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An injured nurse confronts emergency room chaos by Lusine Poghosyan - News - Nurses Arena Forum

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An injured nurse confronts emergency room chaos by Lusine Poghosyan by Idowu Olabode : December 23, 2016, 08:26:28 AM
As soon as people learn I’m a nurse, the stories start. They usually begin with “you know what happened to me?” and go on to all kinds of miserable medical trials and tribulations. For years, I’ve taught in nursing programs and conducted research studies on how to make better use of nurses in our health care system, particularly nurse practitioners in primary care. But it wasn’t until I found myself in a Boston ambulance several years ago that I got a true look at America’s grim health care reality.

It was a sunny winter afternoon, perfect for a walk. My sister, my mother and I entered a small boutique… and what happened next, I don’t remember. When I came to, my mother was screaming. About a dozen people hovered over me. Apparently, I had walked into the store and tripped, and the pain was so bad that I passed out for a second. That had never happened before.
The store clerk called 911. The paramedics arrived. I resisted going to the emergency room; I had only sprained my ankle, I told them. Unfortunately, my mom, my sister and the excruciating pain in my foot were on the paramedics’ side. They believed I could have a head injury or a broken foot.

At the emergency room, someone wheeled me in a wheelchair to the reception area. A nice woman in a tiny cubicle asked for my insurance and credit cards. I voluntarily handed them to her while pleading for painkillers, knowing all too well it was beyond her scope of work. Still, my pain was getting worse.

The receptionist took her time — typing on the computer, opening and closing her desk drawers. After noticing my dissatisfaction, or maybe my pale face, she responded, sounding annoyed. “I am checking your insurance status!” After several clicks, she handed me a stack of papers to sign, including a receipt for $100.

Relief came when the receptionist waved someone to wheel me to the waiting area. Looking around made me realize that the cubicle was a much more comfortable place than where I was going to spend the next several hours.

Still, I felt guilty for being there, taking attention away from all these patients who apparently needed more help than I did. There was a man, probably in his 60s, who appeared very sick. He was lying on a long hospital transport cart as his wife, looking sad, leaned over him and held her head in both her hands. My gaze moved to the next patient, then to the next one, and the next.
Given the work I do, it’s no surprise that for a few moments, I stopped thinking about my own problems and started thinking about overcrowded ERs. Despite the Massachusetts health law that is similar to Obamacare, there are not enough primary care providers to handle even the insured patients. That means often patients seek care in ERs for conditions that could be managed in primary care.

I was eventually seen to by a parade of nurses, physicians, physician assistants and technicians, who wheeled me in and out of rooms for a blood test, urine test, x-ray, and many other procedures. There were a total of 13 individuals, some of whom mixed up my name, or the reason I was there, or the next room I should go to. During one test, I was forgotten about and left alone in a dark room for what seemed like forever, until a new patient was brought in.

During one of those wheelchair rides, I was eventually, finally, given painkillers. Then I was offered them again minutes later. My mom and sister, both nurses themselves, jumped to say “she just took them.” The staff member apologized for the confusion and left. I had a new understanding of a statistic I knew too well, that 78 patients out of 100,000 who visit the ER experience some type of medication error. And they don’t have the benefit of two off-duty nurses watching over them.

The chaos of this overcrowded ER and poor communication among its health care professionals made me see firsthand what I knew from reading research papers and statistics: In this most crucial of systems, patients themselves are like a third wheel.
This emergency room — in Boston, the health care capital of our country — was an unbearably complicated place to navigate, even for a health care professional, even one flanked by two nurses, impaired only by a simple sprained ankle. This leaves one to wonder what the ER experience is like for those who aren’t nurses and for those with far more serious conditions. Or for those who, like many in the waiting room that day, are elderly or struggle to communicate in English.

Obamacare increased the number of Americans with health insurance, and it was a vital move in the right direction — a trend I hope the president-elect preserves even if he repeals and replaces the law, as he says he will. But expanded insurance coverage is only part of the puzzle. We need more primary care providers, such as nurse practitioners, to keep patients from misusing and overcrowding ERs.

I will continue teaching nurses and researching how they can best serve our health care system. One thing is clear: My short stay in the emergency room showed me, in painfully memorable fashion, how much we need primary care if we want our ERs to function properly.

Lusine Poghosyan is an assistant professor at the Columbia University School of Nursing. Follow her on Twitter: @LusinePoghosy10

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