Friday, December 09, 2005

Respectfully Submitted

Someone tell this poor child she doesn't have to go into nursing!

She probably got the medical kit as a gift and she has to play with it while the relatives are there so they don't think she is ungrateful.

The minute they left the house that Christmas night, she went back to her Tinker Toys and Lincoln Logs.

And eventually became an architect.


Dear Doctor,

As an RN, I have a deep respect for what you have to go through to be a part of the medical profession and the responsibilities you shoulder once you get there.

As an RN in the emergency department, I must deal with your misunderstanding of how the department and staff are to be utilized, and how this impacts patient care.

I respectfully submit these requests:
  • Please don't write STAT unless you mean it.
    • We take that literally in the ER. Don't be like the surgeon who had me running for an hour doing STAT medications, labs and paperwork for a patient whose surgery.......was the next day.
    • Having an ER nurse running STAT for things that can be done on the med/surg floor is a blatant misuse of the ER staff.
  • Please do your work-ups on the floor.
    • We know things get done faster in the emergency department. The fact that you appreciate that is a testament to our efficiency. We are fast because facilitating patient-flow is an integral ER function. By holding a patient there for your convenience, you are interfering with that function.
    • Once the ER doctor has seen the patient and made a diagnosis, they can admit the patient with holding orders and the patient can be seen upstairs.To keep a patient tying up an emergency department bed solely because it is easier for the physician is actually
        • Unfair to the patient whose admission is delayed
        • A delay of emergency resources to another patient.
  • Please don't call and give me a list of orders for an incoming patient and then tell me the ER doctor is to evaluate the patient.
    • I am no doctor, but this seems like a breach of professional courtesy. I have never worked with an ER doctor who appreciated this.
    • If you wish to manage the care of the patient, please consider
      • Seeing the patient yourself
      • Talking to the ER doctor directly.
  • Please admit your patients directly to the hospital.
    • With all due respect, the ER is not an office adjunct.
    • There is no need to utilize the ER when the diagnosis has already been made.
    • It is a misuse of the ER and unfair to the patient, both financially and personally, to have to endure a needless emergency department stay.
  • Please know that when you tell a patient to meet you in the emergency department, a room may not be readily available.
    • We will do the best we can to open a room for you as soon as we can.
    • Standing in the nurse's station acting frustrated and impatient does not help the situation, nor clear a room any faster.
    • Calling ahead to alert the ER that you will be seeing an incoming patient can help the staff plan for your needs and most likely have an exam area open and waiting.
I know the ER staff enjoys caring for your patients and working with you to make sure they get the best care possible. It is easier to do both when the ER is utilized appropriately.

Thanks for reading.

Kim, RN


At 12/10/2005 09:37:00 PM, Anonymous dribear said...

I hate it when I call the on-call physician to admit a patient and he/she say, "ok, just hold them in the ER and I will be down in a bit. Because I don't have ummm, er, cahonies, I usually oblige.

At 12/10/2005 11:08:00 PM, Anonymous Anonymous said...

Oooooh, good letter.

STAT drives me nuts. I find our surgeons fairly good...but the GI docs are a bit over the top. They fail to see that "abdomen" falls somewhat behind airway & breathing. I had one specify that he wanted 2 specific-sized IVs (ummm...sure...I need that direction as an ER nurse...and perhaps he should have examined the patient's veins before ordering...) CXR STAT, etc, etc, for a stable patient. I suggested that if he felt the patient was SO UNSTABLE he should request a trauma room, and he was incensed!


At 12/13/2005 01:31:00 PM, Blogger beajerry said...

Great post!


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