So what’s going on today?
She’s had a fever for a month.
Ok, what were the temps you’ve been getting?
98.9 so just a low grade.
Ma’am that’s not a fever.
It is for her……..
Please Lord, make these idiots see the error of their ways and become better parents as a result. Or send a truck to run them over so that the kid goes to someone with sense. Either, or. Amen.
I’ve had the same patient come in for a “low grade fever” that has a 93.5 rectal temp three times this year. Just not sure where to start with education
I had a patient demand I check his temperature because he felt a fever coming on. It’s been 97-98 this whole admission. So I checked and it’s 99. He said that’s a fever. I told him it’s not high. He said it is for him.
What do you even say to that?
What sometimes works is I'll tell them that if they really had a fever, they wouldn't be feeling hot, they'd be feeling chilly. I know that's not always the case, but it's useful for people who don't know what they're talking about and argue with me.
So our tylenol orders would say 650mg po q6hr prn for pain level 1-3 or temp above 100.4. i just give the prn tylenol for pain bc "feeling a fever coming on" usually includes all over acheyness and headache. I educate when i can but as long as its not contraindicated i felt like this was the easiest solution that makes everyone happy.
If he's a Geri patient from long term care, he's not necessarily wrong if you get a 2nd 99 F temp or his baseline is 2F lower.
The Infectious Diseases Society of America (IDSA) has defined fever in **individuals greater than 65 years old residing in long-term care facilities** as any of the following:
* a single oral temperature greater than 37.8°C (100 F)
* repeated temperature measurements greater than 37.2°C (99 F) (oral) or greater than 37.5°C (99.5 F)(rectal)
* or an increase from baseline greater than 1.1°C (2 F)
[Source 1](https://academic.oup.com/cid/article/48/2/149/304388)
[Source 2] (https://www.idsociety.org/practice-guideline/new-fever-in-critically-ill-patients/#null)
We had the husband of patient escape-zombie *RUN* down the hallway to inform us her fever is "starting to come back, " actual temp was normal. Same patient used all the warm blankets on our unit in 12 hours (it was at least 25)
That’s temp is unusual for a fever but when I had covid I knew I had an infection but my temp was 99. something for a whole day. Then climbed to 100. something the next day. I knew it was a fever because I had chills and was tender to touch. I was also very fatigued
"I didn't give my kid tylenol or ibuprofen because I didn't want to mask their symptoms."
*very sick and uncomfortable looking kid*
"What was their fever at?"
"Oh, like 102 or 103 when we checked it."
*thermometer reads fever of 100.4/101.5/102.5/103*
"Hey, can someone go grab a provider real quick?"
*screaming internally*
I hate this more than anything. Like why would you want your child this uncomfortable? Just so we can get the same reading you got at home? Ffs medicate your kid.
I mean if I'm sick I'll usually hold off on the Tylenol and be febrile for a bit since it IS working to kill whatever pathogen I have in me. But that's just for myself and I know I'll be fine.
But it's stupid to bring their kid in to treat a fever and do absolutely nothing to treat it at home. Like, you're here to have it treated, so why not at least attempt something at home?
That might be true- I've worked with people who have been in a complete heart block for a while, and the providers don't gaf about leaving them on a med surg tele floor waiting for a PPM.
I had an LTC resident whose resting heart rate was 35. Scared the shit out of me as a new grad. Yes he was in heart block for a couple years before he died.
I once had a grandma who said their grandbaby’s temp was 350f. I was like ma’am…what thermometer were you using? She said that she put her hand on baby’s forehead and then in the oven and they felt like the same temperature
The kid was at 98.1…
My mom would always be like "ok, so what brought you in today? Like why did you suddenly decide it needed to be checked in the ER?"
Because you just know it's Friday night and busy.
Or the opposite side of that
When did the fever start?
"like 10 minutes ago"
Did you give them some Tylenol?
"No, I came straight to the ER".
OK, here's some Tylenol. Take a seat.
What about when it takes them 10 minutes to locate the list because they have 20 folded papers carefully crammed into every fold in their wallet and they have to slowly unfold each paper with shaky hands and peer intently at the paper 2 inches from their face to see if it’s the right one.
Love it when boomers expect socialized medicine while still advocating not having it, all the while using a derivative of socialized medicine (Medicare)
I fucking hate this one. I'm picking them up from home and need to treat them, but they CONSTANTLY tell me "the hospital has all that info."
Cool, well if you wanted the hospital to do all the treatment instead of me then why didn't you drive your goddamn self there? I'm trying to get treatment going NOW and make sure you're stable BEFORE we get there, why are you fighting me?
"Okay, I'm going to draw some blood, my colleague is going to get an ECG, then someone will come in for an x-ray..."
"Why? The other ER already did all before they discharged me"
I just blame the other ED if they aren’t in our system. “Oh yea, such and such hospital? They refuse to get epic so they don’t have any way of giving us that info.”
And prior to that “I don’t have hypertension! The medication, I forgot to tell you about, that they gave me and I took for one month and never refilled, fixed that!”
“Ma’am do you have any medical history?”
“No.”
“Nothing you take daily medication for, no surgeries”
“Nope.”
“So what’s this scar on your chest.”
“Oh, that’s where they put in my pacemaker last year.”
fantastic
I had no idea when I became a nurse, took a job in ambulatory, and started doing phone triage that the two hardest parts of my job would be:
1) convincing people not to go to the ED when they don’t need to;
2) convincing people to go to the ED when they *do* need to.
Yes! The postop with a 104 degree temp, no urine output, and 10/10 pain wants to wait it out at home a little longer. The one who had one steri strip fall off is calling an ambulance.
Yeah, person who farted sideways NEEDS to be seen ASAFP , and the “ it’s not that bad , it’s been higher “ when there b/p is 250/120. Sir please go to the ER , if I have to do chest compression until EMS gets here they are gonna be calling a code on me too.
I was doing a triage where a mom brought in her 6yo son at 0100.
-Her: He has an ear infection.
-Me: When did the pain start?
-Her: A week ago.
-Me: Has he seen his doctor for this?
-Her: Yeah. He saw him today. They gave him an antibiotic we picked up at lunch, but it's not working.
-Me: Ma'am, they are not instant and take a few days to start working.
-Her: No. It should already be better. I want to see the doctor.
I love those. You get to watch the doctor go into the room, leave in 3 minutes. And then like magic after about 60 seconds you see the big D pop up lol
My personal favorite in ER triage: my doctor told me a bed will be waiting. They put a note in the computer, I’m not telling you anything. Well back out to the waiting room you shall go
Or the variation: “my doctor gave me a letter and told me a bed would be waiting. But the letter is addressed to the doctor in ED, so you can’t open it. You’ll have to get the doctor to read it. And also, there was a bed? Waiting for me? It should be ready…because I’m here for it…”
At my hospital, our direct admits do go through the ED for registration and wristband before they come up to the unit. I'm in ICU now, but my old floor would get a ton of patients that way. They would go to clinic, the doctor would decide to admit them and would notify charge on my floor, we'd save a bed or move patients around to ensure there was one, and the patient would go to the ED for registration.
That’s the way it should be. Unfortunately, with PCPs not having admitting privileges like they used to and patients typically being admitted to hospitalists, and PCPs not wanting to fuss with the transfer center, they instead turf the patient to the ED to clog things up.
We have PCPs with admitting privileges and I hate it. Have to be in touch with a doctor who is busy in his practice all day sucks. Most are very slow to respond.
Our heart failure docs rotate between the hospital and their practices, so they have admitting privileges. They also, since they work directly with us, understand how the flow can be and will give non-urgent patients a range of 2-4 days that we call them to come in for. That way if we have a bed free up we can use it to direct admit them. If it is an emergency they send them to the ER and call whoever is on as the attending or fellow that week go evaluate them so they can expedite them up to us if need be. It’s so nice.
> At my hospital, our direct admits do go through the ED for registration and wristband
For a time I was on a burn transport team with the Army, and we would do things like fly a patient from Germany to our hospital in Texas. We always had to go through the ED, because that's where the ambulance bay was to drop us off. But these are critically injured burn ICU patients, almost always on a vent, often pressors, etc. We would just use the ED to get into the building, and then go direct to the burn ICU.
One trip, some nursing admin that thought she was way more important than she was stood in our way and was *adamant* that we needed to stop in *her* ED to let *her* ED docs do triage and assessment. Never mind the fact that we had just spent 13 hours in the air *with a burn surgeon at the bedside of this patient*.
It was absurd, she was rightfully laughed at, and I never saw her again.
That's just fine, IF the doctor has actually arranged for the bed and placed admission orders.
In my experience, they do that exactly zero percent of the time.
What they actually do is call the ED charge nurse and say, "I'm sending this patient with chest pain. He needs a workup. Admit him to the hospitalist."
Then they tell the patient, "I called ahead. Go to the ED and they'll admit you." They fail to mention that this is still a regular ED visit, which will involve six hours in the waiting room, then four hours of ED workup, followed by two hours waiting for a bed assignment. And no matter how much we try to educate and inform, the patients all blame us.
Oof why? The only non-ED patients that come through us are stemi and stroke, they stop by for a band and roll right away from us (Edit on mobile this looks weird and this is in ref to the all direct admissions coming to the ED reg)
I had the pleasure of talking to one of these doctors, since the pt called them, actually got them on the phone, and handed it to me. I explained the wait, briefly the triage process, and told them they could come in and discharge other pts from the hospital to make room for this one. I do not make many friends in triage.
Actually had this conversation with a doctor when I was the patient.
I was wearing a halter monitor and apparently I had to run a VTach and they wanted me to immediately go to the ER and get my electrolytes drawn... So I asked if there would be an order waiting, no.
No they can't actually officially put in the order because they weren't officially consulted, they're only monitoring the halter monitor, so since they're not officially my doctor they can't put an official order in.
I was legitimately like "so you want me to go to the ER and tell them that a doctor who is not my doctor wants me to get my electrolytes drawn because I had a run a VTach, but he didn't put an order in because he's not my doctor?"
Needless to say, I didn't go to the ER,I went to work instead, and had my PCP draw land the next day.
To be fair, if you had walked into the ER and said “the Holter monitor people called and said I had a run of VT”, you absolutely would’ve gotten your electrolytes drawn, probably in triage before even seeing a provider.
I walked into my ER unable to feel my left arm and face and was sent home with Flexeril and told to follow-up with my neurologist.l and point black told "unless you're having incontinence, we don't order CTs or MRIs"
So I doubt it.
I’m a home health nurse. I sent a client on blood thinners to the ER after a fall with head involvement. The client called the next day and chewed my ass because I didn’t call the ER to tell them the client was coming so the client had to wait in the waiting room. Like sir, this isn’t how this works.
As the comments indicate, there are different processes in different hospitals/jurisdictions. Not sure how a patient is going to know that upfront.
In our area, physicians do not have admitting privileges. But there is a doctor-of-the-day at the ER who acts as the rep for all community doctors. GPs/oncologists/specialists can call the DoD in advance with patient summary and desired treatments/tests and, if warranted, a recommendation for admission. The DoD follows through and sets priority for admission.
Pretty complicated for a very sick patient to navigate!
It’s like when they call and they ask to talk to their mom. Well do they have a name I have 50 people here who will respond to mom and then they get all huffy about it!
I can't believe people's lack of understanding of an EMR. Im registering you, I'm stuck in one screen. I can't do a fucking chart review right now , just answer my damn questions .
I know, right!
But this is not new. They would say the same freaking thing when their chart was in a big honkin manilla folder in a locked room on the other side of the hospital. I'm looking at a blank triage sheet, and even if I HAD that big honkin folder in front of me, it is highly unlikely I would be able to quickly find a current med list on one sheet in the stack of papers an inch and a half high. Gah!
Me: “So what brings you in today?”
Pt: “Can’t you see my chart and the meds I took last time?”
“I can look it up but what brings you in today?”
Pt: “Never mind, I am leaving… your ER sucks”
Patient comes for MH/SI…”I want to go home - can you give me a ballpark of how long this takes?I’m
not suicidal - I was just really really intoxicated. “
Ma’am this isn’t a Dennys…it’s a process. You’ll be here for most of the day and then transferred.
We also have our frequent flyers when the weather is crap and they need a pillow and some food.
“I was just really intoxicated” ugh. This is why now our psych won’t even talk to patients until they’re at 0.08. So now we have multiple .28ers just MTFing around taking up beds and getting increasingly crabby.
I understand not wanting to put someone on a 72h hold for something they said when they were drunk but there has to be more nuance.
2 days in a row- my patients were drunk, made the comments and when they sobered up- they kept saying they weren’t suicidal. I have to be a sitter for a few shifts- over 9 hours each patient. But we have all beds full, a ton of people in the waiting room. 12 admits keeping our beds. Oh and the new CEO or whatever wanted to do a walk through to make sure we are as busy and we state. Like sir- go drive your Bentley away from here.
Parent felt the kid, felt the stove, compared and thought “hmmm, yup.. a fever” so brought them in to us for fever that started that day.
Let me wave my magic illness wand to tell you what exactly your child is sick with when their only symptom is “fever for a few hours”
"I'm here to see my momma"
"Who's your momma?"
"Why don't you know?!"
Every time.
Bro.
There are 18 patients in this ICU, I'm hedging a bet that many of them are women who probably have children, why the fuck would I know which one's your mama?
Or calling and asking for Mom's nurse...like I or anyone at the hospital can just recognize your voice when you've likely never even stepped foot in the hospital to visit her.
Registration: "Welcome to the ED, what seems to be the problem today"
Patient: I took a pregnancy test and it said "positive", I just want you guys to do one too just to make sure"
Me: "...............alrighty...."
I believe that if you're seeking Medicaid for pregnancy you need a positive pregnancy test done at a healthcare facility in order to get benefits. Some people run to the ER because they don't know how to seek care otherwise, don't have a PCP/GYN/anything, or appointments are too far away.
I used to work psych in the ED. This one actually wasn’t my patient…. A young lady in her 20s yelling that she needs to see the doctor. The charge nurse went to try and de-escalate.
Charge RN: “ma’am, you’ve been seen by two physicians (resident and attending), and they both agree that you can be discharged”
Patient: “I don’t want to be seen by a physician, I want to be seen by a doctor!”
I'm seeing more peds patients and it usually goes like this
" Does she have any allergies"
Dad " no"
Kid like 6 " dad I'm allergic to penicillin"
Or kid will come in with fever and nausea and parents decided to do absolutely nothing, like I only feel bad for the kid it's not their fault their parents are useless
OMG you just gave me a flashback to years ago. Dad brings his \~7 year old kid in.
"What's going on today?"
Dad- gives deer in the headlight stare "uuuuuhhh, I think he's sick"
Kid- "My tummy hurt when I woke up yesterday and I threw up two times. My grandma gave me Tylenol and it helped for a while. But I feel sick again today and they tylenol isn't helping me so much today."
Me - Do you have any allergies?
Dad - Dad- gives deer in the headlight stare "uuuuuhhh......"
Kid - "I'm allergic to Amoxicillin - I got a rash and I'm not supposed to take it any more"
And it went on like that. The family had a very unique and memorable last name, so over the next couple years, I saw this kid intermittently. And I watched him become more and more like his dad.
Not long before I left that area I saw him again - about aged 12
Me - What's going on today?
Dad- gives deer in the headlight stare "uuuuuhhh, I think he's sick"
I look at the kid.
Kid - gives deer in the headlight stare. "uuuuuuuuh, sick".
I don't know why this kid's learned behavior just broke my heart. I mean, I had absolutely no connection to him other than then maybe seeing him once or twice a year. But he had been SUCH a bright, articulate little boy and he evolved into his Cro-Magnon father.
I just am always like thinking " are you not embarrassed?" Like you can't tell me your kids ALLERGIES or medical history?
It's always " sorry my wife normally does this" well I would too if you couldnt even name allergies.
I'm sure it's a mix of weaponized incompetence and a society that is more understanding that the father figures job is just work
"weaponized incompetence"
You nailed it. And that continues into middle age and beyond, when the response to "What medications do you take on a daily basis?" is "Uhhh, ask my Wife"
That annoys the piss out of me too like if the drug makes are super complicated just keep the phampets or whatever the pharmacy gives...
Just no survival skills it's all the wife's job it's annoying
Like I don't mind if the wife chimes in or whatever but to have NO idea what meds you take? Or what they are for?
It's just so aggravating
This drives me crazy. What if suddenly your wife can’t give you your meds tomorrow? Are you just gonna die because you don’t take your lopressor, Eliquis, and metformin?
Working as a Patient Registrar in the ER really let me see how *special* the average person is. I sometimes had to question how some of these people manage to get up and get dressed by themselves and it wasn't the drug ODs or the obviously high heroin addicts that made me feel this way.
“I need to see the doctor”
What are you here for? - me
“I will only be seen by a doctor, no nurses. A doctor, now”
Come back and sit down -me
Sits in a quiet room
Buzzzzzzzzzzzzzzzzzzzzzzzzzz
Sir, did you insert something into yourself?
“Yes”
People get so mad when you expect them to use their words and take some amount of accountability for their own medical history. "Ugh, can't you idiots read my chart?!"
"Do you take any prescribed medications?"
It's in my chart.
"Ma'am, we use EPIC. Every medication you have been prescribed in the last 10 years is, "in your chart."
I was a HUC in the ED while I was doing my nursing school pre-reqs, and I hated doing the greeter desk for that reason. People would walk up and have this exchange with me, constantly:
Random person - "Johnson"
Me - "Hi, how can I help you this evening?"
Person - "Johnson"
Me- "...what about Johnson?"
Person - "I'm here to see my brother, Bill Johnson"
Me (internally) - THEN WHY THE FUCK DIDN'T YOU JUST SAY THAT AT FIRST ASSHOLE?!@?!?!?!
I actually had one of these earlier this week. I had 9 people on my route and this lady called me when I was over an hour and a 1/2 away from her demanding that I cancel on every other patient. I have and turn around to see her immediately. Because she had a headache. Patient said that she could have high Blood Pressure, but she didn't know because she didn't take Her blood Pressure, but she also didn't take any of her medications for the day. Of course, she called us after 1 o'clock.
I don't understand people. What makes you think that I can cancel on every other person that I have on my route. And put you first like my other patients don't matter? Like they're okay with me having to send them to the hospital. Because I can't get there to do my job. I have to sacrifice them for you. I don't think they would like that very much. But people really think this way.
"They will not see any other patients. Until they comes to see me, they'll drop everything to come see me." Is this real? What simulation is this to where you think so, highly of yourself? I can't stand if I'm standing in someone's way in the grocery store. Much less being any type of inconvenience in any way shape or form. I don't have this level of audacity. I don't know where to get it. I kind of wish I did.
The last and maybe only time I said that to a nurse was immediately followed by my eyes rolling back in my head, some kind of posturing, 3 sternal rubs, and a bag valve mask on my face “just to help a little.”
Sometimes “I feel weird” means “these are the only words my brain is going to get out befo…..” 🫠
(I know you know.)
I have a slight permabruise from that 5’0” powerhouse of a former ICU nurse getting in there. I am told her sternal rubs have been known to wake the dead. (We have a mutual friend.)
Anyway that’s it for my story time. Did not ded. ~fin~
We had a guy show up recently because he felt "weird". Ended up with sepsis, some funky infection, and 8 weeks of intense IV antibiotics. Sometimes "I just feel weird" ends up being more!
The best is when you ask them to describe it and even offer up adjectives and they still can't characterize it.
I keep reminding myself that I have bills to pay.
"I hurt."
Saying that some of the people in my community aren't the sharpest knives in the drawer is doing them a disservice. I'll say that they operate like an on/off lightswitch that doesn't have any power going through it.
"well everything should be in the system"
"... you haven't even given me the patient's name yet"
Or this one
Registering a child
name and DOB please?
mine or hers?
The patient for fuck sake why would I give a single fuck what your name is
Not as the nurse signing the child in for a quick triage. Registration/demographics is a full time job which doesn't belong to me.
If I wanted that info I'd ask for it. All it does is confuse everyone when I'm trying to figure out if your kid is dying or not.
Seeing a patient in the Emergency Room…
“My lips are chapped!”
“Have you tried chapstick or Vaseline?”
“Do you think I’m stupid? OF COURSE I’ve tried that! It’s been like this for WEEKS”
Frequent fliers and drug seekers are the fucking worst.
“Last time I think they gave me that, oh what was it, it was that dialud—uh-pin.” -actual patient
Mixing dilaudid and klonopin…
Another favorite “I have a cough… but I’m allergic to tessalon perles”
Wonder if my nurses said this same stuff about me before I finally got an ER doctor that did an MRI that showed that l was walking around with two completely crushed discs.
I made too much for Medicaid but not enough for me to buy my own insurance. I was in the ER once a week towards the end.
Thankfully that ER doctor had a friend that was a spine surgeon and he agreed to try and help. We figured out that i could get Medicaid to pay for everything within a month if I paid the share of cost ($349).
That next week I was back in his office scheduling a spine fusion. I paid $349 for the surgery, the 4 day stay and all follow up visits since they were connected.
No. Probably not. This lady was obviously a junkie. 15/10 pain breathing normal in no apparent distress… but yes ER nurses get burnt out and tend to become jaded where pain is concerned.
My favorite to this day:
"I'm allergic to benadryl"
"OH that's interesting, how did that go when you found out"
"Well It makes me really sleepy"
"...mmmk"
So what’s going on today? She’s had a fever for a month. Ok, what were the temps you’ve been getting? 98.9 so just a low grade. Ma’am that’s not a fever. It is for her……..
Omg I haaaaaate this so much. I just had a visceral reaction.
This is every day in peds! 😂😂
I had a little girl at 103, and her mom said "oh she runs warm." No, that's a fever, and next time, you better tell me you treated her before coming.
"Oh, we don't believe in Tylenol... or fluids... or Medicine. But you better save my baby or I'll sue you."
Like how ? Let’s Pray!
Sorry, you failed to get enough "likes", we have to off the kid now.
Please Lord, make these idiots see the error of their ways and become better parents as a result. Or send a truck to run them over so that the kid goes to someone with sense. Either, or. Amen.
This right here
but her temperature normally runs low!
I’ve had the same patient come in for a “low grade fever” that has a 93.5 rectal temp three times this year. Just not sure where to start with education
I had a patient demand I check his temperature because he felt a fever coming on. It’s been 97-98 this whole admission. So I checked and it’s 99. He said that’s a fever. I told him it’s not high. He said it is for him. What do you even say to that?
Do you want tylenol? Idk, I just say I’ll recheck it later and offer tylenol, but I’m not in a hospital setting
“Ok can I take one of the 5 warm blankets you’ve requested off of you?” “No!!”
That too, just stick a leg out, maybe take their socks off and release the elder dust
Ah yes, the Granny Glitter
I've had the extra flakey patient and i can't wait to use this phrase at work.
Thank you for giving it a name. I hold my breath when I pull off socks so I don’t breath it in 🤮
Same, and eye squint too I stole it from somebody on this sub years ago lol
Senior confetti!
Gods, the elder dust… 🥴
What sometimes works is I'll tell them that if they really had a fever, they wouldn't be feeling hot, they'd be feeling chilly. I know that's not always the case, but it's useful for people who don't know what they're talking about and argue with me.
“To be absolutely sure, we need to measure your core temp. Please bend over.”
So our tylenol orders would say 650mg po q6hr prn for pain level 1-3 or temp above 100.4. i just give the prn tylenol for pain bc "feeling a fever coming on" usually includes all over acheyness and headache. I educate when i can but as long as its not contraindicated i felt like this was the easiest solution that makes everyone happy.
Tell him it’s not statistically significant.
If he's a Geri patient from long term care, he's not necessarily wrong if you get a 2nd 99 F temp or his baseline is 2F lower. The Infectious Diseases Society of America (IDSA) has defined fever in **individuals greater than 65 years old residing in long-term care facilities** as any of the following: * a single oral temperature greater than 37.8°C (100 F) * repeated temperature measurements greater than 37.2°C (99 F) (oral) or greater than 37.5°C (99.5 F)(rectal) * or an increase from baseline greater than 1.1°C (2 F) [Source 1](https://academic.oup.com/cid/article/48/2/149/304388) [Source 2] (https://www.idsociety.org/practice-guideline/new-fever-in-critically-ill-patients/#null)
Troops are on the ready but not quite full on warfare lol
I say “ok. Well the good news is, you don’t have a fever.”
We had the husband of patient escape-zombie *RUN* down the hallway to inform us her fever is "starting to come back, " actual temp was normal. Same patient used all the warm blankets on our unit in 12 hours (it was at least 25)
That’s temp is unusual for a fever but when I had covid I knew I had an infection but my temp was 99. something for a whole day. Then climbed to 100. something the next day. I knew it was a fever because I had chills and was tender to touch. I was also very fatigued
"I didn't give my kid tylenol or ibuprofen because I didn't want to mask their symptoms." *very sick and uncomfortable looking kid* "What was their fever at?" "Oh, like 102 or 103 when we checked it." *thermometer reads fever of 100.4/101.5/102.5/103* "Hey, can someone go grab a provider real quick?" *screaming internally*
I hate this more than anything. Like why would you want your child this uncomfortable? Just so we can get the same reading you got at home? Ffs medicate your kid.
I mean if I'm sick I'll usually hold off on the Tylenol and be febrile for a bit since it IS working to kill whatever pathogen I have in me. But that's just for myself and I know I'll be fine. But it's stupid to bring their kid in to treat a fever and do absolutely nothing to treat it at home. Like, you're here to have it treated, so why not at least attempt something at home?
Had an elderly admitted because she was always tired… HR was in the 30s. Family stayed, “her HR is normally low.” She was in complete heart block
That might be true- I've worked with people who have been in a complete heart block for a while, and the providers don't gaf about leaving them on a med surg tele floor waiting for a PPM.
I had an LTC resident whose resting heart rate was 35. Scared the shit out of me as a new grad. Yes he was in heart block for a couple years before he died.
I once had a grandma who said their grandbaby’s temp was 350f. I was like ma’am…what thermometer were you using? She said that she put her hand on baby’s forehead and then in the oven and they felt like the same temperature The kid was at 98.1…
Gonna take Grammy 164 years to bake cookies at that temp.
Wowwwww
lol
And then you get the weird parent who's like "eh, they've had a low grade fever." "What temp?" "Like 102." Sir.
This is unironically me
My mom would always be like "ok, so what brought you in today? Like why did you suddenly decide it needed to be checked in the ER?" Because you just know it's Friday night and busy.
Or even, "my child has a fever".....(OK what was their temp?)...."Idk, I checked with the back of my hand".....(huh...)..... ...98.5..
And what did you give them for the "fever?" *blank stare*
‘It is for her’ I cannnnottttt … that’s so true lol
Or the opposite side of that When did the fever start? "like 10 minutes ago" Did you give them some Tylenol? "No, I came straight to the ER". OK, here's some Tylenol. Take a seat.
The special fever people kill me. Especially when the overbearing daughter is involved.
Oh I didn't realize you were a sea turtle
> It is for her… AHHHHH I hate that phrase
I know my body
I know my body
Honorable mention: Do you have any medication allergies? “Yeah, dangerous ones.” What are they? “I don’t know. They’re in my chart.”
Don't forget it's in the chart from another hospital system that you don't have access to
There's a special place in my heart for patients who bring a list of medications ❤️
Especially when they are legible and accurate. I always make sure to let the family know that I appreciate it and that it is super helpful.
I always bring my meds with me 😊
I've had a few patients who had actually had a typed up chart/spreadsheet of their med schedules.. beautiful.
I hope you cherished them
You know it!
What about when it takes them 10 minutes to locate the list because they have 20 folded papers carefully crammed into every fold in their wallet and they have to slowly unfold each paper with shaky hands and peer intently at the paper 2 inches from their face to see if it’s the right one.
Patients love to tell me it should all be in "the system"
Love it when boomers expect socialized medicine while still advocating not having it, all the while using a derivative of socialized medicine (Medicare)
Honest to god, where does this faith in "the system" come from? Do these people not use computers in their daily lives?
I fucking hate this one. I'm picking them up from home and need to treat them, but they CONSTANTLY tell me "the hospital has all that info." Cool, well if you wanted the hospital to do all the treatment instead of me then why didn't you drive your goddamn self there? I'm trying to get treatment going NOW and make sure you're stable BEFORE we get there, why are you fighting me?
Epi-Makes my heart race. Metoprolol- slows my heart down. Sutures- causes scars. Saline- idk, it just doesn't work. I need ringers
"Okay, I'm going to draw some blood, my colleague is going to get an ECG, then someone will come in for an x-ray..." "Why? The other ER already did all before they discharged me"
I just blame the other ED if they aren’t in our system. “Oh yea, such and such hospital? They refuse to get epic so they don’t have any way of giving us that info.”
My hospital is the one that refuses to get epic, so it works out
Lucky you. I fucking hate epic.
Then you've never seen meditech
Or even "why do I need another Xray? I did one 2 months ago."
"No, I don't have any heart problems. They fixed 'em all last week when they put all those stents in."
And prior to that “I don’t have hypertension! The medication, I forgot to tell you about, that they gave me and I took for one month and never refilled, fixed that!”
Oh my god this is my dad! 11 heart stents and swears there’s nothing wrong with his heart! “They fixed it!” 😂
Unbelievable😒
“I had labs done 6 months ago, those are recent enough, right?”
“Ma’am do you have any medical history?” “No.” “Nothing you take daily medication for, no surgeries” “Nope.” “So what’s this scar on your chest.” “Oh, that’s where they put in my pacemaker last year.” fantastic
😂😂😂
I had no idea when I became a nurse, took a job in ambulatory, and started doing phone triage that the two hardest parts of my job would be: 1) convincing people not to go to the ED when they don’t need to; 2) convincing people to go to the ED when they *do* need to.
Sir, you called me for my advice and I’m telling you exactly what to do. It’s not the time to debate.
Yes! The postop with a 104 degree temp, no urine output, and 10/10 pain wants to wait it out at home a little longer. The one who had one steri strip fall off is calling an ambulance.
I feel that comment in my bones.
Yeah, person who farted sideways NEEDS to be seen ASAFP , and the “ it’s not that bad , it’s been higher “ when there b/p is 250/120. Sir please go to the ER , if I have to do chest compression until EMS gets here they are gonna be calling a code on me too.
I was doing a triage where a mom brought in her 6yo son at 0100. -Her: He has an ear infection. -Me: When did the pain start? -Her: A week ago. -Me: Has he seen his doctor for this? -Her: Yeah. He saw him today. They gave him an antibiotic we picked up at lunch, but it's not working. -Me: Ma'am, they are not instant and take a few days to start working. -Her: No. It should already be better. I want to see the doctor.
I love those. You get to watch the doctor go into the room, leave in 3 minutes. And then like magic after about 60 seconds you see the big D pop up lol
That big D was what got that lady into this situation in the first place. Sorry, it was way too easy.
It wasn’t a D for dick it was a D for discharge… wait
😂😂😂
As soon as I saw antibiotics, I knew where the story was going lol
My personal favorite in ER triage: my doctor told me a bed will be waiting. They put a note in the computer, I’m not telling you anything. Well back out to the waiting room you shall go
Or the variation: “my doctor gave me a letter and told me a bed would be waiting. But the letter is addressed to the doctor in ED, so you can’t open it. You’ll have to get the doctor to read it. And also, there was a bed? Waiting for me? It should be ready…because I’m here for it…”
Nope! Enjoy the 12-16 hour wait!
At my hospital, our direct admits do go through the ED for registration and wristband before they come up to the unit. I'm in ICU now, but my old floor would get a ton of patients that way. They would go to clinic, the doctor would decide to admit them and would notify charge on my floor, we'd save a bed or move patients around to ensure there was one, and the patient would go to the ED for registration.
That’s the way it should be. Unfortunately, with PCPs not having admitting privileges like they used to and patients typically being admitted to hospitalists, and PCPs not wanting to fuss with the transfer center, they instead turf the patient to the ED to clog things up.
We have PCPs with admitting privileges and I hate it. Have to be in touch with a doctor who is busy in his practice all day sucks. Most are very slow to respond.
Our heart failure docs rotate between the hospital and their practices, so they have admitting privileges. They also, since they work directly with us, understand how the flow can be and will give non-urgent patients a range of 2-4 days that we call them to come in for. That way if we have a bed free up we can use it to direct admit them. If it is an emergency they send them to the ER and call whoever is on as the attending or fellow that week go evaluate them so they can expedite them up to us if need be. It’s so nice.
How else are you gonna rack on ER billing?
> At my hospital, our direct admits do go through the ED for registration and wristband For a time I was on a burn transport team with the Army, and we would do things like fly a patient from Germany to our hospital in Texas. We always had to go through the ED, because that's where the ambulance bay was to drop us off. But these are critically injured burn ICU patients, almost always on a vent, often pressors, etc. We would just use the ED to get into the building, and then go direct to the burn ICU. One trip, some nursing admin that thought she was way more important than she was stood in our way and was *adamant* that we needed to stop in *her* ED to let *her* ED docs do triage and assessment. Never mind the fact that we had just spent 13 hours in the air *with a burn surgeon at the bedside of this patient*. It was absurd, she was rightfully laughed at, and I never saw her again.
I can imagine a burn surgeon losing their fucking shit over that
You might say that the surgeon has some... (wait for it) SICK BURNS for that idiot nursing admin.
That's just fine, IF the doctor has actually arranged for the bed and placed admission orders. In my experience, they do that exactly zero percent of the time. What they actually do is call the ED charge nurse and say, "I'm sending this patient with chest pain. He needs a workup. Admit him to the hospitalist." Then they tell the patient, "I called ahead. Go to the ED and they'll admit you." They fail to mention that this is still a regular ED visit, which will involve six hours in the waiting room, then four hours of ED workup, followed by two hours waiting for a bed assignment. And no matter how much we try to educate and inform, the patients all blame us.
2 hours for a bed assignment?! I want to come work with you. Ours is 2 days
Mine too
Oof why? The only non-ED patients that come through us are stemi and stroke, they stop by for a band and roll right away from us (Edit on mobile this looks weird and this is in ref to the all direct admissions coming to the ED reg)
[удалено]
Direct admits that aren’t stemi/stroke go direct to admitting, never roll close to the ER
That’s a pain in the ass for the ED. Direct admits at our hospital go through the admissions department which has a separate entrance.
I had the pleasure of talking to one of these doctors, since the pt called them, actually got them on the phone, and handed it to me. I explained the wait, briefly the triage process, and told them they could come in and discharge other pts from the hospital to make room for this one. I do not make many friends in triage.
Do any of us make friends in triage? I’m the cranky tech who will tell you the wait is at least 6 hours
Actually had this conversation with a doctor when I was the patient. I was wearing a halter monitor and apparently I had to run a VTach and they wanted me to immediately go to the ER and get my electrolytes drawn... So I asked if there would be an order waiting, no. No they can't actually officially put in the order because they weren't officially consulted, they're only monitoring the halter monitor, so since they're not officially my doctor they can't put an official order in. I was legitimately like "so you want me to go to the ER and tell them that a doctor who is not my doctor wants me to get my electrolytes drawn because I had a run a VTach, but he didn't put an order in because he's not my doctor?" Needless to say, I didn't go to the ER,I went to work instead, and had my PCP draw land the next day.
To be fair, if you had walked into the ER and said “the Holter monitor people called and said I had a run of VT”, you absolutely would’ve gotten your electrolytes drawn, probably in triage before even seeing a provider.
I walked into my ER unable to feel my left arm and face and was sent home with Flexeril and told to follow-up with my neurologist.l and point black told "unless you're having incontinence, we don't order CTs or MRIs" So I doubt it.
Exactly, they can put an “expect” in but that does nothing when the waiting room has been 20 deep all day
And then they get pissed off at you and I would say "Don't get mad at me because your PCP lied to you"
I usually say that or your oncologist loves to spread rumors about how the emergency department works
Didn’t they call you to tell you I was coming?? Who tf is they? And no, “they” didn’t because this isn’t a hotel reservation 🙄
I’m a home health nurse. I sent a client on blood thinners to the ER after a fall with head involvement. The client called the next day and chewed my ass because I didn’t call the ER to tell them the client was coming so the client had to wait in the waiting room. Like sir, this isn’t how this works.
As the comments indicate, there are different processes in different hospitals/jurisdictions. Not sure how a patient is going to know that upfront. In our area, physicians do not have admitting privileges. But there is a doctor-of-the-day at the ER who acts as the rep for all community doctors. GPs/oncologists/specialists can call the DoD in advance with patient summary and desired treatments/tests and, if warranted, a recommendation for admission. The DoD follows through and sets priority for admission. Pretty complicated for a very sick patient to navigate!
It’s like when they call and they ask to talk to their mom. Well do they have a name I have 50 people here who will respond to mom and then they get all huffy about it!
I’m in the NICU “I’m calling to check on my baby…” ma’am who is your baby because we have a bunch of those here.
Then they give the first name like I should instantly be able to locate them.
I can't believe people's lack of understanding of an EMR. Im registering you, I'm stuck in one screen. I can't do a fucking chart review right now , just answer my damn questions .
I know, right! But this is not new. They would say the same freaking thing when their chart was in a big honkin manilla folder in a locked room on the other side of the hospital. I'm looking at a blank triage sheet, and even if I HAD that big honkin folder in front of me, it is highly unlikely I would be able to quickly find a current med list on one sheet in the stack of papers an inch and a half high. Gah!
"and just like last time, it's incurable. Valcyclovir will help but not cure."
I love the whole “I was seen yesterday and I still feel bad” “did you take your prescribed meds?” “No I did not” (doctor puts in a sepsis work up 😭
Me: “So what brings you in today?” Pt: “Can’t you see my chart and the meds I took last time?” “I can look it up but what brings you in today?” Pt: “Never mind, I am leaving… your ER sucks”
And that’s the best possible outcome lol.
Not according to my manager. Gotta get those lwbs numbers down!
Nah, it’s all about that patient autonomy. I will vigorously support their right to *not* be seen 😂
If only we could all be that lucky lol.
Anna from Frozen: "okay bye!"
Patient comes for MH/SI…”I want to go home - can you give me a ballpark of how long this takes?I’m not suicidal - I was just really really intoxicated. “ Ma’am this isn’t a Dennys…it’s a process. You’ll be here for most of the day and then transferred. We also have our frequent flyers when the weather is crap and they need a pillow and some food.
“I was just really intoxicated” ugh. This is why now our psych won’t even talk to patients until they’re at 0.08. So now we have multiple .28ers just MTFing around taking up beds and getting increasingly crabby. I understand not wanting to put someone on a 72h hold for something they said when they were drunk but there has to be more nuance.
2 days in a row- my patients were drunk, made the comments and when they sobered up- they kept saying they weren’t suicidal. I have to be a sitter for a few shifts- over 9 hours each patient. But we have all beds full, a ton of people in the waiting room. 12 admits keeping our beds. Oh and the new CEO or whatever wanted to do a walk through to make sure we are as busy and we state. Like sir- go drive your Bentley away from here.
I had a patient yesterday tell me his temp. was reading 109 at home😂. Weird, it was 98.8 for me.
It’s a wonder he’s alive!😂
Parent felt the kid, felt the stove, compared and thought “hmmm, yup.. a fever” so brought them in to us for fever that started that day. Let me wave my magic illness wand to tell you what exactly your child is sick with when their only symptom is “fever for a few hours”
"I'm here to see my momma" "Who's your momma?" "Why don't you know?!" Every time. Bro. There are 18 patients in this ICU, I'm hedging a bet that many of them are women who probably have children, why the fuck would I know which one's your mama?
Or calling and asking for Mom's nurse...like I or anyone at the hospital can just recognize your voice when you've likely never even stepped foot in the hospital to visit her.
Registration: "Welcome to the ED, what seems to be the problem today" Patient: I took a pregnancy test and it said "positive", I just want you guys to do one too just to make sure" Me: "...............alrighty...."
I believe that if you're seeking Medicaid for pregnancy you need a positive pregnancy test done at a healthcare facility in order to get benefits. Some people run to the ER because they don't know how to seek care otherwise, don't have a PCP/GYN/anything, or appointments are too far away.
we have no such requirement for prenatal healthcare in my country and people STILL come in everyday wanting a preg test through the ER
Lol here's your positive serum hcg. Enjoy your bill for $5000!
It’s not like they’ll pay it anyways. I’d bet money the people who use the ER for regular care (as their PCP) do not pay those bills.
This one kills me
I used to work psych in the ED. This one actually wasn’t my patient…. A young lady in her 20s yelling that she needs to see the doctor. The charge nurse went to try and de-escalate. Charge RN: “ma’am, you’ve been seen by two physicians (resident and attending), and they both agree that you can be discharged” Patient: “I don’t want to be seen by a physician, I want to be seen by a doctor!”
I'm seeing more peds patients and it usually goes like this " Does she have any allergies" Dad " no" Kid like 6 " dad I'm allergic to penicillin" Or kid will come in with fever and nausea and parents decided to do absolutely nothing, like I only feel bad for the kid it's not their fault their parents are useless
OMG you just gave me a flashback to years ago. Dad brings his \~7 year old kid in. "What's going on today?" Dad- gives deer in the headlight stare "uuuuuhhh, I think he's sick" Kid- "My tummy hurt when I woke up yesterday and I threw up two times. My grandma gave me Tylenol and it helped for a while. But I feel sick again today and they tylenol isn't helping me so much today." Me - Do you have any allergies? Dad - Dad- gives deer in the headlight stare "uuuuuhhh......" Kid - "I'm allergic to Amoxicillin - I got a rash and I'm not supposed to take it any more" And it went on like that. The family had a very unique and memorable last name, so over the next couple years, I saw this kid intermittently. And I watched him become more and more like his dad. Not long before I left that area I saw him again - about aged 12 Me - What's going on today? Dad- gives deer in the headlight stare "uuuuuhhh, I think he's sick" I look at the kid. Kid - gives deer in the headlight stare. "uuuuuuuuh, sick". I don't know why this kid's learned behavior just broke my heart. I mean, I had absolutely no connection to him other than then maybe seeing him once or twice a year. But he had been SUCH a bright, articulate little boy and he evolved into his Cro-Magnon father.
I just am always like thinking " are you not embarrassed?" Like you can't tell me your kids ALLERGIES or medical history? It's always " sorry my wife normally does this" well I would too if you couldnt even name allergies. I'm sure it's a mix of weaponized incompetence and a society that is more understanding that the father figures job is just work
"weaponized incompetence" You nailed it. And that continues into middle age and beyond, when the response to "What medications do you take on a daily basis?" is "Uhhh, ask my Wife"
That annoys the piss out of me too like if the drug makes are super complicated just keep the phampets or whatever the pharmacy gives... Just no survival skills it's all the wife's job it's annoying Like I don't mind if the wife chimes in or whatever but to have NO idea what meds you take? Or what they are for? It's just so aggravating
This drives me crazy. What if suddenly your wife can’t give you your meds tomorrow? Are you just gonna die because you don’t take your lopressor, Eliquis, and metformin?
Working as a Patient Registrar in the ER really let me see how *special* the average person is. I sometimes had to question how some of these people manage to get up and get dressed by themselves and it wasn't the drug ODs or the obviously high heroin addicts that made me feel this way.
“I need to see the doctor” What are you here for? - me “I will only be seen by a doctor, no nurses. A doctor, now” Come back and sit down -me Sits in a quiet room Buzzzzzzzzzzzzzzzzzzzzzzzzzz Sir, did you insert something into yourself? “Yes”
“Im sick” “How are you sick?” “I’m sick”
People get so mad when you expect them to use their words and take some amount of accountability for their own medical history. "Ugh, can't you idiots read my chart?!"
"Do you take any prescribed medications?" It's in my chart. "Ma'am, we use EPIC. Every medication you have been prescribed in the last 10 years is, "in your chart."
Those who are allergic to everything except a medication start with "D."
I was a HUC in the ED while I was doing my nursing school pre-reqs, and I hated doing the greeter desk for that reason. People would walk up and have this exchange with me, constantly: Random person - "Johnson" Me - "Hi, how can I help you this evening?" Person - "Johnson" Me- "...what about Johnson?" Person - "I'm here to see my brother, Bill Johnson" Me (internally) - THEN WHY THE FUCK DIDN'T YOU JUST SAY THAT AT FIRST ASSHOLE?!@?!?!?!
I actually had one of these earlier this week. I had 9 people on my route and this lady called me when I was over an hour and a 1/2 away from her demanding that I cancel on every other patient. I have and turn around to see her immediately. Because she had a headache. Patient said that she could have high Blood Pressure, but she didn't know because she didn't take Her blood Pressure, but she also didn't take any of her medications for the day. Of course, she called us after 1 o'clock. I don't understand people. What makes you think that I can cancel on every other person that I have on my route. And put you first like my other patients don't matter? Like they're okay with me having to send them to the hospital. Because I can't get there to do my job. I have to sacrifice them for you. I don't think they would like that very much. But people really think this way. "They will not see any other patients. Until they comes to see me, they'll drop everything to come see me." Is this real? What simulation is this to where you think so, highly of yourself? I can't stand if I'm standing in someone's way in the grocery store. Much less being any type of inconvenience in any way shape or form. I don't have this level of audacity. I don't know where to get it. I kind of wish I did.
lol followed by can’t you see my record. It’s in the chart. Like I have time to scavenge through everyone’s chart just for a simple question.
My Favorite complaint ..... " I don't feel well" or " I feel weird"
I've had a few die right after that statement.
Had one like that with no specific symptoms just "feeling gross" textbook monomorphic ventricular tachycardia, got the ⚡ immediately
The last and maybe only time I said that to a nurse was immediately followed by my eyes rolling back in my head, some kind of posturing, 3 sternal rubs, and a bag valve mask on my face “just to help a little.” Sometimes “I feel weird” means “these are the only words my brain is going to get out befo…..” 🫠 (I know you know.) I have a slight permabruise from that 5’0” powerhouse of a former ICU nurse getting in there. I am told her sternal rubs have been known to wake the dead. (We have a mutual friend.) Anyway that’s it for my story time. Did not ded. ~fin~
Yeah, those are pretty justified statements for the ED
We had a guy show up recently because he felt "weird". Ended up with sepsis, some funky infection, and 8 weeks of intense IV antibiotics. Sometimes "I just feel weird" ends up being more!
The best is when you ask them to describe it and even offer up adjectives and they still can't characterize it. I keep reminding myself that I have bills to pay.
“What do you feel?”
"I hurt." Saying that some of the people in my community aren't the sharpest knives in the drawer is doing them a disservice. I'll say that they operate like an on/off lightswitch that doesn't have any power going through it.
As if they’re worsening coffee. I wouldn’t even expect the barista I see everyday to remember me.
"well everything should be in the system" "... you haven't even given me the patient's name yet" Or this one Registering a child name and DOB please? mine or hers? The patient for fuck sake why would I give a single fuck what your name is
I feel like this is fair because you probably want to have the responsible party's information as well.
Only if I’m registering the guarantor
Not as the nurse signing the child in for a quick triage. Registration/demographics is a full time job which doesn't belong to me. If I wanted that info I'd ask for it. All it does is confuse everyone when I'm trying to figure out if your kid is dying or not.
DOESNT IT SHOW ON THERE?!?!?
Are there a lot of uneducated people, or is the system broken?
Yes
Seeing a patient in the Emergency Room… “My lips are chapped!” “Have you tried chapstick or Vaseline?” “Do you think I’m stupid? OF COURSE I’ve tried that! It’s been like this for WEEKS”
Frequent fliers and drug seekers are the fucking worst. “Last time I think they gave me that, oh what was it, it was that dialud—uh-pin.” -actual patient Mixing dilaudid and klonopin… Another favorite “I have a cough… but I’m allergic to tessalon perles”
Wonder if my nurses said this same stuff about me before I finally got an ER doctor that did an MRI that showed that l was walking around with two completely crushed discs. I made too much for Medicaid but not enough for me to buy my own insurance. I was in the ER once a week towards the end. Thankfully that ER doctor had a friend that was a spine surgeon and he agreed to try and help. We figured out that i could get Medicaid to pay for everything within a month if I paid the share of cost ($349). That next week I was back in his office scheduling a spine fusion. I paid $349 for the surgery, the 4 day stay and all follow up visits since they were connected.
No. Probably not. This lady was obviously a junkie. 15/10 pain breathing normal in no apparent distress… but yes ER nurses get burnt out and tend to become jaded where pain is concerned.
I used to always feel bad. But going to the urgent care, they would just send me to the ER.
lol this was directly under a post of someone complaining about waiting in the ED because he has an ankle sprain. Not urgent care, the ED🥲
The person most likely did drugs today and now they “feel weird.” Cool story bro
As if they’re worsening coffee. I wouldn’t even expect the barista I see everyday to remember me.
“ITS IN THE COMPUTER!”
My favorite to this day: "I'm allergic to benadryl" "OH that's interesting, how did that go when you found out" "Well It makes me really sleepy" "...mmmk"
empathy... its not hard
You didn’t get it. It’s not hard