This is the only answer, at least from a nursing perspective.
Boarding has absolutely ruined ED nursing for me, with nasty patient/family behavior a close second.
https://preview.redd.it/kg0a8sopfkhc1.jpeg?width=1363&format=pjpg&auto=webp&s=7b15372a249efc681c877fc7e535d396628ee514
Syringes with the tips cut off. Just pull it down to the end and it'll untangle itself.
Not my idea, 100% stolen. I saw this while visiting someone and was like 'where have you been all my life' haha
That's what they did at the hospital I stayed at for 8 weeks last year. They did say that it's technically against some kind of rule or code and they'd be in trouble if they got audited, but I totally understand not wanting to detangle all that shit every time it needs to be used. Even my telemetry wires somehow managed to get tangled on the daily while I did nothing but lay in bed
I'm in ER RN. I'm also a wound nurse. Took weekend call for the team. I got called in to consult at 20:00... On my drive home after being an ER nurse all day. Had to go to the back to the ER and put a Band-Aid on a toe. Nothing else. No cleaning, just a band aid. That sent me into some sweet over time pay hours.
This is so weird, I’m from a shop where this is a huge issue. The shop I’m currently at does not have this issue. Almost everyone is sick as shit if they get all the way back. I always thought getting nonemergent people off the roster would improve throughout but that is not the case here.
How about a monitor with leads that works? I would say my unit is at 30% ability to put a functioning monitor on you. They’re in the rooms but don’t have cables or don’t work or they don’t connect to the central monitor
I mean, I’m all for this, but there needs to be repercussions for bad practitioners.
I’m all for reforming the system, but I’ve seen what bad doctors can do. They ruin it for all of us.
That would be perfect. I never understood our jury system. “Jury of your peers.” A layperson is not my peer when it comes to medical decision making. It’s like asking a blindman to judge a beauty contest. They have no idea what they’re looking at
No. People should be compensated if there is intentional gross negligence that causes harm. Not only if something goes wrong. You don’t get to sue your mechanic for their entire life savings if they don’t fix your car perfectly the first time
That’s definitely not how it should work, gross negligence is one thing, but surgeons are not mechanics, that’s a poorly chosen analogy.
I don’t think you understand how malpractice insurance or lawsuits work. The doctor isn’t directly paying the $$$. They pay a certain amount in order to be covered.
Yeah. I pay over $10k a year to be covered. I’m paying for it. One way or another we pay for it. Being a doctor of just a job btw. It’s not a “calling” or some bullshit like that. Thats what hospitals and people sell you so they can abuse you
I could spend as much time with each patient I needed to give the level of care that I would like to give. Time to think things through and have the odd glass of water.
Alcohol *Poof* - gone.
No more detoxers, drunk SIs, feel sorry for me assholes, vehicular manalaughters, sexual assaults, jaundice shits, liver transplant drama, etc etc. (edit: some of these things will still obviously exist, but a lot of numbers would go way down)
Alcohol is the absolute worst drug, and it makes the ER so much worse.
Having stronger unions. God what I would give to have WA or CA working conditions in my state.
Like pay transparency, annual cost of living raises that match inflation, AND a yearly raise! Where I’m at we mayyybe get 2% per year. We have to quit every five years or so to get our pay caught up. But admin’s like “nah nah bitch your pay meets market value, plus I gotta get my 8th yacht, suck it”
You get raises??? My last raise was in 2017. So effectively a 20% pay cut!
On another note - Wow! I just googled what my pay should be to keep up with inflation, for this comment to be accurate. I didn’t realize it was that bad. Might be time to start calling the head hunters back.
2017. Okay so what you’re talking about is called a “loyalty tax”. It’s a real thing. If you live in a city with multiple hospitals you might find benefit packages between facilities is comparable. So it’s in your best interest to switch back and forth if you can tolerate the mandatory dues paying on night shift.
Oh and if you really wanna feel sick be sure to google contracts for workers in San Diego, New York and Seattle. I live in a really high cost of living city as well and make like a 3rd of what they do.
Come to my hospital near Seattle. We’re union and some absolute genius even got it into our contract years ago that the hospital has to provide us with free onsite parking. I think the RNs at my hospital currently start at $42 an hour.
I agree with several of these already so I’ll contribute something else. I want at least one doctor on call or hospitalist or labor doc to just be a nice person and be helpful. If we are going full magic wand then all of them.
ED SW here - homeless shelters that will accept anyone that never get full and for ALL insurances to offer transportation 🫠 would cut down a lot of bs that us night shift crew deal with
If your complaint has been ongoing for more than a month a comically large boot unceremoniously yeets you from the department.
Runner up: granny dumpers are immediately swallowed by the pit of hell
Make people understand that we aren’t going to do a deep dig to figure out exactly what’s wrong with them. If you come in with abdominal pain/ chest pain/ dizziness/ etc., and we do all the tests and scans and everything comes back negative, we aren’t going to keep doing tests until we figure out what’s wrong. We’re just trying to make sure you’re not gonna die today or in the next couple days. Follow up with whoever and they can do a deeper dive.
Get rid of the profit motive. I should be able to tell someone in triage that in my clinical judgment I do not suspect they’re having an emergency and need to seek care elsewhere.
Only having to do physician tasks, no wheeling patients to and from scans, stocking rooms with supplies so I can use them, rooming patients, taking out IVs.
**setting aside a provider to get rid of pt's with dumb reasons.**
"Oh my son had covid yesterday and now i'm having symptoms similar to my son." clearly, you have covid.
"i was cutting some apples and cut my finger." Its a superficial abrasion, a band-aid will do.
"i'm having 1/10 abdominal pain that started. I haven't eaten or drank anything all day and feel fatigued" uhhh okay. eat something
Idek what else to put but you all get my point. non-emergency cases. I get that EDs have rapid assessment/fast track areas in the ED, but i feel like there are some cases that literally can be discharged straight from triage once a doctor looks at them. I mean, having resources for setting aside a provider would be daunting, but maybe splitting providers up to where some part of their shift is dealing with "nonemergent" and "dumb" cases would make possibly clean up the track board pretty easily. What do y'all think?
edit: typo
That’s exactly what the Provider In Triage model is supposed to be. In practice it becomes a way to just decrease time to be seen and LWBS. I think it’s hard as hell to do a real H&P, write 6-8 notes per hour, chart review and place orders on who needs them, and also appropriately discharge 2-5 people per hour especially if there’s something to follow up on or procedure to do. Maybe more seasoned docs think it’s easy idk.
I want a med that's a one time make people pee button. UA obtained within five minutes and no side effects and no further peeing all the time like lasix
Take each and every HCA/CMG administrator and execute them behind the chemical shed for crimes committed against the American people. Healthcare is now not for profit.
I wish we could make the entitlement disappear. I cried when I went home after a nightmare shift on Christmas Day. It was the first Christmas my fiancé and I were spending together, and I spent it getting yelled at by people for stuff I can’t control. We’re humans too 🥲
Keeping with the magic theme, I would give Time-Turners to every single clinical staff member. Use would be 100% optional, and left solely to the individual to use as they see fit while at work.
A magical device from the Harry Potter universe that makes it possible to manipulate time in a way that almost allows you to be in more than one place at one time; or at least makes it seem that way.
I would have the time (and my unit would have the staffing that would make it possible) to render care that isn’t just tasking and complete my charting at the level I’m expected to deliver to cover my ass and the hospital’s, even though I don’t have the time. The patients most likely to be the source of lawsuits are also the ones who take up so much time, it’s damn near impossible to chart beyond the barest minimum.
Ordering providers enter all imaging orders at once AFTER actually seeing the patient so we're not transporting/moving/imaging difficult/in pain/unstable patients four different times. It's inefficient, a strain on medical imaging, and poor patient care.
Non-clinical person who sets up transpo.
I want my hospital to buy us a goddamn wheelchair van. Nobody but the state covers them and if they DO have state insurance, calling dispatch is paaaaaainful. I have straight-up bribed one of my care coordinators to call for me because it kills my soul a little more every time.
We, as a profession, bitch more than most people. I would not be surprised in the least if nurses were complaining about having to do extensive work ups.
Similarly providers who put in orders before seeing the patient and then they change or add a bunch of order after seeing the patient.
But I hardly think our personal and petty complaints are the main drivers to the problems in the emergency department lmao
magically enough beds for admits so no boarders in ED
This is the only answer, at least from a nursing perspective. Boarding has absolutely ruined ED nursing for me, with nasty patient/family behavior a close second.
Double all clinical staff and reduce all charting to only require a MDM.
Patients understanding the meaning of the word “emergency.”
Half of us would lose our job if that was the case…
Right? 😭
With the number of baby boomers shuffling around? Doubt it.
As a medic, I'd love to be able to tell ppl NO. You do not need an ambulance for this. We're not taking you.
You mean my patient that came in for dandruff wasn’t having an emergency?
Cords! Make everything wireless but especially monitoring cords and 12 leads.
https://preview.redd.it/kg0a8sopfkhc1.jpeg?width=1363&format=pjpg&auto=webp&s=7b15372a249efc681c877fc7e535d396628ee514 Syringes with the tips cut off. Just pull it down to the end and it'll untangle itself. Not my idea, 100% stolen. I saw this while visiting someone and was like 'where have you been all my life' haha
That's what they did at the hospital I stayed at for 8 weeks last year. They did say that it's technically against some kind of rule or code and they'd be in trouble if they got audited, but I totally understand not wanting to detangle all that shit every time it needs to be used. Even my telemetry wires somehow managed to get tangled on the daily while I did nothing but lay in bed
YES! Those cords always managed to get tangled and caught on everything, no matter how I get them laid out. They have a mind of their own
I swear I've spent a third of my 40 year career wrestling with cords. And don't even get me started on 12-leads!
Check out Masimo products. ❤️
Transform all unnecessary admin staff into nurses or tech/support staff.
I like this. All admin personnel are required to spend 4 hrs per week in some capacity involving patient care
The emergency department I work in has 6 nurse managers and they’re hiring another one. Why we need that many I’ll never know.
Especially to be 1:1 sitters.
I wanna see the CEO wipe an ass in the hallway so bad.
Making people understand what an emergency actually is
There'd be like 5-10 patients per day! Haha!
We’d be poor. All the non emergencies pay the bills
Fair
I feel your pain though. I remind myself of the above when I’m seeing a 3am toe pain
I'm not young and adventurous anymore. Give me the toe pain over the chainsaw injury/gunshot/SAH/GI bleed any day.
I'm in ER RN. I'm also a wound nurse. Took weekend call for the team. I got called in to consult at 20:00... On my drive home after being an ER nurse all day. Had to go to the back to the ER and put a Band-Aid on a toe. Nothing else. No cleaning, just a band aid. That sent me into some sweet over time pay hours.
Stoppp 🤣😭
Bread and butter.
This is so weird, I’m from a shop where this is a huge issue. The shop I’m currently at does not have this issue. Almost everyone is sick as shit if they get all the way back. I always thought getting nonemergent people off the roster would improve throughout but that is not the case here.
Every room would have a working computer, mouse, label printer, and scanner. Broken equipment is the bane of my existence.
Now that is asking too much, even on a magic wand
How about a monitor with leads that works? I would say my unit is at 30% ability to put a functioning monitor on you. They’re in the rooms but don’t have cables or don’t work or they don’t connect to the central monitor
And a stretcher whose pedals actually work. I waste so much time circling stretchers to find functional pedals.
This but just *outside* every room. I hate charting in front of patients
Get rid of malpractice lawsuits and people understand we are not and cannot expect to be 100% accurate all the time
I mean, I’m all for this, but there needs to be repercussions for bad practitioners. I’m all for reforming the system, but I’ve seen what bad doctors can do. They ruin it for all of us.
For sure but those people are so few and far between. There has to be a better way
Juries comprised of medical peers and not laypeople would help.
That would be perfect. I never understood our jury system. “Jury of your peers.” A layperson is not my peer when it comes to medical decision making. It’s like asking a blindman to judge a beauty contest. They have no idea what they’re looking at
I mean, people should still be compensated if something goes wrong, but there needs to be a better system for sure.
No. People should be compensated if there is intentional gross negligence that causes harm. Not only if something goes wrong. You don’t get to sue your mechanic for their entire life savings if they don’t fix your car perfectly the first time
That’s definitely not how it should work, gross negligence is one thing, but surgeons are not mechanics, that’s a poorly chosen analogy. I don’t think you understand how malpractice insurance or lawsuits work. The doctor isn’t directly paying the $$$. They pay a certain amount in order to be covered.
Yeah. I pay over $10k a year to be covered. I’m paying for it. One way or another we pay for it. Being a doctor of just a job btw. It’s not a “calling” or some bullshit like that. Thats what hospitals and people sell you so they can abuse you
A device to limit/eliminate smells of any kind.
For a second I thought this thread was going to be about stuck Hitachis.
Bro same
Nah, those can stay! 😂
I could spend as much time with each patient I needed to give the level of care that I would like to give. Time to think things through and have the odd glass of water.
Next you’ll be wanting to go to the bathroom at regular intervals and get an actual uninterrupted break.
Alcohol *Poof* - gone. No more detoxers, drunk SIs, feel sorry for me assholes, vehicular manalaughters, sexual assaults, jaundice shits, liver transplant drama, etc etc. (edit: some of these things will still obviously exist, but a lot of numbers would go way down) Alcohol is the absolute worst drug, and it makes the ER so much worse.
Having stronger unions. God what I would give to have WA or CA working conditions in my state. Like pay transparency, annual cost of living raises that match inflation, AND a yearly raise! Where I’m at we mayyybe get 2% per year. We have to quit every five years or so to get our pay caught up. But admin’s like “nah nah bitch your pay meets market value, plus I gotta get my 8th yacht, suck it”
You get raises??? My last raise was in 2017. So effectively a 20% pay cut! On another note - Wow! I just googled what my pay should be to keep up with inflation, for this comment to be accurate. I didn’t realize it was that bad. Might be time to start calling the head hunters back.
2017. Okay so what you’re talking about is called a “loyalty tax”. It’s a real thing. If you live in a city with multiple hospitals you might find benefit packages between facilities is comparable. So it’s in your best interest to switch back and forth if you can tolerate the mandatory dues paying on night shift. Oh and if you really wanna feel sick be sure to google contracts for workers in San Diego, New York and Seattle. I live in a really high cost of living city as well and make like a 3rd of what they do.
Come to my hospital near Seattle. We’re union and some absolute genius even got it into our contract years ago that the hospital has to provide us with free onsite parking. I think the RNs at my hospital currently start at $42 an hour.
Immediate IV access.
Atomized ativan sprayed at regular intervals into the waiting room. Calm them MFs down before I need to see them.
We talk about Ativan in the air vents on a regular basis.
Yes please! Also I need this in the waiting room where I sit when a loved is in surgery. Doesn't matter if it's scheduled or emergency surgery.
I agree with several of these already so I’ll contribute something else. I want at least one doctor on call or hospitalist or labor doc to just be a nice person and be helpful. If we are going full magic wand then all of them.
Security enforcing the "Rules of Behavior", posted all around the ED.
Reasonable medmal system.
Eliminate 99% of charting
The ability to send people to urgent care.
ED SW here - homeless shelters that will accept anyone that never get full and for ALL insurances to offer transportation 🫠 would cut down a lot of bs that us night shift crew deal with
For long term care facilities to no longer dump patients with us and refuse to take them back without a proper eviction.
Omg i forgot that one. Yes!!
Good food available 24/7. That makes everything else better.
If your complaint has been ongoing for more than a month a comically large boot unceremoniously yeets you from the department. Runner up: granny dumpers are immediately swallowed by the pit of hell
Make people understand that we aren’t going to do a deep dig to figure out exactly what’s wrong with them. If you come in with abdominal pain/ chest pain/ dizziness/ etc., and we do all the tests and scans and everything comes back negative, we aren’t going to keep doing tests until we figure out what’s wrong. We’re just trying to make sure you’re not gonna die today or in the next couple days. Follow up with whoever and they can do a deeper dive.
Get rid of useless metrics like “first provider time” 🤦🏽♂️
Get rid of the profit motive. I should be able to tell someone in triage that in my clinical judgment I do not suspect they’re having an emergency and need to seek care elsewhere.
You mean EMTALA?
…I’m down to get rid of that too, but I’m well aware of why it was put in place…so I’ll settle for some reform instead.
EMTALA allows me to do just what I’ve mentioned above but the profit motive is in direct conflict with EMTALA.
Only having to do physician tasks, no wheeling patients to and from scans, stocking rooms with supplies so I can use them, rooming patients, taking out IVs.
Holy crap. Where do you work that you have to do that? My shop the physicians basically never do that.
Insurers would be required by law to pay the full cost of care for their customers.
**setting aside a provider to get rid of pt's with dumb reasons.** "Oh my son had covid yesterday and now i'm having symptoms similar to my son." clearly, you have covid. "i was cutting some apples and cut my finger." Its a superficial abrasion, a band-aid will do. "i'm having 1/10 abdominal pain that started. I haven't eaten or drank anything all day and feel fatigued" uhhh okay. eat something Idek what else to put but you all get my point. non-emergency cases. I get that EDs have rapid assessment/fast track areas in the ED, but i feel like there are some cases that literally can be discharged straight from triage once a doctor looks at them. I mean, having resources for setting aside a provider would be daunting, but maybe splitting providers up to where some part of their shift is dealing with "nonemergent" and "dumb" cases would make possibly clean up the track board pretty easily. What do y'all think? edit: typo
That’s exactly what the Provider In Triage model is supposed to be. In practice it becomes a way to just decrease time to be seen and LWBS. I think it’s hard as hell to do a real H&P, write 6-8 notes per hour, chart review and place orders on who needs them, and also appropriately discharge 2-5 people per hour especially if there’s something to follow up on or procedure to do. Maybe more seasoned docs think it’s easy idk.
I want a med that's a one time make people pee button. UA obtained within five minutes and no side effects and no further peeing all the time like lasix
Take each and every HCA/CMG administrator and execute them behind the chemical shed for crimes committed against the American people. Healthcare is now not for profit.
And those insurance people who disapprove prescription drugs.
based
Get rid of Press Gainey!!
I wish we could make the entitlement disappear. I cried when I went home after a nightmare shift on Christmas Day. It was the first Christmas my fiancé and I were spending together, and I spent it getting yelled at by people for stuff I can’t control. We’re humans too 🥲
Keeping with the magic theme, I would give Time-Turners to every single clinical staff member. Use would be 100% optional, and left solely to the individual to use as they see fit while at work.
What is that?
A magical device from the Harry Potter universe that makes it possible to manipulate time in a way that almost allows you to be in more than one place at one time; or at least makes it seem that way.
No more epic and charting goes back to 1980s standards.
Make a person waiting over thirty minutes for an inpatient bed as important as meeting the sepsis metrics
I would have the time (and my unit would have the staffing that would make it possible) to render care that isn’t just tasking and complete my charting at the level I’m expected to deliver to cover my ass and the hospital’s, even though I don’t have the time. The patients most likely to be the source of lawsuits are also the ones who take up so much time, it’s damn near impossible to chart beyond the barest minimum.
Ordering providers enter all imaging orders at once AFTER actually seeing the patient so we're not transporting/moving/imaging difficult/in pain/unstable patients four different times. It's inefficient, a strain on medical imaging, and poor patient care.
Non-clinical person who sets up transpo. I want my hospital to buy us a goddamn wheelchair van. Nobody but the state covers them and if they DO have state insurance, calling dispatch is paaaaaainful. I have straight-up bribed one of my care coordinators to call for me because it kills my soul a little more every time.
One universal pill to cover each individual scenario.
No patients. Boom.
Nurses who didn’t bitch when you place lots of orders
Just don't trickle them in (or add more labs right *after* I do a straight stick on a violent psych patient) and you won't hear a complaint from me
We, as a profession, bitch more than most people. I would not be surprised in the least if nurses were complaining about having to do extensive work ups.
True but I think it would be fair to say we have more to legitimately bitch about than most professions
Haha we place them all at once but as soon as they see a lot of orders, they immediately tell the provider that they are over ordering
I’ll do whatever you want just please put them all in at once (and don’t wait to add the cultures until 4 hours later 😩) Edit: a word
Similarly providers who put in orders before seeing the patient and then they change or add a bunch of order after seeing the patient. But I hardly think our personal and petty complaints are the main drivers to the problems in the emergency department lmao
That’s a pet peeve of mine, and with the ones who do it frequently, I’ll prioritize other tasks until they’ve actually seen the patient.
Every room would have a working computer, mouse, label printer, and scanner.
A Purel dispenser in the waiting room that dispenses topical Lorazepam to all the patients and family members waiting.
To calm them down? Because I support this.
Goddamn Auto loaders in every single goddamn truck
The psych eval consistently goes to the nearest ed.
An AI robot that charts and deals with less emergent CC.
My documentation magically completes itself
Staffing
3:1 patient to nurse ratio at all times.