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

Flo1216 · Jan 10, 2003

Emily, I don't know the outcome because I was in triage and it was insane. I asked about her as soon as I got the chance and I think they had taken her up to catscan. I don't know what happened after that. I know when I left she wasn't there, so I don't know if she was admitted or what. I mean, for her sake I hope it was nothing but I just feel more comfortable erring on the side of caution. My best friend's father went to the ER 3X complaining of chest pain and 3 times they sent him home. I don't know what kind of tests he had(I wish I did) but they kept telling him he had heartburn and gave me an antacid. Well, after the 3rd time, he went home and had a massive MI. Luckily he survived and now has an implantable defibrillator.

fab4fan · Jan 10, 2003

Does this really have to turn into a "trash the ED nurses" thread?

We're doing the best we can, under many times impossible conditions.

I could say horrible things about other departments, too, but it really doesn't help US as a profession. We need to have a little more understanding for each other; no nurse, no department is perfect.

Flo1216 · Jan 10, 2003

I wasn't complaining about the ED nurses...I was complaining about the registrar:) The nurses were fine. This IS a place to vent, though.

essarge · Jan 10, 2003

I work in the ER as a nurse extern/tech and one of the things that I see happen quite a lot is that patients who are "frequent flyers" are ignored/steriotyped etc. This happens mainly with the staff that has been there a while. An excellent example follows:

45 yo male arrived by POV with wife and brother CO severe chest pains. He stated over and over "I know it's a heart attack". They did bring him back immediately and placed him in a trauma bed. Then the nurse assigned came in, looked at me and stated "he's an attention seeker, he's fine I'm sure", and left the room. The other tech that was in there looked at me and we made the patient as comfortable as possible.

A while later his wife came out and stated that the patient has vomited so the other tech and I went in. The patient was in extreme pain, barely conscious, and had projectile vomiting. The wife stated that no one had come in to see him or done any vitals on him yet (this was an hour after he came in). I reported this to the charge and was told to move him into a cubby because they had a rig coming in with a trauma someone would be with him shortly.

The patient continued to vomit and was in and out of consciousness. I repeated told the charge about this and they still did nothing because he was an "attention seeker". As I was checking to see if he was ok (on my own and a full two hours after he had gotten to the ER) the patient started to posture and I yelled "I need help in here!!!!!!".....the patient was coding.

To make a long story short, the patient was ok and was discharged from the hospital after having a massive MI. I went to the NM with this and told her what happened. I don't know what, if anything was done, but I suspect it was a slap on the wrist. This nurse is still working there.

I have never, nor will I ever, assume that nothing is wrong when someone comes in to the ER (frequent flyer or not) and people that do are dangerous and should not be working in the healthcare field or anywhere near it!!!!!

just my two cents worth:)

BBFRN, BSN, PhD · Jan 11, 2003

Sometimes I'm thankful to have a patient with "nothing" wrong with them as opposed to 8 or 9 with high accuity. Less work to do with them.

Sally_ICURN · Jan 11, 2003

Originally posted by fab4fan
Does this really have to turn into a "trash the ED nurses" thread?

In my opinion, I don't think anyone is trashing anyone else. These are all very real experiences and don't necessarily reflect upon all ER nurses and I don't believe they are meant to do so.

I appreciate what goes on out there. Really, I do. And thank you so much for having the stamina to work in sometimes unbearable conditions!

~Sally :cool:

Scavenger'sWife, RN · Jan 11, 2003

You guys are correct.... no one here is trashing the ER nurses....You who work in the ER deserve an award. I think we could really develop a mutual admiration society here, b/c we who work med-surg say "I couldn't work ER!" (Or OB or....etc.) Those who work ER say, "I couldn't work Med-Surg!" So we all have our areas we feel as a comfort zone, or love working.

We have some AWESOME ER nurses at my hospital. Some of the MD's just ...well....what can I say.

Case in point (personal): I went to ER several months ago w pyelonephritis and bronchitis, dehydration, nausea/vomiting. The ER MD gave me *NO* IVF or ATB....just po tylenol and Bactrim and d/c me. The ER RN was scared and kept telling me to BE SURE to come back if I wasn't better in a few hours.

ITSJUSTMEZOE: *THANK YOU* for the love! I could feel your hugzz thro the computer!!! Vent on me anytime, sweetie! :kiss

l.rae · Jan 11, 2003

Originally posted by Flo1216
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.

This would be a huge EMTLA violation. When it is insanely busy and l have critical pt's walking in the front door, sometimes l listen in as they are speaking to registration..which is right by my desk...look them over and SOMETIMES THAT is my first medical screening......especially if someone else is clutching their chest and gasping for air and turning blue....even then, a belly pain that is a&O x 4 and walking around is not the priority....IDEAL= pt sees nurse first, then registers, EMTLA law states no billing/insurance info can be given until pt has had a medical screening....the definition of medical screening is left open...an across the room eyeball CAN be a screening but must be used judiciously. as one time a mom came running in with her 8 yo son stating he couldn't breath....one look and l know that not only was he breathing...he was breathing easily...pink calm talking, didn't even look ill. so l take his sao2, listen to breath sounds, ask mom why she thinks this,,,,she says his throat is too swollen to breath...so l look at throat....yes it is swollen l tell her, but is not interfering with his breathing at all, that he is fine, will have a while to wait, but he would be ok.....she didn't like this....she sits with a chick who c/o abd pain.....she had to wait for several more critical pt's to be taken back in front of her, out to smoke frequently......in the end, these 2 idiots bonded and traded phone numbers, so one could buy morphine from the other....all this right out in the waiting room....geesh. :rolleyes: ....anyway they went on to tell the supervisor that l ignored them blah blah blah.....

And there are some bad ER's...the hosp a few miles down the road is constantly telling pt's that the wait is long why don't they just come on down to ________ Hospital.....turned away a chest pain like that once....was a full blown MI!...so it does happen.

Well, having said all this l will say that l think ER nurses and ER nursing is the least understood specialties out there, by public and other nurses........we are a "different'' breed....and ER nursing is a strange animal.

bagladyrn, RN · Jan 11, 2003

This is not a story to trash an ER - except maybe the doc in question who was obviously too busy to do an assessment. A girl came into our hospital ER after visiting the ER in a neighboring county. She had gone with a complaint of severe abd. pain (red flag anyone?) Doc there had ordered a urinalysis and c&s and given her a prescription for antibiotics. When her distress became worse, her parents brought her to us. The ER nurse at our hospital could spot 'em from across the parking lot and sent her directly to our unit. Later that night we were able to call the other hospital and tell them that their UTI weighed 7 pounds!

Flo1216 · Jan 11, 2003

Wow...I didn't know that. The registrar is in a separate room that you cannot see into, like it is separate from the ER so yeah it was just me and the registrar. And as she was taking my insurance info, I told her I was going to throw up and she goes, " Oh, no don't do that," So I did. All over the floor.

2banurse · Jan 11, 2003

Good for you Flo! Too bad it wasn't over her shoes.

I had volunteered at the ED of one of our hospitals and when people would come through the doors, we would go to them and ask if they were experiencing any chest pain, SOB, etc. We would have a wheelchair for them to sit in and then would bring the patient immediately to the attention of the triage nurse. Others who came in not in outward distress would be given the necessary paperwork and then they would be seen by the triage nurses and directed to either the main ER waiting room or the Fast track waiting room in which we would direct them, many times accompanying them.

Any ins. info etc. would be taken after they have been given a bed in the ER.

Kris

KaroSnowQueen, RN · Jan 11, 2003

My daughter went to the ER with pyelonephritis. They wanted to treat her for meningitis???? She called me to come and talk to the dr. (She was barely 18). The ER dr. got sh***y with me and told me basically that he was THE dr. on call and what HE said went. Well, a lumbar puncture on a kid with no symptoms is not what I think of as necessary. (No head/neck pain, full ROM of neck, pain in mid to lower back, fever, frequency and pain with urination -HELLO!). I informed him he MIGHT be the only doc in that ER but he wasn't the only one in the metro area and went to another ER.

There she was triaged by a nurse first, then sent ME to register. She was in an ER bed within forty five minutes, being given ABT within an hour and a half, and bookoo demerol within two hours for kidney stones.

Moral of the story, some places truly do have idiots working in the ER. Just like any other facility, ER's are not perfect. I felt fortunate that I knew enough and felt enough confidence to take her on to another facility. What about the other people who think the dr. knows everything? I know most of us try to do the best we can for our patients, but some people REALLY ought to be in a different profession.

BTW, the first ER doc was known to me. He sent my 14 year old stepson home with 50 mg Phenergan q4h around the clock, see your PCP in the am. He had a ruptured appendix and spent eight days in the hospital, because my husband believed the doc and not me. I took the kid straight back to the ER and told them not to let that fool near us, to call someone else. This was eight years ago and he's still in there doing stupid stuff. He also had the gall to send a bill for his services (WTF?) while the kid was still admitted. I made a impassioned speech in his waiting room when I presented the bill back to them. He did not get paid and did not send any more bills either.