One of the public’s worst nightmares is to go to an Emergency Room seeking help, being ignored and dying. In fact this is also a nurse’s worst nightmare: having a patient in your care die needlessly.

In this latest (but not last, I’m sure) episode of a woman dying in the ER while waiting, I noticed that the sister was quick to blame the nurses, saying “I want to see the nurses pay for what they did.”

Amazing. Did she not even consider that any doctor could’ve acted as well?

Whenever a person is saved from some life threatening illness or injury they are so quick to thank the doctors. Nurses rarely get a nod. But when something goes wrong, it’s the nurses.

I think it’s awful that patients die waiting to be seen in an ER. But sadly, after having spent 16 years as a NYC ER nurse, I can honestly say I can see how it could easily happen.

Nurses plead not to have things like mandatory overtime and high nurse patient ratio but hospitals and the health care industry consistently either ignore, or fight against these pleas. The public’s not getting quality care and we’re not getting fair working conditions, yet it’s costing a fortune and somehow the hospital, HMO’s/health insurance companies and pharmaceutical company’s are making out like bandits. And they just don’t care-plain and simple. Why change a good thing? (for them)

The ER I left 3 years ago still has a nurse patient ratio that is often 2 ½ times what is considered to be safe according to the California law which is the only one in the country setting compulsory safe nurse patient ratios.

Nurse are too tired, there are just too many sick patients to care for..no time, no available ER stretchers for anyone coming into the ER, with ambulance arrivals lining up in the hall. ..no beds upstairs to move admitted patients to…no meal break to replenish-too busy, can’t be spared. The same story. That’s why I left. And I’m not alone. More and more are leaving (and not being replaced), so the problems in hospital care are bound to get worse.

Many primary care doctors send their patients to ER’s on weekends holidays or at busy times, as they too are feeling the crunch that HMO’s and health insurance company’s are placing where reimbursement for services rendered is concerned. Again these company’s just don’t care… Stay well or die, cause they don’t want to pay.

Add to all of this, the patients who use the ER as a primary care doctor. There are some patients who would come weekly to our ER. What do you do with a patient who calls an ambulance weekly complaining of chest pain and shortness of breath, basically because she’s bitter and lonely and her children don’t want anything to do with her? Chief complaint: c/o CP & SOB…every time. EKG, labwork, chest x ray-all at the taxpayers expense and always negative. After a while the one doctor would see her on the EMS stretcher, tell them to take her off it and sit her in a chair and call social work and psych without even registering her. I told the doctor its the “little boy who cried wolf” syndrome and she agreed responding, “Exactly, she’s gonna die in a chair in this ER one day. One day she’s gonna come in here and it’ll be real but we’ll ignore her. It’s crazy.

But do you do the “million dollar workup” every time?” These are questions we deal with and say “No”. I wonder if the general public would agree. I’d love to know.

Worse yet, are the many patients who use the ER as their primary care physician, yet will often not follow, in any way, the medical advice they are given. They continue to eat junk, smoke, drink too much alcohol, not exercise, etc. They get a prescription and are told to follow up at their doctor or their clinic. They don’t bother to fill it, or they fill it and don’t take it as they should or stop taking it maybe because they felt it didn’t work or made them sicker, yet they don’t follow up with their doctor, or a clinic as they should, to let anyone know this. Then they return to the ER having done nothing to help themselves and expect the ER staff to solve all their problems. Or they decided to skip that appointment for a wound check and now they are back with a raging infection. What do you do with someone who makes no effort to be an equal participant in their own health care? The list of specifics in these situations is long but the end result is the same: a huge crunch of people in city emergency rooms.

Much of the problem is lack of insurance but surprisingly, many of these people have insurance or Medicaid so there is no excuse. There is only ignorance and the belief that it’s someone else’s responsibility to take care of you. And for many with no insurance (certainly though, not all), there is no excuse as well. We all consistently make priorities in what we choose to pay for. Health is a priority yet most people would pay their car insurance before health insurance!

The system is strained beyond measure. The conditions in large metropolitan ER’s across the nation is similar: overcrowding and misuse of ER’s-lack of nurses willing to work under those conditions, leading to worsening levels of care. More people will die waiting for care.