Smoking a cig in the ambulance bay

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The Knife & Gun Club

The Knife & Gun Club

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Has anyone ever just needed to step out into the ambulance bay for a quick smoke? No?

Well neither have I, I’m out here now sipping on my Luke warm coffee after getting yelled at by a nurse with a clip board. Feels about the same I’d imagine. Apparently coffee is a toxic, dangerous substance that will give everyone cancer if you drink it inside the ED.

Anyone have any success getting the clip boarders to relent on this ridiculous practice? I know ACEP put out a position statement about this recently. I have a residency-mandated “quality improvement” project due and think this may be a worthy hill to die on.
 
The Knife & Gun Club said:
Has anyone ever just needed to step out into the ambulance bay for a quick smoke? No?

Well neither have I, I’m out here now sipping on my Luke warm coffee after getting yelled at by a nurse with a clip board. Feels about the same I’d imagine. Apparently coffee is a toxic, dangerous substance that will give everyone cancer if you drink it inside the ED.

Anyone have any success getting the clip boarders to relent on this ridiculous practice? I know ACEP put out a position statement about this recently. I have a residency-mandated “quality improvement” project due and think this may be a worthy hill to die on.
Click to expand...
 
The Knife & Gun Club said:
Has anyone ever just needed to step out into the ambulance bay for a quick smoke? No?

Well neither have I, I’m out here now sipping on my Luke warm coffee after getting yelled at by a nurse with a clip board. Feels about the same I’d imagine. Apparently coffee is a toxic, dangerous substance that will give everyone cancer if you drink it inside the ED.

Anyone have any success getting the clip boarders to relent on this ridiculous practice? I know ACEP put out a position statement about this recently. I have a residency-mandated “quality improvement” project due and think this may be a worthy hill to die on.
Click to expand...

I remember having a clipboard nurse hassling me about having my mask "dangling" and wanting to speak with me and my "supervisor" in residency. Yeah no, I got better things to do. Mind your business and stick to managing nurses.
 
GassYous said:
I remember having a clipboard nurse hassling me about having my mask "dangling" and wanting to speak with me and my "supervisor" in residency. Yeah no, I got better things to do. Mind your business and stick to managing nurses.
Click to expand...
I miss the days when they were preventing people from wearing masks…
 
You got to be kidding. Has things changed this much?

To my last day working in the pits, I have never had a nurse tell me not to eat, drink. Never have them question me when I left the floor, go to the bathroom, surf the internet. I surfed countless times when the place is packed and rack full. What is taking a break and reading the news for 1 min?

I would put my drink away when the health department of some review group was going through the ER.

I am not sure how I would have handled it. Geez, I had something to drink or eat at my desk 75% of the time. Ate between seeing pts ALL the time.

Just crazy.
 
One night shift, I brought in a towering tub of mouth watering, Rotisserie chicken greek-pasta salad from Costco. You know, the recipe they had to stop selling because people were fist fighting in the aisles when it would run low. By the end of that crazy busy shift, my glucose bottomed out in the dirt like a jet plane landing short of the runway. Finally, at shift end, having suffered hypoglycemic, dehydrated, night-shift exhaustion-delirium (you know, like a normal day in the ED) I walked into the break room to get my food.

THE ENTIRE FRIDGE WAS EMPTY!

The absofrickenlutey psycho nurse manager came in and decided TODAY WAS THE DAY to go throw away every single thing in the fridge that didn't have a frickin' expiration DATE on it. An expiration date on it? WHO DATES THEIR FRICKIN' LUNCH??!?!??!!??#(*#($*(#@#(

My head dropped. I honestly was crushed. I didn't even have the energy to blow up. I walked out of that god forsaken hellhole vowing one day to leave and never come back to a #)()(*@#)(*@)( ED ever again. It took me about 5 years to walk that walk, but g-- damn!t, did it feel good when that day came.

Now I have an office with my own mini-fridge, Keurig, microwave and M&M jar. Yeah, I said M&M jar.

Life is farking great.
 
My main jobs always had a lounge with a fridge. If you don't have one, demand it.

I would never put food in with the nurses. Crap goes missing, they will eat half and put it back. People have no shame.

I now have our own expresso machine or Keurig, fridge, sleep room, lounge with TV. Can't go back
 
We don't get a lunch break and the safest way to remain hydrated and normoglycemic in order to provide excellent patient care is to eat and drink at the desk while remaining accessible to nursing staff and patients in case of a critical event such as a cardiac arrest, STEMI, or sick pediatric patient. Not getting a lunch break due to critical need is a concept difficult for non-physicians to understand.

We've had a couple admin through the years get on to physicians for eating at the desk but when it got to the point where they tried to ban drinks we pushed-back and found a compromise. I think technically the policy still is no eating at desk but everyone does it and at this point I kind of dgaf anyway because it's in the interest of patient safety.
 
e30ftw said:
We don't get a lunch break and the safest way to remain hydrated and normoglycemic in order to provide excellent patient care is to eat and drink at the desk while remaining accessible to nursing staff and patients in case of a critical event such as a cardiac arrest, STEMI, or sick pediatric patient. Not getting a lunch break due to critical need is a concept difficult for non-physicians to understand.

We've had a couple admin through the years get on to physicians for eating at the desk but when it got to the point where they tried to ban drinks we pushed-back and found a compromise. I think technically the policy still is no eating at desk but everyone does it and at this point I kind of dgaf anyway because it's in the interest of patient safety.
Click to expand...
I tell the clipboard people that I won't eat or drink at the desk if they can get the hospital to give me a paid 1 hour lunch break, and two paid 15 minute breaks throughout the shift. This usually shuts them up as they can't compute.
 
It's unhealthy to expect physicians to not eat or drink for 8-12 hours at a time. We don't let nurses, pilots, or schoolchildren do it. So why expect physicians to? Either provide paid breaks or STFU and go cram your clipboard, Jenny.
 
I always take min 2-5 food breaks every shift. I don't care how busy. people can wait 15 minutes in the rack. Its not like skipping a 15-30 min break is going to make that rack get any smaller quicker.

If no one is crashing, I take 15-30 break to the lounge for a break. Clears up my mind, I come back more efficient. If I went straight 8+ hrs, I am not as efficient at the end of my shift so no point in skipping a break.
 
Neopolymath said:
Like most things related to nursing policy.... drumrolll please... it's just plain old made up BS.
Click to expand...


Not exactly. What usually happens is that it starts somewhere for a decent enough reason, but then gets completely perverted and warped as it gets passed down and then eventually nobody actually remembers what the hell the original reason was or what it should and should not apply to. Or you have jerks like our old nursing home admin who says things are regs just to get her way. (she doesn’t do that anymore because i look everything up and routinely bust her).

This originally comes from OSHA saying no food or drink where there’s a reasonable expectation for possible contamination with blood or other potentially infectious material. So if it’s a counter that has lots of specimen containers placed on it, you probably shouldn’t be putting your food/drinks there. If not, probably shouldn’t be that big a deal unless people keep spilling on their keyboards etc. Then it’s more of an IT issue.

I did work at a big tertiary place that didn’t want you to eat near where patients could see you or smell what you were eating because some of them had issues with nausea, chemo, or other reasons they couldn’t eat so it was more of a respect for patients thing.

Some of us are fighting the good fight. When this comes up as a question on the hospital epidemiology or infection prevention forums most of us do try to educate the newer folks that it’s OSHA for this specific scenario, not CMS or Joint Commission and that you really need to make sure people have a convenient place to eat and drink close by, esp. in the ED. We usually recommend designated spots for biohazard stuff so the other areas are clean. I’m sorry this has been slow to get through at some of your shops.
 
Rekt said:
It's not even a JCAHO policy. No idea how this myth keeps surviving.
Click to expand...
It's OSHA that you can't have food/drink where blood/urine specimens are tested. So if the nurses are running i-STAT's at the nursing station, well they can't have food/drink there.

Luckily our pods have separate physician areas where we can eat/drink.
 
Docs carry coffee/water all throughout the hospital and on the floor. Are u telling me the ER is any diff than being on the floor? I won’t bring food into a pt room but at my desk or walking the Er. hall?

give me a break.
 
I will add my favorite "infection control" story:

Winter. Apparently one of them got word that in a 400 bed, Level II hospital, two parents in the entire hospital, had kids sent home from daycare with diarrhea. Note: not even clinical staff, not even in the same department. I think one was in "environmental services" and the other in billing.

She wanted to shut the entire hospital down. "We could have an outbreak on our hands!"

Fortunately the CEO and CFO did what they are good at and figured out that would be bad for revenue projections. At least the nurses haven't learned that trick yet. If she had told them it would have saved $100K we would probably still be shut down years later.

Let me provide a survival hint: Always make it about the money.

"Well, if we don't have access to food and drink, we might get woozy and fall. Physicians get big damages for that. One fell, hit his noggin and got $17M from the hospital."

Doctor Sues Hospital for Slip and Fall

With all the insurance industry
affiliates.legalexaminer.com affiliates.legalexaminer.com

Logic and reason won't work. Logic and reason tied in the flimsiest way to revenue usually will.
 
Birdstrike said:
One night shift, I brought in a towering tub of mouth watering, Rotisserie chicken greek-pasta salad from Costco. You know, the recipe they had to stop selling because people were fist fighting in the aisles when it would run low. By the end of that crazy busy shift, my glucose bottomed out in the dirt like a jet plane landing short of the runway. Finally, at shift end, having suffered hypoglycemic, dehydrated, night-shift exhaustion-delirium (you know, like a normal day in the ED) I walked into the break room to get my food.

THE ENTIRE FRIDGE WAS EMPTY!

The absofrickenlutey psycho nurse manager came in and decided TODAY WAS THE DAY to go throw away every single thing in the fridge that didn't have a frickin' expiration DATE on it. An expiration date on it? WHO DATES THEIR FRICKIN' LUNCH??!?!??!!??#(*#($*(#@#(

My head dropped. I honestly was crushed. I didn't even have the energy to blow up. I walked out of that god forsaken hellhole vowing one day to leave and never come back to a #)()(*@#)(*@)( ED ever again. It took me about 5 years to walk that walk, but g-- damn!t, did it feel good when that day came.

Now I have an office with my own mini-fridge, Keurig, microwave and M&M jar. Yeah, I said M&M jar.

Life is farking great.
Click to expand...
I wish we had someone clean out our fridge - it is effing disgusting - we are supposed to date our stuff- finally one person got the OK from mgmt to throw eveything out that wasn't dated- people were given 72 hour notice. Not ****, there was yogurt that was almost a year past its expiration date. The garbage can was a true cesspool of mold. We almost had to throw the entire refridgerator out - but instead bleached the living **** out of it
 
Vandalia said:
I will add my favorite "infection control" story:

Winter. Apparently one of them got word that in a 400 bed, Level II hospital, two parents in the entire hospital, had kids sent home from daycare with diarrhea. Note: not even clinical staff, not even in the same department. I think one was in "environmental services" and the other in billing.

She wanted to shut the entire hospital down. "We could have an outbreak on our hands!"

Fortunately the CEO and CFO did what they are good at and figured out that would be bad for revenue projections. At least the nurses haven't learned that trick yet. If she had told them it would have saved $100K we would probably still be shut down years later.

Let me provide a survival hint: Always make it about the money.

"Well, if we don't have access to food and drink, we might get woozy and fall. Physicians get big damages for that. One fell, hit his noggin and got $17M from the hospital."

Doctor Sues Hospital for Slip and Fall

With all the insurance industry
affiliates.legalexaminer.com affiliates.legalexaminer.com

Logic and reason won't work. Logic and reason tied in the flimsiest way to revenue usually will.
Click to expand...
It’s amazing how true this is.
 
emergentmd said:
I always take min 2-5 food breaks every shift. I don't care how busy. people can wait 15 minutes in the rack. Its not like skipping a 15-30 min break is going to make that rack get any smaller quicker.

If no one is crashing, I take 15-30 break to the lounge for a break. Clears up my mind, I come back more efficient. If I went straight 8+ hrs, I am not as efficient at the end of my shift so no point in skipping a break.
Click to expand...
The beauty of the night shift at a less than busy shop is that you can take a food break after clearing the place out (or at least after seeing everyone and starting the work up).
I still wonder why so many people choose to work in busy ERs when you can find sleepier places… and you know, sleep.
 
Angry Birds said:
The beauty of the night shift at a less than busy shop is that you can take a food break after clearing the place out (or at least after seeing everyone and starting the work up).
I still wonder why so many people choose to work in busy ERs when you can find sleepier places… and you know, sleep.
Click to expand...
More money…
 
Angry Birds said:
I think there are jobs that pay well that aren’t that busy. You just gotta find them. I have one of them.
Click to expand...

I have one of those. Moderately busy small critical access hospital until midnight. Then usually only 4-5 patients after midnight. Typically get to watch a couple hours of Netflix, and take a 1-2 hour nap. It's going to me my only part-time clinical job after October.
 
GeneralVeers said:
I have one of those. Moderately busy small critical access hospital until midnight. Then usually only 4-5 patients after midnight. Typically get to watch a couple hours of Netflix, and take a 1-2 hour nap. It's going to me my only part-time clinical job after October.
Click to expand...
That’s what I have haha. It’s great. Other than the fact that it’s a night shift.
 
Angry Birds said:
That’s what I have haha. It’s great. Other than the fact that it’s a night shift.
Click to expand...
It’s getting harder to transfer patients from those places who are sick. If you get stuck with an icu boarder won’t be fun
 
bravotwozero said:
It’s getting harder to transfer patients from those places who are sick. If you get stuck with an icu boarder won’t be fun
Click to expand...

The hospital I'm at is part of thr larger hospital group in the city. I go through the transfer center and the ER-ER transfer acceptance is automatic in 90% of cases.
 
GeneralVeers said:
The hospital I'm at is part of thr larger hospital group in the city. I go through the transfer center and the ER-ER transfer acceptance is automatic in 90% of cases.
Click to expand...
This is how it is with my hospital and I suspect it’s why the pay has remained high. And yes transfers aren’t a problem. So maybe that’s the solution: find a small hospital connected to a bigger one.
 
Angry Birds said:
This is how it is with my hospital and I suspect it’s why the pay has remained high. And yes transfers aren’t a problem. So maybe that’s the solution: find a small hospital connected to a bigger one.
Click to expand...
How hard is it to find a job at a place like this? I’ve always wanted to work rural but the idea of being at some little shop and stuck with a sick patient requiring an intervention I can’t provide is definitely disconcerting.

I recently talked to a grad from our program who had a total dumpster fire of a woman who was in labor but had a shoulder distocia, he couldn’t get it out, and no hospitals would accept and no ambulances would take the patient.
 
The Knife & Gun Club said:
How hard is it to find a job at a place like this? I’ve always wanted to work rural but the idea of being at some little shop and stuck with a sick patient requiring an intervention I can’t provide is definitely disconcerting.

I recently talked to a grad from our program who had a total dumpster fire of a woman who was in labor but had a shoulder distocia, he couldn’t get it out, and no hospitals would accept and no ambulances would take the patient.
Click to expand...
So what happened to the woman and the baby?
 
The Knife & Gun Club said:
How hard is it to find a job at a place like this? I’ve always wanted to work rural but the idea of being at some little shop and stuck with a sick patient requiring an intervention I can’t provide is definitely disconcerting.

I recently talked to a grad from our program who had a total dumpster fire of a woman who was in labor but had a shoulder distocia, he couldn’t get it out, and no hospitals would accept and no ambulances would take the patient.
Click to expand...

Our biggest issues transferring (outside of places being too full with covid pts) seems to be weather, winter storms and such
 
The Knife & Gun Club said:
How hard is it to find a job at a place like this? I’ve always wanted to work rural but the idea of being at some little shop and stuck with a sick patient requiring an intervention I can’t provide is definitely disconcerting.
Click to expand...

In the past, not very. I can think of about 3 places off the top of my head in Mississippi, and a couple here in WV that are set up like that. I think some will say “in partnership with big tertiary health system”, or “a part of xyz health” and use the mothership’s logo on their promotional materials.
 
CajunMedic said:
In the past, not very. I can think of about 3 places off the top of my head in Mississippi, and a couple here in WV that are set up like that. I think some will say “in partnership with big tertiary health system”, or “a part of xyz health” and use the mothership’s logo on their promotional materials.
Click to expand...
The way WVU Medicine is gobbling up hospitals I expect every place in the state to soon be under their umbrella.

The same is happening in other places. True, independent, even rural, hospitals will soon be a thing of the past.
 
bravotwozero said:
It’s getting harder to transfer patients from those places who are sick. If you get stuck with an icu boarder won’t be fun
Click to expand...
Years ago I worked in a small critical access hospital. 4 bed ED staffed by one MD, one RN, and one LPN. We had a heard of cattle get out and had two car vs cow and one 4 wheeler vs cow accident. Two had to be airlifted and one ground transport. I felt bad so bad for our Ed doc. I had never seen him so stressed trying to get transfers out. 95% of the time the place was chill and mostly minor things or drug seekers (huge drug problem in this town) but every now and then **** would hit the fan
 
Dred Pirate said:
Years ago I worked in a small critical access hospital. 4 bed ED staffed by one MD, one RN, and one LPN. We had a heard of cattle get out and had two car vs cow and one 4 wheeler vs cow accident. Two had to be airlifted and one ground transport. I felt bad so bad for our Ed doc. I had never seen him so stressed trying to get transfers out. 95% of the time the place was chill and mostly minor things or drug seekers (huge drug problem in this town) but every now and then **** would hit the fan
Click to expand...
Time for a little bit of controversy. I call this the "Emergency Medicine Paradox."

I have always said that anyone can practice EM at an academic medical center. Consultants on tap. Every type of imaging, procedure or other test immediately available.

However, where EM skills are really needed is in the situation described above. When you have multiple disasters with essentially no support. Of course, these are also the type of places that are least likely to have EM trained physicians. Hence the paradox.
 
Vandalia said:
Time for a little bit of controversy. I call this the "Emergency Medicine Paradox."

I have always said that anyone can practice EM at an academic medical center. Consultants on tap. Every type of imaging, procedure or other test immediately available.

However, where EM skills are really needed is in the situation described above. When you have multiple disasters with essentially no support. Of course, these are also the type of places that are least likely to have EM trained physicians. Hence the paradox.
Click to expand...
Same issue with residencies. You need enough pathology to support the education of a cohort of residents. But with more pathology comes more specialist, and hence, less pathology that you’re actually managing yourself. One of the biggest frustrations in my training.
 
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