Monday, May 19, 2014

your grandma is my typical patient these days

Why does it seem like my job is getting more stressful?  I mean I have been in the ER for a long time, can handle most anything, but I'm feeling overwhelmed these days. What has changed?

Its weird, I don't think we are getting that many more patients. I think what it is, is that patients are sicker. A typical patient I would say is:

1) 70's, female, living in assisted living
2) limited mobillity, overweight
3) Hx: CAD, HTN, arthritis, UTI, TIA etc.
4) now you have another problem

Here's the thing: You will have the $10000 work up. Monitor. CBC, lytes, troponin, UA at the very least. EKG. Chest xray. No doubt CT of some part of you. Start an IV because why not? Its something to do. Give you nausea meds or pain meds.

You require a lot of my time getting you started.  Then your numerous bathroom needs. You are old and you go often and you have to use the commode. Your family arrives and I have to spend time talking to them. Meanwhile I have 3 other patients, the same or worse than you. I could have an out of control psych, someone who is unstable.

After 4 hours you are admitted of course. I wait at least another hour for a bed if not longer if there are no beds.

In other words, I am running my butt off for 12 hours. We don't have enough nurses. With the whole "decreased reimbursement" baloney.

A nurse I work with dropped a pearl of wisdom this past week: "I'm at the point where if they are still breathing, I will eventually get to them".  In other words, stop stressing out and just plod along and it will all get done like it always does.  I like that.


aki bisw said...
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Anonymous said...

Wow...I could have written this. And it's only getting worse. Our daily census has gone up 15% over the last year while our staffing and available inpatient beds have gone down. We've seen a significant increase in acuity over the last couple of years and it doesn't take much to push us to the point of being unsafe anymore. Wish I could figure out where I want to work besides here...

Alena Mauer said...
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Anonymous said...

Same where I work. Usually the helicopter daughters arrive with multiple questions and requests. I wonder if the nurses At the nursing home are at the beck and call of family members. I doubt it. I usually throw a foley in the old ladies I know I know it's so wrong in so many ways but I don't have 2 seconds to potty them constantly.

Anonymous said...

Same is happening at our facility. Acuity and age are increasing while staffing is decreasing. When your median age of patients is 85 and you have no tech support, it makes it impossible to accomplish all tasks: charting, toileting, keeping fall rates down. The best is that the staffing is kept so sparse that when someone calls out we are getting killed. Then admin cannot understand why no one wants to come in to work extra--hello! we are getting our butts kicked, we need a day off from this place before we quit!

Anonymous said...

70's? Nope, we're getting the late 40's and 50 year olds that look 70 (or more) that have so many co_-morbidities they'll never see 60.