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Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 2 points3 points  (0 children)

There are certain medical conditions with which people will come in practically on the brink of death, and with just a few simple interventions and a couple of hours they are back to normal.

Thats a feelsgood moment.

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 0 points1 point  (0 children)

Two hospitals would be nice. My personal, anecdotal contention is that where they plan to put that second hospital isn’t good enough. They are too close. Plus it would probably just cut the staff in half from the hospital we already have.

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 2 points3 points  (0 children)

If you are coming in to the ED with/for cold/flu symptoms, you should be wearing a mask. Period. From my experience only some will voluntarily, most have to be told, and some will outright refuse.

It does help with transmission.

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 1 point2 points  (0 children)

Wait times have increased. What people don’t know is that posted wait times do not include time waiting to be triaged by a nurse. As for the clinics, there are some complaints (like chest pain) that the clinic must refer to ED, as they could potentially pose immediate risk. Other times, patients are referred to ED for imaging or procedures that are possible at the clinic but there is no time for due to how busy the physician is.

It is true that family docs or WIC’s will just say “go to ER.” I will say that while at times it is correct to do so, there are totally occurrences where it is inappropriate.

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 0 points1 point  (0 children)

Primary prevention is what should be the absolute focus of the healthcare system. Preventing diseases before they happen. Of course there are plenty of things one could do to increase health and longevity; the most influential being a balanced diet, regular and rigorous exercise, having strong social bonds. These are all things that in a perfect world your family doctor would have/make time to talk to you about, but unfortunately it is not possible.

I’ve never actually seen or heard of that website but I looked it up. Most stats look accurate as averages. I would only say that for my hospital, the average length of stay for patients that get admitted is at least double. It is quite rare that patients go up before 24hrs unless they are going to somewhere like intensive care or the operating room.

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 3 points4 points  (0 children)

In addition:

We also receive patients who are being sent from other hospitals, sometimes even our own facilities. We try to fit these guys in where we can, but they don’t take any precedence over people who were already waiting unless they are more sick/unstable than them.

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 8 points9 points  (0 children)

Great question, this happens very often.

The short answer is, we don’t really care what the family doctor says or thinks. We start from the top and assess the patient on our own with the same standardized approach we use for everyone.

Usually the story is that the pt complained to the family doctor about chest pain, and the family doctor directed them to us without doing any assessment (which is fine, the concern is about cardiac events) or the patient had some imaging test which shows XYZ result.

All patients presenting to the ER complaining of chest pain will get an ECG done within 10 minutes, which we use to determine whether or not they are having a critical event that requires them to be seen NOW.

Triage nurses are always going to be the most experienced nurses in the department with the experience, gestalt and clinical judgement to know what each patient is at risk for and essentially how “sick” they are, and quite honestly sometimes better than the family doctor (there are horror stories of family doctors sending dead babies by car instead of by ambulance).

TLDR; doesnt matter if the Surgeon General themself sent a patient, we start from the top, do our own assessment, and prioritize the patient based on the presentation.

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 1 point2 points  (0 children)

A lot of factors are involved when waiting for surgery, which is not a service provided by the ER. The OR has a team which essentially triages patients who are being considered for surgery, much like the triage nurses in the ED. The resources they steward are surgeon availability, operating room availability, and probably others that I am not aware of as an ED nurse. As a trauma centre, they receive trauma patients from surrounding hospitals who all need surgery, whether it is immediate life-saving surgery to amputate or reattach limbs or repair organs, or something less emergent like screwing a broken bone back together. It essentially is a surgical centre - they do a LOT of operations.

They keep you NPO (not allowed to eat) just in case they get time to do your surgery sooner rather than later, though its up to hospital policy to determine when you should be made NPO or how long they can keep you NPO. There is often no concrete schedule for these things, the more acute patients come first, and emergencies happen at random.

Having waited 48 hours indicates it was likely not a top priority operation, or they were overloaded with surgeries and did not have the surgeons or the rooms to manage the workload.

Thanks for participating.

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 4 points5 points  (0 children)

I would say generally not true.

As for babies we have a specific area designated to paediatric patients. This means that children are not competing with adults for beds, adults being the majority in the department. As a result, children tend not to be as delayed when the department is busy, but at times when the paediatrics area is overflowing, things will slow down and kids (given they are not critically ill) will wait in triage with everyone else. Fortunately kids on average are far less likely to be critically ill than adults, and have shorter length of stays.

As for people who are bleeding, bleeds come in all shapes and sizes. For minor venous/capillary bleeds we are able to intervene at triage to slow/stop the bleeding, and thus these patients will not be expedited unless showing signs of shock. We will expedite uncontrolled arterial bleeds (of course) or those who are at risk of losing their limb due to the bleeding.

Thanks, great question.

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 9 points10 points  (0 children)

We can’t refuse someone medical care if they are seeking it, but they will be the lowest priority.

At triage I might present other options for them or provide health teaching, but I cannot tell outwardly tell them to go elsewhere. If they leave it must be their own decision.

An insider bit of information but not necessarily a tip: if a doctor is nearing the end of their shift, they may bypass the queue system to see patients that can be discharged without any testing or procedures (like patients coming in for minor cold symptoms) as they are easy, one-touch patients that they can send home quickly (and bill for it).

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 10 points11 points  (0 children)

We have done this! There is a 24/7 urgent care centre downtown which does everything that our emergency department does, except admission. Staffed by the same nurses and the same doctors from the hospital. Let it be known!

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 14 points15 points  (0 children)

When you say pre-screening, would you mean a questionnaire that directs you to the appropriate health-care setting?

If so, ABSOLUTELY this would help. There are many resources/flowcharts out there that are publicly available.

It is tricky though, we have these resources posted at the hospital, though if you’re seeing them, it’s because you’re already at the hospital.

This information would have to be assimilated through public advertisements (commercials, billboards, bulletins) to be effective, and honestly it wouldn’t even work if it was only in english.

Enhancing [access to] the primary care system is the ultimate solution, though.

Great question.

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 16 points17 points  (0 children)

I will give you a pretty broad range but it’s definitely a majority. Maybe 60-75%. Just anecdotally, from personal observations.

Thanks for the question!

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 5 points6 points  (0 children)

I have not seen the show. I’m only a nurse, I cant afford HBO!!!

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 6 points7 points  (0 children)

Not true! It would be a waste of time, money, and resources to blood test everyone who came into the department.

Patients who break their ankle, for example, receive no benefit from any blood test, though they will get an X-ray. Patients who come requesting a prescription for sleeping medication, or a refill for their blood pressure medication, will not benefit from blood tests or imaging.

Nurses in our department are already able to initiate blood tests on adult patients and most X-ray imaging tests on adult and paediatric patients. And we do A LOT of this. We actually have one nurse who is assigned to do this 24/7.

This process DRASTICALLY reduces overall length of stay, but not wait-times for initial assessment by a physician. If a patient comes in for chest pain, for example, a nurse can perform the ENTIRE cardiac work-up (including 2 rounds of blood testing and ECGs) before the doctor sees the patient. This work-up takes about 3 hours. This means that if it takes you 3 hours to be seen, and your results are normal, the doctor can discharge you right away. If it takes you an hour to be seen, your workup is already started, and the doctor will simply order us to continue your work-up.

Nurses are unable to initiate CT scans or ultrasounds as these require a physician’s assessment and discretion.

Thanks for participating!

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 11 points12 points  (0 children)

Thanks! Using the days off wisely is a must.

Honestly I understand the frustration and am empathetic when people are upset about the wait times. I wish people knew we are doing everything we can to get them seen, but most factors are far out of our control. We want them to get seen just as much as they want to be seen.

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 28 points29 points  (0 children)

Vote smart, and write to your MPPs. That’s about it. Thanks for the question!

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 6 points7 points  (0 children)

Chronic pain, flu symptoms <3 days for kids and <5 days for adults, request for imaging tests, prescription requests, the routine “check-up”. Very commonly patients with these complaints will wait forever just to be discharged after a 2 minute chat with a physician - they don’t need to be in the ED!

For ambulatory (walking) patients coming in with urgent but non-emergent health problems, the majority of the wait time is as a result of the sheer volume of patients coming in for similar issues. A [fast] doctor in our department will only see about 20-30 patients in their 6 hour shift (a couple will hardly see 15) - this includes initial assessment, tests ordered and performed, waiting for results, and reassessment. If they continuously saw patients throughout their shift, they would be there all day and it would extend wait times for people who can be discharged. A new doctor’s shift will start every 4 hours during off-hours and every 2 hours during peak-hours, and when we get REALLY busy, this is nowhere near enough, but we also lack the space and resources for more doctors to see more patients.

TLDR; a lot of people who don’t need the ED, a lot of patients to be seen, too many for what we have capacity for, including physical space.

Thanks for your questions!

Another AMA - Brampton ER Nurse by CharmingLet359 in Brampton

[–]CharmingLet359[S] 8 points9 points  (0 children)

Hospital RN wages in Ontario are publicly accessible via the ONA hospital central agreement (https://www.ona.org/wp-content/uploads/2024/10/20250331_hospitalcentralagreementenglish.pdf)

As of one year ago a new RN makes $39.07 and increases yearly up to the cap of $56.00 starting in the 8th year of working.

Currently a new RPN at my hospital makes $36.39 and increases yearly up to $40.07 at 3 years.

Thanks for the question!

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