ER Nurses Blog

Nurse Pragmatics: Stethoscope

2011-12-27T14:28:00.000-07:00

Now that you have your Christmas monies are you going to upgrade on some of your tools? Some of us are lucky enough we can purchase/replace accessories and tools (stethoscopes) on the dime of the employer. But many of us either have specific preferences, or we don't have the luxury of a benevolent employer--we have to buy some additional stuff ourselves.What are your recommendations for stethoscopes? Why? Background noise reduction? Ones that don't feel as if they're squeezing your brains out?Share your thoughts with the community.

Nursing Pragmatics: Your Shoes of Preference?

2011-12-19T14:22:00.000-07:00

There was a time when nursing shoes were a distinct white flat. Before that, a distinct white mid-low heels. More recently the comfortable but the sometime impractical croc shoe was a favorite. (Who wants an open toe anyways?)What shoe do you use at work? The popular choice is of course the day long sneaker. The choice of footwear is important since you're on your feet all day (plus it saves your back). Choices? Styles? Price points? What's your preference.One thing that's evident, if you can swing it try to get some more info on your feet. Even if it's the Dr. Scholls machine at the supermarket, knowing you have high, mid, or low arches impacts the shoe you purchase.

How do Rules and Regulations Affect Your Care?

2011-11-17T12:51:00.002-07:00

You've heard the horror stories, patients dying in the parking lot of a hospital, or the front steps, because nurses were bound by rules and regulations implemented by administrators to satisfy insurance regulations, HIPPA, hospital policy, etc., in a litigious society.

The age of "I am going to sue you for everything," has had an impact on healthcare delivery. How have you been affected in your workplace? What are the weird things that you cannot do? Anything that concerns you with respect to prevention from doing an adequate job delivering healthcare?

Anybody have their own story of failure to follow procedures? Note, instead of putting the blame on nurses and other hospital staff, there's an unfortunate reality imposed by hospitals policy and procedure manuals.

What's your experience?

Floating ER Nurses

2011-11-14T19:54:00.000-07:00

Interesting dialogue I was following at allnurses.

http://allnurses.com/emergency-nursing/problem-floating-er-632165.html

Male Nurses - the Murse

2011-11-10T10:17:00.000-07:00

Not a purse, a nurse. We're talking about male nurses again. The profession has always been dominated by women, and still is. But we're seeing a few more males entering the field. THe stigma of an all female profession is slowly lifting.

Some of the change is due to cultural changes where women are no longer seen as the sole primary gender capable of offering care.

How many male nurses are you working with? Have you noticed an increase? Any gender bias in school that may prevent male nurses from entering the field?

California: Hospital Jobs vs. Population

2011-11-04T12:55:00.005-06:00

Last post we looked at how employment numbers in hospitals in California faired in the past ten years. for the most part there was consistent upward trends. Why do hospitals continue expanding, and do they expand at a rate of population increase (that is, the number of employed counted as 'expansion' in this post.)

Looking at this graph that look at the percentage change between the population in California and the change in employment in the hospital sector during a ten plus year period from 2000-2011 we get an idea of the trend.

Surprisingly, as population has increased on average of about 1% a year, the hospital sector has grown more. Although we can't conclude how the hospital sector reacts, there is a close relationship between the increases and decreases in jobs to population. If there is a decline in population the hospital sector will respond in the ensuring short term.

Of course, what would explain why the hospital sector increases more than the population increases? Although population may increase in California, it still does not account for the demographic. If there are more older people (which as a nation as a whole that's true) you'll find a greater strain on the health sector. Expect an increase in the number of people who need medical attention and thus growth in the hospital sector beyond the normal population additions.

Data compiled by San Diego Bankruptcy Lawyers derived from RAND.

Employment in Hospitals - California

2011-10-31T14:20:00.005-06:00

How many jobs were there in hospitals over the coarse of the past 10 years? A prudent question to ask to see, among other things, whether funding for hospitals has declined, whether the recession has had an impact on the health sector, and how many are employed in the hospital sector.

I pulled up some stats for the nation's largest state, California, and got numbers in excess of 300,000. Since 2000 the number employed in Californian hospitals (not just nurses and doctors) rose 25% from around 315,000 in 2000 to 379,000 last month in 2011.

The sector did experience a loss of jobs in the 2010 period as did pretty much every other industry in the state. Population took a downward spiral during that time as well (all stemming from the 2008 crash.)

Check out this graph from 2000 to 2011 showing number of employed persons in the hospital sector.

So this data is another example of how essential services remain mostly recession proof. Or put another way, there are job opportunities in Californian hospitals. Next post I'll show the relation to employment in Californian hospitals and population.

Data compiled by San Diego Bankruptcy Lawyers derived from RAND.

Nurses Intuition

2011-10-26T09:57:00.002-06:00

Nurses develop knowledge, skills, and clinical judgment all of which are accented by experience and reflection. But sometimes you just go with your gut. Now, you may not treat based on your gut, but you may adjust your testing procedures to find a or solve an issue you think is there.

How many of you have stories about your 'nurses intuition' in action?

Technology in the ER - Do Smartphones Hurt Care?

2011-10-16T09:54:00.002-06:00

Honest question: are you fiddling on your smartphone phone/ phone at work? Texting in the corner? Checking out the news or Facebook? Facebook on a computer anywhere?

The advent of cheap data and smartphones with snazzy bells and whistles means you can easily get lost in something more interesting than boring patients. OK, maybe it's obvious most of us aren't so flippant when it comes to our jobs, but is it an important issue to address? Do you notice a drop in patient care, or overall care, with added distractions?

Does your unit/place of work have criteria in place to prevent the use of personal electronic devices while on duty?

Schedule Your Next ER Appointment!

2011-09-22T12:46:00.000-06:00

What do you think about systems that permit patients to schedule an ER appointment? http://www.ghs.org/inquickerSome hospitals are trying out the online scheduling system. Have you experience anything like it before in your career?Let's not pretend that all nurses are experts in organizational development and management, but what are your ideas to improve efficiency and decrease wait time in the ER?Sometimes the bright spots (What's working) need to be highlighted. Other times the whole system needs and overhaul. Usually the answer is 'more _________' but more __________ rarely comes when asked so what are the highly effective yet simple things you've seen work at improving the ER?

How's Vacation and Down Time?

2011-09-17T12:24:00.002-06:00

Taking allotted breaks is important, but frankly let's face it, there are times when a break is rare. But downtime is necessary to retain sanity, and frankly, your health. What types of strategies do you use on the job to ensure you get enough rest to offer the best care you can? Does your job have a maximum amount of hours and shifts you can work consecutively?What is your vacation time and do you take it? I know most of the nurses I know can't wait to take their holidays, so that doesn't seem to be a problem :P

Pay Scale the Same for Nurses?

2011-09-02T11:24:00.002-06:00

Any anecdotal evidence that there's pay discrepancies in your hospital/clinic. Generally nurses are paid based on experience. Many are unionized but many are not.

However, there are also reports that there's pay discrepancies based on other aspects such as gender (male v female nurse), schooling (where and how many years), and dare we say--race.

Any thoughts and observations? Or is the system pretty equitable?

Treating Patients Based on Status

2011-08-25T16:02:00.002-06:00

Ok, so the title is probably a bit more negative than I would intend, but here's the question posed through a story.

In the ER you see a number of patients who shouldn't be there. Or the class of patients who should be there but delayed treatment because of cost.

There you are, the nurse in the ER, treating your patient. You think to yourself, "man 1/3 of my pay check is going to fund me right now treating this person." You, of course, don't think 'this person', you think, 'this person using medicaid' or whatever term you use.

Some nurses make a point not to check the insurance status of patients so it doesn't impact their treatment. Others can't help but learn a bit about their ptn.

Do you ever think about the roudabout way you get paid and pay for those you treat?

The Most Disgusting Thing in the ER

2011-08-17T11:13:00.004-06:00

And beyond!

What's the most disgusting thing you've had to do / see in your travels as a nurse? Do'nt spare gross details (although keep it PG-13 :P)

Addition:
Some interesting and disgusting submissions, thanks...> I think.

Why Nursing?

2011-08-08T16:53:00.002-06:00

Why did you choose to become a nurse? Was someone in your family a nurse? Where you a ER or Scrubs fan?

What made you jump into the foray of healthcare? A bit heart? the money? The change to wear scrubs to work? :P

Assaulted on the Job - Patient Abuse

2011-08-08T12:10:00.002-06:00

In the ER you're prone to see more patients of all walks, sizes, and ailments. The highly transient and variety of patients seen also means behavior is less predictable.

How many have been subject to patient abuse? In what form?

What would you classify as patient abuse?

Finally, how has your hospital addressed the concern and what have they done to protect your health?

How do you keep work and life apart?

2011-08-02T11:53:00.000-06:00

Anybody take their job home with them? How do you keep the stress and stories, and heck even the patients, out of your mind when you leave?

It's a tough question, and of course you really can't flip a switch and somehow develop short term amnesia.

Any tips to debrief bad days, bad patients, or particularly traumatic days?

The Horrible state of America's state funded healthcare

2011-07-29T11:50:00.001-06:00

It's not good.

Period.

http://www.zerohedge.com/news/mapping-americas-underfunded-state-pension-and-healthcare-liability-debacle

Injury prevention tips on the job

2011-07-15T12:17:00.001-06:00

save your back! lift with your knees! wear good shoes! nurses, what are some tips you can share on preventing injury on the job?

Scarcity in the ER?

2011-06-27T14:47:00.000-06:00

Let's take a quick survey of your hospital: is there a shortage of ER nurses?

There's a different between a shortage and the desire to hire cheaper nurses.

What state are you in and are you hiring ER nurses? Are you always hiring? Is it because of quick turnover of nurses?

Do you find that the upcoming demographic change (more aging nurses set to retire) is starting to open up more positions?

Or is it hard to find a job in the ER these days?

Overworked in the ER?

2011-06-24T12:54:00.000-06:00

Are you overworked? Working double 12 hour shifts?

What are you doing, or your unit, to ensure nurses and doctors are well rested and prepared for their shifts? Or what could be done to improve work place conditions? Looking to hear from those who've tried some new things and have found success (or failures)

ER Nurses Salary

2011-06-20T14:45:00.002-06:00

Although this is an unofficial survey designed to give prospective ER nurses a heads up of what to expect, but what is your salary as an ER nurse?

Past or present, please include a range of your salary and your state. No need to post your personal details :P

Here is a 'current' estimate of nursing salaries for those with a BSC (seems a bit high?)

Tips for Becoming an ER Nurse

2011-06-10T14:43:00.002-06:00

We had a post on brand new nurses looking to jump inton the ER, but what about those who wish to transfer? The ER, that's your dream cause you're a glutton for punishment, (what can you say?)

What can you do to transfer, improve your chances of making a transition, and succeeding in the ER?

Get some courage and talk to your supervisor? Apply discreetly? Maybe you want to be a tech in ER first?

What does the community think? Any current/past ER nurses with experience from their transition?

What is the Most Pretentious Unit?

2011-05-25T12:18:00.000-06:00

Be honest. Are ER Nurses the biggest drama queens in the hospital? Yes, ER nurses are front line staff and see all the cool stuff like stab wounds and gunshot holes. But, is there a level of arrogance at the frontline? Anybody encounter ER nurses snubbing other units in a kind of smug "I do more than you're lazy a$$" attitude?

Or are ER Nurses really that cool :D Perhaps the level of stress encountered in the fast paced life and death environment (I mean come on, think of life as seen through the lens of all those TV shows) warrants a level of hubris?

Your thoughts?

Advice to Nurses Entering ER for the First Time?

2011-05-18T11:42:00.001-06:00

We'd like to poll the community with a question that has come through the email a few times. For those nurses who have worked or are currently working in the ER, what kind of advice and expectations can you give to new nurses in the unit?

Please offer some helpful advice in the comment section below.

Don't Forget

2011-04-27T11:05:00.001-06:00

We're mostly driven by user submitted content. If you have an anecdote about your time in the ER then please send it our way and we'll post it for the community to read. Email to ernursey @ gmail.com

Try to make your submissions at least 300 words long.

Oh yea, we'll send you a free gift card for some free scrubs for your troubles!

Loud Urogenital Symptoms

2011-03-31T08:28:00.001-06:00

Here's another entry from a nurse who emailed us at ernurseyblog @ gmail and won gift certificate for a free set of scrubs.

20 year old male and his female companion come to the er. They are c/o of urogenital symptoms. (Translation: had unprotected, dirty sex and are now paying the price)

They get their workup and appropriate antibiotics are prescribed. However, they will not leave without pain medication!

It is explained to them multiple times by multiple staff that they are not getting their requested lortabs for an STD. Take tylenol, motrin, antibiotic as directed. (A bar of soap was also provided :>) Increase your fluids, bath, use a condom and you'll be fine.

Male is getting agitated (did I mention his UDS was positive also?) and is now standing in the middle of the ER corridor screaming "You don't understand...I have a really small pee hole and it f...ing hurts to urinate!"

The elderly gentleman in the next room started cracking up..as did staff! We replied (as we called security)

the size of your penis is a personal problem that cannot be resolved in the ER, please leave now!

2011-03-23T17:10:00.000-06:00

A nurse submitted article, part two of a two part series that started here....

.....I went back to my alcove to start charting around 2100. I felt good about that at least. I had already assessed both of my patients and had given nighttime medications. Did I mention this was my 3rd shift on the floor as a new travel nurse, and my 1st shift on my own? The charting system was new to me, so I was glad I had a chunk of time to devote to navigating the charting system.

As I was in the midst of checking boxes and tabbing along, the alarm went off for my patient’s arterial line for a low reading. I looked at the tracing and wondered why it had dampened, when it was brand new that day. My patient still had an EKG tracing, but I went in to check on her to make sure she was okay.

I should also note that my patient was in droplet isolation. I gowned up, put on my gloves and mask and started in to see that my patient was not the responsive, bright eyed, smiling patient that I had come into that shift. I tried to rouse her several times, and then proceeded to check a pulse and did not find one. I called out to call a Code Blue. She had pulseless electrical activity (PEA), which progressed to asystole. I started compressions almost immediately, her frail body surrendering to beneath me. Must. Pump. Hard. It’s an indescribable sensation to feel someone’s ribs moving under your hands, as you try to do the work the heart cannot do itself.

My coworkers ran to assist me, the Code team arrived, someone else took over compressions, someone else gave ACLS medications, and there I was watching (and also providing what I could remember about the patient’s condition and history).

They let her go with just enough effort and called the code at 2133, which was about 15 minutes after I discovered the change. Coming from an open-heart surgery background, I was astonished by the short duration of the code, but also felt at peace
with it. I’ve watched a code go on for over an hour, thinking, when are we just going to give up? There are only so many medications you can give before the body rebels. I’m sure many of you have had this same thought, just know you are not alone.

What I’ve taken away from this experience:

That it can happen to anyone, anywhere.
That nurses are great team players when there is a code.
That my nursing skills transmit to a variety of environments.
And that my gut is never wrong.

If you get the feeling that something is not quite right with your patient, but you can’t put your finger on it, you’re probably right......

Nursing Instinct is Never Wrong

2011-03-18T08:05:00.000-06:00

ER Nurse J sent in this story. BTW, all of the details have been changed, in fact, this is a mere anecdote of what could happen in the ER :D.

It started with a feeling. You know, that gut feeling that nurses get when something is about to go wrong. They call it “nursing instinct”, but no matter the name, it’s never wrong.

My first assessment was nothing out of the ordinary. My patient was on the ventilator for recurrent sepsis, and looking to improve. She responded to my questions appropriately, nodding her head yes when I asked if she felt warm, which correlated to her above 100 degree F temperature. I offered her a cool, wet washcloth for her forehead and a fan, for which she smiled. I asked if she had pain, to which she shook her head no. I continued on, listening to her chest and abdomen, checking her pulses, looking over her IVs, and finished by asking her if she was okay, to which she nodded yes. I informed her I would be right outside her room and would be in periodically to check on her. She smiled, but something still did not feel right.

I sat in an alcove between her room and another patient’s, which allowed me to both see my patient, as well as her monitor. In report I had asked about the patient’s ongoing sinus tachycardia, to which the off-going nurse replied, “The doctors know about it. They’re not concerned, and just want us to keep an eye on it.” How many have heard the “keep an eye on it” warning? That set off an internal alarm, when I continued to watch her heart clipping along in the 130’s. Had it been that high all day? As I looked back in the telemetry monitor records, it seemed it had. I knew her heart couldn’t stand much more after all she had been through.

But I was optimistic. Here she was, on the ventilator, no sedation, no pain, completely appropriate with talks of weaning in the morning. But then, her fever went up. It went up a whole degree in the course of an hour. I went back in to check on her, offered her some Tylenol, to which she eagerly nodded, and administered it via her OG tube. I thought, that the fever could be part of her tachycardia, that hopefully the Tylenol would help, which in turn would help decrease her heart rate. I wanted to believe that things were going okay for my patient, but that internal nudge wouldn’t stop telling me the contrary...... part two next week.x

Free Ambulance Ride With Every Broken Nail

2011-03-12T12:42:00.002-07:00

This blog post was submitted by a nurse who won a free gift card for her contribution.

Working in the ER one of the funniest things that I remember is the day we received a call that the ambulance was bringing in an accident victim with more to follow on arrival. That usually means they are so busy working on the patient they are unable to call report.

We set up our trauma bay and then got everything set up for any major trauma so those tools were close at hand. As the patient rolls in, Ginger, she's sitting up on the stretcher wailing holding a hand wrapped in what looks to be several towels applying pressure. Several of us enter the room while the ambulance crew asked to speak with the triage nurse outside.

Ginger is crying hysterically and we are trying to calm her down and remove the towels to see what damage has been done. She continues to cry “my hand, my hand” as we get down to the last layer still no blood as we are trying to figure out what is wrong, We hear a laugh outside the curtain as we get the last towel off to see no injury that I can see. I ask the patient what happened. Still crying she replied,

“Can’t you see? You must be blind. I ripped off my nail. I need the rest of it off.

” I look at the nail in question which is artificial and excuse myself from the room. She called an ambulance to bring her in because she ripped part of her nail off did not have the money for gas or to get it repaired and wanted us to fix it for her.

I forgot to mention, I work in a military facility where if you’re a dependent all your care, medicine and ambulance rides are paid by the government. I see so many things that just blow my mind working in the ER. My government dollars at work for things you just can’t make up.

Submit Your Story, Win a Gift Card

2011-03-09T10:30:00.005-07:00

We want to hear your voice! Rather than just one or two writers typing away about the ups and downs in the ER, or any unit for that matter, we'd love to turn ERNursey into a collection of voices.

We want to hear from you! If you'd be willing to submit at minimum a 300 word anecdote about your day (changing details, names, etc.) then we'd post it up here.

But wait, there's more!

Apart from being one of the top nursing blogs, we want to reward your contribution!

We've struck a deal to giveaway $20 gift cards courtesy of My nursing Uniforms.

All you have to do is submit an email with your contribution to ernurseyblog @ gmail.com. Include the subject 'ER Nursey' and brief note that you're submitting from the blog.

Right now the first 10 submissions will automatically win (we reserve to reject ones that are obviously fabricated.

Apart from that, help us make ERNursey an online resource for nurses and medical professional to vent, learn, muse, cry, and laugh.

Healthcare per capita

2011-02-08T19:06:00.000-07:00

Is it true that America spend more per capita on health care compared to other developed nations. For for a second that we're going to pay through the nose when the baby boomers arrive (they already have), but what about the actual cost of healthcare?

I've read reports that suggests America's per capita healthcare spending is HUGE.

Oh wait, I forgot to add something, we spend MORE for less healthcare. Countries with universal healthcare spend LESS.

Too many fingers in the pie when it comes to healthcare costs.

Which means that universal healthcare, if possible, could be possible at even LESS the money we spend now.

Think about it, anybody given the choice between no healthcare or free healthcare will chose the latter. If you're sick and you run out of money, healthcare isn't a stupid political discussion, but it's a matter of life or daeth.

Plus, we can do it for less money.

Let's assume for a second we can't. We can't do universal healthcare for less money...... but would we do it for the same amount? MORE healthcare essentially for the same amount of money?

Inefficiencies galore is the name o the game in health, and I for one want something done about it NOW before we all wind up in the poor house, or worse.

A day in the life of an ER nurse part 1

2010-12-29T10:33:00.001-07:00

What a day!

Every day in public health nursing is a new day with new challenges, new faces and loads of obstacles! Having come from LTC – it’s a whirlwind to say the least!

After a Holiday and a Monday at that, I begin to wonder if I will ever see the bottom of my paperwork pile… probably not today. The phone rings and another patient need more medication. I place them on hold, just long enough time, that my provider asks me to check the vaccination record. The patient on the phone gives me her number and her pharmacy information – I give her a promise that I will speak with her Doctor and call her back. With that cleared up, I begin to getting the Childs vaccinations, first by checking the child’s name through the state registry. It shows that the child is due for her regular 6 month shots and is due for the flu vaccine as well. I step into the patient’s room and ask the young mother if she would like the flu vaccine. To which I get a puzzled look and an “I don’t know if I should or not”.

Sitting down next to her I begin to carefully explain the pros and cons of flu vaccine. Eventually the patients’ mother agrees to the vaccine. I leave the room to go to the lab to draw up her daughters’ vaccines ready, As I finish preparing the vaccines and having them double checked by another nurse. As I grab Information for the patient’s mother, I hear behind me, “Hey Chrissie… I think I’m going to give willingly!” there sits behind me, a patient in the blood draw area!

WHEW It’s only been an hour… but I love it!!!

Seven Mondays in a Week: The Consequences of Society’s Decline in Civility Part 2

2010-12-09T11:33:00.000-07:00

Continued from part one on understaffed and sometimes dangerous ERs in our country here.

To pick up from where we left off....

Nurses associations are advocating to end violence against nurses. The Pennsylvania Association of Staff Nurses and Allied Professionals had a conference in early November, Massachusetts Nursing Association is one that has done a lot of work in raising awareness. The Occupational Safety and Health Administration office has issued guidelines for medical centers to address this challenge. However, these guidelines should become enforceable standards. The survey shows that hospitals with a zero tolerance workplace violence program have less than half the number of incidents of other medical centers that have no policy.

In Massachusetts, a House representative and a senator have introduced an act requiring Health Care Employers to Develop and Implement Programs to Prevent Workplace Violence. 26 states now have more strict penalties for assaults on nurses. New York very recently made assaulting a nurse a felony same as assaulting a police officer, firefighter, or EMS personnel. In contrast, 2 states that were going to move these assaults from misdemeanor to felony killed the proposal. Another state deferred the decision. Even in hospitals where severe assaults have disabled staff, the administration has only struck committees yet have failed to disclose when the committee would meet or the results of the meeting.

Prevention and being proactive are the keys to meeting this challenge. If administration is committed to training all staff and encourages reporting of incidents there would be progress towards prevention. Administration must also be committed to having adequate staffing levels at all times in the ED. Several bodies such as the American College of Emergency Physicians and the International Association for Healthcare Security and Safety, have made recommendations such as yearly risk assessments especially if the hospital is located in an area where there is high crime or gang activity. If it means having metal detectors and visitor sign-in those should be put in place as one hospital in Detroit did. Why would anyone need to bring a gun or a knife into the ED?

In the Institute of Medicine’s(IOM) report in 2007 on emergency care in the US they commented that that crowding, boarding, and ambulance diversion were the total opposite of high quality medical care. The Joint Commission for Accreditation of Hospitals had tried in 2004 to institute strong measures to counteract these now common practices but pressure from hospitals caused the measures to be watered down. In no uncertain terms the IOM’s report recommends that these measures be reinstated. Decreasing crowding, boarding and ambulance diversion would go a long way to dealing with ED violence and allow high quality emergency care. The violence is only a symptom; the root caused must be addressed.

One interesting fact is that less than half of ED patients require urgent care. To reduce wait times hospitals are considering NPs to treat non urgent patients.

The Ed puts a microscope on societal attitudes to nurses, health care, and especially violence. The examination is not pretty. Why do patients feel they need to act out their frustrations on someone that will ultimately help them get better? Why aren’t hospital executives proactively seeking to prevent violent incidents? The IOM notes that hospitals have no financial incentives to reduce ED crowding. Are numbers and dollars more important than patients and staff safety and well being? Has society become so desensitized to assaults that it is seen as an inevitable part of life? How can anyone tolerate that a nurse can be abused on the job? Acceptance of the unacceptable says a lot about the people that have the power to change it.

(1)http://urgentmatters.org/media/file/Factors%20Influencing%20the%20Decision%20to%20Use%20Nurse%20Practitioners%20in%20the%20Emergency%20Department.pdf

http://www.philly.com/inquirer/local/20101110_Increasingly_nurses_facing_violence_on_the_job.html

http://www.massnurses.org/health-and-safety/articles/workplace-violence/p/openItem/5190

http://www.massnurses.org/health-and-safety/articles/workplace-violence

http://www.massnurses.org/health-and-safety/articles/workplace-violence/p/openItem/4920

http://urgentmatters.org/media/file/Violence%20Against%20Nurses%20Working%20in%20US%20Emergency%20Departments.pdf

http://www.ena.org/media/PressReleases/Pages/RateofViolence.aspx

http://www.napedu/openbook.php?record_id=11621

Understaffed ERs Lead to Abuse?

2010-12-01T11:30:00.001-07:00

Seven Mondays in a Week: The Consequences of Society’s Decline in Civility Part 1

Would you look forward to work each day if you knew there was a possibility you would be verbally or physically abused?

Emergency departments are experiencing an increase in use by the public. Hospitals are unable to keep up. An analysis of this use points to one unintended consequence of a non universal private health care system. The emergency department of a hospital is the only location in an overburdened health care system where any patient who shows up must be treated regardless of ability to pay. With state facilities and programs for mentally ill citizens, and those suffering drug addiction being eliminated these patients often end up in emergency wards. Visits to emergency departments(ED) for alcohol or drug related incidents are on the rise.

Emergency departments are often overcrowded. Overcrowding is defined as all beds in use and the waiting room full for more than 6 hours a day, patients placed in halls, and seriously ill patients having to wait more than 1 hour to see a doctor. (1)
Long waits are more then rule than the exception. Add sickness, trauma, mental illness and drug use to the lack of privacy, and a less than ideal situation is created for patients to appropriately cope with stress.

Nurses who execute care and spend the most time in triage and treatment suffer the brunt of patient and family frustration. They are subject to verbal and physical abuse at unacceptable rates. Studies have shown that health care workers are the most likely to suffer workplace violence after prison guards and police officers. In a profession where healing and mercy are requirements it is disturbing that nurses are subject to these assaults.

Nurses are abused verbally by been sworn or yelled at, or called names. Physical violence includes being spat upon, scratched, hit, slapped, kicked, or stabbed. Injuries can range from the not visible to months taken off work for severe injuries.

The Emergency Nurses Association believes that violent incidents are underreported according to a recent survey. Nurses often don’t report incidents. They fear it will reflect badly on them as being less than competent. Or they believe that the administration will not take them seriously or be indifferent. They do have some basis to believe that as up to 75% of medical centers do not respond to reported workplace violence. Also many institutions do not have workplace violence policies or prevention programs. Nurses also believe that abuse by patients and families are part of the job. In some cases they can empathize with the scenario that created the violence. Often they believe if they press charges that the perpetrator will escape conviction because they were mentally ill or high on drugs.

The conclusion in part two next week.

Take a Guess: Which one do you think is telling the truth?

2007-08-18T15:46:00.000-06:00

Patient number 1 is a early 40ish man with no medical history that comes in from his job at a construction site where he suffered a sudden onset of right flank pain. Driven in by a co-worker he is barely able to walk in, hunched over, pale, sweaty, diaphoretic, writhing on the gurney, tachycardic and hypertensive. Shortly after getting to triage he starts vomiting. During triage he seems apologetic when he rates his pain a "7 or 8."

Patient number 2 is a twenty something who is brought in from the parking lot in a wheelchair by a friend, they are laughing and talking on their cell-phones when you bring him in for triage. Chief complaint is a twisted ankle. Despite apparently being able to walk to the car at home he is now unable to walk and has to be brought into triage in a wheelchair. In triage his skin is pink, warm and dry and vitals are normal. He rates his pain a "12."

Patient number 1 is given Toradol and Compazine IV and has complete relief of his pain. He is diagnosed with a small, non-obstructing kidney stone. Discharged home with prescriptions for Motrin, Vicodin and Flomax as well as a urine strainer.

Patient number 2 is diagnosed with muscle strain. He is offered an stirrup splint and a prescription for Motrin. He is unhappy and demands a pain shot, crutches, work note and a prescription for Vicodin. He is told no at which point he jumps off the gurney and stomps out of the ER in a huff, screaming "I'm never coming back to this motherfucking place." Another miracle cure, courtesy of emergency medicine.

This is the kind of thing that clogs up ER's all over our country. America is filled with people that contribute nothing to society but come equipped with a massive sense of entitlement, they want what they want, when they want it, when they want it. Told no, they became belligerent and assualtive, spewing threats toward they staff. Fearing patient complaints or confrontation, more than one practitioner has taken the path of least resistance. Hospital administration, driven by their wish for high patient satisfaction scores, fails to allow MD's to practice medicine and join JCAHO in forcing us to be legalized drug pushers rather than medical practitioners.

Someday, when there is an epidemic or surge of casualties from a natural disaster or terrorist attack the ER won't be able to care for those victims because we will be full of patients with 'chronic pain' who are seeking drugs.

R Privacy Issues

2007-08-08T16:17:00.000-06:00

Let's face it, ER's are crowded and noisy. Despite our best attempts to maintain a patients privacy, when the next patient is six feet away with only a thin curtain between them, it is hard not to over hear what is going on next to you.

One night we had an elderly gentleman in curtain area 1 and next to him a prim, middle aged lady. The PA was trying to explain to the man what his diagnosis was but his efforts were being hampered by the fact that the man was very hard of hearing. The problem was something of a personal nature so the PA was trying to be discreet.

PA: Sir, you have pubic lice
PT: What's that you say?

PA: I said you have pubic lice.
PT: What?

PA: You've got lice down there
PT: Can't hear you son, you have to speak up

PA: I SAID YOU HAVE BUGS DOWN THERE
PT: Oh.

Of course we all overheard the conversation, including the prim lady in the next cubicle, who was red as a beet by now. The ER staff, dignified until the end, were draped across the counters shaking with silent laughter until tears ran down our faces.

Most of the time privacy in the ER is an illusion maintained by patients pretending they don't see or hear what is going on around them. Sometimes it is impossible to pretend.

Medication reconciliation

2007-06-27T16:41:00.000-06:00

Do you think medication reconciliation works in the ER?

Giggles comes in from home. She lives alone with a caregiver that comes three times a week but didn't accompany her to the hospital. She is a very vague historian, has no clue what med's she takes or what pharmacy she gets them from. She gives me her physicians name so I put in a call to his office. Three calls and much time on hold later I finally get in touch with the medical assistant who is finally able to tell me that the patient is not theirs. Close to 45 minutes wasted and still no clue what medications she is on. He last hospital record is from three years ago and she was admitted by the hospitalist then. I could start randomly calling pharmacies but there are 39 of them in the area and that would take hours.

Nice mid sixties gentleman comes in with Chest Pain. He knows he takes a blood pressure pill, a water pill and something for his sugar, not the names or the dosages. He gets his med's through the mail from the VA. I don't know about where you work, but I could part the Red Sea easier than I could get that information from the VA.

A 77 year old lady comes in with all her pills (14 different kinds) helpfully arranged in a pill box. It is midnight and her pharmacy and doctors office is closed. It takes over an hour with the identidex system and help from the pharmacist to identify 13 of them. The last one is an alien pill that denies definition and she has no idea what it is for.

Who has time to spend doing this nonsense. Tracking down the elusive med list, the ambulances keep coming, starting IV's, titrate pain meds, do EKG's, start foleys, gastric lavage, restrain and monitor psychotic patients, talk to familys, take admit orders over the phone, arrange to get my patients upstairs and so on and so on. Spending hours trying to track down a med list that is one or two or three people that are sitting in the lobby waiting for a bed or a sick patient who's not being taken care of isn't going to work.

Nurses need to be at the bedside. Period.

Rules for non-bedside nurses

2007-06-24T16:46:00.000-06:00

We are very concerned about the nursing shortage in
America, if the paperwork nurses actually did some nursing, no shortage would exist.

1. Nurses that do not provide direct patient care on a daily basis should not develop policies for nurses that do. (Have you ever noticed how the policies for your nursing practice are written without any input from the people who have to carry out the policies?)

2. Nurses that do not provide direct patient care on a daily basis should not develop forms for nurses that do. (that way a nurse won't have to waste her time putting the VS on the flow sheet and the graphics form and a report sheet etc. etc. etc.)

3. Nurses that do not provide direct patient care on a daily basis should not represent nurses that do in any advertising portraying them as bedside nurses. If you don't do the job, you don't get to claim the glory. ( I don't know about you but I've never seen any of the people who are portrayed as nurses at my hospital or they are all directors and QRM people.)

4. Nurses that do not provide direct patient care on a daily basis should not ever speak for those that do. (It is not OK for QRM to tell admin that the ER nurses should do audits on every patient to see if they meet admission criteria.)

5. Nurses that do not provide direct patient care on a daily basis should not develop staffing guidelines since they have no clue how much work is involved in caring for patients in today's world, including filling out the myriad redundant forms developed by the nurses that do not provide direct patient care on a daily basis. (don't tell us we don't need tech's when you haven't worked at the bedside in 20 years.)

6. Nurses that do not provide direct patient care on a daily basis should not ever have a place on any committee or governmental agency that develop policy or have oversight over nurses that do. (JCAHO etc. needs to have practicing nurses so that someone can tell them how idiotic their policies are and help them actually do some good.)

7. All nursing staff should be required to perform clinical shifts on a regular basis so that they don't lose their skills which may be needed in times of surge capacity and so that they don't forget how hard nurses have to work.

If this sounds a bit bitter, it probably is. Thanks to the non-practicing nurses I now spend more than half my time filling out redundant forms rather than be at the bedside with my patient.

Filth

2007-06-22T16:47:00.000-06:00

A pet peeve for many is the fact many hospitals are filthy. Housekeepers often come from contracted services that provide the lowest amount they can get away with and pay them minimum wage with no benefits. The turnover is stupendous and they have no incentive at all to do a good job.

Sure, the center hall is buffed to a glossy finish but the patient rooms aren't wiped down every day, curtains aren't changed, walls not wiped and high dusting not done. All those areas are teaming with bacteria.

ER's are the worst. The gurney and surfaces wiped quickly by the RN in between patients but the rooms are cleaned well only once daily, if that. Pull our the gurney and look at what is under it. No wonder hospital acquired infections are rampant. That should be the first thing looked at when a hospitals infection rates go up, how many housekeepers are there....is one person responsible for covering three units?

I think housekeeping services need to be hospital based, not contracted. Pay them a decent living wage and give them benefits. That way you can attract and retain people that want to work and not the bottom of the barrel. Fire them if they don't want to do the job because there will be people wanting to work for you. Give them proper training on why it is so important to do their jobs well and hold them to a high standard.

It doesn't do the staff any good to wash their hands until they bleed if the hospital itself is filthy.