Why the ER Wait???

This is Nurses Week! Many of you know I’m an ER nurse. So in honor of Nurses Week, I’ll answer an oft-asked question in the ER: why the long wait? Here’s one of the reasons why…
RN: “You have to have a ride home if we give you any narcotics; do you have someone who can drive you home?”
Pt: “Oh, yes, my [fill in the blank] already said (s)he will be here in 5 minutes to pick me up.”
RN: “Okay, push your call button when (s)he is in the room and I’ll come in with the meds.”
Pt: “Well, I don’t really know when (s)he’s getting here. Do I really have to wait?”
RN: “I’m sorry, yes. Our protocols state that [repeats previous statement]. But in the meantime, we can give you our most powerful non-narcotic pain meds.”
Pt: “Those never work for me. All that works is [ridiculously high dose of a very strong narcotic]. Also, I don’t have a phone; can’t you just give me the meds?”
RN: “I’m sorry, [repeats previous statement]. Here’s a phone for you to use.”
RN leaves, pt pushes call button, RN returns.
Pt: “(S)he’s parking right now. Can you give me the pain meds now?”
RN: “[repeats previous statement about driver being in the room].”
Pt: “But (s)he’s right outside. Can’t you give it to me now?”
RN: “I’m sorry, [repeats previous statement].”
RN leaves the room, pt pushes call button, RN returns.
Pt: “(S)he’s walking in right now. Can you give me the pain meds now?”
RN: “I’m sorry, [repeats previous statement].”
Pt: “But (s)he’s walking in right now!”
RN: “I’m sorry, but [repeats previous statement].”
RN leaves the room, pt pushes call button, RN returns.
Pt: “Well, I guess (s)he’s not coming.” [Pt acts surprised. RN indulges pt.] “I’ll just take the bus. Can I get the meds now?”
RN: “I’m sorry, but you have to have a ride if we give you narcotic pain meds.”
Pt: “But I’m not driving if I take the bus.”
RN: “I’m sorry, but it has to be a responsible adult.”
Pt: “Then I’ll take a taxi. Can I get the meds?”
RN: “I’m sorry, but it has to be an adult who’s responsible *for you*.”
Pt: “But the other ER did it for me!”
RN: “Oh, really? How nice! I’m glad they’re able to do what you want! [Wants to add but doesn’t: Maybe you should go back to them.] But our protocols won’t let us do that.”
Pt: “Well then how can I get my pain meds???”
RN: “I’m sorry, [repeats previous statement].”
Pt: “Well, then, can you just give me a prescription?”
RN: “I’m sorry, but as the ER doctor explained earlier, we can’t give prescriptions for narcotic pain medications to people with chronic pain conditions. As the ER doctor said earlier, you have to go to your pain management doctor for narcotic pain medication.”
Pt: “But I don’t have a pain doctor! Can’t you give me something now?”
RN: “Oh, really? You told me earlier that your doctor is [names a pain management doctor].”
Pt: “Yeah, but I haven’t seen him in a really long time.”
RN: “Oh, really? Your pill bottles here say he prescribed you these meds two weeks ago.”
Pt: “Well, his office doesn’t open until 10.”
RN: “It’s 11:30 right now.”
Pt: “Well, yeah, but I’ve been here for an hour and a half.”
RN: “You’re right, you got here at the ER at 10. When his office opened.”
…And that’s unfortunately not where the conversation ends. And while those conversations take place, the RN’s workload with his/her other patients is piling up, making him/her even slower. On a really special day, the same patient will come back to the same ER less than 24 hours later and go through it all over again. Then when the patient’s pain doctor dumps him/her for repeatedly violating the pain management contract, he/she acts surprised and wounded and still comes back to the same ER every week for the same problem.

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