As usual, I have done my rounds on some "websites" and "blogs" and I have encountered and read and analyzed more than enough posts for me to write this one.
And yes. At 4:15am, I am writing this entry as I am currently on duty as an Emergency Room Staff Nurse in a Private Tertiary hospital somewhere in Southern Luzon. I am thankful that after 14hours of being on duty here, I am able to take a rest for there are no more patients and I have decided to write this. I have less than 2hours to finish this. My 16-hour straight duty is about to end.
Being in a private hospital, I have experienced being verbally lashed upon by patients and/or their relatives and/or companions for factors that they do not recognize or fail to see. I will post numerous factors here that concern my grievances on everything my job is related to and with. This is not a sob story or anything but only the truth of what we healthcare providers usually deal with almost everyday of our lives.
1. Triage. There is this thing we call Triage. It is a systematic classification of patients according to the severity of their illness. Here in the Emergency Room, we will rush in to the patient who has suffered a heart attack or a cerebral stroke instead of that patient who has insomnia. Every second counts in the hospital whether we're in the Intensive Care Unit or Wards, we have to save lives as quickly and as efficient as we can.
I remember this case that was told to me wherein my colleagues were tending to a patient who was hacked by a machete on his left shoulder. He was profusely bleeding and his blood pressure was declining fast. One of my colleagues told the other patients whose cases were not emergent or critical that they will have to wait because they have to attend the aforementioned patient. One relative loudly shouted, "Wala akong pakialam jan! Basta tingnan nyo yung pasyente ko!" His patient was an adult man who just had a sprain. This is one of the things that we deal while at work and see yourself as a relative of the bleeding patient. What will you do if you heard another shouting like this? Saying that he doesn't care if your relative dies or what.
2. Expenses. Of course. Here in the Philippines, it is widely known, whether you have money or not, poor or rich, that private hospitals tend to drain your wallet and pocket. As frontliners in the hospital, we ER nurses are very strict regarding to what we give to the patients. Why? Because some patients are basically ignorant.
There was this case where a patient came in with a request for laboratory tests from another hospital. She was accompanied by a man when they arrived at around 1am. Everyone in this area knows that this is a private hospital they were in. The Medical Technologist ran the tests. I gave them the Charge Slips and asked them to pay for it before the Laboratory releases the results. The man asked me, "Babalik pa po ba kami dun sa isang ospital para bayaran ito?" I answered, "Hindi po. Dito nyo po yan babayaran. Dito kasi yan ginawa." I wanted to ask him, "Tanga ka ba?" Yet he answered, "Nako, wala kaming dala kahit piso." Really, I did my best to prevent myself from asking that question. Sadly, I did prevent myself.
Another case is of this patient who came in at around 2am and had a consultation. Laboratory tests were done. As far as I know, the patient and his 4 companions assured my colleague that they will pay for the tests. They were given the prescription and a copy of the tests and they said that they were waiting for someone to deliver them the money. They went to the lobby to wait. The sun went up and they were no longer there. Thanks to that patient who got a free consultation and laboratory tests, me and my colleague will be paying it for him. Now, see yourself as us. You treated a patient the best you could. Provided the necessary nursing
3. Emergency. It is a protocol, a natural law, innate to all emergency personnel, to provide emergency services to those in need as quickly as possible. That is what we do here in the Emergency Room. When a patient comes in who has suffered from a heart attack, unconscious, breathless, and pulseless, in other words, DEAD ON ARRIVAL, that's where the CODE BLUE comes in. All additional available staff must attend to said patient. Intubation and cardiac monitoring will be done. While the doctor inserts an endotracheal tube that will be the patient's artificial airway, a nurse will be preparing intravenous fluids that will serve as conduit for fast-acting drugs intended for resuscitation. Whether the patient does not have any immediate family to give consent, or any money to pay for the costs to begin with, it is our duty to save lives. Save life first. Payment, deal with it later.
A few days ago, for 10pm-6am shift, I received a patient who was intubated and unconscious. He was in a coma. I learned that he hanged himself and he arrived in our Emergency Room at 5:08pm, dead. Zero vital signs, no pulse, no heart rate, no blood pressure, none. He was still and his face was already cyanotic (bluish discoloration due to lack of oxygen), indicating that there most likely have been irreversible brain damage. The patient was revived after two doses of Epinephrine. But despite his resuscitation, assessment indicated that the patient is already brain dead. He was having seizures and he was not regaining consciousness. No family member was there to give the go signal to admit the patient. So my colleagues waited until at 8pm, the patient's uncle arrived. He was unable to give a go signal when our doctor explained to him that the patient himself will no longer recover. That he was brain dead. That only his body's basic functioning such as breathing and blood circulation are the ones active. That if he is admitted, they will only wait for his body to give up. So he waited for confirmation from the parents of the patient. Before 10pm, nearing my shift, the parents who were far away, decided to have the patient admitted.
He was attached to an ambubag. That ellipsoidal balloon that you press to administer oxygen to the patient via endotracheal tube. From the time that he was being revived up to the time that I received him and up to the time that he was attached to a mechanical ventilator in the ICU, one of our staff was there, making sure that he doesn't lose oxygen. After completing all the requirements for admission, I transferred the patient to the ICU. Not more than 14 hours later, he expired.
A couple of days after, there was this comment that our staff at the time the patient was brought were relatively unprofessional. That they did not render emergency services when they saw the patient whereas they made sure that the patient's companions or relatives have money to pay. And by the way, that comment also indicated that the suicide attempt was a failure. I decided not to dwell to much on it when I realized that the one who gave it got wrong information. Up to now, I cannot fathom how he was able to say that the suicide attempt was a failure when the patient actually arrived dead. The power of gossip and exaggeration.
4. Workload. If I can divide myself into three, I will do it just so that I can give enough attention and care to those who need it. But then, in our case, a 10-bed capacity Emergency Room with only 2 Nurses on Duty, how will you expect me to attend to you when there are four others like you waiting in line? Would you rather that I look at you one-by-one from time-to-time or just focus on one and deal with the rest one after the other? Can you assist a doctor during a minor surgical procedure while monitoring the blood pressure of a hypertensive patient while trying to pacify the whines of a 4-year old kid who doesn't want to take his/her medication while holding a brown bag for a patient who's hyperventilating? And then all of a sudden, a blood-soaked patient arrives, he was hit by a car. This day can't get any better. See Number1.
5. Salary. It is true that Salary itself is a good motivating factor, or moreover, it is the best motivating factor for an employee to exert effort. On our case, it is not. With a monthly salary of less than 10,000php. (Yes it's true. Damn Globe and Sun for denying my Post-paid line application just because my monthly salary is less than 10,000) You get bullied by some doctors, shouted upon by some patients and/or relatives and/or companions, get tired to the bones and soul for just meager salary, not to mention patients who skip billing and the blame will all go to you, salary deduction, yay! I can hardly believe that I earned a license for this.
6. Protocol. It is not us nurses or hospital firstliners who enact the protocols for a hospital. So please, don't blame us if you don't like the system. There are suggestion boxes and forms around. In our hospital, we ask the patient to pay for the charges INDIVIDUALLY. Meaning, any procedures done or medications given, will be charged by their own department. For example, a patient who tripped and had a sprain will be most likely sent to the Radiology Department for X-Ray. He will most likely be given pain medications as well. Before the X-Ray is done, the patient or his relatives or companions will be given a charge slip so that they can pay for it at the Cashier. Then, we will give them the prescription for them to buy at our Pharmacy the necessary medications to be given. Then if there are Laboratory tests, the Laboratory will give them another charge slip for whatever it is that must be tested. As a patient, I will be terribly irritated by this to the extent that I will wage war to whoever invented this scheme.
Okay. A pregnant patient just came in. Patient first, blog later.
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