Saturday, November 2, 2019


The staff-reduction-cost-saving measure is to have only one nurse in triage when there isn't enough staff for the rest of the department.  Truthfully, we could actually use 2 nurses and a dedicated tech most of the time.  We routinely run at about 114% capacity with a 4 hour wait.

My third shift in a row being alone for 87% of my shift was a steady stream of complaints such as rash, febrile kids, and chest pain.  With a couple of weak and dizzy and a rapid a-fib or two along with frequent flyer depression/suicidals.  We use a language line for the non-English speakers which always takes about 4 times longer to triage.  With a paucity of techs most shifts, or because they have been pulled to sit on suicide watches, I have to do my own EKG's.  The line of patients waiting to be triaged just kept getting longer.  

One patient was a name dropper.  Sigh.  That doesn't do anything to make me change my triage process.

Name dropper pt: "My neighbor is Nurse X, do you know her?  She's the head of all the nurses?"

Nurse X is a clinical leader on one of the med-surg floors.  I know who she is.  Definitely not head of all nurses.

I cocked my head as if considering, gave him a quizzical look.  "Mmmm, nope.  I don't know her".

Name Dropper: (disappointed) "Are you sure, she has a really big, important job".

Me; (knowing whatever I say next will be reported back to the neighbor, and not giving a rat's ass)
"Sorry, no.  People that far up the food chain as you say never come down here.  We frighten them".

Name Dropper had chest pain intermittently for about a week, and after a strenuous workout at the gym resulting in chest pain, consulted the neighbor.

I start the usual protocol, EKG, labs, xray, knowing that there won't be a bed for a few hours.  At least unless the diagnostics indicate a heart attack or whatnot.

I got some pushback for the cardiac protocol, he let me do the EKG, but wasn't sure if the labs and xray were really necessary "because I don't have insurance".

I waste little time, offer that the consequence for not doing so could result in death, and have pretty much moved on to my next impossible list of tasks.  Name Dropper decides to consult with Very Important floor nurse before moving ahead.

Me:  "Ok, well let me know what you decide, you can have a seat in the waiting room while you make your phone call".

Got an email from my manager a couple of days later.  "Nurse X doesn't understand why you told her neighbor that you didn't know her".

Response:  "More importantly, does she know me?"