r/EmergencyRoom

My son's an RMO in the ER of a metropolitan hospital. He saw a patient who'd waited 8 hours to see a doctor because of her broken foot. She was referred by an experienced local GP. My son put the moon boot on her and sent her home, suitably supervised by his registrar. Why do GPs send simple cases that they can fix easily to the ER knowing that the ER is backed up and will require extensive waiting times? Do patients wait long hours at ERs because they do not know that the GP can handle his or her issue easily?

Hello fellow ER people 👋

I'm not a new grad (5 years as an RN, 4 in bedside med surg and 1 in outpatient neuro), but I got a new position as a specialty float pool (ER/PCU/ICU) and I start my ER rotation Thursday.

The extent of my ER experience consists of watching the Pitt, so I am terrified.

What is the flow like? How does it differ from med surg? What's the scariest part? Is it as overwhelming as it seems?

Any advice would be much appreciated ❤️

First, THANK YOU FOR ALL THAT YOU DO! 💜

I love all the techs I work with - they make my shifts so much better in lots of ways. I would honestly lose my mind without them.

My question for all you techs out there: what is the best way a nurse can show her appreciation?

I wish I could give each of my techs $100. Is giving everyone a $5 Dunkin or Starbucks gift card silly? Or should I give a bit larger of a gift to my more trusted techs? There are probably about 10 techs who bust their ass and really care about their job. These are the ones I trust completely. The rest are fine (and always essential) but they are a little burnt out if you know what I mean. So they are a little more lazy and clearly don’t care.

So: should I write cards to everyone or just a select few? I don’t want anyone to feel left out but I honestly would rather spend a bit more so that my “good” techs feel noticed and appreciated. I don’t necessarily want to reward the ones who constantly roll their eyes anytime they have to do anything…but maybe they need a little pick-me-up?

Open to your thoughts. Thank you!

I've been an ED nurse in the suburbs of Vancouver, Canada for 16 years. In our department, we see 15-30 overdoses in a 12 hour period (many with the Xylazine additive causing bradycardia and need for telemetry beds). I'm sure seems like a lot, but we see 350 people in 12 hours here. Even though our Healthcare is free, you do have to register with the government for it, and this population obviously doesn't. The government still pays our ED Dr's for seeing these people but it's a lot of extra paperwork for them. These same Drs do, at some point, see people for free but only when a out of country person comes in and cannot pay the 450$ doctors free (It's a total of 1850$ for the ER visit, only including bloodwork/xrays billed later) but we usually only ensure the physicians are paid. I'm just curious how the hospitals in the US handle these situations. Do ambulances pick them up and drive to a further hospital because only certain one's deal with the uninsured? From my recollection, you have some government funded facilities and mostly privately owned. If someone is in active arrest, even from OD, do they go to the nearest hospital? Forgive me for my ignorance, I'd love to understand more and please correct me if I'm wrong!

Hi All!
I have been working IFT as an EMT-B for about 8 months now and am starting my BSN nursing program in the Fall. I have been applying for ER Tech jobs since I got my certification, but never landed any interviews due to lack of expierence (probably for the best; located in Chicago). Though, I have had 2 phone screenings, but both didn't get anywhere.

I finally got another phone screening scehduled for Monday, doing extensive research on the hospital system to actually do well this time. I had a phone screening with the same hospital for the same position in January, but did not prepare as well as I should've and blanked. I am set on landing this, especially since this is like perfect timing as Spring semester is ending, so I will have more time for the orientation period.

So- I need some advice. During the last phone screening they asked stuff like "Why is it important to work in a team?", but does anyone have advice on what else they will ask me? And especially, what are they looking to hear?

Apart from a phone screening, say I get to an in person interview. At that point, what do they ask there?

Thank you!!

*Healthcare workers only please*

I work in a rural critical access hospital that has major staffing retention issues. Most of our nurses are travelers, and the majority of our doctors are brand new attendings right out of residency here for PSLF. In general they tend to follow protocol based care more rigidly than our older more experienced docs, which I largely support.

However, a trend I have noticed in these new providers is complete avoidance of controlled substances at any cost. Many of them will refuse to give any analgesics for bedside reductions (even ketamine), and very minimally for tubed/vented patients, even in the context of burns. I appreciate the consideration for overprescribing, especially in outpatient settings, but as one of our old docs says “substance use disorders don’t come from emergency pain management”.

In addition to witnessing untreated pain, it’s also an issue with our psych patients. We don’t have an inpatient psych unit or psych ER, so we end up providing a lot of longer term psych care. Many of our psych patients are violent offenders and are waiting admission to our one forensic psych hospital in the state for weeks in our department. When these patients become physically aggressive with staff, these young docs will refuse to order safety meds except offering the patient a dose of their daily meds, or oral hydroxyzine, often saying they don’t want to “reward drug seeking behavior”, even with antipsychotics. This has led to significant staff safety issues, and increased fear/resentment in caring for this population.

Has anyone else noticed this change? If so, is it a general sign of the times, or do you also specifically notice it in more recently trained providers?

EDIT: I really appreciate everyone sharing their experience from the patient perspective, but I should’ve clarified that I was hoping to hear from other healthcare workers specifically about their observations/experiences with this phenomenon. I do not doubt that many of you have stories of your pain being untreated/undertreated (as I have witnessed at work - which I alluded to in my post) but I’d love to hear from people providing the care and interacting with new guidelines

EDIT pt. 2: Even after my disclaimer at the top and edit, non HCWs are continuing to flood this post with their personal experience as patients. Guys, this is a subreddit for people who work in the emergency department. It is not for the public to share anecdotes. I posted this to engage in information sharing with other HCWs. There are chronic pain support subreddits, this one is for sharing information with healthcare workers.

A week ago I was in the ED for a TIA. Thanks to the paramedics who shared the same twisty sense of humour as mine and treated my service dog like a celebrity. I was in a bit better of a frame of mind when we arrived to the ED.

I saw how hard everyone worked. I was treated with compassion and I saw other patients being treated with compassion. I was happy that my “ off duty” service dog could bring some relief and comfort to the overworked staff. I saw you. I saw you treat an elderly patient who was all alone and arrived from a nursing home with gentle kindness. I saw you share a laugh with an elderly man who was there with his wife of 63 years.

At the end of it all, everything that needed to be investigated was investigated. I’ve always had respect for those of you that are healthcare professionals. Please stay safe and don’t take any bullshit.

For me it would be what sort of medical situations warrant a visit to the ED vs. urgent care or PCP/specialist appointment

This is both to seek insight and advice. I’m still on orientation and this is my first medical job. I work at the ER and it’s pretty busy, I’m almost overwhelmed with all the stuff I have to understand and learn, but I genuinely like what I’m doing… even though I feel like a failure a lot of the time.

So a nurse asked me to get a urine sample from a patient in the hall while she helps another patient. This was not the pod we were station in and I was called as a favor. My preceptor wasn’t with me, but I have done this step for patients before. I even asked the nurse what exactly she wanted to do and she gave me advice. It was an elderly lady, she was alert and oriented, was able to sit up and stand on her own… so I thought she could do it without me inside. But she fell, I am not very strong and luckily there were emts in the hall to help her up. I saw a nurse near by and told them, but they then told me that “it wasn’t their patient” and left. So after I saw the emt help her I ran to get the nurse and she was mad.

I then find out she had a brain bleed and now she hit her head… I just started crying then and there. It’s my fault I should’ve been in the room with her, I honestly thought she would be okay and I was standing right outside the door and it was unlocked. I’m so embarrassed, I feel like I’ll get in trouble and most importantly I hurt a patient. They are here to try to get better and I only made things worse, I chose this path to help people not harm and I’m just so upset at myself.

She didn’t have a fall risk band, the nurse didn’t tell me I should go in with her, but I should’ve asked and she was wearing socks that indicated fall (BUT I was also told by some people that they kinda just give any color socks to people). I think I should’ve also pulled her socks all the way up.

My preceptor was not mad at me and I asked him what I could’ve done differently, but I don’t know if he was just being nice to me because he felt bad.

My confidence as a tech has just plummeted and I feel like everyone thinks I’m an incompetent idiot that cries now. I’m still learning how to do IVs successful, I’m still trying to learn how to not panic during codes, I still confuse many things and now I don’t even feel qualified for this now.

Any advice on what I should’ve done better or perspective. Please be honest, I don’t want to cause more harm :(

I am currently a nurse in the er but started here as a new grad so they didn’t ask any nursing interview questions! I have an interview next week with another er and was wondering what kind of questions you got during your interview to help prepare!!

TIA

This is a trivial question in the grand scheme of things, I know, but y'all were very helpful with another medical question I had for my story and I would appreciate more help from those who are up for it. Would you be willing to describe what a "fly on the wall" would see as/after someone dies in the ER?

I would like to open the book with my character "regaining consciousness" (as a ghost) upon dying. The backstory I have is that she had a freak bee sting allergy while alone (<- plot-critical) and her throat swelled up, making it hard to intubate her (<- not plot critical, just something that seemed plausible).

I would imagine things like...

• Some sort of oxygen support being on her face -- one of O2 tubes under her nose? Would there be parts of the intubation process in her mouth, even if it was successful?
• The long steady beep you see in movies when someone's heart stops?
• But then I'm guessing someone turns off the monitor because that's a horrible sound?
• And someone calls "Time of death: 10:31 am"?

...And then what?

• What would the tone among the staff be? (Somber? Angry? Gallows humor?)
• Visually, I imagine monitors and tubes and wires. Anything that would visually stand out?
• About long would the medical staff bein in the room? What would they be doing?
• Would the O2 support and monitors be removed right away? By the emergency medical staff there, or is that part of "cleanup" that someone else does?
• The character is alone, and clearly foreign (she's an American in Italy)... I assume a social worker would get involved? Would they be in that space talking to the medical people?
• I'm picturing the hospital staff leaving the room and pulling the curtains closed around the bed. Does this seem probable? Or what would be more realistic?

Thanks for any & all insights. I appreciate you bearing the burden of situations like the one I describe so that so many other people can go home to their loved ones.

Of course, some background is needed..

I'm currently an EDT at a high volume Level 1 teaching hospital in a midsize midwestern/ rust belt city. This is a return to the medical world after a decade out guiding backpacking and canoeing trips. I previously worked as an EDT in the late 2000s after getting my EMT-B (which I've since let lapse). Since returning to hospital work, I've worked in a Cathlab/EP/IR pre post position, OR, and now back in my comfy place in the ED.

The amount of change from 2007 to 2026 in the ED is vast while at the same time remaining the same old-same old. The biggest, most apparent difference is the lack of experienced RNs, and the accompanying lack of autonomy in the nursing role. In my memory, back then, there were always 3 or 4 nurses on each shift that were like sage medical wizards. They would present like any other nurse, telling patients the canned "Its above my paygrade, the Dr will be in to discuss with you". They would sigh and complain about the bullshit just a much or more than the rest of us. But when you walked out of a room they could explain everything wrong with any patient before we even got reads or labs back. Or when shit hit the fan, they would just go into a mode and give directives, start interventions, and even have meds drawn up, so that when the Doc rolled in, they were ready to go. They had seen it all and knew medicine better than some of the Docs.

Now, there is one, maybe two of those nurses in this department (of approximately 200) and they work part time or PRN. The ones that are on the path to experience are actively looking for a way out. I understand Covid did a number on experience all over the hospital, but even the new grads that came in after Covid are leaving after 6 months, a year, 2 years. They're not staying long enough to ascend to the "battle axe" throne. The outlook seems dire. We've lost the institutional knowledge and cant seem to build it back.

For the past few years I've been pursuing an ADN part time at local community college, and I've just begun clinicals. I've always "known" I wanted to be an ED nurse. I like the environment, the feeling of awaiting a trauma or code, the teamwork, being a competent assistant in the workflow, the detective work of initial diagnosis, the sense of pride I feel when telling someone I work ER and they return with that face of "damn! better you than me".

However, as I get closer to the RN role, I'm wondering if I'm missing something. Is the ER really that bad as a nurse? Is the bullshit really that much more impactful in that role?

Between my time in Emergency Med and procedural units, its difficult for me to even conceptualize floor nursing, but would that be a better route? Is it even possible anymore to hang on long enough to become the Ripley of the Resus Room?

Hi guys!

My friends and I are building an app to connect patients with their procedure status, wait time, and a voice agent to help alleviate any anxiety-inducing questions. My friends and I have some issues personally in the ER, especially with the anxiety in the ER without any answers for hours of waiting.

I understand the voice agent will likely never have the humanlike touch, but I really hope it helps to some degree in reducing anxiety/making it easier in the ER.

Please let me know your thoughts and if you think it would be useful in the ER.

https://preview.redd.it/3thi2awon7sg1.png?width=614&format=png&auto=webp&s=d8235930c1d2883d45d01f463a15c6e59da19fcb

I keep getting different answers, and some just get it from the same line but keep it sterile (but I know that’s wrong?)

So the policy is to get each set from two different lines. When I place an IV on I can get it from that one, but for the second what should I do? Our butterfly needles at my hospital is attached to a blood transfer container already, but the blood culture tubes won’t fit in that. The container i attach to the y set of the IV I use for blood cultures is a lot wider.

So should I just put a second IV line on the patient or stick them and then take it out? I’m so confused and everyone I talked to has said that they do it the reality way rather than the policy.

Thank you in advance (sorry if i did not use the proper names, I’m still learning!)

We’ve gotten a lot of complaints about surveys, etc., so we will be pausing these for a while to let the community breathe.