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.
Generally speaking, there are not dentists in the Emergency Department. Some ED's may have dentists on call that they can refer a patient to for a dental emergency, but dentists do not come to the ED, at least in our area. Our ED does have limited on call oral surgeons for dental trauma, but they are not on call every day 24/7. Most of the oral surgeons do not come in to the ED but ask us to send the patient to their office. The ED doc can treat for dental pain with dental blocks (like Novacaine), or infection with antibiotics, but they cannot reimplant teeth. In our ED we have a list of nearby dental clinics that will take uninsured patients on a sliding scale fee schedule that we refer to for general dental problems. In 2012, our ED treated over 800 patients with dental problems, about 1% of our total volume.
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ER's are prohibited by Federal law to turn anyone away that has an "emergency medical condition." So every person has to be screened by a physician or a PA to determine that, which requires taking a medical history and performing a physical exam. By then, the docs in our ER just treat them. There is a hospital in our metro area that has a clinics attached to the ER, and they will screen non emergencies and send them to their clinic. But in our case since we have no on- site clinics, it is to risky to do that and potentially face Federal fines, or risk a patient's safety.
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Sorry it has taken such a long time to answer your question Kendall. Our hospital has an active volunteer program for all areas of the hospital. If a volunteer wants to work in the ER, there is a couple of days of training to familiarize them with the procedures and flow of the ER, and to make sure the volunteers (usually younger people) are not violating any Federal privacy laws, etc. They stop in and talk with the patients, bring them water or food if allowed, warm blankets, and some times just keep people company. The hospital has an active pet therapy program, and the volunteers will bring in the dogs to visit with the patients. Since the ER can be a somewhat uncontrolled environment, we are careful with the pets--they only come in if there is relative peace and quiet.
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It depends on the severity of the fracture--you may not need anything, you may only need a hard soled shoe, you may need a walking boot, or you may need a cast, or even surgery. Every fracture is different and needs to be evaluated by a physician after an x ray. The physician will be able to determine the best treatment.
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I have not seen that particular series. When I was younger I was hooked on St Elsewhere (shows you how old I am!), and then began watching ER a couple of seasons in, then quit watching. I will watch old reruns of "Trauma--Life in the ER",--which I have found to be the most accurate, however after a while I have said--I do this everyday, why do I want to watch it in my free time. I get frustrated watching medical shows on TV, especially shows such as ER, Chicago Hope, Grey's Anatomy, House, etc. They are all just soap operas set in hospitals. I wonder if law enforcement employees get tired of all of the cop shows on TV?
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We have a wonderful relationship with the ED physicians. They are a contracted group of ED board certified physicians, we have had the contract with them for over 20 years. The relationships in the department are very collegial and we work well together. The docs and the RNs are in constant communication about the care of the patients. Since the department is so geographically large, everyone carries cell phones so it is easy to contact each other. We also have the ability to communicate with each other electronically on our computer tracking boards.
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I would love to know the answer to that question! I could write a book and never have to work again! Really, the truth is that we don't know. This is driving hospital CEOs and CFOs crazy because how can you plan for a future when you don't know what is coming. Personally I think that the workings of the ER won't change day to day. I do believe that we will be a lot busier. Our patient visits for 2013 are already up about 10% from last year. I think hospitals will have to do more with less, which means being extremely efficient with money, nurses, equipment and supplies. I already see the nurses working a lot harder for the same amount of money, the raises get smaller and smaller, and the patients are sicker and sicker. I don't know where the money is going to come from. It has to come from somewhere. The patients don't have it, the government doesn't have it, and insurance premiums don't nearly cover the cost of healthcare, so the insurance companies are going to run out of money. It is a crisis that has come to our country and I sure don't see what the answer is.
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