Tuesday, July 20, 2010

In the ER.......

The emergency room is busy, but we're ushered in quickly after registering. My client was having liquid diarrhea and vomiting after I arrived to his house this morning, so I called the case manager and she came right over. She agreed to transport him to the ER in her car as I followed close behind.

It's the usual ER scenario: the same questions asked multiple times, a desultory exam by the attending Physician Assistant, and a long wait for blood to be drawn and an IV started. As the nurse starts the IV and draws the labs, we chat about nursing.

"I've been a nurse for thirty years, and it's just gotten worse and worse," she says as she pokes my client and draws five vials of blood before starting the IV.

"I almost always work without a break, and when I complain, they tell me that this is the ER, and if I don't like it, I should go somewhere else." She places the vials of blood on the counter near the sink and fingers the IV until it's running at the rate she desires.

"They treat us like shit," she continues, "and there are always new grads ready to take our place. I don't know why I put up with it. I don't even have time to eat, and you'd think the management would care that their nurses' basic needs are met. But they don't. They just don't."

She leaves the room, the vials of blood still sitting by the sink. Contrary to safety protocol, she leaves the rail down on the side of the bed where she's been working. She also leaves all of the detritus and trash from the blood draw and IV setup in my client's lap, and dirty gloves on the floor. It's the end of her shift and she's ready to give report and go home.

I overhear a conversation in the hall, the nurses paying no heed to the fact that patients and visitors can hear their every word.

"How's your day going?" one nurse asks her.

"Terrible. It's one of the worst shifts ever. I can't wait to get out of here. I hate this."

She shuffles off to give report, my patient's blood vials still on the counter by the sink. I try to catch her eye but she's already down the hall.

Almost an hour later, she's back, and the blood is finally sent off to the lab, and then she's scribbling madly in charts as the new nurse comes on duty.

The eight hour ER shift has obviously taken a toll, and our original nurse seems fried beyond reason. I quietly excuse her lapses and hope that she can go home and rest.

The new nurse who has just come on duty bustles into the room, greets my client, introduces herself, asks some questions, and shakes her head as she realizes that the previous nurse failed to hook up an automatic heart monitor and oxygen saturation machine on my client when he was first admitted. She untangles the IV, smooths his forehead, offers me a drink and a snack, and bustles out as cheerily as she came in. Meanwhile, I wonder how she'll look and feel in eight hours.

With telephones ringing, bright lights, loud conversations and the constant beeping of monitors, machines and intercoms, the emergency room is no place to rest. In fact, it's not a place anyone ever wants to be, even most of the people who work there. Still, it's an essential place, a human place, and a place where the ill, the broken and the traumatized come for succor and emergent care. But if the nurses and others who staff these emergency rooms are truly treated like so much expendable waste, then how can things ever really change?
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