Veroniche
Western Region, US
Female, 54
I’ve been an ER nurse manager since 2009. Previously, I spent 24 yrs as an ER nurse. My hospital, a Level III trauma center, sees 70,000+ ER patients/yr. My responsibilities include billing, federal/state regulation oversight, metrics reporting, software education of e-records, and hiring/termination/disciplinary actions. The ER is one of the key impacted areas of healthcare reform. It’s a scary and exciting time for us, not just in the care of patients, but what the future holds for healthcare.
You compartmentalize your life, you have to or you couldn't function day to day. There is a lot of sick humor among staff in the break room. I think that if you don't deal with it as it happens and talk about it honestly with a friend or co-worker, you will eventually burn out or develop self-destructive behaviors. ER nurses are a lot like police officers or firefighters/first responders. There is a lot of substance abuse and depression among us. ER nurses do not come to work impaired (generally), but there is a lot of alcohol use outside of work to deal with what we see on a daily basis.
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No. The nurses and doctors are not the police, and that is not a part of our job. The medical treatment any patient receives is protected health information and we cannot release that info to anyone unless the patient oks it, or it is subpeonaed in an investigation. Even though some drug use is illegal, substance abuse is considered a medical problem. However, if, in the course of treating a patient, we find that there might be child neglect or domestic abuse or that a crime against another person has happened, we are obligated to report that. Each state has mandatory reporting laws around abuse. But we are reporting the suspected abuse of another person, not the drug use of the patient. If we find illegal drugs or pipes, etc. on a patient, we do call the police and they come and get the stuff, but in our ER I have not seen the police arrest anyone for that after we have called them. They may check for any outstanding warrants, and who knows what that may lead to. We have great relationships with our local law enforcement, but we don't do their job and they don't do ours.
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The question of “what constitutes an emergency” has resulted in reams and reams of interpretations by government and private sector lawyers. Remember Bill Clinton and his statement “it depends on what the definition of ‘is’ is”…. Generally speaking emergency refers to immediate life threatening injury or illness. What does “immediate” mean? Yikes, I’m drowning in paperwork!!! We actually have patients who come into the ER because they have found a lump in their breast. We examine them, they might have a life threatening breast abscess, who knows until you look at it. For someone who has a lump like you may be referring to is sent to their primary care physician for follow-up. There is not an emergency mammogram. If a patient does not have a doctor, we give out referrals to clinics in the area. We also have a full time ER case manager/social worker that can help the person navigate the system. When a person doesn’t have insurance or any money, then we refer to one of the many clinics that have a sliding scale fee schedule—one of our hospital clinics has that. Sometimes it is not easy to get an appointment, and we try to help set that up sooner rather than later. Speaking of cancer, you would not believe the number of patients that come to the ER and we find a first diagnosis of cancer. The ER is not where you first want to hear that you have cancer.
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When "ER" first came on the scene, I wouldn't watch it, even though many of my non-medical friends did. I said to a friend one time--"when they starting betting on patients' blood alcohol levels on ER, then I might watch it." About the third or fourth episode, sure enough, that was in the story line. To me, "ER" was the first drama that had the terminology and chaos fairly correct, however, it is the nurses that do all of the work with the patients generally, not the physicians. By the time the ER physicians, who are some of my best friends by the way, give all of the orders, the orders have already been done by the nurses. We know what the docs are going to order before they say it. I don't watch any of the current medical dramas, except I have seen a little of "Nurse Betty" on Showtime, which talks about substance abuse in medical professionals. To finally answer your question, yes, the drama is sensationalized. No one would watch it unless it was. Even though the ER is pretty exciting at times, there is no way that we do that every hour all of the time.
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We have one food vending and one drink vending machine in the ER and all of the revenue goes to the vending companies. The can of Coke is $1.50!! If someone needs something more, we direct them to our 24 cafeteria or the cafe in the hospital lobby. A while back, the ER provided free coffee and juice in the waiting room, but it cost about $8000. With budgets being trimmed, that was one of the first things to go. One of the things that frustrate ER staff is a patient who comes in with belly pain and says that they have been vomiting all night and they walk in with a bag of Cheetos or a bunch of food from Taco Bell. That doesn't help your credibility that you have an emergency. Our ER length of stay (how long you are in the ER, including time in the waiting room) averages about 3 hours. Hopefully a person can be without their Coke or Snickers that long.
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Yes, sometimes it can be annoying, especially when you see the same patients over and over, and you have given them referrals for clinics and primary care doctors for their follow-up. In the past 6 months, our ER has seen an increasing number of "clinic" type visits vs. true medical emergencies. Most of these patients are un-insured or under-insured. Also, many patients are using Emergency Departments to get controlled substance prescriptions such as oxycodone or hydrocodone who either do not have a primary care physician or are using the ED for their addiction/dependence. We could have a big discussion just about that and how it is affecting the ER. That being said, we may give referrals to patients until the cows come home, but if the primary care doctors are not taking new patients, or not taking Medicaid/Medicare patients, or not seeing uninsured patients, there is not much the ER can do. The ER is mandated by the Federal government to see every patient to determine if they have a emergency medical condtion, but the clinics/primary care doctors have no such mandate.
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I love the administrative and business end of the job! A nurse geek! I worried that I wouldn't be taking care of patients, but I’m in the ER a lot of the time assisting during busy times and talking to patients and families when they have concerns. It is just the right balance for me. When I was involved in direct patient care, I was taking my work home with me (emotionally). I continually wondered if I had given the best care or had made mistakes. Now, if I miss a spreadsheet deadline or am late for a meeting, it is not affecting the patient at that moment.
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