[Joannie]

I apologise for assuming that it is possible to act and care at the same time. Obviously this is not possible in the ER. It is sad that there are so many people who only consider their own views to be valid. I will not be commenting further on this matter.

[MAISY, RN-ER]

Wow, haven't been around today, hot discussion...this is very simple. I would love for our peers to spend several days in the ER. No one can understand the huge responsibility involved. Every admission is an unknown....no labs, studies, or exams have been performed. Why is the patient sick?

If you work on a floor, you have these answers provided after I am done with stabilizing the patient. Caring is not missing in the ER, but back rubs and palliative care may not be forthcoming. It's not our job! We are about the basic business of breathing, pumping,and body parts working. Not that the other isn't important, but our environment does not lend itself to it!

It's terrible that anyone has to wait, but wait they must. We don't know the whole story because it wasn't written. Blaming nurses for an entire admission is short sighted, and quite honestly, ridiculous! We know this as a group, however, the general public does not!

If it was written as a frustrated parent, we could understand what the patient and their family sees.....the minute her credentials were mentioned....over and over.....she crossed the line and provided unfair and incomplete commentary on an entire profession.

So again, for those of you who work in NICU, ICU, CCU and anywhere else with 1:1, 1:2 ratios....it may be difficult to understand why we feel angry...for those of us who work critical care and run around like crazy....it's easy. She represents as one of us, yet it's obvious she doesn't have a clue.

Maisy

[Michigan RN]

The fact that I go to work, assess my patients, give them their meds, make sure that there is enough Levophed in the I.V. bag so it won't run out and their BP won't drop, turn them from side-to-side so they don't get sores is because I care. I care that my patient's BP is stable, I care that they are getting the correct antibiotics for their infection. I however am not going to stand next to a patient, hold their hand and give them false reassurance that "everything will be ok" when I know that they will likely not survive. False reassurance is not caring. And I am sick to death of the nurses who think that all a patient needs is to have someone hold there hand say those words.

I may not know what it's like to work in ER but I greatly respect the RNs that do. It can suck at times and be crazy busy, but I don't know how ya'll do it. But please don't pretend to think that ICU RNs have it easy because of the ratio. I have gone many days at work without a break, even to go to the bathroom or take a sip of water.


AND LIKE I SAID BEFORE, KAREN MADSEN CAN BITE ME

[Michigan RN]

Originally Posted by MAISY, RN-ER

So again, for those of you who work in NICU, ICU, CCU and anywhere else with 1:1, 1:2 ratios....it may be difficult to understand why we feel angry...for those of us who work critical care and run around like crazy....it's easy. She represents as one of us, yet it's obvious she doesn't have a clue.

Maisy

I am only slightly offended by this argument but I forgive you. NICU,CCU,ICU is critical care so is ER. People think that being in the ICU is easy because of the ratio. Believe it is the opposite ninety percent of the time. Get an unstable liver transplant from OR and that may be your only patient but let me tell you this, you'll run, run, and run some more. You'll be up to your ears in blood products and labs and PA caths.

[MAISY, RN-ER]

Kati,

Don't take it personally....just seems as I looked at the profiles, it was nurses with more specialized palliative care experienced nursing that were objecting to the opinions that were posted.

I try to bring "holistic nursing" to my care, but time, patient loads, and acuity is my enemy....so I do my best. Personally, I don't think anyone would've made Karen Madsen happy.....I am just not sure that anyone can understand the demands and our possible inability to provide "niceties" just by some of these recent comments.

I am with you, hope she's hungry.....my favorite line, she can "bite me too!"

[Michigan RN]

Originally Posted by MAISY, RN-ER

Kati,

Don't take it personally....just seems as I looked at the profiles, it was nurses with more specialized palliative care experienced nursing that were objecting to the opinions that were posted.

I try to bring "holistic nursing" to my care, but time, patient loads, and acuity is my enemy....so I do my best. Personally, I don't think anyone would've made Karen Madsen happy.....I am just not sure that anyone can understand the demands and our possible inability to provide "niceties" just by some of these recent comments.

I am with you, hope she's hungry.....my favorite line, she can "bite me too!"

It's quite alright, Maisy. I'm over it.

My opinion is, if you've never worked in ER or ICU, you don't know how it is. The "concept" of caring to me it totally different there. I've said it before, I may not smile and hold a patient's hand but that doesn't make me less of a nurse and it DOESN'T mean that I don't care.

[CritterLover]

I've been following this thread for a while now, and while I haven't posted in it yet, I did post a comment to the author's reply when it was posted on the website.

Reading these last few pages, I feel the need to point out that caring, and acting like one is caring, are two different things.

One can care without it being outwardly obvious; coversely, one can act like she cares without really giving a darn.

There have been times where I was in triage, when I'm sure the patient had no idea how hard I worked with the charge nurse in the back to try and get him to the back faster. Or that even though I might not have time to recheck VS, I was still keeping a close eye on those that worried me every time I stepped into that waiting room.

Why didn't I tell patients these things, as some are advocating we should do?

Well, for one, it just sounds so fake to me, like I'm trying to shift the blame from myself to someone esle. When in truth, there really isn't any blame to be had, except for the faulty system.

For another, if I were to have to justify/explain/apoligize for everything that could/would go wrong with an ER waiting room stay, it would tack several minutes onto my triage time, and that wouldn't be acceptable.

Finally, some consider warning/educating patients about potential long waits to be an EMTALA violation. (Rationale that risk management is concerned we could be accused of telling those w/o insurance that there was a long wait, in hopes they would leave).

The author stated in her follow-up that she did go to the triage nurse after the initial encounter. I'm curious as to what those exchanges were about. Was she telling the nurse about a codition change, or was she requesting a repeat in VS, or was she just bugging the nurse about the wait time? In general, I only would recheck VS on the patients in the WR if there was no one left to be triaged or if I had given some clonidine for elevated BP or if there was a condition change. (Rationale being that I had a set of VS on the already-triaged group; I needed to see the new patients before seeing the old ones again). If we were "holding" many inpatients and nothings was moving yet people were still checking in, then sometimes I would request to have a tech come up and re-vital the ones still waiting. Usually, though, they waited until they got to the back.

My biggest irriation with the article, though, was the sentiment that you can't be a good nurse if you don't smile all of the time and act all sweet and happy.

While I agree that some degree of giving a darn is pretty important in nursing (and really, in healthcare in general), I do take exception to the idea that you can tell how much I care just by looking at me.

I can already hear the "Is it really so hard to smile?" comments. So before anyone says it, let me reply: yes, sometimes it is. Considering that triage can see over 100 people in a 12 hour shift -- yes, for some of us, it can be difficult to be "on" all the time.

Sigh ..... I can already sense what is coming next. In addition to telling patients how we "strive for five," and are giving them "excellent care" with their "excellent meals" and their "excellent mediciatons," now were going to have to add on "because I care!" with a big "cheerleader" smile pasted onto our faces.

[Ruby Vee]

Originally Posted by CritterLover

I've been following this thread for a while now, and while I haven't posted in it yet, I did post a comment to the author's reply when it was posted on the website.

Reading these last few pages, I feel the need to point out that caring, and acting like one is caring, are two different things.

One can care without it being outwardly obvious; coversely, one can act like she cares without really giving a darn.

There have been times where I was in triage, when I'm sure the patient had no idea how hard I worked with the charge nurse in the back to try and get him to the back faster. Or that even though I might not have time to recheck VS, I was still keeping a close eye on those that worried me every time I stepped into that waiting room.

Why didn't I tell patients these things, as some are advocating we should do?

Well, for one, it just sounds so fake to me, like I'm trying to shift the blame from myself to someone esle. When in truth, there really isn't any blame to be had, except for the faulty system.

For another, if I were to have to justify/explain/apoligize for everything that could/would go wrong with an ER waiting room stay, it would tack several minutes onto my triage time, and that wouldn't be acceptable.

Finally, some consider warning/educating patients about potential long waits to be an EMTALA violation. (Rationale that risk management is concerned we could be accused of telling those w/o insurance that there was a long wait, in hopes they would leave).

The author stated in her follow-up that she did go to the triage nurse after the initial encounter. I'm curious as to what those exchanges were about. Was she telling the nurse about a codition change, or was she requesting a repeat in VS, or was she just bugging the nurse about the wait time? In general, I only would recheck VS on the patients in the WR if there was no one left to be triaged or if I had given some clonidine for elevated BP or if there was a condition change. (Rationale being that I had a set of VS on the already-triaged group; I needed to see the new patients before seeing the old ones again). If we were "holding" many inpatients and nothings was moving yet people were still checking in, then sometimes I would request to have a tech come up and re-vital the ones still waiting. Usually, though, they waited until they got to the back.

My biggest irriation with the article, though, was the sentiment that you can't be a good nurse if you don't smile all of the time and act all sweet and happy.

While I agree that some degree of giving a darn is pretty important in nursing (and really, in healthcare in general), I do take exception to the idea that you can tell how much I care just by looking at me.

I can already hear the "Is it really so hard to smile?" comments. So before anyone says it, let me reply: yes, sometimes it is. Considering that triage can see over 100 people in a 12 hour shift -- yes, for some of us, it can be difficult to be "on" all the time.

Sigh ..... I can already sense what is coming next. In addition to telling patients how we "strive for five," and are giving them "excellent care" with their "excellent meals" and their "excellent mediciatons," now were going to have to add on "because I care!" with a big "cheerleader" smile pasted onto our faces.

In just the minute before I dash off to work let me say that I agree with you wholeheartedly! Especially about the assumption that a big smile means you care while the lack of one means you don't. And Madsen, being a nurse, should know better. I don't think anything could have made that woman happy on that day -- and that's OK. But the public rant that followed is not.

[hiddencat]

I'm not a nurse yet, nor am I a nursing student yet- just finishing my first semester of prerequisites. I've read this entire thread as well as both of Madsen's articles.

One of the reasons I was drawn to nursing is my passion for social justice, being aware of how economic inequalities come to a head with healthcare, and hoping that I could be part of the battle for reform while doing practical things to make people's lives better. I agree with everyone who has said that Madsen missed an opportunity to highlight a flawed system in much need of improvement in her first article, and then was snippy and unconstructively nasty in her follow-up. And kudos to all of you who posted comments to her articles- especially the second one.

She writes that "[o]ur healthcare system is broken, and nursing is a huge part of that. The first way to fix it is to define the problems," but truly misses the boat on that one.

"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."

Interesting you should say that. A couple of years ago, I went to the ER with severe abdominal pain- sharp, knife stabbing, could barely walk. Luckily, things were slow, I was in a bed and hooked up to an IV within a few minutes, and you know what? It turns out I was just constipated/gassy. I imagine my vitals were totally normal, but I certainly didn't know that and wouldn't have appreciated what that meant. But going to the ER, I was prepared for a long wait, because, well...I guess I had the common sense to realize that there's just usually waiting involved in an ER visit unless you're going to die soon.

[Toquay]

Hmm wonder if the ER's supervisor or director were present during this perceived described fiasco? If it was during the day, they are most likely at a meeting discussing how to save and budget even more money, usually by way of bare staffing, or if at night they were home sleeping while staff dog paddled to keep their heads above water. Of course, complaining to magangement, they would just fire the "problem nurse". The real problems of healthcare start at the top not the bottom. Nurses are the perfect scape goat for all of healthcare woes, we are easy targets and very expendable. Nursing is the only career where you are part of the majority but treated like a minority.

Toq