What’s wrong with this picture?
There’s a nurse in it.
Half the hospitals in the San Francisco Bay Area are building new facilities.
It is cheaper to rebuild than it is to retrofit to new earthquake standards.
In all the hospitals I’ve worked at and all the plans I have seen, guess which department gets either rebuilt or worse, remodeled last?
Yep, the ER.
And how much input do you think nursing has in the development of the new department?
Oh, about 0.1%
Yes, they stick up a big set of blueprints and then ask us for our “feedback”.
Show of hands please: how many nurses out there can read a set of blueprints?
Oh, it isn’t only me?
They aren’t even talking to the nurse in the photo. She’s just trying to make heads or tails out of the, you guessed it, blueprints!
So what would the “perfect” ER look like?
Well, for one it would have a triage room with:
- An ice machine
- A sink
- A gurney for examining pedi patients.
- A phone
- A small med refrigerator for holding diptheria/tetanus vaccinations
- Scales – infant and adult
- Tylenol and Motrin
- A cupboard with: slings, ace wraps, ice bags, preformed splints, Kerlix, 4×4 gauze emesis basins and urine specimen containers.
- A view of the entire waiting room through a bullet-proof glass window (that’s not a joke!)
- Dedicated security for ERs in high crime areas.
Then I’d like every room to have the capacity to be a pelvic room. Keep pelvic supplies on a “pelvic cart” that moves from room to room. There is no reason why every gurney can’t break down into a pelvic gurney.
I’d like monitors at every bedside. Cardiac monitors with O2 Sat and BP capabilities.
I’d love to see LARGE ROOMS. There is a world-famous university medical center not so far from me with the tiniest excuse for a trauma room you would ever hope to see. If you can spare space for those damn VIP suites upstairs then you can spare space for your trauma department, of all things. Same thing with Inferior Medical Center – tiny trauma rooms.
Wrong!!! Just wrong!!!
I want all rooms private and I want a bathroom in each room. With urine dip-sticks so I don’t have to run to the dirty utility room to dip a urine.
I think the rooms should be in a “pod” formation around a desk where the nurse assigned to that pod can sit and chart. Pods of 3-4 beds.
An exception can be made for the “crash/Code 3/Critical Care room, which should be huge and have curtains in between beds. No bathroom. If you are well enough to go to the bathroom, you don’t need that room.
Which brings me to another desire.
Desk space. Lots of it. The ER docs need it. The interns and residents/registrars need it. The attendings need it. The nurses need it. The hospitalists need it. The primary doctors need it.
Why does it have to be so hard to find a place to chart?
And since I’m describing the ER of my dreams, is it too much to ask to have a med room that can actually hold more than one person at a time and allow more than one person access to the Pyxis?
I’m going to go waaaay out on a limb and ask for a computer system that allows you to order x-rays and labs before the patient is registered by using their complete name and birthdate, with the medical record number automatically attaching upon registration.
I don’t mind working hard, but I mind working stupid.
Yes, I’m grumpy.
Just did a 12-hour night shift.
Wore just one shoe because the blister on my right heel was so bad, I just put a shoe cover over my sock.
I just limped all night and got lots of sympathy.
And that post-Notre Dame loss headache?
Still have it.
48 hours later.
I’m just one attractive nurse, eh?
And I have 30 seconds to get this to Grand Rounds.
Will I make it?????