Why ER nurses get burnout

20 year old female with right lower quadrant abdominal pain arrives at 0852. She thinks she has a urinary tract infection. She is afebrile, denies nausea or vomiting, has normal BM's. Her other vital signs are normal and she rates her pain 5/10.

Patient is triaged, put in room, urine and labs obtained prior to the physician seeing the patient. The urinalysis is sent for testing and a pregnancy test per protocol.

MD sees the patient one hour after she is put in the room, the urine results have been on the chart for 30 minutes showing blood and leukocytes in the urine. The pregnancy test is negative.

MD takes 45 minutes to get around to putting orders in on the patient after coming out of the room, the patient has been in the department for almost 2 hours.

1 hour later the lab work is back and the chart is flagged for recheck.

45 minutes later after being asked several times the MD goes in to recheck the patient.

A pelvic US is ordered because the patient has a history of ovarian cysts and RLQ abdominal pain.

It is the weekend and the tech has to come in from home which takes around 40 minutes.

An hour later, after 4 calls by the nurse the radiologist has finally read the US and faxed the results to the ER. The US is negative. The chart is flagged for recheck.

The MD goes in to see the patient, comes out and orders a CT scan, appy protocol an IV, a bolus of NS, IV pain and nausea med's.

CT is backed up because of a trauma patient so it takes well over an hour for her to be taken to the test.

An hour later the CT results are back and the chart is once again flagged for recheck.

Ultimately the patient is discharged home after spending most of a twelve-hour shift in the ER. Diagnosis? Pyelonephritis, which is what she thought she had when she arrived.

Multiply this by 31 rooms and add in a waiting room full of angry, sick people who have been waiting for hours for a room - stir into that a couple traumas, a few mental health patients as well as angry patients and their family members and you can see why we get burned out.

AHEM. Dr. Big Workup, in an effort to help you distinguish between the hopeless, chronic drunk who needs a night in the drunk tank and the patient that needs a CT, ECHO, multiple labs, cath urine, EKG, etc. etc. I present:

The Leap non-severity scale.

Please feel free to use it and quit wasting everyone's time!

Stunning post by Aggravated Doc Surg:


The Four Horsemen of a Trauma Death

Witnessed in My ER Today

A 32 year-old female signed in for migraine. She was from out of town. She had several allergies. The PA said he'd give her a shot and she asked politely what he was going to give. He told her Dilaudid and Vistaril. She politely declined stating she did not want narcotics as they made her sick and loopy. She apologized for taking up our time and asked if she could instead have a couple liters of saline and Toradol, Compazine and Benadryl.

You betcha!

First time I've ever seen that happen before.

Schizophrenia

She was the valedictorian of her high school, graduated with high honors and received a full-ride scholarship to a very prestigious university.

She received straight A's her first semester.

Then the voices started.

At first it was only at night when it was quiet and if she turned on the TV it drowned out the whispering. "He's looking at you. He knows you're scared and is laughing. Someone is behind the door. They can see you. When you're asleep he'll come out and hurt you. He'll laugh when he rapes you. They're watching. If you turn your head real fast you'll see them." Soon they were there all the time and no amount of noise could drown them out.

She became convinced that there were groups of men stalking her, waiting to catch her not looking or asleep. She would stay awake for two or three days and then fall asleep in class. She kept thinking she saw something out of the corner of her eye. She spent her days exhausted and terrified. Her grades plummeted. Once meticulously groomed she now forgot to bathe and change her clothes. Then a new voice started. It told her if she died no one could hurt her.

Tonight she is laying on my ER gurney, unresponsive, intubated with blood on the pressure infuser running into both arms. Massive blood transfusions are already completed and despite all of our therapy she is going into DIC, blood is starting to leak from IV sites as well as her NG and ETT secretions. Her chances of surviving are becoming smaller and smaller as the moments tick by.

Tonight she decided not to wait for them to come and rape, torture or kill her, she climbed into her bathtub, turned on the water and sliced open both her arms. Being an A+ student, she read how to slice open the arteries for maximum effectiveness and by the time her tub flooded the dorm room below and the TA entered her room she was all but dead.

Attention Bill Collectors

When I answer the phone that is ringing for the 8 billionth time today at 3:17 pm when the 31 bed ER has 64 patients in it - some since yesterday and we are all running, running, running and getting further and further behind and I am waiting for a call back from respiratory so I can tell them to hurry, come quick we're intubating an infant and instead it is a bill collector looking for one of the ER tech's that is not working today anyway because they called in sick for the 15th time this year.......

I am NOT going to be happy and believe me you WILL know about it (I may have borrowed some specific phrases from Cranky Professor!) In what universe do you think it would be okay with your bill collecting when someone answers the phone "Greatest Hospital on Earth Emergency Room?"

That little conversation is a good example of why I don't give my name out on the phone.