[Spidey's mom]

Originally Posted by Nurseynurseyme

How am I "ganging up" on you. I did not write a word of mean spirited comments. I am trying to give a realistic picture of triage, and the abuse triage nurses receive every single day.

Sorry if I wasn't clear, that comment was a general one, it wasn't necessarily directed at you; in fact I thanked you mostly because you weren't mean!

Sorry for the misunderstanding.

I have already posted on this more than people probably want to read so I don't see a point in reiterating my position and reposting my evidently minority opinion.

Again, thanks for your contribution and thanks for being civil.

Hi - I haven't been here for days and just wanted you to know that I see your points and share many of them.

Not that I don't think ER triage is tough - and that patients are at times "drama queens". And that the ER is abused by folks who need to make an appointment at the doctor's office or use a walk-in clinic.

However, I do think there are some things we can do to make communication better. And that the author made some of those points.

Of course I have a button that says:

"If you have a cell phone, cigarettes and a bag of chips in your purse, find another $3.00 and buy your kid some Tylenol!".


steph

[ERTraumaJunkie]

Nurseynurseme,

This is probably going to sound mean spirited and I promise it isn't meant that way, but if you feel like you are being ganged up on and beat up on in here, then you haven't had to develop the kind of thick skin we ER nurses have.

We deal with "in your face" threats of violence and abuse practically each and every day we go to work. We have been cursed. We have been threatened. Some of us have been physically abused. I have been punched in the face. Spit on. Scratched. And I have been told repeatedly by patients and family members I am the nicest nurse in the ER. And I receive the abuse regardless.

I leave my shift alone at 11 pm each night. I walk cautiously to my car. Never knowing if the drug seeker that didn't get his fix might be waiting for me. Or if the family member whose mother died in spite of all our best efforts may have lost it. I have been stalked by the mentally ill patient that fixated on me as his girlfriend just because I was nice to him each time he came to the ER. I have stood across the desk from a patient and had him threaten to come back to kill me and the doctor because we wouldn't give him a 'script for Vicodin. I am on a first name basis with every cop in town because we get to spend so much time together.

There is no, I repeat, no way anyone can understand what it is like to work in an ER in 2008 unless you have done it. We are under paid (I'm an LPN, so imagine how little I make to take this abuse) and very much under appreciated by both administration and the public. Just getting a thank you from one patient or family member is such a rare occurence that it can brighten our day considerably. Having someone remember and appreciate you enough to mention your name on a Press Gainey survey is enough to make us ecstatic for a week!

Why do we do it? Because once in a while, we get to make a difference and save someone's life. In between toothaches and hangnails, someone comes in that needs us with a true emergency. The public will never understand or truly appreciate what we do. And I can deal with that. Its just part of being a nurse in any position.

But to have another nurse...one with a position in education yet, help foster this environment of misunderstanding and under appreciation in such a public and CREDIBLE way, breaks my heart. That's all any of us are getting at. She had a very public and respected forum, and according to Avery Comarow he "...turned this space over for a day to Karen Madsen...". She very well knew her comments were going to be on U.S. News and World Reports site. And she sold out her colleagues. Plain and simple. And then she sold us out again with her response.

Even though we expect this kind of thing from lay people, it has a much harsher sting when it comes from one of our own. In an environment where healthcare is already circling the drain and patients feel helpless and hopeless, why would someone in such a position of authority help increase the resentment? Why bash nursing as a whole when we seem to be the only ones who DO still care about the patients? Administration sure doesn't.

Mrs. Madsen had a chance to make a difference. She had a voice that could have educated and informed. But she didn't. And definitely as a nursing professor, I see that as her responsibility. She could have helped us as a group by educating the public on the reasons for her difficulties. But she didn't. She just didn't. And that is where her failure lies. She layed blame, but she offered no solutions, no explanations. "It's a stressful place; people are sicker, staff is shorter, beds are fewer". And whose fault is that, Mrs. Madsen? Whose fault is that? The nurse that chooses to work there? Or could it be that maybe since you are in a nice comfy position of authority, you didn't want to rock the cradle by placing blame where it really lies?

"But it took over four frustrating, fearful, pain-filled hours for that help to arrive. Is that truly the best that an emergency room in 2008 can be? Is that truly all we as a society could hope for? Is that truly the best nursing could be as well?" I'm sorry. I know you don't feel she laid the blame at the nurses feet. I do. Is that truly the best nursing could be as well? Yes, Mrs. Madsen. In the ERs of 2008 with administration cutting staffing and refusing to acknowledge what really goes on behind our doors...that is the best nursing can be. And we ARE the best nurses we can be considering what we deal with each and every day.

[pooh54]

Dear Nurseynurseme, Yeah, it can seem to be you're being jumped on. I think that everyone agrees that Karen has some valid points but to condemn the whole nursing profession, painting us as somehow below her expectations and chiding nursing without looking at ALL the factors involved is what has nurses upset. We try to do our jobs in a caring, competent manner and yet are working under constraints that most would consider abusive. Not pointing these out to the public is not helping the nursing profession but harming us. If Karen had pointed out some ways to alleviate the long wait times, the lack of protocols/parameters for the triage nurses (read: no pain meds for 4 hours..again, the physician HAS to order these BEFORE a nurse can give them) to help the pts in the WR's, the slant on her article might have elicited a different response. Nurses are just as frustrated, they are thinking of what they will have to face if their own family members are ever in the same situation and to be honest, it scares us! Please don't take this as a rant against ou, we are all hearing what you are saying, it just would have helped if Karen had been a bit more focused on the system that isn't working with todays needs instead of focusing on nurses who are trying to fix these problems instead of just the nurses.

[tandlsmom]

I have to respond to the letter by Karen. As a FORMER ER nurse these scenerios are all too often. Patients and their families complaining of long waits in ER's across our country. I am appalled that "one of our own" has no idea how much our ER's are in "crisis mode" and is BLAMING the hardworking nurses for it. As a previous ER triage nurse I have seen it all! From patients who were in acute medical crisis and not being seen for hours, to parents bringing in their children because they were misbehaving and they "could not do anything more with them". We had patients with cavities that wanted the ER docs to pull their teeth, patients with mild colds to be treated and patients that frequented the ER at least twice a week because they were lonely and felt special by the nurses. The crisis in our ER's is not due to the nurses but the government, the hospital and the community that turn a blind eye to the problems. I can honestly tell you that an ED triage nurse will be burned out within a year with what he or she faces. It is very clear from Karen's letter the she like many administrators, instructors and government leaders are far removed from the reality of hospitals today. I started in nursing in 1981 and I am amazed at the difference between hospitals now and back then. If you have been out of hospital nursing for more than 5 years you can consider yourself out of touch! Someone out there please defend out nurses!!!!
Ann RN

[Ayvah]

Originally Posted by nurseynurseme

I agree with you, but still I think she was reporting her experience only.

That's the thing, she is NOT simply reporting her experiences. She continually states she is a nursing instructor, therefore "in the know", and purports by this that she has the inside story about what goes on in ERs and that her experience was inexcusable. But she doesn't know, and therefore gives nursing an unwarranted black eye.

I remember one patient asked me about a man with dementia next door who was screaming. I told her we were taking care of him but she was very concerned. I wished I could tell her the reason he was yelling but couldn't. I'm sure she probably was left with the impression that I was callous and uncaring to this man. And I will not apologize for eating at the nurses station so that I can continue to monitor my patient's heart rhythm. When it comes down to it, comparing patient safety vs a bad impression to a family member, I will take patient safety in a heartbeat. The time I apologize for that, is the time I quit nursing due to my priorities not being right.

Ms. Madsen states that the nurses were soulless because they did not care about the person in the waiting room that was crying in pain. Like others have said, its very possible this person was a frequent flier, and lier. As a nursing instructor, she should know this possibility exists, and look a bit deeper at the situation. It is frustrating when one of our own does not give us the benefit of the doubt before condemning us. She states she saw the worst of nursing because the nurse did not smile or show concern. She would have a valid complaint if the nurse did not do her job correctly, but that is not the case. To say that a nurse who is correctly doing her job (but without smiling) is embarrassing, is what is bewildering to me. I would take a competent nurse anyday over a friendly one who does nothing, especially when lives are at stake. She should care about competence over all else, for her daughter's well being.

Yes, I agree that we all can use reminders about the importance of smiling and customer service. The point is that there are immense burdens on nurses the public is unaware of, which massively inhibits our ability to not only keep people alive, but also to have good customer service. Instead of berating the nurses for not being perfect every minute of their shift, how about looking at the obstacles to good nursing, to work on those? She had a golden opportunity to look at the real problems with healthcare which impact morbitity and mortality as well as customer service.

I spoke with a patient about her hospital stay a few months back. She told me with disgust about how her medications were not available, and that the nurse failed her because she didn't check on that at the start of her shift. I informed her about how medications are dispensed, and what pharmacy does, and how they are short staffed, and how nurses are oftentimes communicating with pharmacy throughout the shift, and that it is oftentimes a logistics problem, not a nursing problem. She was very surprised at this, and thanked me for changing her perception of the situation.

Nursing is scapegoated for multitudes of problems. It would be nice if an instructor acted as not only a patient advocate, but also a nurse advocate(so we can be better patient advocates). Its pretty disappointing when a leader of nursing not only fails to step up, but kicks nursing when it is already down.

Look at Maslow's hierarchy of needs. Number 1 is to focus on keeping the patient alive. This trumps any customer service needs. We as nurses must advocate for this above all else. Ms. Madsen, instead of focusing on how to make the ER process better, focuses on a relatively minor problem in a condescending and astonishingly berating tone. Its a one sided story made worse due to the perception that it is a two sided story.

The replies here have all echoed incredible disappointment on her wasting a great opportunity to educate the public and work towards life-saving change. I really have not seen the mean spiritedness that you consistently describe, and I have read every post and reply. Sure, the little things are important and do make a difference. But the bigger problems should take far more prescendence, especially from the mouth of an instructor, and especially when it comes to the life of her daughter.

[Joannie]

I know that everything gets blamed on the nurse, instead of on the system, but honestly folks, patient assessment is a continuous process, and a patient with appendicitis should have been closely monitored. Also, even though we are busy busy all day long, would it kill us to show some interest in our patients as people, even if it is just a two second fly by? And lastly, nursing is supposed to be a caring profession, in case any of us have forgotten. If you can no longer care about your patients, you should be working somewhere else.

[earle58]

Originally Posted by Joannie

I know that everything gets blamed on the nurse, instead of on the system, but honestly folks, patient assessment is a continuous process, and a patient with appendicitis should have been closely monitored. Also, even though we are busy busy all day long, would it kill us to show some interest in our patients as people, even if it is just a two second fly by? And lastly, nursing is supposed to be a caring profession, in case any of us have forgotten. If you can no longer care about your patients, you should be working somewhere else.

abd pain is such a pervasive and ambiguous complaint.
how was the triage nurse to know it was appendicitis?

and where did you read that the nurse didn't care about her pts??
you don't work er, do you?
otherwise, you'd understand the concept of triaging and prioritization.
finally, nsg is sooooo much more than a caring profession.
critical assessments and spit fire judgments, comes to mind.
the absolute sickest, need to be seen first.
in the absence of a blazing temp and projectile vomiting, abd pain can be as major as a perf'd appendix or as minor as gas.
maybe you'll get a clearer view when you come down from your throne, and are on ground level w/everyone else.

leslie

[Joannie]

Actually I am working, and have been for the last 36 years. It was the originator of the post who said that she found the nurses to be uncaring, not me. However, my point was that I know nurses are busy, and I know they are overworked, but often this is presented as an excuse. And incidentally, I don't feel that you are justified in making a personal attack just because I don't agree with your views.

[earle58]

Originally Posted by Joannie

And lastly, nursing is supposed to be a caring profession, in case any of us have forgotten. If you can no longer care about your patients, you should be working somewhere else.

i consider the above statement, a major attack on your colleagues...

Originally Posted by Joannie

It was the originator of the post who said that she found the nurses to be uncaring, not me.

it certainly reads like you were saying it.
furthermore, i still have no idea where your assumptions come from.
and that's all they are, assumptions.
and it comes across as very 'holier-than-thou'.
the er is purportedly to intervene first and foremost, to those who present w/critical s/s, then tending to those w/less urgency.
it is fast-paced, stress filled for all involved.
acting trumps caring.
actually, caring is a bonus.
acting is an absolute necessity.
we need to keep these priorities in mind.

leslie

[Ruby Vee]

Originally Posted by Nurseynurseyme

Thank you, I don't disagree with you. I know ER is a hard job, but so is every other job in nursing.

I guess what I find appalling is the general willingness to gang up on someone who actually made valid point, and on people trying to advocate for the patient. There is a scary willingness on the part of some of us to believe that ALL patients come in LOOKING for something to complain about, they are ALL nasty whining PITA's. And nobody seems willing to consider that there ARE mean nasty nurses out there and I KNOW There are because I have witnessed scary things; like pushing morphine too fast on purpose to make the patient vomit to get even with him for making the nurse call his doctor. This is not a misunderstanding, the nurse in question actually told someone that that was what she had done!

We are not all perfect, and most of us do the best we can. It is not easy. Patients are not perfect. Neither are they all horrible. For some, to criticize one of us is the same as criticizing ALL of us and the claws come out.

I feel ganged up on and beat up in here. I wasn't going to comment again and here I am doing it. But I give up.

Some of the mean spiritedness in here is very very discouraging.

Karen Madsen was bashing the nursing profession and the nurses she encountered; she was not "advocating for a patient." In fact, had she been "advocating for a patient", that could have started in the first paragraph of her vent, where she accuses her daughter of being a drama queen rather than conducting a nursing assessment. If Madsen HAD a valid point, she didn't make it. Rather she vented about her horrible experience rather than take the time and use her credentials to educate the public about WHY there's a long wait in the ER, WHY nurses are forced sometimes to eat at the station, and why patients on post-op floors often have to wait for things like drinks of water and extra blankets. If Madsen, as a nursing instructor doesn't understand these things, shame on HER.

As for why you might feel ganged up on, perhaps it's because you still don't get it. If you haven't worked a mile in the ER nurse's shoes, you have no right to criticize -- especially for something as silly as "not smiling" or requiring food. And as for the alleged "mean spritedness", I've no doubt that some of the ER nurses in here suspect you of bashing on THEM and find you lacking in empathy, understanding, knowledge and respect of them and their terribly difficult job. I know I do.