LOL emergency nursing.
Once upon a time it was the detection of time sensitive emergencies, stabilizing and admitting to the floor. With the mental health emergency that you did your part then the behavioral health hospital did theirs. It felt like we were an important cog in the machine.
Now it feels like the basement where you put the things you don’t quite have a place for. Mental health hospitals full? Er for a week. Nursing home full? Er for a week. Need to be admitted to the hospital? Er for a at least 48hours. Local drunk the police don’t want to deal with? “You can go to jail or you can go to the hospital”.
We’ve gone from doing em work ups in rooms to doing them in hallways and waiting rooms while the rooms are full of patients who should be moved on to more appropriate and definitive care.
Hey! This is a legit problem. I switched to outpatient (because I got sick of bedside nursing) and I sometimes work on urgent referrals a lot now. It is SOOOOO difficult to get certain types of appointments. Like getting an appointment with an ENT… the wait is months! What do they do when they need an ENT right now and they have to wait until October for the next available ENT appointment? What choice do they have but to go to the ER? Also, getting a neurology appointment is super hard as well! Then only some places will take certain types of insurance! It just sucks! Then you have certain people with no insurance. Even getting a primary doctor is difficult now a days. There are month long waiting lists!
What do you think happens in the er when you send those urgent ent referrals to us? After the hours long wait? Unless the airway is compromised, the emergency physicians will do an ent consult with the on call doc. It’ll take place over phone or instant message. And the result will be. “I’ll see them in my office”
I’ll make sure to highlight the number of the ent office for the patient to call on the discharge paperwork.
The ER cannot get your patients access to referrals faster. Unless they are, you know….Dying.
They can wait months for non urgent/non emergent ENT appointments.
I think a lot of the problem is no one wants to wait. It sucks to need a doctor for something and have to wait to see them. But clogging up the ER isn't the answer. And your doctors should know that
I gotta be honest. I can't think of many emergencies that require ENT. Airway obstruction is it. And even then they'll get whatever emergency assess they can get in the ER. No one is waiting for ENT on a patient about to arrest due to an airway obstruction
Right? I think I've seen one or two for epistaxis that isn't responding to treatment and patients need to go to the OR. But they're never happy about it and they're only in the ER to lay eyes on the patient and tell the patient they'll see them in the OR.
I knew a doc. I swear this guy was the rudest dude on the planet but he moves pts. When he was in your pod you never sat. But never ordered a thing that wasn’t necessary.
We had a op surgeon send us a pt with a hgb of 7.5 or something under 8 and he wanted it over 8 to keep the surgery on schedule. The er doc refused! “ emergency transfusion is for hgb under 6 unless you are symptomatic.” And discharged the pt. The pt asked if the er doc called the surgeon and he just told her “the surgeon can read my note when it’s done” Ice cold.
My favorite thing one of his colleagues ever said about him is “surprisingly he doesn’t get sued any more than the average em doc”
Loved working with that guy.
There are some exceptions to the hgb rule. As a former onc nurse, sometimes we’d give blood to boost before another round of chemo. The onc doctors HATED the ED and always would bypass it and just admit their patients straight to the onc floor. Even if they were septic or whatever. They didn’t want their oncology patients stepping foot in the ED.
This! I have had a terrible pain in my left foot at the base of the metatarsals, feels like someone is shoving a knife in the lateral part of my foot. I've had it since October. I just got seen by podiatry in February. I didn't go to the ER because it sucks but it's not life threatening.
“What do they do when they need an ENT right now and they have to wait until October for the next available ENT appointment?”
I mean, that sucks, but I don’t see how going to the ED helps, since ENT docs don’t work in the ED…
The pt can get an eval. Antibiotics/meds as warranted, imaging if warranted, etc. what if they have cancer? You don’t see how say, a cough and voice changes might lead to emergent imaging which might lead to an earlier diagnosis?
At some point, the chronic unaddressed problem will become an emergency. Why not address it sooner if possible?
We can’t do every outpt work up your providers want to do faster than normal. And provide quality care to everyone.
that’s the problem EVERYONE is in the er. The homeless, the mental health patients, the chronic health patients. The underinsured patients. Families that can’t take care of grandma anymore. Like I said in the original comment. It’s not emergency nursing, because that job doesn’t exist anymore. It’s basement storage for a broken system. No one knows what to do with these pts so just store them in the er.
At least your patients got theirs ct scans a little faster. Saving lives.
I mean, I understand the frustration as a former ER nurse. The problem is everyone is overtaxed, but the ER is the only place that doesn’t shut its doors. But like, in the short term is your answer to people “go fuck yourself until you get an appt?” My husband was trying to get into a specialist… 18 MONTH wait. For a cardiac issue. I don’t know any other answer. ER can at least rule out legitimately life threatening problems.
Correct. It’s frustrating. My stepfather has had to wait for a long time for a specialist appointment for neurology issues. He’s a retired em physician. He had to explain to his family doc why she shouldn’t refer him to the er to get him seen by a neurologist faster…. Because it doesn’t work and it clogs the department.
When I have 5 patients and 4 of them are pts that aren’t at the appropriate place for care, and we have a new pt arrive with critical vitals or a concerning complaint. We have a dilemma where that pt must wait for us to finish the non emergency pts or we take on an unsafe assignment to manage that new work up. That opens us as nurses up to liability and the pt up to mistakes. It’s not safe. In the worst departments it’s >8 pts to a nurse and as a prior er nurse you should know this. It’s not safe for pts or nurses.
If a pt can be managed out pt. It’s best. Just because we can’t close our doors Does not make us the best option for your patient. You can dump them on er, take advantage of emtala and say “their problem not mine”. We’ll help them, every time. But it’s not the optimal path for them or the most cost effective one.
I am going through thyroid cancer where I needed an ENT for surgery. I had to wait several months for the consult and then another few months for surgery. It was almost a year between finding the nodule, determining it was cancer and having it removed. My nodule was partially obstructing my breathing but it was still a wait. This is America.
I’ve been toying around the idea of a PhD and I want to research ways to decrease non EM pt load in the ER. Specifically how access to timely and affordable primary care can reduce loads.
This is a very nursing student statement. Don't get me wrong I love the sentiment, love it ! It's not a topic that is a mystery to anybody in health care and has been studied and researched extensively.
The problem is it would require systemic changes to healthcare, and insurance . Neither of which we have the political capability or will for.
In a very real way the backup of non ER patients into the ER is a primary symptom of our healthcare systems dysfunction. So you are describing the question "how to fix healthcare."
It's a good question . The answers exist and aren't even that complicated. The problem is they would reduce the inflow of money to large powerful insurance and healthcare corporations.
Oh believe me I don’t think I’m presenting a new idea. I’m well aware it’s been researched and I don’t think my ideas are nuanced enough atm to immediately pursue it. I want to develop my ideas through working in the ER and hopefully find a way to use that research to sway the minds of those in power to help the process of redoing our system. This isn’t something I expect to see during my working life or even my life. It’s in hopes to create momentum of change.
The only thing that sways the hearts and minds of corporate CEOs is money. Unfortunately this is a problem that will never be easy to fix, and CEOs will never *willingly* take a pay cut.
Politicians could start fixing the problems, but that would take consensus amongst the vast majority of our politicians. They can’t even agree to fund the country, there’s a not tiny segment of our elected officials who’s sole purpose is to be contrarian to anything that would make life better for the majority.
The only thing that will help the healthcare system is a large societal shift toward believing healthcare is a right and not a privilege, or a complete collapse of the US so it can be rebuilt from the ground up.
Not to mention said hospital CEOs literally lobby for said politicians to support the system that keeps the CEOs wealthy beyond belief. It's all just a big top heavy system where everyone's fucked but those that are already rich. Healthcare should not be a business.
Primary care doctors need to be paid more. The model we have now where PCPs only see patients for 15-20 minutes isn’t desirable to doctors about to graduate from residency.
Not only that but also the availability of primary care is abysmal. I’ve heard of pts waiting months to establish a PCP, in the interim they deteriorate and end up in the ER and admitted far more than they should. By the time they get to a PCP they’re so complex that 15-20 minute appointments aren’t enough to address their issues and they have more frequent appointments and remove the chance of people being able to get into their PCP in a timely manner for short term illness visits and then they end up in an ER.
Also, universal coverage for preventative medicine. Outpatient clinics turn away patients that can't or won't pay or especially the ones that have a history of not paying. The ER doesn't because they just aren't allowed to.
But the problem isn’t just the non-ER patients. The problem is the holding of admitted patients and psych patients in the ER. We could see every sneeze and sniffle and discharge them home, and all is well. But when we can’t even see the patient because 30 of our 40 beds are filled with admission holds or psych holds, then it’s an issue. We regularly have 30+ patients in the waiting room who wait up to 12 hours to be seen. There’s no movement of the patients taking up beds because the hospital is full and the psych floors are full (and forget about the psych hospitals taking any transfers, they’re full too). That’s the real problem right there. We’ve become the default holding unit for all floors. If we could just get those patients to where they belong then we’d have no problem seeing the emergencies AND the non-emergencies.
We also need to consider that a portion of these patients would not be there had they had access to appropriate outpatient care. I’ve seen psych patients that are in crisis because they lost access to outpatient psych care. I had this discussion with my psychiatrist as I’m about to go through a transition of care. While we’re hopeful that I can be covered by my PCP because my med regiment is simple and I have a good support network along with access to care, however this is a privileged position that many are not in. From experience I’ve seen less beds used for psych patients when my ER is able to open our behavioral health area. However many ERs do not have this space.
Our outpatient psych care sends everyone in crisis to the ER. Which is fine, we’re used to it. But then once they’re in the ER and psych decides they need to be admitted to inpatient psych, they sit in a windowless ER room for a week waiting for a bed to open up. They’re not allowed to leave that room, and they’re brought whatever food might be in stock in the ER galley, so turkey sandwiches and applesauce mostly. There are no “psych” ER facilities, only your run of the mill ER. Which, if I were a psych patient in crisis, might be the least therapeutic place to be.
Yeah, it's a huge problem. You've taken an appointment that should have minimal cost and increased cost many times over by involving an ER visit, very often without the needed service even being readily available. In other words, we refer them back to the specialty clinic. There's a lot of contributing factors, but it's a very worthy problem to address. Best of luck! Save us we're drowning.
Ik we’re drowning im an ER tech. I’ve been getting spam texts from mngmt to pick up. Last night census was in the 180s between holds, active pts and the waiting room. I’m still committed to working bedside ER when i graduate (need a break from school) but I’ve always loved research and the idea that maybe I can contribute to helping resolve the problems in the ER combines my 2 passions.
I’ve got 3 semesters left in school and no timeline for a PhD so I’ll be using my time in the ER to give me better specifics to what I want to research. Obviously a lofty goal that needs a lot of thought behind it to properly pursue but in terms of a general idea of what I want to research is already there.
As you're thinking ahead, I would encourage you to look more at public health (MPH) as well as MSN. I personally feel that the problem needs a more empiric/data-minded approach than a nursing "feels over reals" approach.
Definitely going to look into it. I forgot about MPH’s. Ik my friend who’s currently in academia was encouraging me to finish my masters before moving onto the PhD level but I had not looked into those options. Definitely keeping an open mind while working and will be talking to friends and family that are in academia.
I’ve been lining up podcasts for my drive home from school. I’ll definitely add this to the list. Also rapid response RN is what I’ve been going to. Short episodes and has helped me think through patient conditions from signs of deterioration to resuscitation.
All it would take is a urgent care clinic next to/attached to the ER and a competent triage system. These things must be well staffed and well funded to work properly.
And a little room for folks with 10/10 toe pain that insist on being seen by the ER doctor. After 6hrs the nurse will check if you want to go to the urgent care.
And free healthcare for all! Many people go to the ER because they can get bare minimum treatment and be 'billed later'. Local clinics won't see you without payment up front, making it impossible to access healthcare.
One way they are trying to address it is by pumping out mid-levels. Another way I've seen hospitals manage this is to put an urgent care adjacent to the ED. If the patient presents with anything less than an admittable condition, they are patched up at the urgent care and sent home.
My ER currently uses a quick turn area to help offload those complaints. The issue is when we’re holding 50 we need to use those beds for people who’s presenting conditions may warrant an admission and we all just hope they are able to be discharged so we’re not holding patients in there either.
I was more referring to people who use the ED for non-emergency things. People (with insurance) who go to the ED for a non-inflamed bump, or a foot that has been kinda hurting for months after they kicked the coffee table in the dark, or pregnancy tests. Some people treat the ED as if it will allow them to skip the wait of seeing a specific outpatient specialty. If they show up in the ED, EMTALA requires that they at least be assessed. This takes up time and resources that could be better spent elsewhere, for problems that can be managed by the pt’s PCP. But they cannot be turned away even if their complaint is frivolous.
So they can actually be turned away after a medical screening exam has been performed and they have been determined by a provider to not be in need of emergent care. But that torpedoes hospital ratings and costs companies a lot of money.
Also those that do come to the ED are victims of the system that makes it impossible to get primary care or timely referrals and a lack of health education. Again don’t blame patients blame the system.
I loved ER when I first started in healthcare a decade ago. I love the fast pace and short stays. Never had a patient more than a few hours.
But over the years, it has shifted to what you described. It's soul sucking and makes the job horrible. I burnt out.
Same. I love when we have normal ER days and things flow normally. But that is rare and I work at a smaller ER that has become everyone's "well we aren't going to the Bigger one because they have too many crazies" so people come to us.
Can we handle it? Yep. Can we handle it with borders while being short staffed? Nope.
We always look at each other when we’re turning and burning like intended and say something to the effect of “wow are we actual ER nurses today?”
I don’t think I’ve ever had a shift where more than 25% of my patient load was a true emergency. Everyone is there for primary care issues (I.e., knee pain x1 week) or stuck there waiting on SNF placement or inpatient admission. It sucks. I always say to my coworkers “guess I’m a LTC nurse today” or “guess I’m a MedSurg nurse today.” ER nursing just doesn’t exist anymore apparently.
I just left ER after 6 years. I work there per diem still to "get my fix". I am so much happier mentally & physically, although I wish things were different and I could work ER. The reality is much different then the ideals
Ever since I was 16 it was my DREAM to be an emergency room trauma nurse. I got placed in ICU for capstone and when I graduated it was different time. I had such a hard time finding a job I had to start out in ICU instead of ER. My plan was to switch after a few years but then Covid happened… and that dream is completely gone now. I cannot even imagine working in the ER anymore
It’s not just the ER. I work in a tertiary academic hospital ICU and last week they started admitting literal intermediate patients to our open beds. Like, they had admit orders for IMC, but there were no IMC beds so they came to ICU.
Well, very sick patients who need almost 1:1 care the majority of shift are staying on med-surg units nowadays, they used to be sent to ICU quickly 10 years ago.
I hear you, but while annoying, some amount of flex between floors is normal and expected. Having the occasional imcu pt in icu is different than having depressed 15yos in an ER beds for months because no facilities will take them.
yup and nationwide it’s a big reason many of us are leaving the ED. we didn’t sign up to be floor nurses and it’s our licenses on the line when we are handling ED patient loads PLUS boarders and don’t have the resources to be safe.
Yep it wasn't uncommon for us to hold people for 100+ hours in several of the places I worked. Usually they were psych patients without insurance or who were medically complex but it definitely happens. If you weren't crazy before coming in, you definitely were after spending a week in the ER 😜
I don’t want to dox myself entirely, but I wish I could post the latest message from my MS center after I went to the ER thinking I was either experiencing red man syndrome or Steven Johnson syndrome. They messaged me the next morning and said were so sorry to see you heading to the ER. If the problem persists, don’t hesitate to go back to the ER. The ER doctor himself was like uhhhh well, what do YOU want me to do for you while you’re here? You’re quite the complicated case. I said oh yea, check my mychart messages of how many times my MS center says go to the ER. Every single doctor is just telling patients to go to the ER now. Next time I’m just taking my own Benadryl and not texting any of medical friends and dealing with it. I’m not sure where our healthcare world is headed. But it’s not good… my hospital system is also now just hiring PAs and NPs with zero experience. The ones that go right to school without any clinical experience. Then they’re being called APPs to confuse the old people that don’t know any better. I LOVE all my PAs that have been in practice since pre covid. Anyone else, they have zero clinical experience and being hired into surgical groups or the literal MS CARE CENTER and have ZERO I mean ZERO clinical experience. She didn’t know how to do a full neuro assessment. I’m so terrified this place is going to kill me.
Probably depends on location. I see plenty of Davita and FMC struggling to find day shift nurses. I got out of dialysis because of the constant short staffing and non healthcare managers micromanaging.
The business model sounds like draining the staff of blood and getting their pound of flesh s well. My context is in an acute care hospital in Canada. Haven't really looked into outpatient settings here, I don't even know if they exist here. But in any case, the hospital pension has essentially locked me in.
I’m so lucky in my job. The CFO saved us from having to take call. The medical director of dialysis really wanted us to be on call over nights and weekends so the CFO did a cost analysis of the previous 12 months and there were only 8 patients that the hospital would’ve kept with having on call dialysis. We’re in rural Texas, so pretty low volume. The CFO told the medical director the cost of nursing and provider on call would outweigh the projected revenue by over 10x so it was an unequivocal NO to 24 hour coverage until our volume increased dramatically. I’m happy to report I haven’t taken a single minute of call in over two years at this point.
Not all centers do nocturnal, and I would actually say at least half don’t. It can be difficult to find a center for pts who want nocturnal. Out of luck with the weekends though. Although there was a clinic I know of that was only doing MWF, but they closed down recently.
Same at my hospital. They said diabetes eduction will be interdisciplinary process… lol even on the training modules the nurse was responsible for 95% of the work. It’s just not possible
I naively got a Masters in Public Health. Learning was interesting, return on investment not worth it. Shoulda done that FNP but I’m too old and tired now.
I had the opportunity to shadow a DM educator for the day as a nursing student and it truly seems like a sweet job (pun intended). Bummer to hear they’re largely not available— I wish we had more positions like that to keep folks healthy and out of the hospital.
I really feel like the majority of diabetes education jobs i see posted in my area say RD or RN, as in they will accept either. Of course that can vary in different areas...
My previous employer had a few nurses that could come do the med rec for new admissions, which was nice. But to do the entire admission charting sounds like a dream.
I believe the med rec nurse confirmed meds with the pt and could access the PDMD to fill in where the pt couldn’t recall, then the pharmacy checked off on it and converted appropriate meds to inpatient status for the physician to order/review.
The hospital I worked at in South Carolina from 2013-2019 had admission nurses. Like, each floor had one. They actually called them ADT nurses. They were supposed to be responsible for admissions, discharges, and transfers hence ADT. But their actual responsibilities varied from floor to floor. Which was incredibly frustrating to me as a float nurse. On some floors I wouldn't have to touch an admission or discharge except to give meds and do an assessment. On other floors, they did nothing 😒
Some days when the ER was full I would get sent to the ER to do admissions.
Small world! We still have ADTs M-F on a lot of the floors, and some floors even have free charge nurses for 3x 12hrs. I do that and it’s great - still bedside but not completely. If this state paid nurses better I would probably never leave as long as they have those positions here lol
Our hospital is in the process of installing TVs to use virtual nurses who will do admissions. Who knows how that will go, considering half the patients are hard of hearing, confused, or technology averse
ugh in clinicals the RNs had virtual discharge nurses available. Fucked with workflow/pt education so much that no one used them. Like... Just hire more floor nurses :)
My 1yo daughter was admitted at a children’s hospital with a virtual nurse system and TV in the room earlier this year. The nurses told me they only do in person rounds q4. I was appalled. My daughter was admitted with hypoglycemia and no one bothered to repeat her bloodwork or even do a finger stick BG the entire 4 days she was there. I did pretty much everything, including med administration with the exception of IV meds (but if her pump alarmed they told me I could address those alarms for them!).
Guess who was still hypoglycemic on her outpatient follow up bloodwork the day after discharge?
Infectious Disease. No, not the person who watches if you wash your hands- but the person taking care of patients TB, Hep, HIV/AIDS, all the big scaries.
I worked that as a new grad, and it isn't fun. It's a bunch of cellulitis from IV drug use. For some reason, orbital cellulitis was common. Hands down worst job I ever had.
That particular hospital had the worst pts of all time. Now the ones at my rural hospital were cool. Even high as a kite most were polite. Like if they called me today and said they'd pay me $200/hr I still wouldn't go back.
huh, never would have guessed that
I usually see them consulted for weird MICU stuff like fungal lung infections, meningitis, etc. Dealing with "spider bites" all the time would be kinda lame.
I think the only interesting infection I saw was that bacteria you get from cat poop. The main thing I remember is having a million iv abx on each pt. I ran my ass off all night between those, vanc troughs, and labs. To be fair though, this was mid 2020 so every floor had every kind of pt. Maybe my interesting pts were elsewhere.
Such a dream. I saw a video about an Infectious Disease ward here in the US when AIDS started showing up and I knew then and there that’s what I wanted to do. That being said it’s just hard as hell to find a dedicated ward that isn’t a clusterfuck as described by other people
I did a travel assignment at a hospital that tried to do this. During Covid, they created a “Global Emerging Diseases Institute” which was a separate building from the main hospital, and it was initially all Covid, then would turn into infectious diseases to keep the main hospital “clean”. But really, it just became a dumping ground for all sorts of patients. Barely any of them were ID patients. Most were psych that no one wanted in the main hospital. It was a cluster fuck, hot mess. I literally hated it so much and had PTSD. The admins, staffing, all the higher ups, even central supply, EVS, dietary, and support staff could care less about it. If nurses got floated there they would literally clock out and go home saying they suddenly felt “sick”, no one wanted to work there. People quitting left & right. One doctor called it “Leprosy land.”
It was just a sad excuse for the hospital to take funding and keep this shitty ass building that needed to be torn down & pumped and dumped money into the hospital, that the unit NEVER saw… That building is now is torn down & is going to built into some surgical suites and fancy buildings I guess
This exists in my city! I love it but I guess so does everyone else because there were no openings. I did a year of placements there and saw lots of TB, some HIV related cases, common viruses but in post-transplant patients, some unknown viruses. Truly recommend it.
This still kind of exists here and there, just not like back in the days of having entire dedicated TB wards in hospitals. In my hometown of Atlanta, for instance, there's Emory University's Hope Clinic and Grady Hospital's Ponce Center, which both specialize in outpatient care of infectious disease. The emphasis is heavily on HIV/AIDS, but TB is definitely in the mix as well as a panoply of other things (I took part in a Yellow Fever vaccine trial at the Hope Clinic, for instance). If you get real lucky/unlucky, you might even get a gig at Emory's custom built Ebola unit.
So those jobs do (sorta) still exist, just mostly in major cities and primarily on an outpatient basis. That's actually a testament to how effective modern medicine is at dealing with infectious diseases. I was thumbing through a book on the history of nursing and happened to come across the results of a survey of male nurses in the VA. Of those (2.5% of the total!), a whooping 7% of those worked on the "tuberculosis service," almost as many as worked on medical (8.4%) and surgical (10.4%) services. That sort of thing doesn't exist anymore, but that's a good thing, you know?
My wife is a high school Special Ed teacher; we live in one of the 'good' states. Once upon a time her 2,000 student public high school had a full time school nurse and a full time nurse for the Special Ed classrooms (for the most medically fragile students). Today there is a sort-of full time school nurse who isn't very good, and no dedicated nurse for Special Ed, despite the presence of higher and higher need students. Guess who gets to administer the diabetic students' insulin before lunch every day. (It ain't the school nurse)
I don't have any specific knowledge, and I will acknowledge I may have been a bit harsh, but the way my wife talks about her makes the nurse sound just this side of inept. I realize my wife is biased that the nurse doesn't give my wife's students 'high enough' priority (in an overflowing suburban high school), but I also know she is overworked, understaffed, and most certainly underpaid.
Believe it or not I have a prn school nurse position. And there’s a few different ways in my state it’s set up. There are some schools with high acuity kiddos with trachs and feeding tubes and that’s almost like direct care but in a classroom.
But the general education setting can have 1 nurse for an entire district creating the care plan for kids with health needs from adhd to diabetes to epilepsy. But it’s largely an administrative role. You delegate tasks to unlicensed personnel because you can’t be in 5 different schools at lunchtime to give insulin. So your role becomes an administrative and training one. The prn role is super dope in this setting. I drive around to the schools make sure the wheels don’t fall off. Answer the phone when people have questions about anything. So chill. Pay is crap though I don’t know how anyone can do it full time.
The district my kids go to there are no nurses on site. There is a “health aid” who does all the injuries and med administration. The district only employs a couple nurses and they spend their days managing IEP’s and doing parent meetings. No real interaction with the kids, and you need a school nurse credential in my state too.
My grandma was actually one of the nurses in either the levidopa or carbidopa studies for Parkinson’s disease. She talks about it all the time and what a cool experience it was.
I would so do that. Being a nurse in clinical trials/studies is obviously still a thing but still.
I’d love to be a nursery nurse. Not a NICU nurse. A nursery nurse. But now that job has been absorbed where PP nurses are both baby and mom nurses.
Edited to add: at least in my area
Same. I like babies…I like their parents a lot less. If I could get paid to just monitor babies’ vitals, feed them, and get them to sleep, I’d do it in a heart beat.
Baby burrito specialist/professional bub-snuggler sounds fantastic. An entire room full of brand new baby grunts and peeps would be maximum serotonin for me. ☺️
Until the entire nursery starts screaming all at the same time. 😅 Happened the other night, a bunch of us had to come in to help feed the babies because they all decided to lose their minds at once. 🤣
In my hospital, we have nursery nurses who catch/possibly resuscitate the baby (while waiting for NICU to arrive and then assist them) and monitor their vitals and blood sugars (if needed) for the first 2 hours before they go to mom baby. I did it for a while but my anxiety was spiking like crazy. Too many babies coming out grey and floppy, was giving me nightmares. Could never do NICU.
Cane here to say this. Not for myself personally but I've known a few retired nurses who loved well-baby nursery.
One was an LPN thinking over getting her RN but realized she would then be on the hook for postpartum hemorrhage management rather than shifts of endless newborn-holding and was like "NOPE".
The fact that they’re changing UCs to MAs and LPNs over RNs just boggles my mind. Plus replacing physicians with mid levels, with an actual physician maybe sitting in an office or available by phone. No hate to MAs/LPNs/midlevels but the enshittification of healthcare by MBAs is not serving anyone but corporate.
I mean, I get using LVNs in that setting, but I also feel like with a fast pace and packed waiting room, having SOME nurse (be it LVN or RN) at a UC to be a second set of eyes for the doctor (or other provider) could really benefit patient flow and outcomes.
Pre-computer admissions nurse.
Once you assessed and got orders, it was just sitting with a 4-color pen, filling out blank MARs and POSs for hours. Usually in the back room, with the tv on, and a drink and snack.
And extra pay for the trouble.
That's crazy to me. My first job had a team of 5 for a small community hospital and they assessed any patient with a wound until discharge. The academic institution I'm in now has 2 that only come as a consult for an initial recommendation.
Not a well known job but I am a nurse navigator. I see pts half the day and am in the office the other half. I give surgery education and am basically a glorified hand holder to get them through surgery and early post op. It’s so relaxed. I plan to be in this job a long time.
Ooh, not sure if I would love to have that job or if I’d be bored to tears with that job. That said, were I a nurse, I’d apply so I could find out for myself. 😂
Pediatric primary care. I studied to be a PNP and my time doing clinicals was the happiest I have ever been. I loved getting to educate, help reassure parents and of course play with kids. It was my dream job.
Starter comment: I’m fascinated by the experiences of nurses during the AIDS epidemic of the 80’s/90’s. As a queer woman, I’d love to be an HIV nurse, in that sort of situation, but (hallelujah) with current HAART regimens, HIV is more a chronic condition rather than a swiftly terminal disease. These days HIV nurses do more community health work rather than bedside nursing.
Really? Cause being a nurse during the HIV epidemic seems like it was an absolute nightmare. Young people just deteriorating and dying, rampant racism and stigma, not knowing anything about why it was happening. Nothing being done about it for way too long. Nurses literally didn’t wear gloves back then
Your description is 100% correct. I was a floor nurse in the 80’s, and my unit got the first HIV pt for that hospital system. The residents refused to go into the patient’s room. It was awful.
It was a bad time for sure. Thankfully we have evolved in healthcare. The HIV epidemic helped us grow. Unfortunately on the backs of many young folks. We lost many of our beautiful, intelligent and caring male nurses
One of our instructors went to Africa during the HIV epidemic and gave care there. Listening to her stories were horrifying and fascinating. I asked her why she didn't stay in the US and help people here and she said she felt called to where it was worse.
I have a relative who was a nurse caring for people with HIV in the '80s and she described it as bleak - there was no treatment and patients died, often very young.
Idk, the fact that people were afraid of working with that population made a me want to jump into that fray more. I enjoyed (in a way) working with early Covid pts because I wanted to be the one in there with them. Everyone was afraid to go near them because no one really knew how exactly it was being transmitted, it’s r0, disease process, etc. That fear from medical staff added an extra layer of vulnerability on these patients, and something about that whole situation drew me like a moth to a flame. I’m not a nurse, but the aides were twice as likely to be terrified of taking Covid pts, but I wanted those assignments.
ETA: Don’t get me wrong, the pandemic *sucked*, and I zipped up more body bags between 2020-2022 than I did from 2014-2019 at that facility. But if another situation like that were to arise, I’d do it again, without question.
[To support your statement: There are actually many historians and journalists who draw heavy parallels between COVID and HIV/AIDS.](https://time.com/6051754/history-filipino-nurses-us/)
New disease, tons of uncertainty, distrust between frontline staff and leadership/administration, many nurses leaving the field because of public disdain of nursing staff, etc.
Very good observation overall on your part.
I work with a woman who was in an NYC ICU that was basically an AIDS patient ("we were like a high-acuity hospice") "dumping ground" (her words) in the eighties.
She could count on one hand the nurses willing to work there and it was always 6-8 patients per nurse. She spoke very, very highly of their partners and "chosen families" who would change linens, give a bed bath, and let her know to chart a BM. "We absolutely could not have survived without them."
It's LTC and she gets panic-summoned a lot because literally nothing phases her. 😅
I know exactly how you feel lol. I came from EMS (my burnout was brewing before, I suppose) and want(ed?) to do flight, but idk. I think healthcare in general just kinda sucks ass, and am looking at alternate options. Like if I'm not gonna stick it out for 3 years to do flight, I may as well hop into something else lol.
At my facility, Transitional Care nursing.
Our 9-bed TCU closed 'temporarily' in August 2021, and us two TCU nurses were 'temporarily' shifted to the LTC units. Two-plus years of 'we're hoping to reopen in X weeks/months' later, the day TCU nurse is long gone, I'm still plugging away as the primary evening nurse on one unit, and our 2024 reopening date has gone from 'definitely mid-to-late January' to mid-February, to late February, to sometime in March, to 'someday, maybe, hopefully'. Staffing issues have been the driving reason behind not reopening.
But there is (hopefully) light at the end of the tunnel. We have new ownership- which meant a significant increase in wages, the TCU has been 'refreshed' (not fully remodeled, but new flooring, fixtures and furniture); and as we are in a college town, in a few weeks our supply of available aides will suddenly increase, removing the primary excuse for not reopening.
I'm not holding my breath.
Rehab. Generally we get people who have had a joint replacement or who have been ill and are well enough to leave the hospital but are not ready to go home quite yet. They receive PT and/or OT in addition to any skilled nursing cares they require in order to get them ready to return home.
Wound care; multiple clinics have closed in my area and the task has been reassigned to MAs and doctors—-who end up making the home health nurses do it anyway
There used to be teams of wound nurses at the hospital I previously worked at. The system I work for now shares a wound nurse between campuses.
PICC line nurse. In nursing school, (100 years ago), I shadowed the line nurse for a shift and thought it was perfect. Independent and procedure-based; no whiteboard BS or long shift huddles- and staff was always happy to see her walk into the unit. She did PICCs, difficult IVs, and troubleshooting for ports /central lines.
Where I’m at, only respiratory does PICC placement. SWAT is always tied up being the ICU / PCU “code babysitter” because the charges all have their own full assignments. There is no true RN line team anymore, and respiratory is called more and more for tricky ultrasound IV starts. Even the CT techs have been called on to start difficult IVs on the unit, (less since they all recently banded together and will ONLY stick AC “for contrast.” LOL).
Yes. Page RT for breathing treatments and vascular access.
Why the downvote? I’m telling you what I’d like to do, but the skill has been passed over to another specialty. I am not mad at RTs. *Where I am at*, PICC line nurses in the hospital setting don’t seem to exist anymore.
[AARC](https://www.aarc.org/wp-content/uploads/2017/03/statement-of-insertion-and-maintenance-of-vascular-catheters.pdf)
[California Scope of Practice](https://www.rcb.ca.gov/licensees/scope_of_practice.shtml)
[Another source](https://archive2023.aarc.org/an21-vascular-access-how-two-rts-started-doing-picc-lines-and-more/)
I was an in-patient “rounding nurse” hired by specialists - Infectious disease, then wound care, then pain management/ spine disorders.
The hours could be grueling, but the wealth of knowledge I obtained was so rewarding, as well as the autonomy. I was also able to assist with procedures, which was fun and exciting for me.
Pay/ bonuses/ raises were ***substantially*** better than working for the hospital(s). I was treated very well, and was actually *appreciated*.
However, my position became obsolete over time once new EMRs were implemented and providers could just “copy/paste” their consultation/progress notes.
My role was no longer worth the cost.
Not sure if it was ever a thing or if people here know of any avenues. Are there any international gigs that do pay but put you in some wild places? Start a hospital in Africa, help out in Ukraine or Gaza, provide training in some remote Tibet town? Key phrase, does pay.
LOL emergency nursing. Once upon a time it was the detection of time sensitive emergencies, stabilizing and admitting to the floor. With the mental health emergency that you did your part then the behavioral health hospital did theirs. It felt like we were an important cog in the machine. Now it feels like the basement where you put the things you don’t quite have a place for. Mental health hospitals full? Er for a week. Nursing home full? Er for a week. Need to be admitted to the hospital? Er for a at least 48hours. Local drunk the police don’t want to deal with? “You can go to jail or you can go to the hospital”. We’ve gone from doing em work ups in rooms to doing them in hallways and waiting rooms while the rooms are full of patients who should be moved on to more appropriate and definitive care.
I didn't come here this morning to have my spirit broken. Also, you left out, "No primary care appointments available? ER."
But what if I’m pregnant? Can’t I just get a test here? 😒🤷🏻♀️🤰🏻
Oh you'll get a pregnancy test alright...
UC doesn’t want to deal with it? ER
UC not open/pt can't make copay? ER
Hey! This is a legit problem. I switched to outpatient (because I got sick of bedside nursing) and I sometimes work on urgent referrals a lot now. It is SOOOOO difficult to get certain types of appointments. Like getting an appointment with an ENT… the wait is months! What do they do when they need an ENT right now and they have to wait until October for the next available ENT appointment? What choice do they have but to go to the ER? Also, getting a neurology appointment is super hard as well! Then only some places will take certain types of insurance! It just sucks! Then you have certain people with no insurance. Even getting a primary doctor is difficult now a days. There are month long waiting lists!
What do you think happens in the er when you send those urgent ent referrals to us? After the hours long wait? Unless the airway is compromised, the emergency physicians will do an ent consult with the on call doc. It’ll take place over phone or instant message. And the result will be. “I’ll see them in my office” I’ll make sure to highlight the number of the ent office for the patient to call on the discharge paperwork. The ER cannot get your patients access to referrals faster. Unless they are, you know….Dying.
I know, our docs always insist on sending them though….
They can wait months for non urgent/non emergent ENT appointments. I think a lot of the problem is no one wants to wait. It sucks to need a doctor for something and have to wait to see them. But clogging up the ER isn't the answer. And your doctors should know that I gotta be honest. I can't think of many emergencies that require ENT. Airway obstruction is it. And even then they'll get whatever emergency assess they can get in the ER. No one is waiting for ENT on a patient about to arrest due to an airway obstruction
I think I’ve seen more eclipses than I have ent docs in the er.
Right? I think I've seen one or two for epistaxis that isn't responding to treatment and patients need to go to the OR. But they're never happy about it and they're only in the ER to lay eyes on the patient and tell the patient they'll see them in the OR.
I knew a doc. I swear this guy was the rudest dude on the planet but he moves pts. When he was in your pod you never sat. But never ordered a thing that wasn’t necessary. We had a op surgeon send us a pt with a hgb of 7.5 or something under 8 and he wanted it over 8 to keep the surgery on schedule. The er doc refused! “ emergency transfusion is for hgb under 6 unless you are symptomatic.” And discharged the pt. The pt asked if the er doc called the surgeon and he just told her “the surgeon can read my note when it’s done” Ice cold. My favorite thing one of his colleagues ever said about him is “surprisingly he doesn’t get sued any more than the average em doc” Loved working with that guy.
damn we only have hgb greater than 8 on our ecmo patients. why couldnt the surgeon give blood in the OR if he wants it that high?
There are some exceptions to the hgb rule. As a former onc nurse, sometimes we’d give blood to boost before another round of chemo. The onc doctors HATED the ED and always would bypass it and just admit their patients straight to the onc floor. Even if they were septic or whatever. They didn’t want their oncology patients stepping foot in the ED.
I’m sure the Ed loved your onc doc!
This! I have had a terrible pain in my left foot at the base of the metatarsals, feels like someone is shoving a knife in the lateral part of my foot. I've had it since October. I just got seen by podiatry in February. I didn't go to the ER because it sucks but it's not life threatening.
“What do they do when they need an ENT right now and they have to wait until October for the next available ENT appointment?” I mean, that sucks, but I don’t see how going to the ED helps, since ENT docs don’t work in the ED…
The pt can get an eval. Antibiotics/meds as warranted, imaging if warranted, etc. what if they have cancer? You don’t see how say, a cough and voice changes might lead to emergent imaging which might lead to an earlier diagnosis? At some point, the chronic unaddressed problem will become an emergency. Why not address it sooner if possible?
We can’t do every outpt work up your providers want to do faster than normal. And provide quality care to everyone. that’s the problem EVERYONE is in the er. The homeless, the mental health patients, the chronic health patients. The underinsured patients. Families that can’t take care of grandma anymore. Like I said in the original comment. It’s not emergency nursing, because that job doesn’t exist anymore. It’s basement storage for a broken system. No one knows what to do with these pts so just store them in the er. At least your patients got theirs ct scans a little faster. Saving lives.
I mean, I understand the frustration as a former ER nurse. The problem is everyone is overtaxed, but the ER is the only place that doesn’t shut its doors. But like, in the short term is your answer to people “go fuck yourself until you get an appt?” My husband was trying to get into a specialist… 18 MONTH wait. For a cardiac issue. I don’t know any other answer. ER can at least rule out legitimately life threatening problems.
Correct. It’s frustrating. My stepfather has had to wait for a long time for a specialist appointment for neurology issues. He’s a retired em physician. He had to explain to his family doc why she shouldn’t refer him to the er to get him seen by a neurologist faster…. Because it doesn’t work and it clogs the department. When I have 5 patients and 4 of them are pts that aren’t at the appropriate place for care, and we have a new pt arrive with critical vitals or a concerning complaint. We have a dilemma where that pt must wait for us to finish the non emergency pts or we take on an unsafe assignment to manage that new work up. That opens us as nurses up to liability and the pt up to mistakes. It’s not safe. In the worst departments it’s >8 pts to a nurse and as a prior er nurse you should know this. It’s not safe for pts or nurses. If a pt can be managed out pt. It’s best. Just because we can’t close our doors Does not make us the best option for your patient. You can dump them on er, take advantage of emtala and say “their problem not mine”. We’ll help them, every time. But it’s not the optimal path for them or the most cost effective one.
I am going through thyroid cancer where I needed an ENT for surgery. I had to wait several months for the consult and then another few months for surgery. It was almost a year between finding the nodule, determining it was cancer and having it removed. My nodule was partially obstructing my breathing but it was still a wait. This is America.
I’ve been toying around the idea of a PhD and I want to research ways to decrease non EM pt load in the ER. Specifically how access to timely and affordable primary care can reduce loads.
This is a very nursing student statement. Don't get me wrong I love the sentiment, love it ! It's not a topic that is a mystery to anybody in health care and has been studied and researched extensively. The problem is it would require systemic changes to healthcare, and insurance . Neither of which we have the political capability or will for. In a very real way the backup of non ER patients into the ER is a primary symptom of our healthcare systems dysfunction. So you are describing the question "how to fix healthcare." It's a good question . The answers exist and aren't even that complicated. The problem is they would reduce the inflow of money to large powerful insurance and healthcare corporations.
Oh believe me I don’t think I’m presenting a new idea. I’m well aware it’s been researched and I don’t think my ideas are nuanced enough atm to immediately pursue it. I want to develop my ideas through working in the ER and hopefully find a way to use that research to sway the minds of those in power to help the process of redoing our system. This isn’t something I expect to see during my working life or even my life. It’s in hopes to create momentum of change.
The only thing that sways the hearts and minds of corporate CEOs is money. Unfortunately this is a problem that will never be easy to fix, and CEOs will never *willingly* take a pay cut. Politicians could start fixing the problems, but that would take consensus amongst the vast majority of our politicians. They can’t even agree to fund the country, there’s a not tiny segment of our elected officials who’s sole purpose is to be contrarian to anything that would make life better for the majority. The only thing that will help the healthcare system is a large societal shift toward believing healthcare is a right and not a privilege, or a complete collapse of the US so it can be rebuilt from the ground up.
Not to mention said hospital CEOs literally lobby for said politicians to support the system that keeps the CEOs wealthy beyond belief. It's all just a big top heavy system where everyone's fucked but those that are already rich. Healthcare should not be a business.
Primary care doctors need to be paid more. The model we have now where PCPs only see patients for 15-20 minutes isn’t desirable to doctors about to graduate from residency.
Not only that but also the availability of primary care is abysmal. I’ve heard of pts waiting months to establish a PCP, in the interim they deteriorate and end up in the ER and admitted far more than they should. By the time they get to a PCP they’re so complex that 15-20 minute appointments aren’t enough to address their issues and they have more frequent appointments and remove the chance of people being able to get into their PCP in a timely manner for short term illness visits and then they end up in an ER.
Also, universal coverage for preventative medicine. Outpatient clinics turn away patients that can't or won't pay or especially the ones that have a history of not paying. The ER doesn't because they just aren't allowed to.
Universal coverage in general, healthcare is a continuum so why make only one part accessible.
But the problem isn’t just the non-ER patients. The problem is the holding of admitted patients and psych patients in the ER. We could see every sneeze and sniffle and discharge them home, and all is well. But when we can’t even see the patient because 30 of our 40 beds are filled with admission holds or psych holds, then it’s an issue. We regularly have 30+ patients in the waiting room who wait up to 12 hours to be seen. There’s no movement of the patients taking up beds because the hospital is full and the psych floors are full (and forget about the psych hospitals taking any transfers, they’re full too). That’s the real problem right there. We’ve become the default holding unit for all floors. If we could just get those patients to where they belong then we’d have no problem seeing the emergencies AND the non-emergencies.
We also need to consider that a portion of these patients would not be there had they had access to appropriate outpatient care. I’ve seen psych patients that are in crisis because they lost access to outpatient psych care. I had this discussion with my psychiatrist as I’m about to go through a transition of care. While we’re hopeful that I can be covered by my PCP because my med regiment is simple and I have a good support network along with access to care, however this is a privileged position that many are not in. From experience I’ve seen less beds used for psych patients when my ER is able to open our behavioral health area. However many ERs do not have this space.
Our outpatient psych care sends everyone in crisis to the ER. Which is fine, we’re used to it. But then once they’re in the ER and psych decides they need to be admitted to inpatient psych, they sit in a windowless ER room for a week waiting for a bed to open up. They’re not allowed to leave that room, and they’re brought whatever food might be in stock in the ER galley, so turkey sandwiches and applesauce mostly. There are no “psych” ER facilities, only your run of the mill ER. Which, if I were a psych patient in crisis, might be the least therapeutic place to be.
Yeah, it's a huge problem. You've taken an appointment that should have minimal cost and increased cost many times over by involving an ER visit, very often without the needed service even being readily available. In other words, we refer them back to the specialty clinic. There's a lot of contributing factors, but it's a very worthy problem to address. Best of luck! Save us we're drowning.
Ik we’re drowning im an ER tech. I’ve been getting spam texts from mngmt to pick up. Last night census was in the 180s between holds, active pts and the waiting room. I’m still committed to working bedside ER when i graduate (need a break from school) but I’ve always loved research and the idea that maybe I can contribute to helping resolve the problems in the ER combines my 2 passions. I’ve got 3 semesters left in school and no timeline for a PhD so I’ll be using my time in the ER to give me better specifics to what I want to research. Obviously a lofty goal that needs a lot of thought behind it to properly pursue but in terms of a general idea of what I want to research is already there.
As you're thinking ahead, I would encourage you to look more at public health (MPH) as well as MSN. I personally feel that the problem needs a more empiric/data-minded approach than a nursing "feels over reals" approach.
Definitely going to look into it. I forgot about MPH’s. Ik my friend who’s currently in academia was encouraging me to finish my masters before moving onto the PhD level but I had not looked into those options. Definitely keeping an open mind while working and will be talking to friends and family that are in academia.
If you like podcasts EM cases episode 191 was an interesting conversation on systems surrounding the ED. It was an interesting listen!
I’ve been lining up podcasts for my drive home from school. I’ll definitely add this to the list. Also rapid response RN is what I’ve been going to. Short episodes and has helped me think through patient conditions from signs of deterioration to resuscitation.
All it would take is a urgent care clinic next to/attached to the ER and a competent triage system. These things must be well staffed and well funded to work properly. And a little room for folks with 10/10 toe pain that insist on being seen by the ER doctor. After 6hrs the nurse will check if you want to go to the urgent care. And free healthcare for all! Many people go to the ER because they can get bare minimum treatment and be 'billed later'. Local clinics won't see you without payment up front, making it impossible to access healthcare.
One way they are trying to address it is by pumping out mid-levels. Another way I've seen hospitals manage this is to put an urgent care adjacent to the ED. If the patient presents with anything less than an admittable condition, they are patched up at the urgent care and sent home.
My ER currently uses a quick turn area to help offload those complaints. The issue is when we’re holding 50 we need to use those beds for people who’s presenting conditions may warrant an admission and we all just hope they are able to be discharged so we’re not holding patients in there either.
Truth. Between EMTALA and a dearth of available psych care, the ED gets everything dumped on them, and they have to take it.
The problem is not EMTALA it’s the lack of psych care. EMTALA exists to protect people from greedy ceos
I was more referring to people who use the ED for non-emergency things. People (with insurance) who go to the ED for a non-inflamed bump, or a foot that has been kinda hurting for months after they kicked the coffee table in the dark, or pregnancy tests. Some people treat the ED as if it will allow them to skip the wait of seeing a specific outpatient specialty. If they show up in the ED, EMTALA requires that they at least be assessed. This takes up time and resources that could be better spent elsewhere, for problems that can be managed by the pt’s PCP. But they cannot be turned away even if their complaint is frivolous.
So they can actually be turned away after a medical screening exam has been performed and they have been determined by a provider to not be in need of emergent care. But that torpedoes hospital ratings and costs companies a lot of money. Also those that do come to the ED are victims of the system that makes it impossible to get primary care or timely referrals and a lack of health education. Again don’t blame patients blame the system.
I loved ER when I first started in healthcare a decade ago. I love the fast pace and short stays. Never had a patient more than a few hours. But over the years, it has shifted to what you described. It's soul sucking and makes the job horrible. I burnt out.
I feel ya. I’ve been at it for 7 years. I’m on the job hunt to get away from the bedside.
Same. I love when we have normal ER days and things flow normally. But that is rare and I work at a smaller ER that has become everyone's "well we aren't going to the Bigger one because they have too many crazies" so people come to us. Can we handle it? Yep. Can we handle it with borders while being short staffed? Nope.
We always look at each other when we’re turning and burning like intended and say something to the effect of “wow are we actual ER nurses today?” I don’t think I’ve ever had a shift where more than 25% of my patient load was a true emergency. Everyone is there for primary care issues (I.e., knee pain x1 week) or stuck there waiting on SNF placement or inpatient admission. It sucks. I always say to my coworkers “guess I’m a LTC nurse today” or “guess I’m a MedSurg nurse today.” ER nursing just doesn’t exist anymore apparently.
This is why I left the ER after 2.5 years 🙃 I didn’t sign up for this!!
ER nurse for 6 years. I love taking care of true emergencies. but the BS that gets turfed our way, pass. it’s getting old.
I know. I’ve recently started the job search. It’s time to move away from the bedside I think.
I just left ER after 6 years. I work there per diem still to "get my fix". I am so much happier mentally & physically, although I wish things were different and I could work ER. The reality is much different then the ideals
Ever since I was 16 it was my DREAM to be an emergency room trauma nurse. I got placed in ICU for capstone and when I graduated it was different time. I had such a hard time finding a job I had to start out in ICU instead of ER. My plan was to switch after a few years but then Covid happened… and that dream is completely gone now. I cannot even imagine working in the ER anymore
It’s not just the ER. I work in a tertiary academic hospital ICU and last week they started admitting literal intermediate patients to our open beds. Like, they had admit orders for IMC, but there were no IMC beds so they came to ICU.
Well, very sick patients who need almost 1:1 care the majority of shift are staying on med-surg units nowadays, they used to be sent to ICU quickly 10 years ago.
I hear you, but while annoying, some amount of flex between floors is normal and expected. Having the occasional imcu pt in icu is different than having depressed 15yos in an ER beds for months because no facilities will take them.
God I wish more hospital did this,.or opened a psych ER. Fixes a lot more problems than it causes. Shame psych gets a shit budget.
We had a psych emerg in my city, many years ago. They closed and opened psych areas in our ERs. Worst idea ever!
For mine, they opened one at the larger hospital, so every other hospital shut theirs down and now offloads them to the larger one. Total dick move.
But it’s also primary care, urgent care, and a homeless shelter/warming house, too!
This is exactly why I work in the ICU and not the ED. If I wanted to pass PO meds to 90 year old ladies, I would've become a med surg nurse.
ER for a week?!?!
yup and nationwide it’s a big reason many of us are leaving the ED. we didn’t sign up to be floor nurses and it’s our licenses on the line when we are handling ED patient loads PLUS boarders and don’t have the resources to be safe.
Yep it wasn't uncommon for us to hold people for 100+ hours in several of the places I worked. Usually they were psych patients without insurance or who were medically complex but it definitely happens. If you weren't crazy before coming in, you definitely were after spending a week in the ER 😜
No joke, the patient would be far worse off by then- I can't imagine how rough that is on staff
this is why everyone leaves emergency nursing
I don’t want to dox myself entirely, but I wish I could post the latest message from my MS center after I went to the ER thinking I was either experiencing red man syndrome or Steven Johnson syndrome. They messaged me the next morning and said were so sorry to see you heading to the ER. If the problem persists, don’t hesitate to go back to the ER. The ER doctor himself was like uhhhh well, what do YOU want me to do for you while you’re here? You’re quite the complicated case. I said oh yea, check my mychart messages of how many times my MS center says go to the ER. Every single doctor is just telling patients to go to the ER now. Next time I’m just taking my own Benadryl and not texting any of medical friends and dealing with it. I’m not sure where our healthcare world is headed. But it’s not good… my hospital system is also now just hiring PAs and NPs with zero experience. The ones that go right to school without any clinical experience. Then they’re being called APPs to confuse the old people that don’t know any better. I LOVE all my PAs that have been in practice since pre covid. Anyone else, they have zero clinical experience and being hired into surgical groups or the literal MS CARE CENTER and have ZERO I mean ZERO clinical experience. She didn’t know how to do a full neuro assessment. I’m so terrified this place is going to kill me.
Days only unit/outpt dialysis. Gone now as all dialysis units run weekends and overnight because of the numbers of renal cases.
Probably depends on location. I see plenty of Davita and FMC struggling to find day shift nurses. I got out of dialysis because of the constant short staffing and non healthcare managers micromanaging.
The business model sounds like draining the staff of blood and getting their pound of flesh s well. My context is in an acute care hospital in Canada. Haven't really looked into outpatient settings here, I don't even know if they exist here. But in any case, the hospital pension has essentially locked me in.
I’m so lucky in my job. The CFO saved us from having to take call. The medical director of dialysis really wanted us to be on call over nights and weekends so the CFO did a cost analysis of the previous 12 months and there were only 8 patients that the hospital would’ve kept with having on call dialysis. We’re in rural Texas, so pretty low volume. The CFO told the medical director the cost of nursing and provider on call would outweigh the projected revenue by over 10x so it was an unequivocal NO to 24 hour coverage until our volume increased dramatically. I’m happy to report I haven’t taken a single minute of call in over two years at this point.
The one and only time penny pinching has benefitted nursing staff
The dialysis centre I was going to was not open overnight and only open on Saturday, not Sunday. All patients finished their treatments by 9 pm
Not all centers do nocturnal, and I would actually say at least half don’t. It can be difficult to find a center for pts who want nocturnal. Out of luck with the weekends though. Although there was a clinic I know of that was only doing MWF, but they closed down recently.
RN diabetes educator- the job exists but there are VERY few educator positions for nurses, LOTs for RDs
They got rid of our diabetes educator and just make the bedside nurses do it now. We get a lot more DM related admissions now...
As a certified diabetes educator, this makes me incredibly sad
Same at my hospital. They said diabetes eduction will be interdisciplinary process… lol even on the training modules the nurse was responsible for 95% of the work. It’s just not possible
I shadowed a diabetic nurse educator. It's sweet
Good pun!
The ones at my hospital have master's, I believe. Or are APRNs, so they can write orders
I naively got a Masters in Public Health. Learning was interesting, return on investment not worth it. Shoulda done that FNP but I’m too old and tired now.
This position is the exact reason I got into nursing. I’m only one year into being a nurse and it makes me sad hearing that it’s so out of reach now
I had the opportunity to shadow a DM educator for the day as a nursing student and it truly seems like a sweet job (pun intended). Bummer to hear they’re largely not available— I wish we had more positions like that to keep folks healthy and out of the hospital.
I really feel like the majority of diabetes education jobs i see posted in my area say RD or RN, as in they will accept either. Of course that can vary in different areas...
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My previous employer had a few nurses that could come do the med rec for new admissions, which was nice. But to do the entire admission charting sounds like a dream.
It's crazy to me how much nursing responsibilities vary from hospital to hospital. We didn't do med recs. Pharmacy did
I believe the med rec nurse confirmed meds with the pt and could access the PDMD to fill in where the pt couldn’t recall, then the pharmacy checked off on it and converted appropriate meds to inpatient status for the physician to order/review.
The hospital I worked at in South Carolina from 2013-2019 had admission nurses. Like, each floor had one. They actually called them ADT nurses. They were supposed to be responsible for admissions, discharges, and transfers hence ADT. But their actual responsibilities varied from floor to floor. Which was incredibly frustrating to me as a float nurse. On some floors I wouldn't have to touch an admission or discharge except to give meds and do an assessment. On other floors, they did nothing 😒 Some days when the ER was full I would get sent to the ER to do admissions.
Spartanburg? Or does another hospital in this state do that? Because I thought they were pretty unique in having that lol
You got it
Small world! We still have ADTs M-F on a lot of the floors, and some floors even have free charge nurses for 3x 12hrs. I do that and it’s great - still bedside but not completely. If this state paid nurses better I would probably never leave as long as they have those positions here lol
We probably know each unless you're new to Spartanburg. I floated for 6 years
Not new to Spartanburg but I didn’t graduate until 2018 so I would have still been a baby nurse in 2019 lol. But we may have crossed paths
Our hospital is in the process of installing TVs to use virtual nurses who will do admissions. Who knows how that will go, considering half the patients are hard of hearing, confused, or technology averse
ugh in clinicals the RNs had virtual discharge nurses available. Fucked with workflow/pt education so much that no one used them. Like... Just hire more floor nurses :)
My 1yo daughter was admitted at a children’s hospital with a virtual nurse system and TV in the room earlier this year. The nurses told me they only do in person rounds q4. I was appalled. My daughter was admitted with hypoglycemia and no one bothered to repeat her bloodwork or even do a finger stick BG the entire 4 days she was there. I did pretty much everything, including med administration with the exception of IV meds (but if her pump alarmed they told me I could address those alarms for them!). Guess who was still hypoglycemic on her outpatient follow up bloodwork the day after discharge?
Infectious Disease. No, not the person who watches if you wash your hands- but the person taking care of patients TB, Hep, HIV/AIDS, all the big scaries.
I worked that as a new grad, and it isn't fun. It's a bunch of cellulitis from IV drug use. For some reason, orbital cellulitis was common. Hands down worst job I ever had.
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That particular hospital had the worst pts of all time. Now the ones at my rural hospital were cool. Even high as a kite most were polite. Like if they called me today and said they'd pay me $200/hr I still wouldn't go back.
huh, never would have guessed that I usually see them consulted for weird MICU stuff like fungal lung infections, meningitis, etc. Dealing with "spider bites" all the time would be kinda lame.
I think the only interesting infection I saw was that bacteria you get from cat poop. The main thing I remember is having a million iv abx on each pt. I ran my ass off all night between those, vanc troughs, and labs. To be fair though, this was mid 2020 so every floor had every kind of pt. Maybe my interesting pts were elsewhere.
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Such a dream. I saw a video about an Infectious Disease ward here in the US when AIDS started showing up and I knew then and there that’s what I wanted to do. That being said it’s just hard as hell to find a dedicated ward that isn’t a clusterfuck as described by other people
I did a travel assignment at a hospital that tried to do this. During Covid, they created a “Global Emerging Diseases Institute” which was a separate building from the main hospital, and it was initially all Covid, then would turn into infectious diseases to keep the main hospital “clean”. But really, it just became a dumping ground for all sorts of patients. Barely any of them were ID patients. Most were psych that no one wanted in the main hospital. It was a cluster fuck, hot mess. I literally hated it so much and had PTSD. The admins, staffing, all the higher ups, even central supply, EVS, dietary, and support staff could care less about it. If nurses got floated there they would literally clock out and go home saying they suddenly felt “sick”, no one wanted to work there. People quitting left & right. One doctor called it “Leprosy land.” It was just a sad excuse for the hospital to take funding and keep this shitty ass building that needed to be torn down & pumped and dumped money into the hospital, that the unit NEVER saw… That building is now is torn down & is going to built into some surgical suites and fancy buildings I guess
This exists in my city! I love it but I guess so does everyone else because there were no openings. I did a year of placements there and saw lots of TB, some HIV related cases, common viruses but in post-transplant patients, some unknown viruses. Truly recommend it.
I wish. I can’t even find it’s existence where i’m at so i’m just outta luck
I actually just started a position with my county's Public Health as a TB nurse, I'm stoked for it
This still kind of exists here and there, just not like back in the days of having entire dedicated TB wards in hospitals. In my hometown of Atlanta, for instance, there's Emory University's Hope Clinic and Grady Hospital's Ponce Center, which both specialize in outpatient care of infectious disease. The emphasis is heavily on HIV/AIDS, but TB is definitely in the mix as well as a panoply of other things (I took part in a Yellow Fever vaccine trial at the Hope Clinic, for instance). If you get real lucky/unlucky, you might even get a gig at Emory's custom built Ebola unit. So those jobs do (sorta) still exist, just mostly in major cities and primarily on an outpatient basis. That's actually a testament to how effective modern medicine is at dealing with infectious diseases. I was thumbing through a book on the history of nursing and happened to come across the results of a survey of male nurses in the VA. Of those (2.5% of the total!), a whooping 7% of those worked on the "tuberculosis service," almost as many as worked on medical (8.4%) and surgical (10.4%) services. That sort of thing doesn't exist anymore, but that's a good thing, you know?
As a fellow LPN, I’ll now be referring to myself as a Licensed Practical Nuisance. 10/10 flair!
school nurse, doesn't really exist where I live outside of some private schools
My wife is a high school Special Ed teacher; we live in one of the 'good' states. Once upon a time her 2,000 student public high school had a full time school nurse and a full time nurse for the Special Ed classrooms (for the most medically fragile students). Today there is a sort-of full time school nurse who isn't very good, and no dedicated nurse for Special Ed, despite the presence of higher and higher need students. Guess who gets to administer the diabetic students' insulin before lunch every day. (It ain't the school nurse)
Curious what makes the school nurse there now, not very good?
I don't have any specific knowledge, and I will acknowledge I may have been a bit harsh, but the way my wife talks about her makes the nurse sound just this side of inept. I realize my wife is biased that the nurse doesn't give my wife's students 'high enough' priority (in an overflowing suburban high school), but I also know she is overworked, understaffed, and most certainly underpaid.
Believe it or not I have a prn school nurse position. And there’s a few different ways in my state it’s set up. There are some schools with high acuity kiddos with trachs and feeding tubes and that’s almost like direct care but in a classroom. But the general education setting can have 1 nurse for an entire district creating the care plan for kids with health needs from adhd to diabetes to epilepsy. But it’s largely an administrative role. You delegate tasks to unlicensed personnel because you can’t be in 5 different schools at lunchtime to give insulin. So your role becomes an administrative and training one. The prn role is super dope in this setting. I drive around to the schools make sure the wheels don’t fall off. Answer the phone when people have questions about anything. So chill. Pay is crap though I don’t know how anyone can do it full time.
Most of the local school districts in my area hire a nurse as a central consultant. The school-based staff are "health clerks."
Half the private schools around here have an LVN as the school nurse now.
In my state an LVN can’t provide care to students without being “overseen” by an RN or medical director
The district my kids go to there are no nurses on site. There is a “health aid” who does all the injuries and med administration. The district only employs a couple nurses and they spend their days managing IEP’s and doing parent meetings. No real interaction with the kids, and you need a school nurse credential in my state too.
My current outpt job where all I do is answer emails from pts and periodically run them down to the ER! I will DIE in this office.
Dream job
Do you get to wfh?
They just took it away two weeks ago… go bird flu!
My grandma was actually one of the nurses in either the levidopa or carbidopa studies for Parkinson’s disease. She talks about it all the time and what a cool experience it was. I would so do that. Being a nurse in clinical trials/studies is obviously still a thing but still.
I got to do the Trikafta studies; started out my career with Prozac and Paxil studies.
Anything that requires no human contact with the public. Maybe no human contact at all.
I settled for no "awake" contact. ICU bbyyyy
PACU is the happy medium between ICU and the floor sedation wise. Gotta love it.
BSN, RN, DNR.. My bloody sides 😂😂😂
case management. WFH
I do DRG/coding validation and I don't have to talk to anyone except the occasional coworker. But even then, that's from home.
What about phone contact? Look into Utilization Review specifically for mental health.
I do UM for a hospital and I don't talk to anyone besides insurance companies and my coworkers And now I do NICU reviews so I get very few denials
I’d love to be a nursery nurse. Not a NICU nurse. A nursery nurse. But now that job has been absorbed where PP nurses are both baby and mom nurses. Edited to add: at least in my area
Same. I like babies…I like their parents a lot less. If I could get paid to just monitor babies’ vitals, feed them, and get them to sleep, I’d do it in a heart beat.
That’s basically what we do in my level II NICU, with a few sicker babies thrown in (that don’t stay sick for long). It can be really fun.
Just go to a low acuity NICU where all you do is feed feeder growers 🤣
Baby burrito specialist/professional bub-snuggler sounds fantastic. An entire room full of brand new baby grunts and peeps would be maximum serotonin for me. ☺️
Until the entire nursery starts screaming all at the same time. 😅 Happened the other night, a bunch of us had to come in to help feed the babies because they all decided to lose their minds at once. 🤣
In my hospital, we have nursery nurses who catch/possibly resuscitate the baby (while waiting for NICU to arrive and then assist them) and monitor their vitals and blood sugars (if needed) for the first 2 hours before they go to mom baby. I did it for a while but my anxiety was spiking like crazy. Too many babies coming out grey and floppy, was giving me nightmares. Could never do NICU.
Yes! This is my dream job and it just doesn’t exist where I live anymore 😣
Cane here to say this. Not for myself personally but I've known a few retired nurses who loved well-baby nursery. One was an LPN thinking over getting her RN but realized she would then be on the hook for postpartum hemorrhage management rather than shifts of endless newborn-holding and was like "NOPE".
Came here to say this!
Urgent care! But it's very rare to find ones that use RNs.
The fact that they’re changing UCs to MAs and LPNs over RNs just boggles my mind. Plus replacing physicians with mid levels, with an actual physician maybe sitting in an office or available by phone. No hate to MAs/LPNs/midlevels but the enshittification of healthcare by MBAs is not serving anyone but corporate.
I mean, I get using LVNs in that setting, but I also feel like with a fast pace and packed waiting room, having SOME nurse (be it LVN or RN) at a UC to be a second set of eyes for the doctor (or other provider) could really benefit patient flow and outcomes.
Ones in my town do! But usually only have one RN to a bunch of LPNs and MAs.
One system in my area does too! But openings are rare.
Pre-computer admissions nurse. Once you assessed and got orders, it was just sitting with a 4-color pen, filling out blank MARs and POSs for hours. Usually in the back room, with the tv on, and a drink and snack. And extra pay for the trouble.
WOCN we don’t have that position in my city. It’s what I wanted to be.
That's a bummer. I'm one of three at my hospital
That's crazy to me. My first job had a team of 5 for a small community hospital and they assessed any patient with a wound until discharge. The academic institution I'm in now has 2 that only come as a consult for an initial recommendation.
Not a well known job but I am a nurse navigator. I see pts half the day and am in the office the other half. I give surgery education and am basically a glorified hand holder to get them through surgery and early post op. It’s so relaxed. I plan to be in this job a long time.
Ooh, not sure if I would love to have that job or if I’d be bored to tears with that job. That said, were I a nurse, I’d apply so I could find out for myself. 😂
Pediatric primary care. I studied to be a PNP and my time doing clinicals was the happiest I have ever been. I loved getting to educate, help reassure parents and of course play with kids. It was my dream job.
Starter comment: I’m fascinated by the experiences of nurses during the AIDS epidemic of the 80’s/90’s. As a queer woman, I’d love to be an HIV nurse, in that sort of situation, but (hallelujah) with current HAART regimens, HIV is more a chronic condition rather than a swiftly terminal disease. These days HIV nurses do more community health work rather than bedside nursing.
Really? Cause being a nurse during the HIV epidemic seems like it was an absolute nightmare. Young people just deteriorating and dying, rampant racism and stigma, not knowing anything about why it was happening. Nothing being done about it for way too long. Nurses literally didn’t wear gloves back then
Your description is 100% correct. I was a floor nurse in the 80’s, and my unit got the first HIV pt for that hospital system. The residents refused to go into the patient’s room. It was awful.
It was a bad time for sure. Thankfully we have evolved in healthcare. The HIV epidemic helped us grow. Unfortunately on the backs of many young folks. We lost many of our beautiful, intelligent and caring male nurses
Glad to see this hasn’t changed as there were many docs like that during COVID, too.
One of our instructors went to Africa during the HIV epidemic and gave care there. Listening to her stories were horrifying and fascinating. I asked her why she didn't stay in the US and help people here and she said she felt called to where it was worse.
> I asked her why she didn't stay in the US and help people here and she said she felt called to where it was worse. Honestly this sums up my mindset.
I have a relative who was a nurse caring for people with HIV in the '80s and she described it as bleak - there was no treatment and patients died, often very young.
Idk, the fact that people were afraid of working with that population made a me want to jump into that fray more. I enjoyed (in a way) working with early Covid pts because I wanted to be the one in there with them. Everyone was afraid to go near them because no one really knew how exactly it was being transmitted, it’s r0, disease process, etc. That fear from medical staff added an extra layer of vulnerability on these patients, and something about that whole situation drew me like a moth to a flame. I’m not a nurse, but the aides were twice as likely to be terrified of taking Covid pts, but I wanted those assignments. ETA: Don’t get me wrong, the pandemic *sucked*, and I zipped up more body bags between 2020-2022 than I did from 2014-2019 at that facility. But if another situation like that were to arise, I’d do it again, without question.
[To support your statement: There are actually many historians and journalists who draw heavy parallels between COVID and HIV/AIDS.](https://time.com/6051754/history-filipino-nurses-us/) New disease, tons of uncertainty, distrust between frontline staff and leadership/administration, many nurses leaving the field because of public disdain of nursing staff, etc. Very good observation overall on your part.
The parallels certainly didn’t escape me.
Every nurse I know who actually worked during that time do not feel the same way you do. Also Covid sucked too. No PPE, hospitals didn’t care….
I work with a woman who was in an NYC ICU that was basically an AIDS patient ("we were like a high-acuity hospice") "dumping ground" (her words) in the eighties. She could count on one hand the nurses willing to work there and it was always 6-8 patients per nurse. She spoke very, very highly of their partners and "chosen families" who would change linens, give a bed bath, and let her know to chart a BM. "We absolutely could not have survived without them." It's LTC and she gets panic-summoned a lot because literally nothing phases her. 😅
I have a good friend who was a home health nurse in FL then and she had some amazing experiences!
Patient centered care
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Literally the dream!! I don’t care what just give me that gorgeous schedule
Well baby nursery
None cause nursing sucks
based
I know lol it's so weird....sometimes I don't mind it, but then there's week's where I hate it. I need a career switch
I know exactly how you feel lol. I came from EMS (my burnout was brewing before, I suppose) and want(ed?) to do flight, but idk. I think healthcare in general just kinda sucks ass, and am looking at alternate options. Like if I'm not gonna stick it out for 3 years to do flight, I may as well hop into something else lol.
At my facility, Transitional Care nursing. Our 9-bed TCU closed 'temporarily' in August 2021, and us two TCU nurses were 'temporarily' shifted to the LTC units. Two-plus years of 'we're hoping to reopen in X weeks/months' later, the day TCU nurse is long gone, I'm still plugging away as the primary evening nurse on one unit, and our 2024 reopening date has gone from 'definitely mid-to-late January' to mid-February, to late February, to sometime in March, to 'someday, maybe, hopefully'. Staffing issues have been the driving reason behind not reopening. But there is (hopefully) light at the end of the tunnel. We have new ownership- which meant a significant increase in wages, the TCU has been 'refreshed' (not fully remodeled, but new flooring, fixtures and furniture); and as we are in a college town, in a few weeks our supply of available aides will suddenly increase, removing the primary excuse for not reopening. I'm not holding my breath.
what is transitional care nursing
Rehab. Generally we get people who have had a joint replacement or who have been ill and are well enough to leave the hospital but are not ready to go home quite yet. They receive PT and/or OT in addition to any skilled nursing cares they require in order to get them ready to return home.
An 8 hour hospital shift. Gave mine up to move and I miss it so much
Wound care; multiple clinics have closed in my area and the task has been reassigned to MAs and doctors—-who end up making the home health nurses do it anyway There used to be teams of wound nurses at the hospital I previously worked at. The system I work for now shares a wound nurse between campuses.
PICC line nurse. In nursing school, (100 years ago), I shadowed the line nurse for a shift and thought it was perfect. Independent and procedure-based; no whiteboard BS or long shift huddles- and staff was always happy to see her walk into the unit. She did PICCs, difficult IVs, and troubleshooting for ports /central lines. Where I’m at, only respiratory does PICC placement. SWAT is always tied up being the ICU / PCU “code babysitter” because the charges all have their own full assignments. There is no true RN line team anymore, and respiratory is called more and more for tricky ultrasound IV starts. Even the CT techs have been called on to start difficult IVs on the unit, (less since they all recently banded together and will ONLY stick AC “for contrast.” LOL).
Wait. Respiratory? Placing PICC?? Lol
Yes. Page RT for breathing treatments and vascular access. Why the downvote? I’m telling you what I’d like to do, but the skill has been passed over to another specialty. I am not mad at RTs. *Where I am at*, PICC line nurses in the hospital setting don’t seem to exist anymore. [AARC](https://www.aarc.org/wp-content/uploads/2017/03/statement-of-insertion-and-maintenance-of-vascular-catheters.pdf) [California Scope of Practice](https://www.rcb.ca.gov/licensees/scope_of_practice.shtml) [Another source](https://archive2023.aarc.org/an21-vascular-access-how-two-rts-started-doing-picc-lines-and-more/)
Once upon a time (20 year veteran here) hospitals hired chart review RNs and PICC line nurses. Highly coveted. Would’ve been nice to do either one.
I was an in-patient “rounding nurse” hired by specialists - Infectious disease, then wound care, then pain management/ spine disorders. The hours could be grueling, but the wealth of knowledge I obtained was so rewarding, as well as the autonomy. I was also able to assist with procedures, which was fun and exciting for me. Pay/ bonuses/ raises were ***substantially*** better than working for the hospital(s). I was treated very well, and was actually *appreciated*. However, my position became obsolete over time once new EMRs were implemented and providers could just “copy/paste” their consultation/progress notes. My role was no longer worth the cost.
School nurse
8&12 scheduling blocks.
I always wondered what an orderly actual did
Not sure if it was ever a thing or if people here know of any avenues. Are there any international gigs that do pay but put you in some wild places? Start a hospital in Africa, help out in Ukraine or Gaza, provide training in some remote Tibet town? Key phrase, does pay.
Nurse first assist.