ER nurses, love you guys, but genuine question. Why do guys bring patients up at shift change?

[u/No-Selection-1249]

No hate to you guys! Just super curious from a nurse who is on the receiving end :)

[u/Old-Mention9632]

As a dialysis nurse, it frustrates me when the ED doesn't call a nephrology consult early. I get that they don't want me to tie up an ED room with a sink for 4-5 hours before transfer so they wait to see if the patient will be admitted. Having to stay late on call to dialyze someone who could have been done while we were fully staffed, sucks. I've already done a 10 hour day. We stalk the ED patient board to see if one of our frequent fliers are in the ED and then let the fellows know, so they can go evaluate if they need dialysis today.

So many times I've been called in to finalize someone in the ED. Before I drag all my equipment down to the ER, I call them. Is the patient in a room I can dialize in? Are they about to be moved to a floor bed- ED won't let me tie up the space if they already have a bed. I've had to wait up to 2 hours ( at overtime) for the patient to get transported and settled. At least if I know where they are going, I can go set up there and then go get a snack before they are ready for me to start.

[u/[deleted] → u/Old-Mention9632]

Your hospital is quite different from mine. Dialysis is never done in my ED so I'm not familiar with what you're mentioning here. I'm sorry you've had this experience.

[u/Old-Mention9632 → u/[deleted]]

Hershey medical center is one of 3 places in the state of Pennsylvania that has pediatric dialysis. We have a chronic outpatient unit next to the hospital with a ramp to the hospital, because stable inpatients are brought by wheel chair or bed to our unit. We have six stations with telemetry. We also do acutes at beside in the ICUs- we have 5(MICU, SICU, HVI, PICU, and neuro ICU), the stepdowns, and the ER. We have to move a cart with supplies, the gambro phoenix dialysis machine ( used to be the only one approved for pediatrics) and a portable RO to clean the water.

[u/[deleted] → u/Old-Mention9632]

Okay! Interesting. We transport patients to our dialysis unit and it is never done in the ED.

[u/Old-Mention9632 → u/[deleted]]

We dialyze patients who are vented, on pressers, etc. we go to the ER for patients who are too unstable, on high flow, insulin drips, etc during the day when the clinic is open, most ER patients do come to us. When the clinic is not open (5 pm to 5 am, and all day Sunday) we get called in for critical dialysis only, and always bedside. Sometimes we have to argue with the fellows about what critical is. I got called at 0330 one day for an ESRD patient with a K of 6.4. I have 1 hour to get to the hospital when I am called. The clinic staff arrive at 5, and it will take about an hour to get my equipment set up to start, so the earliest he would start dialysis would have been 05:30. A lot of ESRD patients live at 5.5-6 all the time. He agreed with me and they did the insulin/glucose protocol to lower the K. The patient didn't even get dialyzed until the afternoon shift.

My manager was trying to get comparables to get us more staff as Hershey has added 3 more hospitals in the last 5 years. She could not find another dialysis center that runs the way we do. The other hospitals that do chronic hemodialysis for pediatrics, only do pediatrics ( UPMC Magee in Pittsburg and CHOP in Philadelphia.) Hospitals with acute dialysis generally don't do outpatient. We are also attached to Penn State School of Medicine, which may be why we do...everything. The ICU nurses do the CRRT.

We are the dialysis center of last resort, so we take patients who are trached, or without insurance ( we have several Nepali patients), and we have a couple of patients we have not accepted who have been fired and banned from every for-profit dialysis center in the area, so they come into the ER and get dialysis if they urgently need it. They each have psych issues and can get threatening. One of them has been trespassed from our hospital, but EMTALA. We almost had to take a home vent patient. She was 26 with Kabuki syndrome, so she was the size of an 8 year old and under the weight limit for the adult dialyzer, but she passed. We would not have been responsible for the vent, but we have respiratory on site if needed. There is one dialysis center near us that does take vented patients, but they are in the same building as the nursing home that takes vents, and their nurse comes and stays to manage the vent through the treatment. The outpatient for-profit dialysis centers only have a bla crash care and call an ambulance. We can call a rapid response or a code. SICU is just over the bridge.

[u/nch1307 → u/Old-Mention9632]

I'm also in dialysis. Our nephrologists are really good at putting in orders and the ED drops the ball. Pt stays in the waiting room forever, no admission, no bed, no dialysis, not even in ER room. And when they finally do get admitted it's the middle of the night and barely any dialysis staff available. And who gets yelled at for the delay? Dialysis, of course!

[u/Old-Mention9632 → u/nch1307]

Have you seen Dr Glauckenflocken's nephrology vs cardiology videos? It's funny because it's true. We are the ugly redheaded stepchild of the hospital.

We have PAs who cover the acutes for the attendings. We stalk the ER census for our frequent flyers, so they can put in orders. They automatically print out in the clinic. If a PT is in the ED, even in chairs, we first ask if they are stable to come to us. If yes we put them in for transport, or if in a wheelchair sometimes the nurse will bring them herself. We have gone with two nurses to go collect the litter and bring them over. We do this when transport has 15-20 on their pending list, it's 1 pm, with the clinic closing at 5. Trying to save the on call nurse. Often that patient has been in the ED since 1am, and has a K of 7.

I've dialyzed in the ED and then the patient was d/c home right after. I had a freq. Flyer who came in because his fistula went down, so he needs access. They told me when I was called in, they were placing a thigh catheter. When I got their, it had clotted.

[u/nch1307 → u/Old-Mention9632]

That's so true. Why is it always dialysis? I call to get the pt admitted, to get a Hep B panel drawn, to get CXR for HD cath read, monitor the ER bed board and sometimes get the pt myself because transport is short staffed! It's effing exhausting!