By: Beth

Beth — Sat, 12 Jul 2008 05:26:33 +0000

Dan-As an ER/Trauma RN for over 15 years, I can tell you this is a HUGE problem. Much more so than you’ve described. It’s not a particular area of the US. I’ve spent 13 years practicing locally and have been a travel RN the last few years, all over the country. The problem is, in my opinion, 3 fold: #1) There is a doctor shortage. So much attention (warranted) is paid to the nursing shortage, that the dwindling number of practicing doctors & students enrolling in medical school (so we can expect the number to decline further in the future) is overlooked. My personal physician sometimes is booked 3 weeks in advance! The problem may be ‘minor’, the patient may be ‘uncomfortable’, but what can a person be expected to endure for 3 weeks until the appt? By then, it may be a much more serious condition. So, the alternative is: the ER. Where does the fault lie? Well, really nowhere. Can’t blame the doc, can’t blame the patient for not being willing to wait weeks for medical care. What’s the answer? Partly, particularly in this area, reduce malpractice insurance (stop awarding huge malpractice settlements, which Madison County is known for), some incentive to recruit medical students. Otherwise, I don’t know the answer. #2) Not so much in this area, but in NC & AZ, the immigrant population is large. They have no insurance, so no MD will accept them as patients & they know the ER can’t turn them away. So there is an evergrowing population that is contributing to the number of ER visits annually. The same is true with many uninsured or underinsured US citizens. Abuse of the public aid system is a joke. Even if they had an MD that could see them, they still come to the ER. They can come in for anything, at any time and it’s free! I’m SURE, if the government got tuff on this abuse, the number of ER visits by these abusers of the system would drop. If they had to pay for the visit, I’d bet they wouldn’t come to the ER for nonsense. As God as my witness, I have had them come in with a sty or broken fingernail (pulled back the skin a little & it hurt! Geez!). All this ties up the staff, the ER beds & makes the wait longer for everyone. When you tell them they have to wait because sicker patients get seen first-let the fun begin! Now the nurse is tied up explaining why the wait is so long, instead of caring for the patients. #3) Money. Yep, the almighty dollar. I don’t know why lay people think doctors & nurses make so much money, but in reality, we don’t. Example: Let’s say I make $45/hr. Sounds like good money, doesn’t it? An average ‘code’ takes about 15 minutes. If I (God forbid) would have 4 back to back codes, I get paid less than $11 for each code. Yep, knowing all those meds, the machines, the protocols, signs/symptoms, the education to try and save maybe YOUR mother/father/brother/sister gets me about $7.50 after taxes. On occasion, there isn’t even an MD available so the RN’s run the code themselves! Many hospitals I have worked at, in an attempt to save $, cut back on ancillary staff (secretarys, techs, nurse aids), so now, instead of concentrating on being a nurse, I’m emptying linens, restocking shelves, cleaning the room after each patient, all while a sick someone is waiting to be seen. What a waste of my time! Hospitals are so liability conscious, that nurses are forced to spend so much time documenting, it takes away from patient care. Again, extending the length of time someone is taking up an ER bed, & we can’t ‘turn over’ that room for the next patient. So, would I encourage someone to get into nursing? 12 hours on your feet, no lunch break, getting attitude from patients/visitors, having 6 patients when I should have 3-4, being witness to someone else’s pain, sorrow, suffering, many times doing the MD’s job…..for about $35/hour? No. I tell them stay far far away. It’s not ALL about the money, but it’s not WORTH the money. Hence, the nursing shortage. Nurses call in sick, they won’t pick up extra shifts, they have a high incidence of substance abuse, high burn out rate, low morale is rampant, they get out of direct patient care (i.e. management, etc.). If there are no nurses to take care of these people-they sit in the waiting room. Personally, if I were offered more $, I may consider working more shifts, but not for a pat on the back. CEO’s need to expand the ER’s, offer higher wages, open ‘urgent care’ departments and staff them with nurse practitioners. The government needs to open stand alone urgent cares. This will help alleviate some of the backlog in the ER waiting room. In other words, private institutions AND the government need to part with some $ to offer alternatives to the ER & make it worth becoming (& staying) a nurse (or doctor). In closing, the average wait in an ER waiting room is 4-6 hours. I’ve seen them wait as long as 9 hours. With no available beds to put them in, no doctors or nurses to care for them, less physicians in private practice, when the complaint is a trivial nuisance rather than an emergency, there will be no fix. I don’t see an end & the forecast is frighteningly gloomy. Myself…..I work my 40 & that’s it & I’ve enrolled in a masters program ‘cuz I’m jumping ship as well.

Comments on: Crowded emergency rooms

By: Beth