January 21, 2012, 12:30 pm

Four Ways To De-Stress Your ER Visit

No one ever wants to go to the emergency department, but unfortunately illness and injuries don’t keep Monday through Friday office hours.

Here are four tips that will make your visit go smoother and keep you safer as you enter the world of the emergency department:

1. MAKE A LIST, BRING THE LIST

Bring in a copy of your medications, including all vitamins and supplements, and dosages!

Of all the things you can do to prepare for a visit to the emergency department, this is the most important!

Your safety can depend on the accuracy of this list!

Patients often think their medications are “on file” in the hospital record or that the ER has access to their doctor’s office file. This is not the case.

You are the ultimate source for knowing exactly what you take and when, and the ER staff will depend on you for that information. Even if your medications are memorized, in the stress of an emergency visit, you will forget medications or dosages.

Don’t take that chance. Take the time to make that list now, before you need it. Keep a copy on your computer, and keep it updated. Carry a copy with you at all times.

2. ROOM FOR TWO…

Emergency departments are hectic, crowded places, and visitors are limited to one, maybe two people at the bedside. Everyone else waits in the waiting room.

You should bring someone with you, but limit your companions to two. If you receive pain medication, they can provide a ride home. They can help you get what you need while you are in the department. If English is not your first language, they can help translate. They can provide updates to family and friends on your condition.

Nothing is worse than seeing six adults escort a patient into the ER, only to have four or five of them biding their time in the waiting room until the patient is discharged. Even the simplest complaint can take longer than expected to resolve if the ER is busy.

Do your family and friends a favor. Bring one or two, and keep the rest updated by phone.

3. THE WAITING IS THE HARDEST PART

Let’s be honest. A trip to the ER means waiting.

Emergency departments are working hard to decrease the amount of time you wait to be seen, but sometimes it can’t be helped.

You wait to be seen by the triage nurse. You wait for the nurse practitioner/physician. You wait for the labs to be drawn, the EKG to be done, for radiology to be ready to do your x-ray…for the results of the lab, of the CT scan…for the specialist…for the discharge instructions.

In ER, we wait quickly!

The best hedge against having to wait is to bring something to do while you wait!

Bring a book, a Kindle, a magazine. Crochet. Knit. Do a crossword puzzle.

Have an iPad? Watch a movie, surf the web.

Here’s where that cell phone comes in handy. I’ve seen parents entertain kids with videos and games on their cell phones.

4. …ABOUT THAT CELL PHONE…

Cell phones are absolutely fantastic in the ER for keeping boredom at bay while waiting and for keeping family and friends up to date on your condition. But…

Don’t let them interfere with your healthcare by taking your attention away from what’s happening around you!

Texting during physical exams, answering calls or texting during the triage interview, continuing to talk on the phone when the doctor is standing at the bedside to discuss your case, all these things take away from the one thing you are there to focus on: your health.

Give the nurses and doctors your undivided attention. Just remember, there isn’t a text or a phone call as important as your health!

*****

Hopefully, you won’t have to visit an ER in the near future. But if you do, these four tips: (a) Bring the list, (2) limit your companions to two, (c) bring something to do while you wait and (d) keep that cell phone in perspective, will make your trip to the ER a little less frantic!

January 20, 2012, 5:04 pm

Not A Laughing Matter

Tea time at the nurse’s home!

Considering it’s been a full two months since my last post, I’d say I took a rather extended “tea time”!

I didn’t intend to take a hiatus, the hiatus just sort of took me!

I’ve actually been blogging regularly, both Masters In Nursing.com and All Healthcare Jobs.com, but it’s time to sweep away the cobwebs and spend some time at “home.”

This post was originally written for my column at AllHealthcareJobs.com. It’s about emergency nursing, so I thought I’d get back into the swing of things by posting it here at Emergiblog.

*****

Working in the emergency department is never dull. Oh, we have our moments of down time, but they can be shattered instantaneously by the blast of an ambulance ring-down or a critical walk-in patient (or three!)

Not all cases are serious, life threatening or traumatic. Some chief complaints are downright odd. If the truth were told, some of the reasons people present to the emergency department are downright humorous.

Humorous to everyone, that is, except the patient. No matter how off-the-wall the complaint, it is always serious to the patient.

People come to the emergency department because they are (a) in pain, (b) worried, or (c) have come to the end of their ability to cope with a problem. Sometimes it’s all of the above, but every ER patient is worried.

They are worried that they are sick, worried that what they have is serious, worried that they are pain, worried that nothing they have tried has helped.

Or, they are worried because they looked up their symptoms on the internet and are convinced the tiny red dot on their forearm is melanoma and their friend’s sister’s co-worker’s cousin had the same thing and it’s 3 am and they can’t sleep because they are worried.

This means that while the stated reason for the trip to the emergency department may make me want to roll my eyes and smack my head, the real reason the patient is sitting in front of me in triage is worry.

And worry is never funny.

Unfortunately, the availability of information on the Internet seems to have done more to escalate worry than to alleviate it, as patients look up symptoms, see the worst possible diagnoses as possibilities, and feel an ER visit is imperative.

So much of what we do in emergency care is reassurance. Reassurance and education. We examine patients and reassure them that they are okay. We educate them about their problem, giving them information that will help them cope or ally their fears, so they need not worry.

As an ER nurse, I may find a chief complaint humorous after the fact. But when a worried patient is in front of me, it is not a laughing matter. For that patient, at that moment in time, it’s the most important thing in the world. It’s important enough to get them out of bed and into an ER in the middle of the night.

That needs to be respected.

November 16, 2011, 9:02 pm

A Message From “Rank and File, RN”

Looks like Mr. Administrator has some ‘splainin’ to do!

And I suggest he be straight with my colleagues, because a nurse can sense BS before it is even spoken.

I am not in management, and I never will be.

No, I am one of the “rank and file.” And right now, this member of the “rank and file” is hotter than hell.

**********

What set me off?

A comment in a post on the Health Leaders Media website, entitled Top 5 Challenges Facing Nursing in 2012. The article, written for nursing management, refers to nurses as “rank and file caregivers” and disparages their understanding of the importance of the “patient experience” to reimbursement:

If you haven’t found a way to drive home the importance of patient experience to direct-care nurses, find it now. You know how much reimbursement is at stake, but the rank and file caregivers still don’t get it.

The author goes on to state:

In fact, the nurse-patient relationship has always been about patient experience…Your best nurses instinctively know this. They already create a good patient experience. They help patients understand their care, involve families in decision-making, coordinate multidisciplinary care, sit with patients to explain complex diagnoses, and even, occasionally, have time to offer a quick hug or hand to hold.

What? This is like punching someone in the face and then offering a compliment.

I have a revelation for you – we all know it. We understand what the requirements are for a “good” patient experience and it is what we have been doing as nurses since the dawn of time.

Since “the nurse-patient relationship has always been about patient experience,” why is this a “challenge” at all? This is nursing care, and always has been!

Why are administrations freaking out now that patients will be evaluating their nursing care?

Suddenly, all these new programs are flying into place. Educate! Communicate! Medicate! Smile!

What do you think we, oh, excuse me, the “rank and file caregivers” have been doing all this time?

*****

Let me tell you what the “rank and file caregivers” have to deal with in terms of the “patient experience”.

There is a hospital in my area that has switched their meal service into something that looks, and tastes like the old airplane food from the 1970s. It comes in segmented cardboard trays and is microwaved.

As you can imagine, these meals are not popular with the patients. They give the meals poor scores on the satisfaction surveys.

At a recent meeting, the “rank and file caregivers” were lectured by the food service department that these low scores were the fault of the caregivers for not presenting the food in a pleasing manner, laying it out nicely on the table, and describing it with glowing adjectives.

That’s right, the same “rank and file caregivers” who are managing complex medical problems on multiple patients, coordinating multidisciplinary care, educating patients and family on medication side effects and complex diagnoses and documenting until their fingers are numb were lectured for their lack of culinary presentation skills.

Who is running the freaking show, Gordon Ramsay?

No wonder morale is in the toilet.

*****

Well, I’m off to take my blood pressure meds, and maybe some Ativan.

All I can say is this “rank and file caregiver” is going to keep on doing what she has been doing for over 30 years. They can call it “patient experience” or HCAHPS, or give it any project title they want.

I call it good nursing care, and the patients will finally have a say in what that means.

Don’t worry, admins, if your bottom line depends on the nurses, it’s gonna be alright.

Rank and file, RN, signing off.

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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