A friend sent me the article you wrote about your son's (and your) experience at St. Peter Hospital Emergency Department. I am sorry for your son and hope he is doing better.
I worked at St Pete's ED for nine years, finally leaving a year ago for many of the reasons you described in your letter. I could no longer work there and feel like I was able to provide safe and compassionate care for the patients and their families, nor for myself. I needed to get out for my own mental health! While many of the issues are specific to that ED and its policies, the larger problem is that our community does not have an adequate number of hospital beds for in-patient care and it all falls back on the ED. At any given time, half or more of the patients occupying beds (in hallways or otherwise) are actually admitted to the hospital but there are no beds for them on the inpatient floors, so they wait, often for days, in the ED. Clearly this causes a back-up to where there may be only 1 or 2 open ED beds to accommodate patients in need of emergency care. This is a very complex issue, but from my perspective, our community (and the surrounding 5 counties served by St. Peter Hospital) needs another large hospital. In the meantime, Providence-Swedish needs to stop being so profit-driven and actually pay their staff wages to compensate, attract and retain nurses at all levels. The majority of nurses in the hospital have assignments of 5-6 patients. It is absolutely impossible to provide safe care to that many people. Better pay, better working conditions would help increase staffing, which would open more beds, provide better nurse to patient ratios and trickle down to reduced back-up in the ED.
As far as the pain medication policy, I agree it is frustrating. I hated working the "greet desk" where people who were waiting would need immediate care but we were not able to help. There are many issues behind this, one of them being that if a narcotic is given, the patient is supposed to be monitored and re-assessed within an hour. As you can see from your experience, that is not practical. The fear being someone might get too sedated or their blood pressure would drop, or they would have another adverse reaction while they were in the waiting room and the staff would not know this. Also, if an IV is placed and the patient is sent back to the waiting room, it can and has been used by drug-seeking patients as an easy way to inject their drug(s).
As a side note, I am also a retired Paramedic-Firefighter with the Olympia Fire Department (25 years). It's true the EMTs in Thurston County cannot administer medications (except aspirin for suspected Acute Coronary Syndrome, and epi pens for anaphylaxis). However, they could have requested an ALS unit (paramedic) for pain management. Since your son was at Squaxin Park, they may have figured it was more efficient to transport him to the hospital rather than wait for the paramedics to arrive (of course, ultimately its possible the medics would not have even given him pain meds because they would have had to transport him then and potentially end up stuck waiting in the ED with him, which takes them out of service for potentially life threatening calls...the "what ifs" are endless).
So thank you for your article and for reading this letter. I am deeply disturbed by the situation at St. Peter ED. I loved emergency nursing until it became such a horrible situation there. It was bad before Covid, actually, and Covid only made it worse. However, the problem is not Covid. The problem is multi-faceted. There are many things that the leadership of the ED could do to help, but ultimately Providence-Swedish leadership needs to wake up and stop ignoring the horrendous situation. I hate the fact that I can no longer feel safe telling friends and family to go the ER when they need to. Better pay, better working conditions for all of the nurses would help and ultimately, another hospital for our community is what is needed to improve this situation (CMC is tiny and inconsequential).
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