Wednesday, April 21, 2010

The Hallway Seat

Our emergency department, including our express department, consists of thirty-six rooms, four nursing stations and three physician stations. Within the three physician stations, there are nine available computers strictly to be used by the ER team--the attendings, the residents, and the PA/NP extenders--during their shifts. We also have a consult area, a comfortable room with five more available computers, to be used by physicians visiting our ER to admit their patients.

You would think that with so many available computers, there would not be a lack of space to sit down and accomplish your work. But, unfortunately, this is simply not true. Because of the ever-evolving list of admitted patients, the consult room is typically filled with ancillary-service physicians. And between our emergency department coverage of multiple ER attendings and residents, it is rare to have an open, unused computer in our physician stations.

Sometimes, when I show up for a shift, it may take me fifteen minutes to sort out who is working at each computer station and which one might be available for my use. Although I don't enjoy it, I've even had to pull rank on some of the interns and medical students, kicking them off, just to have a place to sit. They understand my predicament, of course, and I try to do it in a respectful way. Still, though, that wasted time and energy can be a frustrating start to a shift.

One of the working solutions? As a result of the shortage of physician computers, we now have three additional laptop computers. They sit on a wheel-based pedestal and are easily plugged in and transported through our ER.

Enter one of my partners and her brilliant idea.

One day, out of her own frustration, my partner decided to set up her own work station. She grabbed one of the laptops, plugged it into an outlet in the main nursing station, and set up the computer just outside of the station, along a stand-up work counter. She got an extra phone and set it on the counter, facing her. She also found a two-foot by three-foot wood-paneled tray and cleaned it off, creating her own little desktop. A comfortable chair completed her newly-furnished work area. To really add a polished touch, she ran to the gift shop and bought herself a couple of carnations, trimming their stems and placing them in a make-shift dixie-cup vase alongside the phone. Compassionate and classy. What a combo.

Not only did she have her own work-space, but it was also an ideal setting for her to keep her finger on the pulse of the ER's activities.

It took a little getting used to, but slowly, the presence of her sitting in the hallway along the counter, just outside of the busiest nursing station, gained favor. From her viewpoint, she could see ambulances arriving and departing, talk directly to the nurses responsible for the most critical patients, and, most importantly, have direct access to the most important person in our department, the unit secretary, who sat just ten feet away. How perfect. And from the staff's point of view, it was nice to have an available physician right in the open.

One day, a few weeks later, after she had finished her shift and I had arrived for the start of mine, I couldn't find an available computer. I looked at Shirley's work station, immaculately clean and empty, and decided to give it a try.

"Shirley," I said, calling her cell phone from the counter phone, "it's Jim. Do you mind if I sit at your work station during my shift today?" I felt I owed her the phone call, out of respect for her diligence in making this new space. Shirley couldn't have been any more gracious. She was actually excited about someone wanting to experience her invented area. "Of course, Jim. And thanks for calling and asking. Anytime I'm not there, feel free to use it."

Slowly, I started using this work-space when Shirley wasn't. It quickly became apparent to me why Shirley enjoyed this spot so much. I didn't feel walled-off from the ER's flurry, sitting in the closet-sized physician stations. Instead, I sat quietly within the hectic pace of the ER, thriving off the frenzied energy that surrounded me. I accomplished my work with a new vigor and gained a new appreciation for our hard-working staff.

I knew I became a mainstay fixture, like Shirley, when I came in one day to find several folded, colored Kleenexes stapled into the shapes of flowers, sitting on the counter and welcoming me to a new shift. I looked at all of the laughing nurses, wondering which one learned such a useful talent in high school while serving on the prom committee. Probably Ken.

Still, there are some downsides to sitting out in the open. Sometimes, on the crazy days, the spillover patients from triage, at the end of the hall, will direct their angry gazes at me. Because I sit in the easiest-to-find place, nurses will often run to me to ask me to see a critical patient or show me a concerning EKG. Likewise, I might be the first one a patient or their family encounters to complain or ask a favor from. Sometimes, I return to my workspace to find a closed-container of urine or vials of blood sitting on my desk, waiting to be sent via our tube system to the laboratory. Just a few shifts back, while waiting for a room to open, the paramedics had taken my empty chair and given it to a drunk guy, who had just shit himself , to sit on. UGH!

Yesterday, though, was probably one of the hardest times I've had to date. While a family mourned the unexpected loss of their mother in the room directly across from me, a schizophrenic patient in the room next to them was yelling obscenities and acting out in the worst of ways. Despite closing his glass door and administering intramuscular medicines, he totally disrupted any peace we attempted to create for the saddened family. We had no other available rooms to move the schizophrenic patient to, unfortunately, and watching this family's misery deepen from his erratic behavior and yelling was upsetting to all of us.

I would not have witnessed this had I been in my corner of the physician's workstation.

Still, the good outweighs the bad, and I thoroughly enjoy my new seating arrangement. I wonder, though, if any of you have had similar problems in your work environment. Especially the ER setting. If so, how have they been solved?

Thanks, Shirley, for a great alternative. I owe you a bouquet of carnations!

For the next few days, if you need to visit your local ER and just happen to find a doctor sitting in the hallway doing his or her work, it's probably Shirley or myself. A buzzcut? That would be me. A pretty woman with highlighted, straightened hair? Shirley. Feel free to stop by and say "hi."

Just don't complain...

As always, big thanks for reading. Next post will be Friday, April 23rd. May the rest of your week by good...


DreamingTree said...

I think most nurses would relate to your experiences in the hallway seat. Our work areas are right in the thick of it -- no place to hide. It seems that I have a tattoo on my forehead that reads, "ask me for help." Family members consistently stop me when they need something or have questions. I know it's because I'm visible and I make eye contact. As much as I hate interruptions (since I usually have a million things to do) I can't be rude, and tend to sympathize with them.

Pissed Off Patient said...

Amazing that you literally don't have the work space you need. Glad you're able to make it work somehow.

I have never in my life said 'boo' to anyone in an ER once I'm in a room. I wonder is that an asthma thing?

I'm always just sitting there looking for the next breath, I never have time or breath to complain. Even if I probably should!


NurseExec said...

My first job in the medical field was as a unit secretary in a 14 bed ER. This was back in the pre-computer days. I remember being at the desk in the middle of the department and the ER doc's favorite seat was next to me. His rationale? "This is heart of the department". I thought that was a pretty cool thing for him to say. Interestingly enough, I worked that job for about 2 weeks when I realized that I wanted to be on the other side of the desk as a nurse. The hospital paid for me to go to nursing school and the rest is, as they say, history....

Katie said...

Yesterday wasn't a good day for me either. Thanks for the reminder not to complain because the good can outweight the bad. Today's a new day and it WILL be better.
<>< Katie

Kellene said...

Oh yes! I'm not in medicine but IT Security. I started a new job a few months ago, and my first desk was right in the middle of a pod of middleware developers (guys who create the stuff that talks to everything else). It was the perfect place to sit and get to know how the company actually functioned. I was able to establish a relationship with the people who's behavior I most need to influence, and hear what their daily struggles are in person.

After a few months, I was moved to a newer, larger cube in the middle of the telecom area. I share a half-wall with a conference room, so I get to hear everything that goes on there. Again, I'm getting to know a lot about hwo we actually funtion (as opposed to how we say we function), I'm in the middle of a busy area, and I'm getting to know a bunch of people who are key to how we do business.

In a few months, my "permanent" office will be built next to the network guys. Ha! More people to know, more people to be involved with on a day to day basis.

The more "important" my job gets, the more critical it is for me to understand the day-to-day life of people who do the basic work of my division. They are the ones who get things done. Understanding their challenges and needs lets me lead them so much more - and I get the fun of staying connected to the technology and people who love it.

Fancy offices with windows are nice, but I love being a part of the action - even if the action is a bunch of geeks typing away on computer code or configuring a server.

Heather said...

We have laptops on wheels too! We call them COWs (computers on wheels)...which has been a problem when yelling-- "Hey, I see your COW by room 711" and the family member thinks you're talking about them. ;)

I make my station near my patient rooms just like you do. And, good or bad, it's always an interesting perspective.

Stephany said...

When my daughter was admitted to the ER last summer, due to the residential care facility pulling rank and sending her for a mental health eval, she had a nurse sitting in the middle of the area where she could observe 3 patient rooms at one time, write notes, and all of this took place with one chair, and a rolling bedside table she created for a work station.

It became impossible to hear each other speak or for me to answer questions about my daughter because of the schizophrenic man yelling obsentities behind us, left on a ER rolling bed/gurney, in the hallway, lacking dignity in one of his worst moments.

I became increasingly frustrated they did not find a space for this man.

Mental health patients, need compassion just as much, along with patience. If your patient was given an intramuscular drug, it would have skewed the observation for admit into a psych ward, so I assume he must have been discharged after that.

The man in the hallway in my daughter's ER was sent home in a taxi without an eval, or care.

My daughter was committed.

ER's house emergent crisis, and we cry, we are seen at our worst moments, all of us don't want to be there, any time someone is compassionate or takes the time to smile and care it is noticed, it is also noticed when we are set aside---as difficult or annoying, people KNOW the looks on doc and nurses faces.....

911RN said...

Too funny...."space" in the ER is premium, high dollar, real estate. Admire Shirley's ingenuity and love the fact that you adopted and actually, enjoy her new work station for all the reasons stated.

In our ER, the docs are in the same "fish bowl" as the nurses, in the middle race track of the ER-just positoned to one end. It keeps them in the mix of the ER,the nurses, the patients and THE most important person, the unit secretary!

We only open Minor Care for the busy summer, tourist season and we are stuggling this year on where to house this area.Having task force meetings this week and trying to get it straight before season is upon us. Tick, tock.

Outpatient/Chemo has become very busy and "taken over" our former Minor Care area as our little hosptial on the OBX continues to grow.

Computers have not been a big issue. We have 3 available desktops "reserved" for ER docs, 5 for nursing, 1 for secretary, 2 COWS,2 laptops, 5 in previous Minor care area and EVERY patient room has a computer in our 17 bed ER.

Yes, Dr Jim- I am trying to recruit you! However, I may be out of luck if I don't learn how to make some of those kleenex flowers to adorn your reserved station;) I was not on the prom committee- probably taking a useless class like Advanced Biology or something. Thought I might need that to be a nurse- who knew? I needed advanced, kleenex flower making instead!

Enjoyed the post.

Anonymous said...

It must be really frustrating not to have a computer available when you need one -- Shirley's idea was perfect! Glad you took advantage of it, too. And I'm touched that you came to enjoy that spot in the middle of things, even if you end up being the "go to" guy when patients have questions.

I've spent little time in ERs, but when I have, it's been with my parents, one or the other of whom needed ER care. I don't like to bother ER personnel, but sometimes the wait for answers can be dreadfully long. Thanks for being friendly and helpful to those patients who approach you, Dr. Jim.

Anonymous said...

This is exactly what environmental and interior designers to to re-design work spaces. It's interesting to me that Shirley did it on her own instincts. Whenever it gets too busy at my workplace, I usually take my laptop or a work laptop and go to the library zone space and turn on my cellphone in-case I need to come back (I work at a school).

When I'm volunteering as team leader in the geriatric hospital, it is hard to find an inch of space at the Nursing station, especially at rush hour-seriously. I can't work in the patient lounge because of confidentiality-- patients would get paranoid that I'm writing about them, but it's just the norm--so I often go to the kitchen if it's empty, or the PA/TR/OT/Physio lounge, or sometimes the hallway too. We have carts in the hallways, and I can often lean my binder on the carts to finish up my notes. The work has to get done, and I don't want to have to come back over time to finish it up.

SeaSpray said...

It's frustrating when there isn't enough workspace ..especially when you are busy.

The makeshift set up sounds like a good one though.

Perhaps you can have input in getting a more permanent solution in a location you prefer. ?

I am sure the family appreciated your efforts in attempting to silence the schizophrenic patient.

Stacie said...

What a wonderful idea! And great insight to the working conditions you all face...

Stephany said...

Adding to my original comment, I had my "mental health advocate hat" on, this story kind of hit home for me.

It's obvious Dr. Jim is a compassionate and caring doctor, and I appreciate the stories here.

I think the bouquet of kleenex flowers is too funny!

Cal said...

The hub, so you won't miss a thing.

Jabulani said...

Sounds like our school. I do voluntary reading with the kids; some days there is just nowhere for the 2 of us to sit so I can hear them read. Last summer, I hit upon the idea of going outside and we sat under a tree - it's the only quiet and unbusy place we can find. This summer, I plan to go there straight off. I've even got a rug I'm going to lay out at the start of my sessions!! Goodness knows what I'll do if it's raining...