Is the cynicism inevitable?

Specialties Emergency

Published

I'm sure this topic has been hashed and beaten to death, but it's new to me, and definitely not something i can vent about to Facebook or even my family (non-medical)...I started working in the ER setting in January, in the "Minor Care/Fast Track" area. ESL 4's and 5's and "soft 3's" are ours to deal with. Loving the kids, but sometimes their parents/guardians/whatever blow me away. The lady who insisted I give their kid ibuprofen before they left because she had none at home and couldn't afford any. Of course I got the order and gave it to the patient, but in the back of my mind I'm thinking resentfully, "$5+ for that pack of cigarettes you were out smoking when they called your daughter's name in the waiting room but you can't afford $3 generic Tylenol?" I try to put myself in their shoes, but sometimes it gets difficult to understand how a parent's priorities can get so out of order. At least she brought her daughter in, though...

Obviously working in the ER you see, hear and deal with a lot of things you wouldn't otherwise be exposed to...how do you deal with these situations in your mind? The example I gave is nothing compared to what I'm sure a lot of you have dealt with...how do you keep from becoming cynical and jaded???

Specializes in Emergency & Trauma/Adult ICU.

It's up to you to judge where the line is between *realism* and *cynicism*.

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If you aren't cynical and jaded, you aren't payig attention.

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Specializes in ER.

The only inoculation I know is regularly scheduled breaks from life in the er.

Full on vacations that leave you remembering that there were moments when you learned how precious life is, when you watched people be heroic or graceful, when you learned that a team of people can be a room full of heroes for a reason bigger than a paycheck, when you saw a miraculous resuscitation, and a death that shouldn't have happened but did anyway. Its those moments that make you feel lucky to have become an ER nurse.

For the record, I consider myself completely jaded. Ha ha

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I'm getting jaded and I don't care.

I've even told pts who complain that "it takes all those doctors and nurses to work on one person", yes, it does. And if you were actively dying or one of your family members you would want everyone to work on you to save your life". This usually get me a dirty look and I don't care.

I've had pts follow me into a sick pt's room asking for a blanket and I've told them that's not the priority, we have a SICK person here I have to tend to FIRST and you will get your blanket once I'm done dealing with this EMERGENCY. I say this as I'm walking right past them with the airway cart/crash cart/hand full of supplies.

But that one pt that really is sick, that we've worked on to get to the cath lab/OR and WALKS out the hospital 10 days later makes it all worth it.

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Specializes in ER, progressive care.

I have been working on and off in the ER since January but I just officially transferred recently...and I'm already jaded. Do I love the ER? Absolutely. But some of the things patients come in with are absolutely ridiculous. Mom brings in her 2 week old because "she felt hot." Didn't take the infant's temp at home. Infant did not have a fever. The other night I had an elderly patient come in complaining of constipation. That's it. At 0300. VSS, no other complaints, just constipation. And trying to get the provider to refill a prescription for honestly something that wasn't necessary at the time and could have waited until they could see their PCP in a few hours. It's things like that that are in my opinion a total waste of time.

It's the adrenaline rush I love and stabilizing TRULY SICK individuals that I love. I also have an amazing team of nurses, techs and docs that I work with that make a world of a difference.

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Specializes in Med-Surg, Emergency, CEN.

I found that I went through a period of "all patients are entitled drug seekers" but that fades away to something more tempered. I feel like compassion returns after a while. Naïveté? Of course not, but compassion definitely.

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Specializes in Med Surg, ER, OR.

Yes, the fact of cynicism in the ER environment is certainly an interesting one. I have been there for 4 years now and there are moments that I truly wonder about my view on the lives of others, but there are other moments that bring me back to the reality of people actually having souls and caring about the life of others. Does it sound like we are jaded, cold, or heartless? It certainly does at times. But, taking vacations away from the environment and relishing in family time is important! My wife and I recently took a medical mission trip and this helped resecure my thoughts in the human race. Once again, the cynicism that arises, I believe, is mostly from the environment of the ER. I am very involved in my church and I believe that it is my belief in God that has kept me sane.

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Specializes in Emergency.

I started out in the ER all bright and shiny with stars in my eyes. I knew that not all the patients I would see would be truly ill but I had the impression that it would be the "man-flu" over reaction types. There certainly are many of these patients, but then there are the liars, the drug seekers and those who truly don't give a darn that they aren't sick, they want immediate treatment for their (admittedly minor) problems. There are the patients who could have prevented their visit with some different life choices, but take no ownership of this. There are people who will treat you like garbage no matter how kindly you behave to them.

It hardens you, or it breaks you. Many people choose to leave the specialty for this reason. I have discussed it with my peers and many say "I won't last." I often am not proud of the way I react internally to patients, although I am proud that I am able to continue to provide the same care to them as I do to others.

Every once and awhile I will have a moment when I know I am not too far gone. I recently had a patient in with no urgent medical complaint. Instead this person was suffering from one of the most horrific family crises I can recall. I discharged her and the went and cried like my heart was breaking in the bathroom. I can still walk a mile, but I will say that it is getting harder.

I think the cynicism is a defense mechanism, and a functional one. If I ever find it that I cannot treat a certain patients with some compassion it will be time for me to pack it in.

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Specializes in ED.

I've been in the ER for almost five months now, and I've not really been bothered by much. Until a few days ago, when I had to work with a 101 degree fever, a horrible cough, chills, headache, congestion....and I had to care for a few pts with the same complaints (only their "fever" was 99.0 F). My favorite part was that I was coughing so hard I was close to vomiting, exhausted because my coughing was so bad I didn't sleep much, plus the nasal congestion...and I never observed these pt's cough, blow their nose, nada. Yet their pain was a 10/10, they were just soooo sick, asking for pillows and blankets and rolling around in their beds crying about how sore their throats are...and here I am, their nurse, far sicker than any of them, they're getting excuses from work for the next few days, and I'm getting told "sorry, we're too busy, I know you're sick, but you can't go home early." I think that was the moment this starry eyed new nurse became a jaded crab.

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Specializes in Pediatric nursing: ED, forensic, neuro, triage.

The ED can be a maddening mix. Personally the best strategy for me, in combatting cynicism and annoyance (both of which can fester into burn-out) is to FORCE myself to treat each patient concern with equal respect and care. If my non urgent cases are having to wait and their care is delayed because of a code, I tell them so. Not in a judgmental-you're-gonna-have-to-wait way, but in a way that conveys respect and truth and care. If all I can do for them in that moment is to turn the lights down and offer some words of support, then that's what I do. The little things really do go along way and can soften even the stingiest of annoying patients...... It will in turn soften you and make things easier.

I'm honestly burned out for other reasons, but doing the above makes getting through the night a little easier : )

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Specializes in ED.

I have definitely become jaded and cynical after 4 years in the ED. That being said, I have also learned that sometimes the ones that we think are bogus can actually be legitimate. So I treat strive to treat everyone as if their complaint is legitimate. I have found that if you treat your frequent flyers with respect and kindness, they may actually be your advocate when things in the department go to hell. Also, sometimes a warm blanket or pair of booties can go a long way to keeping someone satisfied while they wait. I try to keep in mind that even drug seekers get sick and the mom that brings her children in for sore throats and earaches is at least seeking medical care for those children. It takes very little energy to be kind, even when you just want to roll your eyes and scream but you will feel much more satisfied at the end of the day. I guess after all this time, my cynicism has turned in to a type of resignation. But I can honestly say that I am very satisfied and happy with my job.

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@Pudnluv: I totally agree and appreciate your post. I think becoming cynical is just a natural evolution of coping with the ED. I think it's tremendously important though that we don't let that prevent us from providing appropriate care regardless of our personal opinions. My cynicism has long been tempered by this thought "No matter what that person came in for, it has no bearing on MY life (other than perhaps the stress of work time)...AND I figure that person took time and energy to present for SOMETHING....may not be what they say but they obviously have a NEED. 1. I'm not going to cure addiction, stupidity, laziness, lack of prioritization, bad parenting or any other maddening human condition. 2. Yes they take time but I'M not going to prioritize differently...my motorcycle trauma will always trump that gotta-know-right-now 2am pegnancy test. 3. (Mostly) the better you treat them the more pleasant they are and the faster they leave (unless they suffer from what I call Chronic Adult Entitlement Syndrome)....to summarize...just go with the flow. Turn the cynicism into humor or use it to sharpen your assessment skills.

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