I finished my second day at the hospital yesterday. it was much much better than the first. The first had me very alarmed for variety of reasons, but thats over now.
The emegency area is not all that busy perse, but there are a few things in the culture that are going to drive me nuts. firstly it takes forever for a bed to open up upstairs. I held a patient in the ER for 13 hours, waiting on a bed. She had been admitted on paper at 11:30 at night, and was still in the Emergency Dept at 7 am when I came on. I got her admitted sometime after lunch. We get real hospital beds for these patients, so it isnt that bad, and actually she went from a very nice private ER room to a semi private upstairs, so not so sure her husband would have complained so much if he knew that! So those admit and hold patients take up a ton of space. If we could move them within a few hours, we would almost never have anyone in the waiting room.
Secondly, I think it takes inexcusably long for a doctor to go see the patient. The docs in general are a little pompous. They fit in well with this population who have that expectation that the doctor is going to be "all knowing" etc. so it isn't that they are necessarily rude, but they definitely are not very collaborative with the nurses. I am used to working with docs, not for them, so this should be different. Since we are not able to start a patient with labs etc, we have to wait for the doc to write the orders. So I might see a guy with a moderate complaint, start an IV, draw the blood, and then it is siting in the lab doing nothing for 30-45 min waiting on the Doctor to see the patient. If thye would let me order the stuff and sign off on it (as is practice in many many places) by the time the do moseyed in there, he might have all the values back. I know tha sounds like i am overstepping my bouds, but it is very very common practice because we seem the same stuff everyday, we know what tests are going to be done.
Thirdly: there is very little teamwork between the nurses. Admittedly, people are very busy with their own patients, but I always like to help out when I can. My first day the other guy working my "side" with me kept thanking me prousely because I came in and helped with some stuff when I had time. I know why now, people just somehow remain blissfully unaware of the other patients in the department, but well, thats all fine. I think over time I can actually change that part of the culture by continuing to help out and then expecting it in return. Over the past 2 days I've noted that the nurses are surprised at that, but that they do readily come and help me if I specifically ask. Sooo, we'll see.i have no major plans to change culture, but it will be an interestng experiment.
The acuity of the patients is in general high. The population is mostly eldery and of course with the elderly everything is more severe. If they fall they really hurt themselves, fi they get a respiratory infection or a urinary infection it can rapidly lead to all sorts of complications. So, most of the patients I worked with ended up being admitted.
good things are that in general the nurses are nice and friendly. It's one of the few places where people have not questoned me extensively about my background. They seem glad to have the help, and happy to tell me places to go and do stuff in the state.
Coffee is FREE for employees!!!!!! I especially like this fact. My favorite thing to do around 4 pm is have a cup of coffee, so I now do not have to spend 1.75 anymore.
There are enough supplies to get stuff done. and the rooms are actually stocked and set up for emergent stuff.
The PA's are younger and so far are fun to work with, smart and more collaborative with the nurses. thir role is super limited though, probably by the pompous doctors!
I have yet to see an infant with an uncontrolled fever. Yaaaay!
the patients do know their history and their medications for the most part, making everything easier.
Not sure I am going to love the pace and everything, but this seems to be do-able for thirteen weeks.
Now today i must go and get a cable splitter…so I can watch tv and use the internet (Laxy me) and contact the NTI and see how much they want to charge me for their services….