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Apriori

Is this normal? (EM)

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I'm a full-time EM PA and I'm trying to decide if my work situation is typical of most EDs. To start, I'm a newer PA and have been at this ED job for about 1 year. My issue is with fast track where I am the sole provider for 13 beds and more often than not all 13 of those beds are full all day long. I have a couple years urgent care experience prior to this ED gig and feel very comfortable with the typical "minor" complaints; I can churn out ankle sprains, URIs, and UTIs easily. However, I get sent many soft 3's and a couple truly sick patients that are mis-triaged. I understand this can happen anywhere,  but I have no say in moving them to the main side. Last shift I had two lacs, an open fracture of the hand, and ten other patients waiting to be seen in addition to a stack of lab results I needed to complete. The docs rarely come over to help even when it's super busy. I feel exhausted, undervalued, and underappreciated.  Is this what EM is and I'm just not cut out for this speciality? Or is this just a bad job? I would appreciate any outside perspectives.

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That sounds like a horrible gig and a recipe for disaster for patients and your license. Clearly they do not value PAs, and no, that's not what all EM jobs entail. With a year of experience you should be able to find a more suitable job. 

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That is insane to have to routinely cover 13 beds as a sole provider. Would have to be getting compensated triple digits an hour to put up with that considering the liability. 

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In an urgent care or ED fast track setting ~3(patients + procedures)/hour is reasonable if the acuity is really level 4's.  So, with 13 full beds, many patients will be waiting ~ 4 hours to be seen & discharged.  If the acuity includes many level 3's, throughput is going to drop to 2-2.5/hour.  It sounds like there are very unreasonable expectations of what throughput is reasonable.

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I encountered something similar many years ago, while doing some per diem shifts at a local ER.  Fast track side opened at 0900hrs daily.  Twelve beds.  Starting around 0730, triage nurses would hold patients.  At 0900, they would fill all twelve beds.  Sometime after my third or fourth shift, the ER director (MD) called me to his office, and explained that their goal was to have patients seen and discharged within one hour of being roomed.  I told him his math skills were suspect, and took my name off their roster.

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1 hour ago, PickleRick said:

I encountered something similar many years ago, while doing some per diem shifts at a local ER.  Fast track side opened at 0900hrs daily.  Twelve beds.  Starting around 0730, triage nurses would hold patients.  At 0900, they would fill all twelve beds.  Sometime after my third or fourth shift, the ER director (MD) called me to his office, and explained that their goal was to have patients seen and discharged within one hour of being roomed.  I told him his math skills were suspect, and took my name off their roster.

Don’t see how anyone would be able to chart in a meaningful way much less provide safe patient  care at that pace. 

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Welcome to the world of being a PA-C.  No matter what job I had they just kept piling patients on & mostly had no say.  

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9 hours ago, PickleRick said:

I encountered something similar many years ago, while doing some per diem shifts at a local ER.  Fast track side opened at 0900hrs daily.  Twelve beds.  Starting around 0730, triage nurses would hold patients.  At 0900, they would fill all twelve beds. 

Holy cow! I think I worked at the same place. To top it off, any patient who arrived on a backboard was placed in fast-track. 

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While the work environment was the same, I only had four beds to attend to at a time.  No assistance from MD/DO staffing if they were quiet but I was getting slammed.  This is where my suggestion for utilization of running horizontal mattress wound closures come from.  Less time and patient in/out faster.  This is back when FT was a new concept so I probably dealt with it two out ten EM years.

Edited by GetMeOuttaThisMess

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I just wish every PA and NP out there would just quit this type of gig

the doc's figured out it is toxic and now it is pushed onto PA's, if we just revolted against the crappy corp medicine types in unison we would win....

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13 hours ago, ventana said:

I just wish every PA and NP out there would just quit this type of gig

the doc's figured out it is toxic and now it is pushed onto PA's, if we just revolted against the crappy corp medicine types in unison we would win....

I just put my notice in and two other PAs are leaving as well. Never felt more relief in my life. 

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2 hours ago, Apriori said:

I just put my notice in and two other PAs are leaving as well. Never felt more relief in my life. 

For every one PA that leaves a terrible gig like this, there are 10 new grads desperate to make that school loan payment who will take the job, and if they don't an NP will.  It's the sad state of over-saturation.

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On 11/20/2019 at 11:56 PM, Apriori said:

I'm a full-time EM PA and I'm trying to decide if my work situation is typical of most EDs. To start, I'm a newer PA and have been at this ED job for about 1 year. My issue is with fast track where I am the sole provider for 13 beds and more often than not all 13 of those beds are full all day long. I have a couple years urgent care experience prior to this ED gig and feel very comfortable with the typical "minor" complaints; I can churn out ankle sprains, URIs, and UTIs easily. However, I get sent many soft 3's and a couple truly sick patients that are mis-triaged. I understand this can happen anywhere,  but I have no say in moving them to the main side. Last shift I had two lacs, an open fracture of the hand, and ten other patients waiting to be seen in addition to a stack of lab results I needed to complete. The docs rarely come over to help even when it's super busy. I feel exhausted, undervalued, and underappreciated.  Is this what EM is and I'm just not cut out for this speciality? Or is this just a bad job? I would appreciate any outside perspectives.

The first time I was getting killed and everyone else was chillin their heels in the main ED I’d make sure, politely, that they knew I was in need of help. The second time I’d make sure, not politely, they knew I needed help. The third time I’d tell them they either got their asses back there and helped me or I was walking out the door and they could handle all of it themselves without me. 

 

That being said it sounds like the ER you work at has a staffing issue that, if they won’t address it, you need to remove yourself from. 

Edited by anewconvert

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When I did Fast Track , a bit more than twenty years ago, I usually saw sixty patients on any weekend 12 hour shift and with a partner we saw within the same amount per shift. Look at your daily log and see where you fit into the same abuse that we had with the same problems plus breaking away for trauma.

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4 hours ago, surgblumm said:

When I did Fast Track , a bit more than twenty years ago, I usually saw sixty patients on any weekend 12 hour shift and with a partner we saw within the same amount per shift. Look at your daily log and see where you fit into the same abuse that we had with the same problems plus breaking away for trauma.

I used to see 60 in 12 hrs too....then we got EMRs in 2000 and our productivity was cut by 50%+. We doubled staff to see the same # of pts. 

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