I wrote to Jane Fonda today.
I won’t get a response, but I wrote to her anyway. Why not? One of my favorite films is They Shoot Horses, Don’t They? It’s a classic from 1969. If you haven't seen it, then I advise you to rent it. It’s not about nurses but it could be. It's about dancing as fast as you can.
Last week at my ER, and probably like many ERs in the country, the night shift was extremely short staffed. Seven registered nurses to be exact and the hospital did not divert the ambulance patients. Is this safe practice?
Nobody minds a real emergency, in fact nurses welcome it. Bring on the sick, the strokes, the heart attacks, the congestive heart failures, the accident victims, and the stab wounds.
Bring it!
This is an ER and we are ER nurses, trained and prepared for all “notifications.” In fact we will work together to make sure patients are safe and comfortable. Healing is our job.
But what happens when the emergency medical service brings in the drunks and drug addicts to an already exhausted staff?
It takes three nurses to strip an alcoholic, clean the patient, list the property, restrain the combative patient for safety reasons, draw bloods, start an IV, give Ativan, Haldol, Oxygen, monitor vital signs, and listen to the shouts and insults for hours to come. All because of the endemic failures of the healthcare system.
A drunk is not allowed to sleep it off on the streets of NYC. The ER has become a bed and breakfast. What happens to the truly sick when nurses are wrestling with the bullshit of a healthcare system that needs to be re-evaluated? Who is monitoring this, anyone?
The EMS recently brought in a well-known homeless patient to our ER who had literally flagged down the ambulance from the street as if it were a cab. The chief complaint in triage was, “Patient reports, ‘I want a sandwich.’”
When I did my assessment of the patient, he was alert, oriented to person, time and place, ambulated well, and denied any chest pain or problems. Nothing, except, “I want a sandwich.”
The EMS knew this and still brought the patient as an emergency. By law, they have to. If the ambulance is not to blame, who is?
We have a broken healthcare system that does not care about our professional licenses. A license that we as registered nurses worked so hard to get and maintain.
The patient with the sandwich got the best possible care with a clean stretcher to sleep in, Tylenol for a hangover, and fresh clothes from the volunteer office. This patient was still our responsibility and left a happy man.
(By the way, I didn’t write to Jane about my work issues. I wrote to her for personal diversion. She happened to remind me of a cancer patient I loved and adored…one of the reasons I stayed a nurse.)
So RNs, be careful, wise, and safe. When you are short staffed, take your time with medications and take time out for hydration. We have to take care of ourselves, because they shoot horses, don’t they?
As an Rn that also works EMS, I sympathize with you. EMS does not like dealing with the frequent flyer alcohol/drug patients any more than you do, however the tale regarding "cheif complaint 'I want a sandwich'" caused a giggle. Without a medical complaint, the pt should not have been transported to you. I am not in NYS, so maybe protocol is different there, but that would not have happened with my compnay. Alcoholics sleeping it off in the ER is widespread; depending on location, they cannot be released until ETOH level is under a certain number, a policy I disagree with. They should be "sleeping it off" in a jail cell, not an ER bed. However, I realize that jail cells are overcrowded too. I don't have an answer for the problem, but it is one that needs addressed. I don't see a solution until people realize that ERs are not primary care centers.
ReplyDeleteI hear you...Im an RN on a med/surge/onc floor. Sometimes these guys will be admitted with an infection from shooting drugs. They will need IV abx for 6 weeks but nobody feels ok with sending them out with a PICC. So for six weeks, they stay on the floor, demand extra food, extra pain medication, and in general take massive ammounts of time away from the lady next door who is dying of cancer. The hospital has a new staffing grid so now I have 6 really sick pts and my CNA has 12. Impossible to give good care. Not to mention safe care. sigh. The system is broken. I'm not sure who can fix it. Stay strong.
ReplyDeleteI actually believe it would be cheaper and more beneficial to start a dedicated facility for the drunks and drug addicts. This facility could have the basic emergency room equipment with perhaps 1 RN and several EN's or carers to carry out care until they can be released. If they become a medical emergency they could be stabilized and transferred to the hospital at that point. This would not only free up the nursing staff in the hospital but make it a safer environment for people who are unwell or who have sick children. I understand that the homeless, drunks and drug addicts are a sign of our failing social system alot of the time and we need to be responsible for them, but hospital and jail cells is not where they belong, unless they are unwell or criminals.
ReplyDeleteI have not even read the article yet. I got to "I wrote to Jane Fonda today" and now I cannot stop laughing.
ReplyDeleteSymptoms heart disease can be many factors including dizziness, shortage of breath, tight chest pains and even sudden weight gain.The problem with symptoms of heart disease is that many of the symptoms are often present in many other medical conditions and can be linked to stress at work, lack of exercise, smoking or obesity.
ReplyDeleteI here Ya!!! The Emergency Department I work in has the same problem except we have them come in with all sorts of medical problems that do need a medical or surgical admission. Then once the have a good sleep and some sandwiches and cups of tea, they abscond. Then come back the following week for another go.
ReplyDeletei think healthcare service in this country is being abused by people who doesnt need it at all, had all sorts of patients who stayed over for few days in an acute surgical bed simply because their family/carer will be away on holiday or wont be availabe until after the weekend ????? patient who have been discharged and come back 18hrs later because the family couldnt cope again re-admitted on acute surgical bed.
ReplyDeleteWow...I knew that being a nurse would be challenging but I didn't realize things were that bad. That makes me a little angry but I still want to help people, as an RN.
ReplyDeleteYou hit on many valid points and I'm glad you are trying to explain just how different our jobs in the medical field have become (ie. a bed-and-breakfast for alcohol abusers). WEll done.
ReplyDeleteJim
Great post. This is exactly why I quit my last job. I felt I was over worked, underpaid, over stressed, and every time I walked through those doors, I felt as though I put my license at risk.
ReplyDeleteIt was damn near impossible to have 4 or 5 seriously critical patients to take care of, while the nurse manager stuffed extra hall patients on top of that just so that our ER could have better times than the other ER's in the area. It was absolutely ridiculous.
So I quit. I found another job that I actually like, and I've never once had to worry about my ass being on the line.
I am working on a tele unit now but I do remember the frequent fliers when I worked ER... Never fails they have the same Medication allergies to Toradol, Asprin, Tylenol, Ultram and motrin! And yes there were the drunks... (I can tell you the drunks are worse when they get admitted to the floor and start having DT's) and the druggies that make it past ER to the floor think they need more and more Dilaudid or Morphine (whatever their drug of choice is). It is sickening to watch them sit in bed demanding ice cream, cokes and more Dilaudid or Morphine with a smile on their face! If I am in pain I am not smiling! Something has to be done! Drunks and Seekers are robbing from the people that are really sick.
ReplyDeleteThis could be any typical night in our ER. The only difference is, in Massachusetts, we are NOT ALLOWED to divert ambulances. Some knucklehead in charge of the state Dept of Public Health decided that is was not good practice for hospitals to divert EMS to the next closest facility when they become overwhelmed. Now, this might be working out in Boston, where there are multiple high-acutity centers within a few mile of each other. However, in the western part of the state, I there is only on level-one trauma center to handle the gunshot/stabbing/traumatic MVC cases for a forty-mile radius. Fill us with a few traumas which utilize a grat deal of our staff and we have no capacity for the lower-acuity and BS cases which could (and should) be taken elsewhere. No diversion = unsafe conditions every day of the week.
ReplyDeleteAnd we have the some problem in Denmark where I work as a RN in a ED. Drunks who are taking up our time, and people come whit very small problem wich dosen't belong in a ED. I think it's the same problem all over the world, where U can find a ED !
ReplyDeleteI think you are my new favorite blog. The humor, the grittiness, the sensitivity and understanding make yours a great blog. Keep going!
ReplyDeleteSeems like it would be in the best interest of administration to have a few motel beds / boxed lunches on hold for the homeless coming in via EMS for a sandwich... really folks... there has to be a breaking point...
ReplyDeleteIts not just the US system that is a hot mess with need for reform. I have worked as a Med-Surg RN in both the UK and USA and the UK actually manages to be worse. Like, two RNs to 30 med surg patients worse. Our short staffed ED in England(two RNs and an aide for the entire ED) were overwhelmed with drunks, drug seekers, "social" admissions like your homeless man who wanted a sandwich and the like.
ReplyDeleteI am no fan of the US system but please don't believe that government healthcare is going to be an improvement. It can get worse.