"Your ER sucks!" and other pleasantries...how you handle them?

[livingthedream77]

Hello, ladies and gentlemen of the ER.

It's happened to us all, and I would love to hear your experiences.

I work in a TINY 6 bed ER in the middle of corn town USA. There are 2 other hospitals of the same size near us, 5 miles, and 10 miles away.

Middle aged man comes in with his spouse, with c/o low abd pain for 2 mos, worse in last few days. Wife has a stack of test results, CT reads, etc, which is literally 1/2 inch thick, complete with CDs, mostly from nearby hosp.

She will not let him speak for himself, gets very angry when I speak to the pt, not her, concerning sx. He tells me he has trouble urinating, sense of incomplete emptying. Look through docs, US abd yesterday (at closeby hosp), states marked bladder distention consistent with bladder outlet obstruction, suspect prostate hypertrophy. Also seen is cholelithiasis.

Explain we will do UA, standard blood tests, will take approx 1 hr, will go from there. Super duper.

45 mins later, wife snaps on another RN that NOTHING has been done, we've been waiting here OVER AN HOUR, no one had bothered to check on them, he's hungry, hasn't eaten since yesterday.

Other RN talks to doc, he goes in, explains eating bad idea d/t abd pain, he's read US results, suggests bladder scan, and dependent on results, straight cath. Pt says "oh, yeah. They've done that before and I felt better right away." Wife argues with doc that it can't be urine retention, HAS to be his gallbladder.

Meanwhile, I go in with scanner, explain. Pt is cool. Wife starts with "I have to tell you. Your ER SUCKS! Your waiting room sucks! The staff here SUCKS! No one was in here. This should be like the ICU. You should be in here every 5 mins making sure he didn't fall out of bed!" ...etc.

Take the therapeutic high road. "Oh, I'm sure you are sick of hospitals, with your husband's hx of leukemia, etc. I wish it was like the ICU also, where there are only 1 or 2 pts per nurse, but being in the ER, we treat by severity not time of arrival.....blah blah blah."

Her response? "Well in (other hospital) they knwo what's wrong. They would've had an IV in already. What the hell is wrong with you? Why isn't he getting fluids?!"

Explain, "we suspect urinary retention, giving fluids isn't recommended..." etc.

*evil glare*....."are you going to scan or just stand there?"

Deep breaths...do scan... >725ml is result. OK, now please go urinate...nope, can't.Not at all.

OK, I'll tell doc. Insist they are going out for a smoke. Explain no smoking on grounds, you leave grounds, you're AMA, etc. They go anyway.

Should have signed them out AMA....but in the interest of pt care (didn't want his bladder to explode) did not do this.

Guess what?! Now go do a straight cath, doc says. I love my job, I says. Yeah....not happening. Curling up, can't get past prostate. Get OK for coude. That works, eventually. 825ml out, 100% relief of pain.

Wife now silent, her MD from Google University called for gallbladder, it was retention, now she's really ******. Go in to give dc papers, follow up with urologist, etc...."thanks for nothing. ("*****" muttered under her breath).

Wanted to say, if you think we suck it so hard, and X hospital is the place to be, why did you come here? But I didn't.

Thoughts? ****** me off. Solved your problem, but you're more worried that YOUR WebMD dx was wrong, than your husband isn't in pain anymore. I'm sure a complaint is coming, not that concerned, documented everything till Hell wouldn't have it.

Thanks!

[livingthedream77]

Kalipso, I think the worst part of it is as you say, these people want you to help, and you're trying, but you're getting 'verbally abused' for it.

No where else would this happen. If you bad mouth a teenager at the McDonald's, the manager will step in and tell you to leave. Where is our support? Even a simple "I would appreciate it if you did not talk to me that way, it interferes with my duties" will be frowned upon by management.

Patients are patients, big difference between that and a 'customer'. The patients are NOT always right.

Cute

Witty, charming, and brilliant, too.

We conservatives are the reason nurses have a crappy lot in life

Nope, it's actually the policies that you promote, not you as people.

and labor unions are the ONLY way to solve those problems.

Well, waiting on the generosity and largesse of the executive class certainly isn't going to provide any improvement.

Good that you didn't drag politics into it, though.

It's an inherently political topic.

[Crux1024]

I am grateful that generally when someone appears to doctor/ER shop and comes to the ER with results from another nearby hospital with the same or similar complaint, they get a lecture from the MD about staying at the same hospital for continuity of care. then case management gets to go in and lecture them as well. I don't think they like it much but it gets the point across.

[uRNmyway, ASN, RN]

It also angers me that, at least at my facility, if a patient files a complaint -- it is presumed that they are correct and that the nurse must have behaved inappropriately -- and the nurse will receive a written reprimand from HR. This makes me very angry and distrustful.^^^^^^^^

^^ Yes ^^But only because the nursing profession chooses not to demand it. How many nurses on this board are anti-union? Quite a percentage from what I've observed over my 7 years visiting here. How many identify as 'conservative' and staunchly back Republican, Libertarian, or Tea Party candidates? Perhaps a minority but not a small one. In the present "corporations are people and money is speech" environment, as the power and influence of unions is steadily eroded via legislative and judicial means, the lot of nurses should be expected to worsen, not improve.

Coupled with the deliberate overproduction and saturation of nurses in the market, it's a pretty discouraging landscape. Simple supply-side economics will drive down the working conditions and compensation of nurses.

Oooh, hold on now. I come from somewhere that is pretty darn left-leaning. Unions are everywhere. If you work for a hospital, it is MANDATORY to be part of the union and pay their dues. Nurse to patient ratio? 8-9:1 med-surg nights. I've also worked post-op ortho where it was 12:1 night shift. Unions did NOTHING to help that, they just used the dues to go have nice dinners and have 'conferences' in nice hotels on nurse's backs.

I'm not saying that corporations running healthcare is great. I'm just saying that government and unions being in control is DEFINITELY not better or the right answer.

[stygianabyss]

I always say "Sorry you feel that way. This isn't a prison, you're free to choose your hospital"

[GrannyRRT]

Reading discussions like this makes me more mindful of my own behavior, expectations and demands in customer service anywhere.

We have McDonald's at the hospital and I really feel bad for the young people working there. If the line isn't moving fast enough or some healthcare professional is taking a break after a few demanding patients they feel it is necessary to express their frustration at whoever has the misfortune to be working behind the counter. This in turn causes other healthcare professionals in that line to get vocal with some very nasty comments at these young cashiers who are probably only 17. But, somehow we justify our own bad behavior by our worse patient.

Take a deep breath, smile and be thankful your worst patients are not members of your own family. But, one thing about small towns, everyone eventually becomes like your family or neighbors and you learn to tolerate them just like you do with some of your own.

[MECO28, BSN, RN]

A McDonalds?? In a hospital?! Good lord, talk about one stop shopping...does your cath lab offer a punch card?

[NurseOnAMotorcycle, ASN, RN]

Had a pt apologize for repeatedly swearing at me by saying "I don't like to be a b!+

Pt complained about me to anyone that would listen. Apparently I wasn't as impressed by the level of "good at it" as I was supposed to be.

[Pudnluv, ASN, RN]

We were intubating a pt the other night and the pt on the other side of the curtain was complaining that no one had been in to see him. When his wife told me they were going to leave, i replied, "so leave". I told her it was absolutely her right to leave if she wished and that we were not going to hold them hostage. She told me they were upset that no one had been in to see them (EKG was done, IV inserted and pt placed on monitor at time of arrival). I explained that non breathing pts had priority over pts who could breathe well enough to complain. I don't remember if they left or not.

Also had a family member who kept complaining to other staff members that no one had been in their room all night. This was after I had spent a good 10 or 15 minutes in the room for the umpteenth time. I confronted him directly and all he could do is stutter.

I tend to get a bit crabby at about hour 10 of my 12 hour shift.

[Catch22Personified]

I just do the best I can for the patient and that's all. I've only been annoyed to the point where I said: "Go ahead and leave! Your insurance won't pay if you leave. It's a free market, so go ahead."