last night we had 65 patients in the 12 hours I worked.
12 of them had chronic back pain
3 had migraines
7 dental pains
13 abdominal pains - 5 of which had more than one ER visit in the last 7 days
6 chest pains- one of these patients was a dialysis patient who had kidney failure d/t untreated HTN who would rather smoke crack than go to dialysis.
2 stroke symptoms
4 toddlers with fever, none of which were in any distress and none of which were given any tylenol or ibuprofen at home.
1 patient with new onset atrial fibrillation
4 senior citizens with pneumonia - one whose family wanted everything done despite the fact that she was severely demented - didn't recognize any of the family and was bed-ridden in a nursing home.
1 senior citizen with altered mental status d/t a UTI
the rest had various other complaints none of which needed an ER visit.
Out of 65 patients 12 were admitted. Of those twelve, 7 had severe chronic medical problems related to smoking, drug abuse or non-compliance with treatment.
At least 40 of them had no emergency medical condition at all. 27 of those visits were paid for by Med-i-cal - meaning you and me. Eight of those came in by ambulance - also paid for by you and me.
You can talk socialized medicine all you want - in my opinion we already have socialized medicine -EMTALA and Medi-Cal which has lead to rampant abuse of the ER. Socialized medicine will only make that worse unless something is done to fix the underlying problems, people need to be told NO sometimes.
NO, we are not going to continue paying for your dialysis since you chose to be non-compliant by not taking your med's or coming to your appointments.
NO, we are not going to provide millions of dollars of intensive care to treat a contracted, demented nursing home patient who has no cognitive abilities or quality of life. We are going to keep them pain free and let them die with some dignity.
NO, you can not come to the ER with your chronic pain. You can go to the clinic. Took your months worth of pain meds in two weeks? Too bad.
NO, we will not pay for anymore treatment for your smoking related problems as long as you continue to smoke.
NO, the government cannot cut any further mental health dollars and in fact - they shall be forced to fund a mental heath hospital with their own urgent care that is open 24 hours a day. There will be a clinic in every community of greater than 30,000 residents. Cutting funding to mental health has not saved a dollar. In fact it has cost us billions of dollars in repeated ER visits, increased drug abuse, incarcerations, homlessness and crime.
NO, drunks cannot come to the ER -they will go immediately to the drunk tank. BILLIONS of our tax dollars are spent every year on chronic drunks who drink themselves into a stupor daily then pass out on the sidewalk and end up in the ER. If you demonstrate a trend for this then you will be incarcerated since you obviously cannot take care of yourself.
NO, we will not pay for obesity related illnesses if you are doing nothing to help yourself. Trying to eat healthy and exercise OK otherwise you are on your own.
NO, you cannot call an ambulance for a non-urgent problem. It is ridiculous how many people come in by ambulance every day for non-emergencies.
Until we expect people to have some personal responsibility we will just continue bankrupting our country. Giving people unlimited access to free will just continue to allow them to have no responsibility for their actions. The government will continue to tax the hell out of those of us that work and are responsible to pay for those that are not. I don't know about you but I am getting a little tired of that.
Friday, May 8, 2009
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35 comments:
Those are all great ideas! Why aren't you in charge??
AMEN! You said it! I vote for you in charge!
Found your blog on RealityRN.com. As an ER nurse, I feel your pain!!! I work in a very low-income area so half of my time is spent dealing w/ patients who delayed care b/c they couldn't afford it and now are really sick, and those who come every day and aren't actually sick.
The situation is getting worse and worse.... I agree w/ you 100%!!
Amen, sister.
Especially the part:
NO, you cannot call an ambulance for a non-urgent problem. It is ridiculous how many people come in by ambulance every day for non-emergencies.
One thing that's always struck me about "free" healthcare vs. private insurance is that the former seems to pay for ambulance "rides" no matter what.
Getting a free ride to the hospital seems to embolden the EMS Abuser's sense of entitlement, such that our (EMS) attempts to educate folks on proper use of EMS are met with belligerence.
Many private insurers only pay for EMS transport for legitimate medical emergencies; if they deem it's not an emergency, the insured is responsible for the bill.
It'd surely cut down on frivolous ambulance rides if EMS abusers were stuck with the bills.
If someone calls 911, I've got no problem showing up. However, if there is no medical emergency, I wish it were in our authority to tell folks that they'd need to arrange for a different mode of transport, & encourage use of a PCP rather than ER.
I'd like to remind everyone that EMTALA doesn't apply to 9-1-1 ambulance calls. You CAN get an order to not transport if the EMS director isn't a pantywaist.
I don't agree with everything said but wholly endorse a quick medical screening exam on chronic pain patients, drug seekers, people with multiple repeat visits, and nonemergent conditions. This covers you on the EMTALA front. They can decide if they want to be seen for the problem and then pay for the visit if they want. Unless hospitals allow us to do this though, our hands are tied. Ours does not at this point for fear of creating a "Bad vibe in the community". Whatever.
Not only am I a critical care nurse but i get floated to the ER also. On top of that I am a volunteer fireman and most of my calls are ems calls. I became a volunteer to see people who really needed my help. Well with that said I couldn't agree more with people calling for problems they could of taken care of themselves. Now I get to take care of people in the hospital who have at least 2/3 of the time put themselves there because they didn't care of themselves and now want us to take care of them. And on top of that I take my own free time with my family to stop what I am doing and run to someones house in an emergent fasion to find out that I just left my dinner on the table to take care of someone who is diabetic and just binged on 2 pizza's with ice cream wrappers all over the floor (with an estimated body weight of 400lbs) with their sugar 450. Now I am gonna bring them to the hospital so the overwhelmed ER nurse can stop taking care of the acute asmatic patient so she can "take care of the person who took my free time and now is taking the ER nurse's possible lunch time (yeah right)to help someone who WOULDN'T STEP AWAY FROM THE FOOD"
We can get the ER nurse to slap a stamp on these people: "Drunk", "Addict", "Fattie", "Waste of Money", right on the forehead.
Then, fill up a bus. Ship them off to a camp, where they can dry out, slim down, kick the habit. Those who won't work don't eat. Those who can't work don't eat. Showers for everyone.
Amen...all is so true! enjoyed the blog..hey add a follower gadget..easier to follow u
I agree with your post for the most part. I dont work ER but am an RN on a med-surge, oncology floor. Frankly Im tired of taking care of ppl that come in and want their pain meds. Let me say first that these meds are PRN, but they act like if your a minute late even if they are sleep and dont request them, you have broken the law and they call your supervisor and complain. If you try to get them to follow the doctors orders such as ambulating and getting out of bed, they call your supervisor and complain. In this day and age of customer service instead of acutual nursing we are left with no choice but to become leagalize drug pushers or face disiplinary action. I like my job, I like helping ppl. But attitudes like these are a big hinderence.
This post is screaming with common sense. No wonder none of it has been implemented.
First, my story. I have been self-employed for years. Finally got private insurance in 1992. I have not had a major claim on my policy EVER and have not had any claim (other than yearly physical) since 2002.
My mortgage is $X per month. I have a $5,000 deductible on my health insurance, but even with that, my monthly health insurance premium is $0.5X.
What is wrong with this picture?
NO, we are not going to continue paying for your dialysis since you chose to be non-compliant by not taking your med's or coming to your appointments.
As a person with zero health care training, I agree with this.
NO, we are not going to provide millions of dollars of intensive care to treat a contracted, demented nursing home patient who has no cognitive abilities or quality of life. We are going to keep them pain free and let them die with some dignity.
This one makes me nervous, ethically. In the stark terms that you lay out, I agree...but where is the clear dividing line? Who is to determine no cognitive abilities or quality of life. -- well it is somewhat easier with an elderly patient who used to be able to do X, and can no longer do X....but what about a child? "useless lives"?
NO, you can not come to the ER with your chronic pain. You can go to the clinic. Took your months worth of pain meds in two weeks? Too bad.I am so with you....mostly. The drug seekers poison the well.
NO, we will not pay for anymore treatment for your smoking related problems as long as you continue to smoke.
Yup.
NO, the government cannot cut any further mental health dollars and in fact - they shall be forced to fund a mental heath hospital with their own urgent care that is open 24 hours a day. There will be a clinic in every community of greater than 30,000 residents. Cutting funding to mental health has not saved a dollar. In fact it has cost us billions of dollars in repeated ER visits, increased drug abuse, incarcerations, homlessness and crime.Agree 100% -- county jail is NOT a good substitue for community-based care for the mentally ill.
NO, drunks cannot come to the ER -they will go immediately to the drunk tank. BILLIONS of our tax dollars are spent every year on chronic drunks who drink themselves into a stupor daily then pass out on the sidewalk and end up in the ER. If you demonstrate a trend for this then you will be incarcerated since you obviously cannot take care of yourself.
Personally I number "chronic drunks" in the "mentally ill" category -- self-medicating mentally ill.
NO, we will not pay for obesity related illnesses if you are doing nothing to help yourself. Trying to eat healthy and exercise OK otherwise you are on your own.
While in principle I agree with this, how do you prove that an obese person is trying to become non-obese, or less obese?
NO, you cannot call an ambulance for a non-urgent problem. It is ridiculous how many people come in by ambulance every day for non-emergencies.
Agree 100%.
I have been an ER nurse now for 3 months and EVERYTHING you said rings true. What are we doing? Why is it that I spend half my time on patients that don't need anything but a smack on the back of the head, and instead I'm restraining the angry drunk, medicating the drug seeker, telling the way too young mom to go home with her toddler that coughed 3 times and now apparently has swine flu. I don't understand how we continue to throw money down the drain on these people. I've been a nurse for 3 months now, and I got into it to save lives- and instead I'm hanging banana bags and helping to intubate patients that have overdosed on crystal meth. It's pure insanity.
I hate dealing with these patients. I really do. It is this same theme where I am stuck taking care of patients who fundamentally refuse to take care of themselves. If they actually paid me to do it, and not have to go back and chase the gov for a 10% reimbursement rate, then it would be a different story. The thing is that this is not customer service. That is a fundamentally flawed model.
When I am *forced* to do things because money will be taken from me that was never given in the first place, it is extortion.
Yes, if we want to reform healthcare, then we must not succumb to the seduction of socialized/universal/one payer healthcare.
We must, instead, apply common sense.
I would add that we need to place a walk-in fee on the EC. Cash. Up front. Nothing big, but enough that people will not whimsically go to the EC, which has become all things to all people. Say, $35. That's enough to make someone go to their PMP, if they can. It's not so much to keep someone from coming in if they are really hurting, but it is enough to keep the chronic pain folks from coming to the EC begging for dilaudid. I think.
I think that EMS crews should have some say in whether patients need transport. I remember working on a rig and having patients calling an ambulance because they didn't want to pay for a cab. Hell, I remember a group home calling an ambulance because they didn't want to pay to gas up their car to take someone to a scheduled appointment.
Bah! enough whining from me.
Greta Post!
These are profound facts of the ER that we, the EMS provider, see each and every day. The problem I see is that the people writing the rules for our industry (Washing ton D.C.) do not work in the trenches and have no idea of how rampant the abuse is.
I am a FF and let me take it one step further for you. We pull up on scene and once we make “Patient” contact we find the “Patient” has a cough, cold or some OTC treatable problem that EMS transports the “Patient” to the ER for. Call is over and now we are walking out the door of the house, in the “Economically depressed area”, with a huge big screen TV, ipods, video games and various items I worked hard to buy for my family, and there sitting in the driveway are anywhere from one to four cars that could have been used to transport the “Patient” to the ER.
Co-pay for Ambulance service that comes directly out of ones entitlement check or the co-pay is due upon determination by the EMS provider that the incident is non-life threatening, would do wonders for this situation.
I am of the humble opinion that with my field experience and EMS training, I can determine between life threatening and general illnesses. This said, give me the authority to release the ambulance and give the “Patient” a voucher for a cab ride. Oh Yeah, and the ride does not go to the ER where it clogs a vital community service. A community service that saves lives; a service that does not need to be fatigued with unwarranted “Patients”; a service that does not need cold and flu viruses added to the environment where a “true patient” may be fighting for their very life. The ride goes to a twenty-four hour clinic.
This clinic could be staffed with helpers who are entitlement recipients that have to provide community service as part of the entitlement program. This way we would at least be getting something for our tax dollars.
At some point America has to wake up to the fact that it is wrong to be able to sit around watching TV, on an ever growing rear-end, and all the while earning more than minimum wage for doing so.
Thanks
As both a RN and Registered social worker, I completely agree. People need to take responsibility for themselves and their actions. I hate to say that the government should get involved, but they need to something so that we, as tax payers don't have to pay for these irresponsible people who refuse to act appropriately and follow their medical treatment or maintain sobriety.
I am sure this post would have to be my ED - and I am not in the US.
What irritates me - every very busy shift, reduced staffing, no beds in the ED.
we get
some fat woman with a 'migraine' who wants to be seen immediately and always has the overly concerned relatives who hassle the busy nurses about when will the patient get a injection because 'she's in so much pain'.
these patients never bother to take anything at home and are in typically poor health due to their over indulgent lifestyle.
Yep - we get them without fail, every frantically busy shift. Makes me wonder if patients out there do it deliberately just to make the life of our ED staff more difficult and miserable than it is already
Geez, you really are a hateful, petty, burned out individual, aren't you? God forbid you take a minute out of your shift to deal with drunks, people needing painmeds, and other things that might seem petty to you, but are an emergency to the people involved. I've met lots of great nurses over the years, thank god I've only run into a handful burned out shrews like you!
i cant believe u can dispute the posts here. Ridiculous. Its not that we dont want to deal with drunks, or people needing pain meds. We are talking about the big picture here . You obviously do not work in a hospital ( at least not more than a few months )and have no clue what is going on .
I agree!! People can be such babies sometimes. They need to tell those people who are "frequent flyers" no, go see your doc tomorrow! And tell those people who call the ambulance to call a taxi instead.
I can not imagine a more demanding job! You all have made a very brave career choice, and I so appreciate you all!
I just hope that you will remember that there will always be damaged people, emotionally and mentally.
I know a high number of people who are addicted to food, alcohol, cigarettes, drugs, and bad relationships. They all have sicknesses related to the abuse they've put their bodies through. They all have medical bills they can't afford to pay.
Most of them were physically abused as kids. Most of them grew up in homes where this lifestyle was the norm.
I hope that you find a way to nurture yourselves so that you don't loose the compassion that drove you to choose this career. We need you!
I completely agree. Make noncompliant diabeticsm smokers, and obese people pay for their own treatment!
100% correct!!!!!!!!!!
Ever thought about reviewing your career choices? I think you should.
Amen, Sister! I work in PACU and have seen so many unnecessary appy's that turn out to be nothing. We do a lot of self-pay clients. Well, make that no pay. Also lot of Passport (KY's state insurance). Many of them really know how to work the system. When someone can tell me more about the drugs I am giving than the pharmacist, I get really aggravated and want to give them nothing. But, I do it with a smile.....
I'd think you worked in my ER but we see WAY more than 65 patients per shift. The kids with fevers probably irritates me as much as the chronic painer out of med arriving via ambulance.
AMEN!!! I couldn't have said it any better myself!! If patients had the choice to pay for services in the ER or wait until their pcp opened up the next morning...I think we all know that the ER wouldn't be near as busy as it is now!!! It amazes me everyday how many people will bring their 5 month old in at 3 am for an earache that they've had for a week, but now...it's an emergency. Kid's not crying, no s/s of any problems, but mom thinks now's a good time to take care of this? WTH?
AMEN!
I agree with a lot of what you say in your blog. As a fellow emerg nurse - have seen it all.
However, "socialized" health care - as in what they have in Canada and most of civilized Europe has statitsically shown to have good health outcomes for the population. People live longer, healthier lives. And in most countries, spend LESS per capita than those in the US.
I, just as much as anyone, would love to see ER abuses gone, but cutting really healthcare to the masses is what is what keeps the US at the bottom of the first world countries when it comes to health.
I applaud you and all of the ER nurses out there.
I am an RN that works on a med/surg oncology unit. We get ER admits when our census is low from the ED. Most of the middle of the night admits are chronic pancreatitis, abdominal pain and the like. As I work up the admit I find that they are homeless and needed a few days of food, a drug seeker wanting a fix, or a chronic alcoholic that has killed their liver and pancreas. I usually spend more time running for the ridiculous requests for more pain meds and coffee in the middle of the night than I do taking care of my acutely ill, or perhaps dying oncology patients. We actually can identify the frequest flyers by name when the transfer report comes up from the ED. I think we should give a bonus to the admitting physicians for not admitting these types of patients that are not acutely ill and could have managed the illness at home. I also believe that the ER should be for ER only. Since the government wants to get into the thick of this dilemma, I say good luck.
This is why there is a nursing shortage. We get burned out too fast because of the abusers so that the real patients can't get the care they so richly deserve. As a child I was told no often, as a parent I tell my children no, maybe it's time we started telling adults that have no common sense "NO".
As a nurse in Tanzania (from the US) today I saw a young lady - 13 years old, who has been limping around on a broken foot for two days because her family could not afford the $5 medical treatment here (for x-ray and physician consult)... and still, although she got that today, the only doctor in the area who can put a cast on will not be in until Monday! So, off she goes with the splint that I put on her foot. I just wish I had the money for the cost of one EMS ride to buy supplies to do it myself!
The Problem for people who don't do our kind of work is they think were burned out or are bad nurses, when that couldn't be farther from the truth. Also what they don't understand is all these unnecessary ED visits is why our healthcare cost are through the roof. I have myself taken a patient out side when he came to the ED at two in the afternoon on a tuesday with a tooth ache and said well F*@K me I thought i worked in a hospital not a dentist office, handed him a script to go see his dentist and left him standing in the ambulance bay mouth wide open...written up...yes...but the feeling it gave me priceless!
I must say that I do agree with some of the comments, but not all of them. I'm a nursing student, I don't work. I haven't had insurance in 3 years. I don't have a PCP. Due to lack of ability to pay, I can't go to urgent care. I can't get medicaid. Where does that leave me? I have to go to the ER. And since I'm not qualified yet, how do people know that some problem they are having isn't an emergency. I just went to the ER last semester, via ambulance, for PVC's. It scared me and I didn't have a vehicle to get to the hosp and my boyfriends kids were here and I couldn't just leave them here. I was always told that nurses don't know who does or doesn't have insurance. Is it really our job to know? We should provide the best care we can regardless of the pt's ability to pay. People that don't work in the ER are paying for my medical care also. Its a sticky situation and I think there needs to be more options available for someone that doesn't have income or insurance. Its not available to everyone.
Wow,
I have been an ER nurse for 12 years in a level one trauma center and I have heard it all.
With that I am happy to report, some of you may not be though, that I still care about other human beings no matter how drunk, drug addicted, abusive, or homeless. Those with chronic conditions, poor access to healthcare, smokers, no education and so on.
I am the nurse, I am there to care for them and educate them and hope that it helps them or they find a way to help themselves.
I too get tired and feel genuinely jaded about the health care system and sometimes get tired of seeing the frequent flyers.
I dont blame them though and I will still care for them in a respectful manner.
I believe in universal healthcare for all as a basic human right. I want to pay for my fellow citizen to have access to healthcare as I hope they too would like to pay for mine.
I know that if a person is given help and education and is healed that they will maybe be able to return to the workforce and pay taxes that will further benefit all the citizens of America. Without hope, really, where are we!
The system DOES NOT work the way it is now. There is too much apathy and complaining and not enough doing and changing.
If anything has left me feeling that there is no hope, it is this blog.
Thank goodness someone is saying this.
If only the people who are misusing/abusing EMS and ER's would read this, maybe..just maybe they would get a clue.
Seriously, with the flu (both of them) bug running rampant, who wants to sit in a crowded ER. Yech, I'd rather sit in boiling oil.
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