January 9, 2009, 3:06 pm

Pain, Potty and Position Protocol for the Professional Peon

Wow – that is a mega cap!

There must be 2.5 inches between the black stripe and the top of that thing.

Too much space there. I give it a 8.75 on the Emergiblog Cap Rating Scale.

I see this nurse is making sure the doctor does all his documentation.

Some things never change.

If I had a nickel for every time I was told, as a nurse, to put the appropriate order form in front of the doctor’s face if he wasn’t using it, I’d be flying to every Nascar race this season.

Don’t know ’bout you, but the doctors I work with are professional men and women who can take responsibility for their own charting and ordering protocols.

I’m a Registered Nurse. I raised my kids. I don’t need to be babysitting doctors.


It has been my belief that the ER technician is the unsung hero of the department.

Doctors and nurses come and go, but a solid ER tech (along with a solid unit secretary) are the foundations of a smooth running department.

One would think that management would understand and appreciate the never-ending work of the emergency department technician.

One would think.

Let’s examine this in a hypothetical situation and see if we can draw any conclusions.


Pretend you are an ER tech in a medium-sized community hospital; we’ll call it Hotel Get-Well. You work 12-hour shifts.

Your duties? As varied as the patients you care for. You transport them to x-ray and you run their blood to the lab.

Some days, every bedpan and commode are filled just for you to specimize and measure the contents thereof. Those colorful suction canisters are changed by your gloved hands, the same ones that just helped change the diaper of a patient old enough to be Lincoln’s grandfather on his mother’s side.


Every single ER patient is transported up to their room by you, and we don’t have the technology of beaming them up. Every single patient in the entire hospital who receives a Celestial Discharge is taken to the heavenly holding area. By you.

IF you are not busy (!), you are expected to help other departments take their patients to CT or go with the house supervisor to take a patient to the MRI.

“No!” is not an option, btw.

These expeditions can take up to 1-2 hours, during which time the ER is short-staffed.

To make it worse, sometimes you are asked to run and get medical records because it is scary down there and you’re a guy and the supervisor is female and, well, you won’t get raped/maimed/murdered or abducted by the the Homicidal HIPAA Hell-Cat.

Oh, and did I mention that you are not the house “orderly”? This isn’t even in your job description.


You clean every ER room after discharge, you re-vital patients on a regular basis and you never rehydrate yourself because there is no time to pee anyway.

If any stock is low, it’s probably (sarcasm) your fault (/sarcasm) because you did not order it and either way you have to run to Central Supply and pick it up. And while you are on the way, you might as well take down all the instruments that you have cleaned and prepped for sterilization.

You are responsible for stocking every single 2 x 2 and every packet of Surgilube. God forbid you forget to do the QC on the One Touch.


You dress wounds, you apply splints, you do crutch training and you act as the go-fer when the doctor is suturing. You run out with wheelchairs to help people who can’t possibly get out of their cars, even though they managed to walk to them and sit down on their own power.

You hold cricoid pressure and you knew the appropriate rhythm of chest compressions long before the Bee Gees became the poster boys of CPR.

At any given time you answer to one secretary, four nurses, a physician’s assistant and a doctor.



Pretty intense job description, eh?

It gets better.

Now, in the name of patient satisfaction, you have been told it is your job to round on every patient every hour, including those in the waiting room.

Of course, you must document all of this.

Welcome to the “Pain, Potty and Position Protocol”.

And while our hospital, techs and all others discussed in this post are hypothetical, that title is not.

I wish I had made it up.


When the hell are you supposed to do all this? If our hypothetical ER was the size of the Daytona International Speedway {second superfluous Nascar reference} , this could be an issue.

But it’s not.

The hypothetical managers, when faced with the hypothetical red-faced-spittle-producing anger of this new hypothetical protocol say, “Now, now.  It’s just a nice thing to do when you aren’t busy.”

When you are not busy.

Some folks just don’t have a clue.


So on behalf of all those hypothetical ER techs at the Hotel Get-Well, allow me to join you as we hypothetically hurl.

Should the term “Joint Commission” come up in relation to this new program of patient satisfaction, I swear I’m going to become a Nascar groupie or a Starbucks Barista.

Just when you though you’ve heard it all, the inane garbage continues to spew forth from the Powers That Be.

Why not just let us be?


  • Annemiek

    January 9, 2009 at 4:18 pm

    Lovely! Great post. I love the way you put it. We too just got to hear about the 4 P’s.

  • Black Cloud ER Tech

    January 9, 2009 at 5:46 pm

    And that’s just a partial list of an ER Tech’s duties… and do this all while the department is on ambulance diversion! Whether it be direct patient care, department duties, or admin chores…It astonishes me when a new duty arises that I would have never thought of in a million years.

    As an ER Tech, I am very fortunate to work with a wonderful group of ER RN’s, PA-c’s, MD’s, and unit support staff. Having known other ER Techs in the vast metropolitan area that I live and work in, a conclusion is easily drawn: coworkers make or break the job. The duties are the same whether you are at hotel-get-well or any ER throughout the United States… but when the “unsung heros of the department” need help, a good core staff that works together day in and day out, the jobs get done, the patients get the best patient care in the land, and we have a good time doing it. (it does help when a staff member brings a laptop with Journey or Chicago blaring from its tiny speakers… had to insert a Journey plug for Kim).

    With this all said, if the ER Tech knows their job like they know the inside of thier eyelids, the 3-P’s protocol and documentation wouldn’t be needed. It is almost instinctual to an ER Tech to check up on all of the patients MORE OFTEN that once an hour. If the tech isn’t doing this, he or she isn’t doing thier job properly. It seems that the ER Tech who does their job 110% should be frusterated (to say the least) that they have to document that they have, infact, done thier job in the name of patient satisfaction.

    Just to play devils advocate, it would seem applicable for a brand new nursing student or er tech to implement the 3-P’s protocol so that they get used to rounding on patients and become accustomed to the needs of the various patients that they will be caring for in the future. But for the seasoned ER Tech, much like the one at Hotel-Get-Well, to say the least, this is additional paperwork to fill out, amongst the loads of other paper work that need to be filled out when doing supply orders, instrument cleaning requests, and, oh yeah, most important, patient charting.

  • Trauma Junkie

    January 9, 2009 at 6:22 pm

    I too, hypothetically, am hurt for those ED techs. Not to mention that at most facilities, the techs are paramedics or basic EMTs, so they can also push meds during a code if necessary. That alone is a HUGE responsibility.

    As far as the “Pain, potty, and position protcol,”
    is concerned, that’s just plain silly. Yours truly once worked at a CNA at a hypothetical hospital where the CNAs were required to document rounds on the care plan re: pain, potty, and position… and when you work on a busy ortho unit full of alzheimer’s patients from the local nursing home– it’s damn near impossible. I got it done by learning to chart a few things:

    1. Pt resting in bed comfortably at this time. NAD noted. No c/o. Will cont. to monitor.
    2. Pt c/o pain __/10. Reposition and report to primary nurse. Will f/u.
    3. Pt lying in bed with eyes closed at this time. No s/sx of distress or discomfort noted.

    Those three were on copy and paste for me all the time. lol

    I’m glad that now all we have to chart on is the doc flow sheet (vitals, pain, intake and output.)

  • Kirsten

    January 9, 2009 at 10:03 pm

    We as well, are implementing the fantastic PPP for the PP in a little less than a month. We are required to watch a dvd that is shown ONLY DURING THE DAYTIME from 11-3 in one hour increments to instruct ourselves on the fine art of asking patients if they -need- anything. Because, you know, nursing school didn’t TEACH me anything.

  • DBS

    January 10, 2009 at 9:21 am

    Yes what’s with this 4 P’s crap. At my hospital we have been told it is our responsibility as the RN (which is fine) but I thought I was already doing this in caring for my patients. Apparently not! I guess when I ask my patient if they need something for pain or if they need to get up to the bathroom I wasn’t being clear enough.

  • Strong One

    January 10, 2009 at 2:05 pm

    It is an un-sung hero position that doesn’t get enough credit. These techs as well as the unit secretary and the aides (CNA) all play a great role in the entire patient continuum. No licensed professional is worth their weight in water if they do not recognize this small but very important fact.
    Great post.

  • Jamie Davis, the Podmedic

    January 10, 2009 at 8:57 pm


    As a former ER tech, and on behalf of all ER techs, I thank you! I know that the support of the nurses in the ER where I worked was one of the contributing factors for me to return to school and get my nursing degree.

    Thanks for the great blog and leadership in the community!

    Jamie Davis, the Podmedic
    Host of the Nursing Show

  • ashesh

    January 10, 2009 at 10:23 pm

    And those are just more reasons why I am NOT becoming an ER tech. Hypothetically, I don’t know about you, but I would sure as hell lose my head in between all those damn duties. Oh how I love your writing!!

  • aries33

    January 12, 2009 at 6:05 am

    you wrote our daily routines in a very nice way.
    I hate to babysit those doctors.

  • mojitogirl

    January 13, 2009 at 6:45 am

    So very well put! Give me a decent ER tech and I know my night’s on smooth wheels.

    Speaking of NASCAR, interesting fact from my last place of employment prior to landing in Paradise: I worked at Halifax Hospital, right across the street from Daytona International Speedway. Every year during race times, we’d have the opportunity to go work the clinic at the Speedway during races. One of our nurses was the director there, and there were always openings if you were race fans and wanted to be in the thick of things. Personally I tried to stay out of town and avoid the traffic if possible, but I know you’re a race fan and this might be up your alley someday.

  • CallMeTeacher

    January 13, 2009 at 9:01 pm

    As I am looking at a potential 2nd career in nursing, how can I obtain a position as ER Tech? I would like to obtain one, preferably on the weekends, as I am a teacher and can’t work doing the week.

  • EGrace

    January 14, 2009 at 11:32 am

    Thank you! There’s a whole collection of people who are sturdy, reliable, and rocks that are depended upon and who haven’t the status of others…

  • […] Kim from the Emergiblog always has great comments on the state of nursing both in her perspective as an RN in the ER and on nursing in general.  One of her recent posts paid tribute to a job I used to have back in the day – ER tech. […]

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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