Ralph and Robert,

I agree with both of you, good point about the rubber (expanding)
walls in the ER. Sometimes the level one ER I'm from resembles a
scene from one of those "after the apocalypse" movies. I've had a 22
pt/1 RN ratio on numerous occasions.

Ideally the patient comes first, but I ask this: WHICH patient? A
more realistic statement MIGHT be- The department comes first.
Triage doesn't stop at the front door. The nitro for the pt in bed 3
takes a front seat to the glass of water for the guy in bed 7.
Working up the asthmatic that the medics just brought in takes
precedence over the lady who wants you to go outside and get her
daughter who is smoking in the parking lot. We've got to keep the
department moving smoothly and SOME of the needs of our patients
must be delayed (or denied) in order for this to happen. (By denied
I mean things like the pt waiting for surgery who wants a drink of
water, or the guy with a BP of 60 and syncope who wants to walk to
the bathroom, etc) But overall, I agree with both of you, the
department, and the patients needs (both medical and human) come
first.

So am I wrong to think that there is nothing wrong with the idea
that as long as patients are sitting in hallways, and nooks and
crannies that they should be getting care from nurses who's
specialty is INPATIENT care? What's the difference between a hallway
in the ER and a hallway on a med/surg floor? ER nurses are forced to
use a whole different set of paperwork/orders/charting once the
patient is admitted, so some of their orders are on one set of
paperwork and some are on a totally different type of chart if they
are admitted. The ER nurse's specialty/focus is not on the
scheduled, ongoing care that is needed by inpatients. If the ER
nurse can be expected to increase his/her patient load to
accommodate WHATEVER the volume, why can't the floor nurse also be
expected to? What's wrong with the idea that the BEST nursing care
for the admitted patient is on the med surg (or other inpatient)
unit?


Let me mention a (somewhat) related topic:
I've seen a disturbing trend toward these feedback surveys and
satisfaction scores.
Don't get me wrong- I TOTALLY understand and strongly believe that
the "human" needs of out patients are just as important as the
medical ones, but doesn't this "requirement" by the administration
make the "press-gainey" top 10% place some additional (unrealistic)
demands on an already strained ER staff? Especially when we are
pissing them off by keeping them in the ER for HOURS after the've
been told they're "admitted"? We're doomed to not get a fair report
from those patients, no matter what. I treat ALL my patients with
respect, compassion and understanding- I try my best to treat them
as if they were a family member. But still, they are going to be
unhappy overall if they spend 12 hours in the ER waiting for a bed.
Once the survey comes back negative, the ER has another "more work
to to" memo. DAMMIT! I did MY part, why don't the bast@&@$ with the
suits do THEIRS?

(My apologies to the original author of this thread, it looks like
you actually ARE trying to come up with some answers- BRAVO to you
Sherry!!)

-Indy



--- In emergency-nurse@yahoogroups.com, "Ralph Cochran"
<rcochran9867@y...> wrote:
> Robert I agree with you...in part; I have worked the floors and in
> the ER and the work load is busy on both but very different. One
of
> the greates differences is on the floor when you're full you're
> full in the ER the wall smust expand to full the need beds are
> placed in hallways cubby holes and the closet if necessary to get
> patients in to be seen. The positive aspects of ER nursing is you
> actually have a doctor in the inmmediate area and don't need to
wake
> ont up at 2 in the morning and listen to them rant and rave about
> it. Another different aspect is when we hold patienst in the ER it
> takes up bed space for patients coming in to the ER to be seen.
> Emergency rooms are designed to get the most patinets in and out
as
> physically possible . They are not designed to hold patients;
there
> are no bathrooms in each room. most don't have televisions or
phones
> in every room - some rooms are not even rooms, but curtained off
> areas with no provacy whatsoever they are not designed with
> comfortable beds but thin mattressed stretchers. there are no
chairs
> for visitors to utilize in these areas and if they are they are in
> the way of staff and subject to be moved out of the way and stuck
in
> a closet somewhere. When a pt comes up from the floor or is a
direct
> admit yto you you know what the diagnosis is and the patient has
> been stabilized foir the most part. In the ER the only warning we
> get is, at best, a fractured report over a scratchy radio by a
> frazzled medic or first responder with limited training in patient
> assessment. While I have great respect for EMS personell, and was
> one myself for a long time, (as with our profession) some are
better
> at it than others. Sometimes the only warning is a loud sound at
the
> ambulance bay door as someone bangs at the door trying to get in.
> The pull issue from the floors doesn't usually happen because
> staffing is kept to a minimumon the floor to keep costs down. if
the
> ER is busy, chances are that the floors are filling up as well
from
> admissions from the ER so no help is available to be pulled. If
> there is available help, the newest nurse on the floor usually a
new
> grad, is sent because nobody likes to be out of their comfort zone
> fromtheir normal unit. The unwriten law of "send the newbie
> prevails" To get back to the point. I DO agree with you on the
> principal issue...AS ER nurses, we KNOW about the things that I
just
> spoke about and we chose to work in the ER anyway...Either deal
with
> it or switch to a more controlled environment. I get job offers
> weekly via the US Post office in all areas of nursing so there is
no
> shortage of opportunities out there. Before anyone gets mad at me
> let me temper my comments by saying that I don't like the
situation
> any better than anyone else but we have to remember, the patient
> comes first. It has to be that way or we are no better than
> the "pencil pushers" we get angry with every day that institue the
> insane staffing guidelines and cost saving measures that are
forced
> on us, making our job just a little harder than it should be.
>
>
>
> --- In emergency-nurse@yahoogroups.com, Robert Jellings
> <robertjellings@y...> wrote:
> > I'm sorry to say but I think your nurses may need to grow up a
> little. I realize the job in the ER is difficult but it is just as
> bad on the floor. I'm sorry if I offend anyone. I have seen many
> nurses complain about their needs and then neglect the needs of
> their patient. That is why we are doing this. I don't think nurses
> should take whatever abuse they get from their
> patients/superiors/family or other staff but I do think that
putting
> a patients needs before their own, as long as it's safe to do so,
is
> important. That being said. Maybe you could see if some floor
nurses
> would like to float down or come in on those days when you can't
get
> anybody. Of course they would need some orientation. But some may
be
> up for it because burnout happens there also. And it would be
> cheaper than Agency nurses.
> >
> > "Sherry Walter, ECC" <slwalter@n...> wrote:Are there any
hospitals
> out there who have very high patient satisfaction scores with
> >60,000 visits that would be willing to
> > share what they are doing to achieve high scores. If so please
> contact me via email or telephone.
> >
> > Also, does anyone have any suggestions on how to handle boarding
> pts in the ER? Any creative strategies...as you all know ER nurses
> are not Floor nurses and it leads to burnout.
> >
> > Sherry S. Walter, RN, MSN
> > Clinical Director Emergency Care Center
> > Phone 783-1648
> > Pager 789-6836
> > Fax 783-2384
> > slwalter@n...
> >
> >
> >
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