ER Nurse Attitude

[Chlometov]

A few weeks ago, my 89 year-old grandmother fell at her home, resulting in a bleeding gash in her arm (and later discovered, a broken hip). My mother took her to the emergency room. I wasn't there, so everything I write here is what was told to me by my mother.

After my grandmother was brought into the ER and placed into a room, arm still bleeding, she and my mom waited an hour and was still not seen or treated by a nurse or doctor. My mother goes out into the hallway to find someone to see what's happening and why no one has seen them yet. I don't remember the exact events, but there was one nurse who was extremely curt with my mother. She stated, "We literally having patients dying right now", using her hands to emphasize, and added that it's okay for bleeding to occur for a certain amount of hours, her justification was that infection won't occur until hour 6 of bleeding. (Which really is not in the best interest of my grandmother, who has anemia and frequently requires blood transfusions, but I can give the nurse the benefit of the doubt because how was she supposed to know that?)

I just feel like the nurse was very rude about the situation, and could have handled it better. I understand that nurses need to prioritize patient care regarding acuity, but just bluntly stating that she "literally has patients dying" invalidates both my mom's right to be concerned for her mother and my grandmother's need for treatment and care.

It is possible that my mother could have been bothersome to the nurses, I wouldn't know beause I wasn't present to witness it, but couldn't the nurse have calmly explained the situation and why no one has seen them yet?

I am experiencing some cognitive dissonance from this situation, because I have been on both sides of this. I am angry at this nurse for being rude to my mother and inattentive to my grandmother, but I also know how irritating family members of patients can be, unaware of the fact that nurses have several patients for which to care. (So far in my hospital experience, dealing with family members is my least favorite part of nursing.) I'm trying to justify the actions on both the part of my mother and of the nurse, and I just want to know your thoughts on this.

[dudette10, MSN, RN]

Yeah, the nurse was rude, and a lot of people gave reasons why she might have been rude. She could have just as easily said, "We are all caught up with emergency situations. Your mother is currently stable, and someone will be with her as soon as we can. Thanks for your patience." But she didn't. Shrug it off. :)

[VICEDRN, BSN, RN]

To be honest, I don't see anything in your post that actually demonstrates that the nurse was being rude. I work in the ER and I have often found that there is a double edged sword in talking to patients and their families. First of all, they are upset about the situation they are in and unrealistic about their wait times. (Seriously, an hour to be seen is nothing.) Second, they want information and are largely capable of rational thought.

So if I were to say, "I'm sorry for your wait. We are busy with patients that are LITERALLY trying to die right now...it might be be percieved as rude now matter how I say it because...well...its not the answer someone who is upset, unrealistic, operating without information (they don't know our other patients) but still capable of rational thought wants to hear. In other words, I literally become their whipping boy because they don't like the answer.

When they argue and you tell them, you could wait up to six hours to have that gash sutured, their rational mind understands that you are trying to prioritize but they don't like where they fall on the priorities list.

Further, I think patients and their families become self conscious and their egos get bruised because they can't think of anything more serious or important than what is happening to their family member until they realize that they have been independently assessed as stable and can wait. Its hard news to react to!

I don't know how many times I have seen that happen or been the victim myself. I remember a specific situation in which a family member complained that a physician had been "rude" to them when he informed them of a patient's death. However, I had been standing in the room when he delivered the news. He was professional, straightforward and honest. He gave them time to answer questions and expressed his sympathies to them. He is one of the nicest docs I have ever met yet...he was rude to them?? No, not so.

Bottom line: No one likes bad news. No one likes being told that someone else is sicker.

[imintrouble, BSN, RN]

I'm wondering why, in this age of customer service hysteria, they don't have a hostess in the ER. Doesn't have to be a nurse, just a well dressed, professional looking person to go from room to room with a hostess cart offering coffee, cookies and approved platitudes.

The above might sound like sarcasm, but I don't mean it that way.

It would free up medical staff, and thrill families who require frequent 1-1.

The OP's family was not upset with the message, but in the way it was delivered. The nurse was rude. Hire somebody whose job is simply to schmooze the pts.

[VICEDRN, BSN, RN]

I'm wondering why, in this age of customer service hysteria, they don't have a hostess in the ER. Doesn't have to be a nurse, just a well dressed, professional looking person to go from room to room with a hostess cart offering coffee, cookies and approved platitudes.The above might sound like sarcasm, but I don't mean it that way.It would free up medical staff, and thrill families who require frequent 1-1.The OP's family was not upset with the message, but in the way it was delivered. The nurse was rude. Hire somebody whose job is simply to schmooze the pts.

Some ERs have this. It works to a point but also has its drawbacks. They feed everyone but scurry to come get you when a patient vomits up what they fed them. They push through complainers to the detriment of other patients. They make non medical judgments in situations and exert their influence to get what they want. Better yet, they make a convenient spy for management so it's ends up being another rear you have to kiss rather than helping you out since they can impart no medical wisdom to patients. (Ex. Why do I need this test? Customer service rep: let me ask your nurse! Another example: customer service rep: patient says you didn't medicate them for pain. You: I already told them that they have to wait...)

[OCNRN63, RN]

If you weren't there to witness the exchange, how do you know the nurse didn't explain things calmly to your mother and it was your mother who took things out of context?

Codes do trump everything else in the ED.

[Esme12, ASN, BSN, RN]

Thank you, all, for your responses. I just wanted to see all of your perspectives on the issue. I had explained to my mom at the time that nurses can be pulled in several different directions at once and that I can understand why the nurse was acting the way she was. It was just a frustrating night for all parties involved. Like I said before, I felt particularly torn on the issue because I have been on both sides in my short experience of being in the hospital. I feel like I mention this in every post of mine, but I'm still only a student so I still have a lot to learn when dealing with patients, families, and colleagues

The ED is a difficult place to work. Everyone needs to be seen immediately.....from their (the family and patient) point of view. I have always found that the hardest to deal with is the parent with their first born child that took 3 years of in vitro to get with the first chin laceration that the child will survive this injury and waiting will not cause the child their life.

The families perception of urgency is completely on the other end of the spectrum from the ER nurse priority and point of view. That the nurse didn't take the time to "explain" or not sound rushed is sometimes the necessary evil in the ED.....for all you know they were coding a baby.

Yes sometimes we are over whelmed and rushed and in our task oriented demeanor (which is imperative in the ED) we may sound harsh or not very fuzzy. It is very possible that the nurses delivery of the message left plenty to desire...but she may have been so overwhelmed.

I'm sorry your Grandma was injured and I will say prayers she will heal quickly......just remember that your mothers love for her mother....clouds her vision slightly. The demands on the ED nurse can sometimes make her responses less than optimal.

Good Luck in school.

[JZ_RN]

The nurse was being honest, and while that may come off as rude, she's probably been dealing with people pestering her or being nasty to her all day. The nurse is a human being. I am positive she deals with a lot of jerks daily. And sometimes, a person can't take anymore, so maybe she was rude but it's not personal.

A bleeding cut is not life-threatening. They probably had stroke or heart attack victims or stat surgical needs or women in labor or something. I get that she thinks it was rude but would you want them rushing back a person with a non-life threatening injury (or listening to someone whine) if your loved one was slurring their speech, face drooped, can't talk, can't walk, unconscious, or having chest pains? No. They aren't making you wait on purpose, you just have to wait as long as it takes. They are human and can only do what they can do. Honestly, I find that if a patient or family member bugs me about something non-emergent it makes things go much slower, makes me annoyed/angry, and makes them end up actually waiting longer. And whining about it the whole time.

[JZ_RN]

I'm wondering why, in this age of customer service hysteria, they don't have a hostess in the ER. Doesn't have to be a nurse, just a well dressed, professional looking person to go from room to room with a hostess cart offering coffee, cookies and approved platitudes.

The above might sound like sarcasm, but I don't mean it that way.

It would free up medical staff, and thrill families who require frequent 1-1.

The OP's family was not upset with the message, but in the way it was delivered. The nurse was rude. Hire somebody whose job is simply to schmooze the pts.

They'd cut a budget and lower nurse staffing to do so, and the patients and families would still whine.

[psu_213, BSN, RN]

I'm wondering why, in this age of customer service hysteria, they don't have a hostess in the ER. Doesn't have to be a nurse, just a well dressed, professional looking person to go from room to room with a hostess cart offering coffee, cookies and approved platitudes.

Basically that is what our volunteers do. For legal reasons they cannot touch pts, even if it is for repositioning, helping them out of bed etc. They can get the pt a warm blanket, which often helps.

[ERloverRN]

In high stress events like a code or a patient you know is going to code you re not going to have a smile on your face as an RN. The house is burning down and someone is complaining about being hungry.

People coming out into the hall and starring down for a nurse bugs me to no end. We are low staffed and over worked. We want to keep our licenses so the least sick patient is going to come last. Next time it would be best to take your grandmother to an urgent care.

[KelRN215, BSN, RN]

I, also, based on what I've read here do not view the nurse's actions as rude. She was being honest. People are dying and those people are a higher priority than Grandma's laceration. Many nurses have been in this situation... you have a patient trying to die so you are spending all your time with that patient and then you have someone else complaining that their IV pump has been beeping for 5 minutes and no one's attended to it or that their lunch hasn't arrived yet. The nurse may not have had time to stop and say "I'm sorry for the wait, we have several critical patients that we need to attend to. Once we get those patients stabilized and move to the ICU, we will see your mother as soon as possible." These kind of explanations often don't necessarily do any good either.

I recall trying to explain how prioritizing worked in the hospital to parents who thought that their kid should be a priority for an MRI because he came in having seizures. Briefly, this child presented with classic infantile spasms and it was more important to get an EEG. The overnight resident kept the child (who was like 6 months old and didn't need to eat overnight) NPO overnight in case there was an early MRI slot. MRIs that required sedation were prioritized when the Radiologist arrived in the morning. The results of this child's MRI could have told us why he was having infantile spasms (and it did, he'd had a stroke in utero) but it wouldn't have affected or changed his treatment. Once he was put on EEG the diagnosis was confirmed and he started treatment that same day. When I came on in the morning the parents demanded to know exactly what time the child's MRI would be. I didn't know because the Radiologist didn't come in until between 8-9am. I calmly explained that and that the Radiologist prioritized all the cases as soon as he got in... if, for example, a child had come in overnight with a new tumor that was picked up on CT, that child would be priority for the first MRI slot. The father screamed that he didn't care about anyone else's child that his child was having seizures and that he was the priority patient. The child didn't end up having this MRI for several days and, as I said, it didn't affect his treatment for his seizures at all.

I imagine your mother wasn't the only person to ask that particular nurse what the hold-up was and that she was incredibly stressed if dealing with several critical patients.

[OnlybyHisgraceRN, ASN, RN]

I know nurses are supposed to be full of customer service and compassion in all, but when we are busy running around with emergenices sometimes we may come off a little short.

Tell your grandma not to take it personally. I wonder if people post about waitresses, police men, and teachers being rude. It seems as though nurses are suppose to be perfect.