I give excellent pt care, I work to treat the pts well and in a professional manner. But still I have questions at time. I work in an Emergency Dept.

I'm sure like all of your reading this, you have staff meetings that seem to be a waste of time. I wouldn't mind the meetings if they presented information that helped me give better care or were informing us of policy updates.

But the meeting seem to always follow the same format.

1.) You got 2 positive responses from pt feedback.

2.) All the things you are doing wrong.

3.) Leave if you are unhappy here.

Under the 3rd point come the topic of abusive, usually ETOH/drug impaired pts. Our demographics included a large percentage of male pt's in their 40's upwards. Many have Mental Health issues and a large percentage have substance abuse issues. Some of these pts have attacked the staff on occasion. One staff member that was bitten by a pt was investigated because she pushed his head trying to get her arm out of his mouth. She was removed from the dept for over a year while being investigated.

During our meetings we are told we should expect to be attacked and abused by the pt's because "this is an ER" and are encouraged to find other jobs if we are unhappy.

I'm not an unhappy nurse, I enjoy my job and I enjoy pt care. However I don't think it should be accepted that we are going to be attacked by pt's. I work at a facility that is very punitive against the nursing staff. It seems as if any nurse that gets fired is a feather in the cap of management. They are able to point out to their bosses that they got rid of some bad staff.

My question is, if you work in an ER, are you supported in pt attacks? Or does the management blame the staff?

Another question I have regards searching pt belongings. If someone comes with SI/HI or they are going to be 1013'ed (declared mentally unfit) I'm good with going through their stuff to ensure they don't have any items that could harm them. If they come in with a possible OD, I'm good with looking through their stuff. But if they come in Walkie/talkie, A&O x 3, I don't see where I should have to search their belongings to make a list of their items (if they are going to be admitted.) If I was going to be admitted, I don't believe I give up my right for privacy. But the policy where I work expects us to search all belongings of admitted pt's and to doc all their items. If we find NARCOTIC meds we are to get a witness and dispose of the drugs - if there is no one their we can send them home with.

How does your facility handle this?

I have asked questions at our staffing meetings and you would think we could refer to a single policy but that never seems to be the case. Policy changes by the week or even day some times. I've had emails telling me what we were not allowed to do one day and two days later I get an email telling me we are expected to do those things - from the same person.

So, to be clear, I am not disgruntled. I"m gruntled if anything, though I am frustrated. My hospital gives a lot of lip service to pt care but they don't show in the right ways. Despite this I do the best care I can. But I do worry that with polices in such flux, and SO SO HARD TO FIND, there could be problems later.

And one more thing as a side note of a more personal nature. My coworkers give me a hard time (joking) because I introduce myself to my pt's as Mrs.XXXXXXXXXXX. When they ask about it I tell them I have at least 10 years of formal education though this may not be apparent based on my writing skills. I'm 61. I'm a professional and I always address my pt's as Mr. or Mrs/Ms. I'm not the pt's friend - we are not on a first name basis. We have a professional relationship. If I was 16 and working at a fast food place, I wouldn't have any say in the matter. The pt's address the doctors as Dr. and while I am by no means an MD, I am a professional in my field. Does anyone see a problem with expecting the pt to address you as Mr/Mrs? When I've asked the naysayers they are never able to give a cohesive argument. I'm not going to change what I do but it would be nice to see what others thought.

I know some may think safety but all the pt has to do is ask for my last name or any of the staff and someone will tell them. I also wear a badge/ID with my First and Last Name that must be visible at all times. My full name and address is also registered with the state so anyone can look it up. I couldn't keep the pt from knowing my surname if I wanted. So I do not believe safety is a valid argument against being addressed by one's surname.

Should pt's address you by your surname or first name?

(I'll try to make this a poll question but not sure if I know how.)

If nothing else, I thank you for letting me rant. Just no emails saying I"m burned out and need to find another job please.

Thanks

3degreeRN

Honestly, an RN requesting that their patients address them as Mr or Ms whatever seems a bit pretentious.

I'm not an ED nurse, but I would leave this facility yesterday. Assault is a crime. We don't come to work to be subjected to violent crime. I'd hate to think that it will take an RN getting beaten to death for this place to wake up... but seriously, if you are not safe you need to remove yourself.

In my ICU, if a pt strikes at a staff, they are immediately put into 4-point restraints at a minimum.

I'm not the one to search their stuff, so can't speak to that.

And I don't care if they call me by my first or last name. If they use a cuss word in lieu of my name, I'm clear that I won't answer to that, though.

Should pt's address you by your surname or first name?

I introduce myself to my patients as first name last name, nurse. Most of them address me as nurse or sometimes my first name if they can recall it. When they ask someone else about their nurse they usually refer to me as the tall blonde or attempt to describe me by the color of my clogs It seems patients have a hard time remembering our names, we all look the same in our pyjamas, errr scrubs.

I call my patients by their first names too (different culture perhaps, I'm Scandinavian), and I think that most would think that I was mocking them

somehow if I referred to them as Mr or Mrs.

About the violence. Yes, the risk of violence is an unfortunate part of ER nursing. It can sometimes be expected but should in my opinion never be accepted. An employer who doesn't offer support and stand up for their employees and does everything possible to minimize the risk for or escalation of violent behavior, is in my opinion a very poor employer. I personally wouldn't work under such conditions.

I don't have anything to say about the constantly-evolving policies, but it does suck. Your environment is not supportive of nurses, especially ones that defend themselves. The one about the nurse who tried to extract her arm from the patient's mouth, and got a long investigation about it is all the evidence one needs for a nurse-toxic environment.

As as for the name use, do what you want. I call pts Mr./Ms. But refer to myself by my first name. Only children and teenagers in my personal life are corrected if they call me by my first name.

Eta: kudos on the REM reference. Whatever happened to them?

So many different things to consider here. I understand that there is the risk of having abusive patient's come in, but you should have a means for dealing with them that helps keep the staff as safe as possible. The first hospital I worked at gave us the opportunity to take a class of which defensive maneuvers we were allowed to use when being attacked by patients. All of them were about getting out of harms way without hurting the patient. They took staff safety very seriously.

As for filling out the belongings on admission, someone has to do it. Every hospital I have worked at had the admitting nurse do it. It is done for liability reasons. If something is lost or broken, the list of patient's belonging's helps determine if the hospital is responsible for it or not. Looking through the belongings also gives staff the opportunity to identify the things that need to be taken home and be sure that the patient won't be self-medicating while in the hospital (ideally).

As for the name, when I meet my patients, I say "Hi, I'm (first name) and I'm going to be your nurse today/tonight". I don't offer my last name and prefer not to have it on my badge. I've worked at hospitals that have allowed me to not have it on my badge. My last name is confusing for most people to pronounce/spell. I feel I would not have as good of a relationship with my nurse if she insisted I called her Mrs. _______. It just seems to cold and distant to me when I put myself in the patient's position. While I'm not expecting a friendship, I am expecting more warmth than that presents, in my opinion.

I give excellent pt care, I work to treat the pts well and in a professional manner. But still I have questions at time. I work in an Emergency Dept.

I'm sure like all of your reading this, you have staff meetings that seem to be a waste of time. I wouldn't mind the meetings if they presented information that helped me give better care or were informing us of policy updates.

But the meeting seem to always follow the same format.

1.) You got 2 positive responses from pt feedback.

2.) All the things you are doing wrong.

3.) Leave if you are unhappy here.

Under the 3rd point come the topic of abusive, usually ETOH/drug impaired pts. Our demographics included a large percentage of male pt's in their 40's upwards. Many have Mental Health issues and a large percentage have substance abuse issues. Some of these pts have attacked the staff on occasion. One staff member that was bitten by a pt was investigated because she pushed his head trying to get her arm out of his mouth. She was removed from the dept for over a year while being investigated.

During our meetings we are told we should expect to be attacked and abused by the pt's because "this is an ER" and are encouraged to find other jobs if we are unhappy.

I'm not an unhappy nurse, I enjoy my job and I enjoy pt care. However I don't think it should be accepted that we are going to be attacked by pt's. I work at a facility that is very punitive against the nursing staff. It seems as if any nurse that gets fired is a feather in the cap of management. They are able to point out to their bosses that they got rid of some bad staff.

My question is, if you work in an ER, are you supported in pt attacks? Or does the management blame the staff?

Another question I have regards searching pt belongings. If someone comes with SI/HI or they are going to be 1013'ed (declared mentally unfit) I'm good with going through their stuff to ensure they don't have any items that could harm them. If they come in with a possible OD, I'm good with looking through their stuff. But if they come in Walkie/talkie, A&O x 3, I don't see where I should have to search their belongings to make a list of their items (if they are going to be admitted.) If I was going to be admitted, I don't believe I give up my right for privacy. But the policy where I work expects us to search all belongings of admitted pt's and to doc all their items. If we find NARCOTIC meds we are to get a witness and dispose of the drugs - if there is no one their we can send them home with.

How does your facility handle this?

I have asked questions at our staffing meetings and you would think we could refer to a single policy but that never seems to be the case. Policy changes by the week or even day some times. I've had emails telling me what we were not allowed to do one day and two days later I get an email telling me we are expected to do those things - from the same person.

So, to be clear, I am not disgruntled. I"m gruntled if anything, though I am frustrated. My hospital gives a lot of lip service to pt care but they don't show in the right ways. Despite this I do the best care I can. But I do worry that with polices in such flux, and SO SO HARD TO FIND, there could be problems later.

And one more thing as a side note of a more personal nature. My coworkers give me a hard time (joking) because I introduce myself to my pt's as Mrs.XXXXXXXXXXX. When they ask about it I tell them I have at least 10 years of formal education though this may not be apparent based on my writing skills. I'm 61. I'm a professional and I always address my pt's as Mr. or Mrs/Ms. I'm not the pt's friend - we are not on a first name basis. We have a professional relationship. If I was 16 and working at a fast food place, I wouldn't have any say in the matter. The pt's address the doctors as Dr. and while I am by no means an MD, I am a professional in my field. Does anyone see a problem with expecting the pt to address you as Mr/Mrs? When I've asked the naysayers they are never able to give a cohesive argument. I'm not going to change what I do but it would be nice to see what others thought.

I know some may think safety but all the pt has to do is ask for my last name or any of the staff and someone will tell them. I also wear a badge/ID with my First and Last Name that must be visible at all times. My full name and address is also registered with the state so anyone can look it up. I couldn't keep the pt from knowing my surname if I wanted. So I do not believe safety is a valid argument against being addressed by one's surname.

Should pt's address you by your surname or first name?

(I'll try to make this a poll question but not sure if I know how.)

If nothing else, I thank you for letting me rant. Just no emails saying I"m burned out and need to find another job please.

Thanks

3degreeRN

Your facility should be teaching you MAB or CPI. There are relatively safe ways to handle assaultive patients that protect you and the patient from harm. In the case of the bite. If you push their head away from the bite you're apt to lose a piece of your arm and hurt the patient as well. Instead push your arm into the bite and downward and they will automatically open their mouth. It's funny but in six years of working acute psych I was only injured twice - one time seriously. If your facilty is not teaching you these skills they run a huge liability of lawsuits from both patients and staff when injuries occur.

Hppy

As a patient I don't care whether you introduce yourself as Sally or Ms. Smith. Everyone should be allowed to determine how others address them.

It's not going to affect the relationship I have with my nurse. In the ER or as a patient on the floor I'm not going to bond with my nurse. We're not friends. It's a professional relationship.

I would care if the nurse called me Sue and insisted that I call her Ms. Smith. That would be rude. As long as she called me Ms. Jones, then I would be comfortable with calling her Ms. Smith.

Doctors are actually really bad about this. They call the patient by their first name, but expect the patient to refer to them as Dr. Brown. It's a way for them to establish power in the relationship.

I wonder if establishing a more formal, professional atmosphere in the ER by using title and last name might encourage some people to behave better?

As for titles - I don't mind if my patients call me by my first name - When I worked in psych we were very informal because psych patient's can become really billigerant with authority figures. The trick with these patients is to try not to set them off because once the fuse it lit there will be an explosion I guarantee. (BTW I love the term mentally adrift). Of course I work with a lot of Alzheimer's patient's and am lucky if they remember their own names much less mine. Most of my patient's I address as Mr, Miss or Mrs but again the average age of my patient's is between 75 and 100 so for me it's a respect and generational thing.

In California - the law states that all patients but especially psych must be treated in the least restrictive manner possible and the use of restraint's is strictly regulated. The person must be assessed by a physician after the first hour and every two hours thereafter with new orders for the reason for restraints specifically noted. Doctor's hate that so they usually will DC the restraints if they can pretty quickly.

hppy

My question is, if you work in an ER, are you supported in pt attacks? Or does the management blame the staff?

We are supported where I work. We also have a capable, responsive security staff, and a good working relationship with the police. I have worked where this was not the case, and to say "it sucked" doesn't even begin to adequately describe the level of suckiness.

Another question I have regards searching pt belongings. If someone comes with SI/HI or they are going to be 1013'ed (declared mentally unfit) I'm good with going through their stuff to ensure they don't have any items that could harm them. If they come in with a possible OD, I'm good with looking through their stuff. But if they come in Walkie/talkie, A&O x 3, I don't see where I should have to search their belongings to make a list of their items (if they are going to be admitted.) If I was going to be admitted, I don't believe I give up my right for privacy. But the policy where I work expects us to search all belongings of admitted pt's and to doc all their items. If we find NARCOTIC meds we are to get a witness and dispose of the drugs - if there is no one their we can send them home with.

How does your facility handle this?

Inpatient nurses document the patient's belongings when they arrive on the inpatient unit. The purpose in non-behavioral health, non-SI/HI/OD patients is not primarily to look for contraband, but have documentation for 2 days later when a patient reports something missing.

And one more thing as a side note of a more personal nature. My coworkers give me a hard time (joking) because I introduce myself to my pt's as Mrs.XXXXXXXXXXX. When they ask about it I tell them I have at least 10 years of formal education though this may not be apparent based on my writing skills. I'm 61. I'm a professional and I always address my pt's as Mr. or Mrs/Ms. I'm not the pt's friend - we are not on a first name basis. We have a professional relationship. If I was 16 and working at a fast food place, I wouldn't have any say in the matter. The pt's address the doctors as Dr. and while I am by no means an MD, I am a professional in my field. Does anyone see a problem with expecting the pt to address you as Mr/Mrs? When I've asked the naysayers they are never able to give a cohesive argument. I'm not going to change what I do but it would be nice to see what others thought.

I know some may think safety but all the pt has to do is ask for my last name or any of the staff and someone will tell them. I also wear a badge/ID with my First and Last Name that must be visible at all times. My full name and address is also registered with the state so anyone can look it up. I couldn't keep the pt from knowing my surname if I wanted. So I do not believe safety is a valid argument against being addressed by one's surname.

Should pt's address you by your surname or first name?

(I'll try to make this a poll question but not sure if I know how.)

If nothing else, I thank you for letting me rant. Just no emails saying I"m burned out and need to find another job please.

Thanks

3degreeRN

I work with a nurse who uses surname only when introducing self to patients. Sometimes new staff think it's "weird" ... for about 5 minutes ... then they find other things to worry about. So it's a non-issue. I wasn't crazy about the wording of your poll - whether or not a patient should address their nurse by first name or surname - but I voted "Nurse Smith" to indicate that I think that is a perfectly acceptable form of address, and that an individual nurse certainly has the ability to dictate the boundaries of interpersonal interactions.

Wishing you a better shift next time you work.