Veroniche
Western Region, US
Female, 54
I’ve been an ER nurse manager since 2009. Previously, I spent 24 yrs as an ER nurse. My hospital, a Level III trauma center, sees 70,000+ ER patients/yr. My responsibilities include billing, federal/state regulation oversight, metrics reporting, software education of e-records, and hiring/termination/disciplinary actions. The ER is one of the key impacted areas of healthcare reform. It’s a scary and exciting time for us, not just in the care of patients, but what the future holds for healthcare.
We have a great relationship with the ER physicians and nurses here--very respectful and collegial. The physicians trust the care that the nurses give, and rely on the nurses to keep them updated on the patient's condition. ER nurses also have great intuition and sixth sense. Since we are with the patient more, sometimes we will know what is wrong before the doc does. It is true that the nurse does most of the physical work and bedside tasks with the patient. The docs are doing the diagnostic puzzle solving behind the scenes. I think the stereotype you mentioned is continued because of medical TV shows and movies. There may be lack of respect in some ER's, but not mine. When I first started here, I saw a physician give a patient a bedpan and then clean the patient up. I asked her if she had been a nurse before she went to medical school, and sure enough, she had been an ER nurse. Generally, you won't see physicians doing bedpans.....or cleaning up vomit....but I am ok with that.
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The "slowest" times in our ER are Thursdays all day, and Friday mornings. Mondays are the worst! Our city has an NFL team, and during football season, it is really quiet on Sunday afternoons during the games. So if you can “schedule” your emergency :) .... October generally is a slow month, so maybe the last Thursday morning in October would be good. Summer is full of active people that have hurt themselves doing something. Winter is flu and all kinds of infectious diseases. We’re geared to take care of really sick and dying patients, and we do that very well. If you are really sick, you will be seen quickly. However, if you have a minor illness or injury, the sickest patient will always be seen first. We recently purchased software that will allow a patient with a minor injury or illness to "reserve" a place in line from computer or smart phone. Once we are up and running it will be interesting to see what happens. There is a lot of brainstorming on how we can take faster care of patients with minor illnesses or injuries.
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YES YES YES!! Emergency Departments are mandated by the federal government to make sure that a patient that comes to the ER is treated for an emergency medical condition. We are not allowed to ask about insurance or ability to pay with the patient when they walk thru the door. That does not mean, however, that the patient will not receive a bill for their treatment afterwards. There is a misconception in this country that "ER care is free." It is not free, and it is extremely expensive, but we cannot ask an ER patient for money or proof of insurance up front. We also cannot give different care in the ER to patients who have insurance over the un-insured or Medicaid patient. The uninsured have difficulty in finding follow-up care and so end up in the ER for their minor illnesses because we cannot demand payment before they are seen. I am confident in our ER that we do not discriminate with our treatment of patients. Right now, our ER alone has over one million dollars in unpaid debt from patients who are unable to pay for their care. Who pays for that? We all do, in higher taxes, higher insurance premiums, and higher prices for those who are able to pay. There is no free lunch.
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Daily! It is an ongoing issue and causes staff a lot of worry and anxiety. We have a security officer at the front, and all of our doors are locked, however there is no way at this time to stop people, patients or visitors, from bringing weapons into the ER. A couple of the ERs in our area have metal detectors, but we are in a suburban area and it doesn't set a "welcoming" tone. And no one needs to have a weapon to be violent, fists and arms and legs are sufficient to cause injury. I have been pushed and shoved, threatened with death and bodily harm, pinned onto a gurney by an intoxicated huge guy. Most of the violence is due to drugs and alcohol in either patients or their families/visitors. Our state is attempting to pass laws that would make it a felony to assault a health care worker. There is also a tremendous amount of verbal abuse and threats and it is getting worse day by day. We are not even in a high crime area. A lot of times I just want to say, "where is your mother, and who taught you to act like this?"
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In 1986 Congress passed a law called "EMTALA", the Emergency Medical Treatment and Labor Act, which requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. The actual law is only a couple of pages long, but the interpretation of the law has kept lawyers busy for 25 years. There is a good article in Wikepedia on this very subject. To answer your question--No. Where I work, every employee is highly trained in the EMTALA rules and regs, so I have not seen it here. Hospitals can be fined hundreds of thousands of dollars if an investigation shows that emergency care was refused to anyone. Patients who think this has happened to them have reported this to their various state and federal agencies, and the hospital is investigated. However, not every reason a patient comes to the ER is an emergency medical condition. The law requires that the patient be examined for an emergency medical condition. If the condition is not deemed an emergency medical condition (and there is a whole lot of people trying to interpret what that means), then the ER is not obligated to treat you, however, they must examine you. By the time the ER doc is done examining a person, they end up treating the patient anyway. This law is sometimes called an "unfunded mandate", because there is no funding to go along with the law. The law says we have to do it, but the patient has to pay for it. If the patient can't pay for it, whether through insurance or their own money, then the hospital ends up eating the cost for that care. This is one reason why I believe emergency care is so expensive. That's a whole other topic....
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It depends. Our hospital CEO has been a patient in the ER a couple of times, and initially no one knew who he was and he just went through the system like anyone else. He thought the care was outstanding, and he was treated appropriately. Thank goodness. We have also had a "secret shopper" program to see how patients are treated, we are not doing that any more. The only thing the 'secret shoppers" do anymore is monitor staff handwashing. Several years ago, a patient who had Secret Service protection ( that is all I am going to say) needed to come to the ER. The Secret Service called ahead of time, and we arranged a "back door" entry, and expedited this person's treatment. It was so well managed, that even many of the staff had no idea what was going on. At a previous hospital we treated the mother of a prominent state official, and we expedited her care, and made sure everything was really private, but she was not seen before anyone who was sicker. I always want to have my family or myself treated in the ER that I work in because I know how good of care we give. When I know we have to come to the ER, I usually call ahead to see which doctors and nurses are on, and generally we have that "perk" of asking a specific person to take care of you. Of all of the times me or my family members have been in the ER, however, we have never bumped anyone that was sicker. This is a little off the subject, but one of my jobs is to make sure that no staff look at medical reccords of "famous" people, or unusual patients or accidents, unless they are directly involved in the care of the patient. Since our medical record is electronic and protected, you can easily see when someone is poking around that shouldn't be--it shows when you logged in and from what IP address. That can get you fired in a heartbeat.
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I have seen a few, but mostly I see RNs getting advance nursing degrees like nurse practioner, and Masters or Doctorates in nursing. It is a different mind-set, nursing vs physician. There is a different approach to the patient and a different scope of practice. I think being a nurse would help you be a better physician, though, because of the time a nurse spends with the patient, and the interpersonal skills needed.
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