Long Shifts

I’m sure all of you have noticed a lack of new material this past month/holiday season. I have been working my butt off the past month, and not because I wanted to. There are only six of us to cover three, twelve-hour shifts daily, seven days per week. There are no part time people capable of picking up extra shifts for those who get sick or take a vacation. We have all had to work extra shifts this past month because one of us became ill. The past two weeks I’ve worked three on, one off, three on, one off, three on, one off, and then some. You might think seeing patients is easy and to quit whining, after all, you’re just writing the orders not actually doing anything.

Well my dear friends, seeing and evaluating an average of twenty-seven patients daily is hard work. No, it’s not as physically demanding as running twelve hours as a nurse in the ER, but you are just as depleted by the end of a 13-hour stint as the nurses. To make my job easier, and the Urgent Care RN’s job easier, I’d like to point out some things you, the triage RN, might take into consideration before you send a patient to my Urgent Care.

Seventy-five year old black females who complain of crushing chest pain earlier in the day, and a family history of being the only family member never to have had an MI, should probably not be sent to UC. Especially, when they present to triage with a complaint of left chest pressure radiating to the left arm. Need I ask what were you thinking?

Eighty-five year old men with a chief complaint of back pain and a history of compression fractures are ok for UC. When they also complain of lower abdominal pain and nausea I have to ask what were you thinking?

Two-year-old males with a 104-degree rectal temp are ok provided they look non-toxic. Two-year-old males with a 104-degree temp, audible stridor without the use of a stethoscope, a mother who stats the child was drooling until he became so dehydrated the drool stopped, are probably not good UC candidates. I have to ask what were you thinking?

The eighty-five year old man who looks like death on a popsicle stick and has the sallow-waxy look of death, and can’t walk, is probably not a good candidate for the UC. Likewise, the seventy-five year old female who comes in by ambulance because she can’t walk, and complains of LLQ pain, is probably not a good candidate for the UC. I have to ask what the hell were you thinking?

The 40-year old female with a 102.5-degree temp and pelvic and flank pain might not be my first choice to send to the UC. Well, it’s probably just a UTI, I hear the triage nurse say. Hmmm, ok, I respond, did you check for CVAT in triage. It’s quick and easy, just put your hand flat on the patients flank, and tap it with your fist, gently. If the patient slaps you, it’s probably pyelonephritis not a simple UTI. Oh, and by the way, WHAT ABOUT THE 102.5 DEGREE TEMP IN AN ADULT WITH PELVIC PAIN? What were you thinking?

The eighty-two year old male complaining of urinary retention for the past twelve hours and a history of a prostate the size of a bowling ball is probably not a good candidate for the UC. It’s times like that I wish I had a shoulder fired foley-gun. Just whip out the old TURP-OH-MATIC, and in no time the old fart is on his way. In real life, I have to call the patients internal med doc to see who he wants for urology. Then I have to call the urologist and beg him to see the patient. Then, I have to get the doctor to speak to the urologist, because the urologist is an arrogant prick, and won’t talk to a Nurse Practitioner. Then, I have to convince the ER doc to speak to the urologist about a patient he knows nothing about because the patient was sent to the UC and NOT the ER WHERE THE DAMN PATIENT SHOULD HAVE GONE IN THE FIRST PLACE!

The 32-year old female with urinary retention is probably not a good candidate for the UC especially when she has a history of this problem.

The seventeen-year old with sharp right upper chest pain and no breath sounds was an understandable miss. When in triage I almost never listened to the apex of the lungs. I listened at the bases and usually figured if there was air making it to the bases, the patient was probably ok. This patient’s x-ray revealed a 30% pneumothorax to the right lung.

These are just a few of the “Urgent Care” patients I have had to deal with over the past week. We are continually told that we are supposed to run them through as fast as possible, and see as many patients as possible. When I get an ER patient mistakenly triaged to the UC, it really slows me down. The other aspect of an incorrect triage falls on the RN’s shoulders. There is only one RN in UC, so, when a patient needs blood drawn, IV’s started, IV meds repeatedly, and they can’t walk themselves to the bathroom, everything comes to a halt while the RN is sequestered with the “ER” patient.

Unlike the ER, we are a timed shift. We are open for 12 ½ hours. Every minute we spend past 12 ½ is extra time for us as there are no DSP or NSP to fall back on. What is a DSP/NSP? That’s a Day-Shift-Problem or it’s going to be a Night-Shift-Problem. Oh, by the way, a note to day-shifters, patients don’t disappear when you lay your tiny little dayshift heads on your pillow and drift into oblivion.

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