WHAT is wrong with my ER??? Grrrr...

**canoehead, BSN, RN** · Jan 7, 2003

Initially I thought you worked in the ER, but on the floor all you can do is assess carefully and create a paper trail. By the way, social admits happen all the time at our hospital too, especially from LTC on a Fri night when they get tired of dealing with someone they just refuse to take them back. Apparently the hospital is the only place that can't say no, legally.

fab4fan · Jan 7, 2003

The guy with abd. pain/N/V/D could have been admitted to observe for things that may have shown up hours later. And if the pt. was feeling really sick, would have had problems caring for himself, and had no one willing to help him at home, then you have an unsafe discharge situation. It does seem ridiculous, but what if he went home, was alone, tried to get up, was dizzy, fell, hit his head, had a bleed...do you see where I am going with this? It does seem dumb, I agree.

The other pt., what can you say. Things do get overlooked, and if she came in saying she just hit her head, things in the ED were busy...I can see how that might have happened (not that it makes it right). Also, I can't tell you how many times an alert/oriented pt. will tell us one thing, then tell the doc another, then the doc comes back and says, "Why didn't you tell me about XYZ?"

Every department misses things; we're human. It's hard to believe that everyone there is a goofball, but, I don't work there, so I don't know your situation. Did you fill out an incident report on the elderly woman? Have you discussed your concerns with your NM?

Also, the ED does not decide admissions; that's up to the attending.

Sorry if I sound a little testy, but I do get tired of the ED being blamed for everyone's woes. Most of us are trying to do the best we can, and we don't have the luxury of telling an ambulance to wait to bring a pt. in because we're busy; often we are also holding pts that should have been admitted, so we're trying to do floor nursing and ED nursing at the same time. As far as assessment, if a pt comes in c/o a sore throat, I don't do a head to toe assessment...I don't know any ED nurse who does. You do what is pertinent; if we did head to toe assessments on everyone who came in, we'd still be working on pts. from 4y ago.

Sorry you've had such bad experiences.

Dr. Kate, BSN, RN · Jan 7, 2003

Sometimes it just seems that everyone takes stupid pills and works hard at being dumber than dirt.

Out here we can always blame the santa ana winds. But the phase of the moon, tilt of the earth, sunspots, they all work.

Poor assessment in the ER brings home why it is essential for every patient to be assessed by an RN on admission. People are human and things get missed. And there is always the whole raft of things the patient just happens not to share with anyone.

l.rae · Jan 8, 2003

Originally posted by fab4fan

Also, the ED does not decide admissions; that's up to the attending.

Sorry if I sound a little testy, but I do get tired of the ED being blamed for everyone's woes. Most of us are trying to do the best we can, and we don't have the luxury of telling an ambulance to wait to bring a pt. in because we're busy; often we are also holding pts that should have been admitted, so we're trying to do floor nursing and ED nursing at the same time. As far as assessment, if a pt comes in c/o a sore throat, I don't do a head to toe assessment...I don't know any ED nurse who does. You do what is pertinent; if we did head to toe assessments on everyone who came in, we'd still be working on pts. from 4y ago.

Sorry you've had such bad experiences.

a big AMEN from me fab4!....l will conceed that we get some real screwball admits in our ER too.....stupid residents, not the nurses fault. Floor nurses have a hard time understanding that ER assessments are focused assessments....if a A&Ox3 pt says l have no other pain/injuries, l generally take their word for it..... got a broken toe?....if pt is pink and eupnic...l don't get a sat and listen to breath sounds...get the picture?....when squads are coming in left and right with critical pts, head to toes are not apprropriate for every ER pt;)

Scavenger'sWife, RN · Jan 8, 2003

A Huge Thank You to you guys

I had a bad day and I needed to vent..........

You guys were correct. I will now accept my twenty lashes with a tourniquet...

This is why I love this BB.....You screwed my head back on straight, but did NOT yell at me personally.

I will now revert to my former sweet, loving self...:chuckle

DIPLOMATICRN4HIRE, MSN, RN · Jan 9, 2003

Honey we would never be so generous to beat you with the IV tourniquet lol Its the IV tubing lol

It was a bad day and yes there are times where you must inhale and exhale and wonder what kind of day the person that just sent you that patient had. Its hard when I worked ER , there were times you prayed that if it would just slow down one minute you could do all that could be done, but it never does.

Vent away it allows you to let go of that days crap and you will have a brighter tomorrow. Vent Girl Vent.

Hugs to ya for being a great nurse

Zoe

Sally_ICURN · Jan 10, 2003

My daughter, who's an asthmatic, walks into a Kaiser ED. I parked the car while her boyfriend went in with her. She's audibly gasping for air and in panic mode because she can't breathe. Her inhaler isn't doing crap. When I walked in, to my utter and complete shock, there she and her boyfriend was sitting in the waiting area, both with looks of complete fear in their faces! When I asked what the hell was going on, the boyfriend told me that the triage area took her vitals and then they were told to go and have a seat and to let them know if it got any worse!?!?!?!?!?!

WTFFittyFF? And that's EXACTLY what I said to the triage person. Of course after that, they immediately took her back.

Don't get me wrong, I'm a nurse, I totally feel for my overworked, stressed out, unappreciated, underpaid, disrespected, etc., etc., colleagues out there, but this was just plain negligence and unbelievable stupidity on the part of the triage person!!!!!!!!!!

Trauma Columnist · Jan 10, 2003

I'm an ER charge nurse in level one trauma center who is sometimes so overwhelmed that yes (unfortunately) people have to wait. Not people with resp distress of course. Whatever happened to across the room assessment???

In our large hospital - we hold pts out the wazzoo sometimes - last night we had five ICU admits I had to keep for up to five hours before bed could be cleared.

And...I hate to say it but its gonna get worse.

Flo1216 · Jan 10, 2003

I am doing my ER rotation right now and yesterday I was in triage. A 45 year old woman came in and was complaining of sudden, severe headache, right- sided weakness and numbness and tingling in the right side. Her vitals were all normal but I put her as emergent based on what she told me. She was also crying. The RN who I was assigned to disagreed with my putting her as emergent, because her vitals were normal. But she(the pt) also has a hx of HTN and had taken her BP med that morning. The nurse has about 20 years experience on me, so of course I am now second-guessing myself. If she had just complained of the headache and her vitals were normal, I may have thought migraine and downgraded her from emergent but based on her other symptoms I thought STROKE or ANEURYSM and put her as emergent. I figure she could always be downgraded from emergent later but if I had put her in fast track and she threw a clot or something, I don't think I would be able to live with myself. The nurse felt this was a woman trying to get out of work. I thought if that were the case, she was going to extremes, you know? I think if I had to do it again, I probably would have made the same decision. I would rather be accused of overreacting rather than be accused of being negligent. What would YOU have done? :confused:

emily_mom · Jan 10, 2003

Flo,

You neglected to tell us the outcome.

Kristy

Flo1216 · Jan 10, 2003

Last summer I stumbled into the ER with SEVERE abdominal pain. I was greeted by the registrar who rolled her eyes and me and told the security guard he shouldn't have opened the door, as if I were bothering her. She then took my insurance info and sent me into the waiting room for an hour where I ran back and forth to the bathroom evacuating from both ends. I almost passed out. I never saw a nurse or anything or even had my vitals taken. Also I was the only one in the waiting room.I could have collapsed and no one would have known. I don't know where the securty guard went. Once the nurse came in and got me(an hour later), everything was fine and I was treated appropriately. My question is, why is the registrar my initial encounter? In the ER where I work, pts sign in and then the nurse calls them , does vitals , etc. Is this common practice? What if I had a ruptured appendix or something and based on the registrar's asessment I am sent to the waiting room to die? It was weird.