plum tuckered

I really wonder who is going to work in the ER in the coming decade. As time goes on ERs are becoming more and more difficult to work in. The patient acuity has skyrocketed. There are more people living into their 90's accompanied by all the things that can go wrong by then. Medicine and technology are keeping people alive longer and longer. So the people with a myriad of medical problems present over and over to the ER.

A lot of people think ERs are places where you come if you have an accident, a heart attack, stuff like that. That's true, however the vast majority of our patients are people who are already chronically ill and now they are having some kind of other problem. Here is a typical ER patient these days: non english speaking immigrant with cancer with mets who is failing and the family presents with the patient. The family barely speaks english. There is confusion in the family about how much they want done. So they decide to do everything: labs, IVs, UA, xray. THis is the kind of person it is impossible to get an IV on. They really have no urine when you cath them because they are so dehydrated. The cultural divide between hospital staff and the family is wide, even with the assistance of an interpeter.

And that's just one patient of many with similar complex presentations. The days of sprained ankles and lacerations seem to have fallen by the wayside in ERs, my ER anyway. We have become mini ICUs. The thing about us is there is no staffing that takes acuity into account, ER staffing is based on volumes.

My days in the ER are numbered. I just don't want to work this hard under these kind of conditions for much longer. It is too exhausting. I had a nurse who just graduated from school tell me that she knows she won't last over the long haul in the ER because the acuity and the stress is too much. My advice: Don't stay for years and years. Its not worth the toll it takes on you.