SPOKANE, Wash. — Emergency rooms have become a safety net for overlapping crises in Spokane and statewide. With limited capacity already, wait times are increasing and bed space is falling short for those with immediate physical emergencies.
“The hospital systems are really trying to address burnout, they’re trying to address our mental health, but a lot of the things that we need are bigger than the system can provide,” Lanny Lucas, a registered nurse at Multicare Valley Hospital said.
If you believe nurses are the heart of healthcare, then how is the system to pump patients without the central muscle? For an industry that’s main purpose is to help others, many factors are leading to a helpless feeling among those working in emergency rooms.
“Our altruism is still there, we still care, but the challenges are really getting to be insurmountable in some places and people are leaving,” Lucas said.
Lanny Lucas believes in the mission to help others; he’s been following that dream for decades. But now, that dream is living on unsteady ground. Like this nurse’s conscience, emergency rooms are overwhelmed.
“If we haven’t built in 15 years, and we have a 15 to 20 percent increase in growth in the area, where are those people going to go, right? They come here still, but now they’re in the waiting room,” Lucas said.
Emergency departments here in Spokane, state and nationwide have become the epicenter, a safety net, of care for overlapping crises: homelessness, substance abuse, mental disorders.
And with an increase in people part of this demographic arriving to the ER in need of care and beds, rooms are falling even shorter; in turn, wait times are increasing for people with true physical emergencies, like a pregnant woman, a heart attack, a broken arm.
On average, Multicare Deaconess sees just over five patients a day in the ER with behavioral health issues and about ten percent of them stay over 24 hours. Deaconess North sees an average of one patient a day with behavioral health issues, and Valley Hospital sees just under four patients a day with behavioral health issues, six percent staying over 24 hours.
“So, a lot of my true emergencies are now being seen in hospital beds that are set in the hallways or secondary areas or even chairs now,” Lucas said.
Nurses like Lucas are carrying a heavy burden, asking themselves: how can I help the behavioral health patients while also making sure to never turn away a true emergency, in a department with ‘emergency’ in its name?
“Just walking in and telling a patient, ‘Hey, we’re going to admit you, but I don’t know when,’ that’s just a failure, that feels so wrong,” Lucas said.
Left with one of the most difficult decisions: who’s sicker? To Lucas, whose only mission is to provide care no matter who you are, there’s no right answer.
“We also have to take care of these psych patients, we have to take care of these patients that come in and are not able to care for themselves, for whatever reason,” he said. “I’m not their judge, I’m there to make sure they’re safe and there to make sure that they don’t harm themselves or harm anyone else.”
According to the Emergency Medical Treatment and Labor Act (EMTLA), the federal mandate from the Centers from Medicare and Medicaid Services (CMS) states, any emergency department that receives Medicare dollars (which is almost all of them) must provide a medical screening to any patient presenting for care.
The emergency department is then required to provide stabilizing medical care to its ability, including for patients with a mental health emergency.
And since Deaconess and Valley Hospitals in Spokane do not have inpatient mental health units, this may mean that these patients are waiting in the ER to be transferred to a facility for definitive care, like a shelter or rehab center; yet, as these services run short, the time a mental health patient spends in the ER an add up. Sometimes hours, sometimes days, sometimes even weeks.
“What happens most of the time, those folks that stay for the long time in our emergency departments, are not the unhoused, they are those that need an involuntary psychiatric bed placement, or those who have developmental delay or who have long-term care needs that we cannot meet, and we can’t find a community agency who has a bed who can take them and meet their level of care,” Jennifer Graham, Chief Nursing Executive for Deaconess and Valley Hospitals, said.
And it’s not just happening in Spokane; Washington as a whole is struggling.
Cassie Sauer is the CEO of the Washington State Hospital Association, and while you may think more hospital space is the answer, she poses another avenue.
“We need different capacity. You need an emergency room to be there if you get in a car wreck or fall off a ladder or have a heart attack, that’s what it’s intended to be for. It’s not intended to be ‘we don’t have anywhere else to put this person, so we’re going to take them to the ER,’” Sauer said. “To create different kinds of services will go much further in alleviating the strain on ERs.”
Sauer says King County, where Seattle is hit hard with this exact issue, has already paved a path of change.
That leaves Spokane County waiting to catch up; Multicare has created an observation room inside Deaconess downtown where mental health patients can be held, but sometimes even that special room fills up.
“I am not aware of any plans right now to increase the number of involuntary mental health beds in Spokane, there is an ongoing shortage,” Graham said. “We hope to see an increase of funding for these services in Washington state, and until then we will continue to be a safety net in the community.”
And that safety net is held together, tightly, by people like Lucas. But that burden is heavy on the heart of a nurse.
“I want to feel like I’m doing a good job, I want to go home and feel like I’ve done what I’m supposed to do and a lot of times, just given the challenges that we have that are bigger than the hospital system, I just don’t. I just don’t feel like I’ve done a good job, and that’s demoralizing,” Lucas said. The burnout is real, and it’s going to take a lot to reverse. But this job is needed, and many nurses will continue to show up.“I tell my new nurses, learn to save some for yourself, save some for your family, but the truth of the matter is, I get to save lives.”
