Monday, October 24, 2011
more complexity = more money
The patients coming to the emergency room these days are no longer as simple as a sprained ankle or UTI. We get those, but they are a increasingly small percentage of who we see. Our typical patient has become someone with some kind of chronic underlying illness, sometimes a couple of them, who is in for an exacerbation of the illness or another problem complicated by their underlying illness. For example, we might get an ambulance call for someone with abdominal pain. They forget to mention that they are also a quadriplegic with decubitus ulcers that are MRSA positive. A woman with a UTI comes in, however she had a heart transplant last year and is having signs of rejection. Honestly, these kinds of patients are becoming more commonplace.
Everyday,policies and procedures change. Documentation requirements change. New drugs are being used. New programs are started. We have an MI program involving getting people to the cath lab in 15-30 minutes within arrival. Before they go,they have to have IVs, meds given, drips started. Documentation done. We have a stroke program. TPA started within an hour. A post cardiac arrest hypothermia program which involves placing the cool down device, staring about 5 drips, foley, OG etc. These are just a few of the complex procedures that are becoming commonplace in ERs along with
handling ventilators, bipap, rapid infusers, central lines, CVP lines, rapid sequence intubation, etc.
Then there is the documentation. We do electronic charting. Charting around conscious sedation, blood transfusion, restraints, critical patients has become a nightmare. With increasing HIPAA, medicare, CMS requirements, documentation is nearly impossible to keep up with.
I make a decent wage after all these years, but I should be getting a lot more. My job is complex, the responsibility is enormous, the stress is at times overwhelming. What other job involves this kind of complexity and makes this little money?
If hospitals don't pay more money, they will face a severe shortage of nurses, worse than the one that is predicted in the next 20 years. Nurses coming into the profession are not going to stay in this kind of
environment if they are not paid equal to the requirements. Why would they? They have so many other opportunities. I see them talking advantage of those opportunities. Many of them are becoming nurse practicioners, CRNAs, heading straight out the hospital door.
Posted by girlvet at 12:01 PM