Emergency Room Manager

Emergency Room Manager

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.

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Last Answer on May 25, 2014

Best Rated

Why are ER bathrooms so frequently filthy? I'd think that in hospitals of all places, there would be more concern with germs and therefore more attention to the upkeep.

Asked by Mr Clean about 6 years ago

They are dirty because they need to be cleaned more! We have three bathrooms for 58 patients, and two public restrooms. They are cleaned once a shift (three times a day), and more if we call them, but it is hard to keep up with them. When the budget trimmers come around, housekeeping is looked at as a non-patient care item, so sometimes the axe falls with those type of departments first. However, a lot of the hospital complaints have to do with cleanliness and I would agree that we don't give that as high of a priority as we should. You can tell a lot about a place by how clean it is/or not. And that is not even taking into account all of the infectious diseases and just plain yuck that you may see. Kind of like a subway platform. Now I digress a little--but follow me here. Any hospital is highly regulated--thousands of pages of rules and regulations that we have to follow to keep our federal funding. The cleaning of blood has different rules, bodily fluids are different, chemicals used to clean are very specific. We can't just wipe off a toilet with a wet wipe like you do at home and call it good. The hospital has a whole department devoted just to making sure that we all follow the rules. The rules and regs are there to protect the patient, and sometimes we spend more time trying to keep the rules than taking care of the patient and keeping them happy and safe.

In a recent Republican debate, Ron Paul was asked whether uninsured patients should be denied ER treatment and he responded that that's what freedom was all about: the choice to take your own risks. The (conservative) audience cheered, although it wasn't clear whether it was merely in approval of individual liberty, or in favor of letting uninsured people die. As a professional healthcare provider in the trenches, how do you feel about it?

Asked by Kyle about 6 years ago

Individual liberty--feel strongly about it! With great privilege, however, come great responsibilities. Freedom without responsibility is anarachy. Responsibility without freedom is slavery. I think greater people than me said those things before.... As Americans, we have individual liberty, and also responsibility to others. Letting uninsured people die--what kind of question is that? That's kind of like asking the question "when did you stop beating your wife?" I think you can come up with a more thoughtful and informed question than that. Let me help you think about what you are trying to perhaps ask-- Is there a limit to what we, personally and collectively, should spend on keeping people alive? What responsiblity do we (personally and collectively), have to others in terms of their healthcare and financial responsibility? Should people be accountable for the choices or decisions they make that are under their control?--ie, should others pay for uninsured patients that smoke, are overweight, ride a motorcycle without a helmet, etc? Former Colorado governor Richard Lamm said about 30 years ago "the elderly should just die and get out of the way." That is a polarizing statement. Ask me a question that puts some thought into it, because these are the very questions that healthcare professionals and government officials wrestle with every day. I'll try to answer that with my opinion and the opinion of others that are more qualified than me.

What inspired you to go into nursing?

Asked by ShipofFuels about 6 years ago

I’m afraid I don’t have a wonderfully inspiring story of how I got into the nursing field. I would love to be able to say that the life of Florence Nightingale drew me into nursing, but it was a lot simpler than that. I was originally a music/piano major, and came to the realization that I did not want to practice the piano the rest of my life. At that point I had no idea what I wanted to be when I grew up, but needed a direction. Many of my friends on my dorm room floor were nursing students and I thought “I could do that,” and that’s how it started! Once I got into the classes and clinicals, I loved it!

Are there any TV shows that portray an ER accurately?

Asked by Kyle about 6 years ago

When "ER" first came on the scene, I wouldn't watch it, even though many of my non-medical friends did. I said to a friend one time--"when they starting betting on patients' blood alcohol levels on ER, then I might watch it." About the third or fourth episode, sure enough, that was in the story line. To me, "ER" was the first drama that had the terminology and chaos fairly correct, however, it is the nurses that do all of the work with the patients generally, not the physicians. By the time the ER physicians, who are some of my best friends by the way, give all of the orders, the orders have already been done by the nurses. We know what the docs are going to order before they say it. I don't watch any of the current medical dramas, except I have seen a little of "Nurse Betty" on Showtime, which talks about substance abuse in medical professionals. To finally answer your question, yes, the drama is sensationalized. No one would watch it unless it was. Even though the ER is pretty exciting at times, there is no way that we do that every hour all of the time.

If someone lands in the ER after overdosing on illegal drugs, are you required to alert the authorities?

Asked by Rx about 6 years ago

No. The nurses and doctors are not the police, and that is not a part of our job. The medical treatment any patient receives is protected health information and we cannot release that info to anyone unless the patient oks it, or it is subpeonaed in an investigation. Even though some drug use is illegal, substance abuse is considered a medical problem. However, if, in the course of treating a patient, we find that there might be child neglect or domestic abuse or that a crime against another person has happened, we are obligated to report that. Each state has mandatory reporting laws around abuse. But we are reporting the suspected abuse of another person, not the drug use of the patient. If we find illegal drugs or pipes, etc. on a patient, we do call the police and they come and get the stuff, but in our ER I have not seen the police arrest anyone for that after we have called them. They may check for any outstanding warrants, and who knows what that may lead to. We have great relationships with our local law enforcement, but we don't do their job and they don't do ours.

What's the most bizarre thing you have seen? Or perhaps the craziest thing you have seen someone put in a bodily orifice?

Asked by tjspot about 6 years ago

The creepiest thing I have seen, I wouldn't call it bizarre, but I will never forget it--a patient came in with his arm amputated just above the wrist in a farming accident. When there is a chance to put the part back on, there is always a staff member whose responsibility is to take care of the amputated part. In this case, it was me. I opened the cooler (the patient had been flown in from a rural area), and the arm was just lying there in a plastic bag in a container on ice. It reminded me of "Thing" from the Addams Family. I almost expected the hand to climb out of the cooler by itself. By the way, the surgeons were able to reattach the hand and with a lot of physical therapy, it ended up being a pretty functional hand. Anything you can imagine has been put in a bodily orifice. From the common Lego up the nose, bean in the ear, lost tampon (how do you forget about a tampon?), and you can let your imagination run wild, it has probably happened. There are stories all over ERs about this, but this one was one of my patients--a young man inserted a thin glass chemistry tube about the size of your pinky into his urethra. He had to go to the OR to get that removed. This was not in an orifice, but here is the scenario--I was there. A gentleman had placed a common hex bolt around a certain body part and low and behold it became stuck. It became a medical emergency because the blood flow to the body part was being stopped and it was becoming blue, no blood flow. We had to get a pair of bolt cutters from the hospital engineers, and the physician who happened to be 9 months pregnant, was leaning over the gurney trying to get enough strength to cut that 3/4 inch bolt off before he lost his member. She's nearly in labor, he is screaming and thankfully it worked. After about an hour, he regained blood flow and his pain went away. He said "thanks" and walked out the door. Whatever.... I'm sure there are better stories out there, but I only want to refer to what I've seen or done myself.

Do ER employees eventually get desensitized to morbidity?

Asked by TrimTebow about 6 years ago

You compartmentalize your life, you have to or you couldn't function day to day. There is a lot of sick humor among staff in the break room. I think that if you don't deal with it as it happens and talk about it honestly with a friend or co-worker, you will eventually burn out or develop self-destructive behaviors. ER nurses are a lot like police officers or firefighters/first responders. There is a lot of substance abuse and depression among us. ER nurses do not come to work impaired (generally), but there is a lot of alcohol use outside of work to deal with what we see on a daily basis.