the benefit of every doubt. it irritates the fecal matter right out of me to see fellow nurses trashing er nurses, trying to argue that their pain is special or that the er nurse isn't treating their loved one as specially as they deserve.
i've been sick for the past week. belly pain and intermittent nausea. i was running a temp. last week; but that's gotten under better control. food/fluids taste like crap. i feel like ****. i'm exhausted and tired. i ache all over.
but still, i have to endure mr. "my foot really hurts man! it's been hurting all day! we were playing a squash game but it suddenly got worse! it's the worst pain in my life!!!" no tenderness to palpation. good pulses and reflexes. no swelling or edema. intact cms. i ordered the x-ray (per protocol) and it came back negative. doc assessed pt. and released him home (dx: sprained ankle)
i'll spare y'all the ordeal of the actual discharge process (which took 6+ hours.... and ultimately ended up involving the local police department. seriously..... don't ask!!!)
besides, any patient who is cursing at the staff can darn well wait until "please" and "thank you" become a part of their vocabulary!
a cussing/abusive patient moving extremities in threatening gestures? you're describing a "stable patient" there m'am - one with a patent airway (aeb their cussing), with obvious circulation (aeb the beet-red face) and no apparent neuro deficits (aeb the extremity movement); who is also aox3 with their constant complaint about how long they have had to wait in the er!!
"next!"
cheers,
a member of the "heartless/uncompassionate/whathaveyou er/ed nurse" brigade. :icon_roll
Your post is not entirely accurate. While people don't necessarily die from the discomfort of pain, they can and will die from the physiological prolonged effects of pain on their bodies. When a patient is in pain, physiologic systems are altered at many levels and pain can and does cause very serious side effects. Whether it's tachycardia and increased b/p, or other s/s that may be related. And while pain may not mean sick in one person, it can mean deadly in another - ever taken care of a kid with a perf'd bowel or appendix? You are correct, triage works (in most cases), and that those who are coding are priority one.
The OPs situation sucks for her, and this patient was not very understanding. It sucks and there was really no reason for the outburst from the patient. Some patients are like that though, the only people they give a damn about are the ones they see in the mirror every morning. If only we could ship them off to some deserted island in the South Pacific....[/quote
As usual, someone is misinterpreting a post and my original post does not require such a bloviated reply. The point is, no one is dying from minor pain today, here, in my waiting room. The c/o elevated bp and long term adverse of effects of pain are irrelevant in triage in my waiting room. You can triage however you chose, but when I have to go to court and defend my license, it won't be over rushing back an earache related to chronic sinus infection over someone with new left sided weakness, just because the weakness had no pain.
Again, it is EMERGENCY MEDICINE. Anything else can go see their pcp. Oh, wait, they don't have one. That is why there are in the ED clogging up the system.
Furthermore, a child with appendicitis or perfed bowel will have other s&s other than pain. That's why we do a hx, assessment, and are educated to know better. It's callled thorough triage. You are presumptuous to assume I don't know better.
Thanks to those of you that commented and understood where I am coming from. I sometimes get so upset on this forum, even though I try hard not too.
I was really enjoying this post, us ranting, venting, and discussing the non-life threatening, usually really non-exsistant whiney, drug seekers thinking they are able to demand things over real emergencies because they are entitled. It was nice for a moment, someone talked about the stupid earache guy, the lady with the boo-boo on her finger, the demanding dad, all interrupting codes. It was nice to discuss these idiots with other er nurses who get the point of a thread like this. Then we have people come in and think we need educated about pain and how it can be deadly, and worse than that we have people who undermind our triaging and general nursing expertise by telling us how we shouldn't blow off things because we may kill someone. I don't need educated, I have 13 years er assessment skills gained at a level 1 trauma center that is among the top 5 in the country, I have had questions in the past-and I ask them, or go to a previous post and read up on things, I don't go changing up a post to try and appear holier than thou. No, I come here to listen, laugh, and rant about my job (especially to laugh), and in a post like this I think that we should be able to do that. I hate when a great post goes bad because someone feels we are cruel and uncaring or are not being throrough and causing harm.
By the way, even after their enlightenment- I still hate whiney patients who wouldn't know pain or an emergency if it slapped them in the face, I still hate those who feel a sense of entitlement, and I HATE drug seekers!!! :banghead::banghead::banghead::banghead:
Thanks to those of you that commented and understood where I am coming from. I sometimes get so upset on this forum, even though I try hard not too.
I was really enjoying this post, us ranting, venting, and discussing the non-life threatening, usually really non-exsistant whiney, drug seekers thinking they are able to demand things over real emergencies because they are entitled. It was nice for a moment, someone talked about the stupid earache guy, the lady with the boo-boo on her finger, the demanding dad, all interrupting codes. It was nice to discuss these idiots with other er nurses who get the point of a thread like this. Then we have people come in and think we need educated about pain and how it can be deadly, and worse than that we have people who undermind our triaging and general nursing expertise by telling us how we shouldn't blow off things because we may kill someone. I don't need educated, I have 13 years er assessment skills gained at a level 1 trauma center that is among the top 5 in the country, I have had questions in the past-and I ask them, or go to a previous post and read up on things, I don't go changing up a post to try and appear holier than thou. No, I come here to listen, laugh, and rant about my job (especially to laugh), and in a post like this I think that we should be able to do that. I hate when a great post goes bad because someone feels we are cruel and uncaring or are not being throrough and causing harm.
By the way, even after their enlightenment- I still hate whiney patients who wouldn't know pain or an emergency if it slapped them in the face, I still hate those who feel a sense of entitlement, and I HATE drug seekers!!! :banghead::banghead::banghead::banghead:
Yeah I totally agree with you. Just the other day I had a family member call regarding his FIL who had come in for HA he has had for 3 weeks shouting at me on the phone because a neurosurgeon hadn't seen him in the ER. By the time I was ready to hang up on this jerk, he had already threatened to come down to the ER to kick my a## if I didn't have the neurosurgeon see him. The guy was discharged with scripts, etc. but what I liked about the whole thing was when the son in law attempted to come back to his FIL's room I had already made arrangements to block that from happening with security because he threatened me. The entitlement mentality really irks me too. This thread I think will go on for quite sometime. It's nice to beable to vent to fellow ER nurses as we all know what going on. We all see it.
I think its our years of experience that allow us to see the good, the bad and the ugly.... and to know which is really which and to use our knowledge to weed out the players.
We have lots of drug seekers here, and I think that my knowledge level is high enough that when one of them comes in with a medical emergency, vs the usual need for narcotics, I deal with them on that level and provide them with excellent professional care.
It drives me nuts when people (other nurses, the public, whoever) decide to make assumptions about the care I am giving. I was assaulted by a patient in December, do you really think the next time she comes to the ER with her "excrutiating pain", that I am going to deal nicely with her??
:banghead:
TraumaNurseRN
497 Posts
Yes, you are right we weren't talking, but with an open forum I felt putting my experience in about the earache gave a different perspective.