ER Nurse Attitude - page 4

by Chlometov | 9,134 Views | 70 Comments

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... Read More


  1. 7
    Quote from canigraduate
    Having been on both sides myself, as a nurse and a family member, some nurses are rude.

    The scenes I have witnessed are usually caused by nurses who are rude for no reason. That's their personality. There have been the few occasional instances where the nurse was perceived as rude because she didn't have time to talk, but she always came back later and explained what was going on.

    My mother, however, is one of those patients that look for ways to get offended. So, if you say that you were needed by another patient, she gets all dramatic and can't believe that anyone else is more important than her.

    If your mother tends to be easily offended, then the nurse may not have been at fault. If she is normally a laid back and forgiving person, then the opposite may be true.

    Not having been there, you may never know the truth.
    Over 20 years in nursing, and worked at a zillion places. I have to agree. At the same time, I wasn't there, and as you have stated, neither were you, OP, right?

    About that nurse that was going on about six hours bleeding yadda, yadda, well, IMHO, she shouldn't have said that at all. In fact, by the time you take to say all that, someone could have taken at least a cursory assessment. Frankly I would have been a bit concerned about internal bleeding from the hip injury, but I also would be concerned with her other injury. . .depending. . . I would want to know if it looked like spurting blood or oozing blood.

    No she may not have "rated" as immediate medical attention; but at the very least, rather than the nurse going into that bit about the 6 hours, what she could have firmly but respectfully said was "We are doing all that we can to get your mother seen as soon as possible." If people don't understand how an ED has to operate, no one really has the time at that point to clue them in on how patients are seen. EDs are not clinics, nor are they physician offices. And you can't expect it to be a first come first serve approach to treatment. That would be unethical for those with immediately life-threatening conditions.

    Personally, I think they should have people that kindly explain this to those in the waiting area or in-take zones when they patients and families come into the ED. Or they should play them a video on how the ED operates. I saw this in a veterinary ED once. Actually, the video was quite good, and re-cycled every so often. Hand people a brochure or something about the basic process for seeing patients. For some folks, and of course not all, a little bit of time and essential information on procedure does help people settle in--of course, if the mom has a screaming infant that is burning up and has an ear infection, well, that will only do so much for the mom. And people are naturally concerned about their loved ones, regardless.

    But people should have a basic understanding of the admission, exam, and treatment procedure. It can't always be done, but honestly some people seem to feel that EDs operate like clinics or medical offices.

    Having said all of that, the message gets undermined when you see nurses hanging around desks talking, No, Iím not talking about when they are doing paperwork, using the computer, or dealing with phone issues. Iím talking about when they are just hanging around laughing and talking. Now, I haven't seen a whole lot of that in say inner city EDs where there is no shortage of GSAs and other outrageous stuff, and those nurses literally do NOT get a pee break, and they run, literally are moving the whole 12 hours. But in some of the community hospital EDs, I've gotta say, darn, it looks bad for nurses there. Patients and families take note--and so do other folks.

    So yea, I don't care what you are waiting on, if I see you dorking around at desk or somewhere, and you are not writing, computing, deal with in-comings, or something that appears productive, and my loved one isn't getting treatment--hasn't even been seen by a nurseówell, I have to say. I am going to say something. You might not like it, but it go both ways. If you are coding or pre-coding, but all means, do what you must do and have at it. But ifyou are just taking up space while others need some help, come on already.

    It's the lamers and those that don't know how to haul butt or keep a steady work ethic throughout their shift that give nursing a bad name.


    When nurses, however, are busting their humps, give them space and respect. Like I said, it goes both ways, and it's about having some insight and balance from more than one side of things.

    OP, I'm sorry your mother felt she and her mother were disrespected. If that truly was the case, which none of us can know, I apologize and feel terribly that that happened. It shouldn't have.

    OTOH, if those with immediate and critical needs had to have the priority at the time, and if some were unintentionally curt, try to understand how the procedure must work. Try to consider how you would feel if your loved one was critical or in need of directly immediate attention-only to be pulled away but the concerns/demands of those less critical. There is a reason for triage.

    Again, don't know what really happened. . .wasn't there. I hope all is going well with your GM now, OP.
    macawake, Orange Tree, canigraduate, and 4 others like this.
  2. 8
    Another fun way to look at it is: if you were the family of the patient who was dying, would you have wanted the nurse to respond in ANY other way to a family member of a living, stable patient?
    anotherone, psu_213, Orange Tree, and 5 others like this.
  3. 11
    OP, as you continue school clinicals, please remember that the dying come first. Always. One hundred percent of the time. Otherwise you'll kill a patient.

    Have I gotten your attention?

    Good.
    anotherone, psu_213, Orange Tree, and 8 others like this.
  4. 3
    As with most such cases there are many variables. The ER may well have been very busy with patients who were more seriously ill and/or dying, so an arm lac is not going to be pushed ahead of the more serious cases. The perception of the ER nurse bing "rude" is just that, and (unfortunately) that is how stressful situations are often perceived. The ER nurse likely had no time for the pleasntries, but had more serious business to address at that moment.

    This reminds me of a woman in one of our ER rooms who was waiting for the doc to see her. She assumed the ER Waiting Stance Position (leaning against the room's door frame, arms folded, foot tapping, and face scowling. Across the ER was a cardiac arrest resuscitation attempt in progress (curtain drawn, but anybody who ever watched ER would know by the sounds what was occurring.

    I approached her and asked if I could help her, and she regaled me with how she had "waited too long to be seen" and was going to leave soon if the doctor did not arrive shortly. I explained in general terms that the doc was busy with a cardiac arrest across the ER, and that she was definitely on the short list to be seen. She replied that she did not care what else was going on because she was a busy person and time was important to her. All I could do was walk away to maintain my 'gentlemanly' ways.

    We all want to be first, or at least ahead of somebody, but often that is just not possible. People expect the ER to be fast, and they are in an emergency. with non-urgent patients, the turnaround time is usually somewhat more than the 48 minutes that people see on TV.
    psu_213, SoldierNurse22, and samadams8 like this.
  5. 2
    At least your grandmother was brought to a room/bed and not left in the waiting room. Small consideration perhaps, but a consideration indeed. With Press Gainey surverys sent out pretty much immedietely, then I would use that forum. Right or wrong, I think it is up to the triage nurse to say "I am putting you into a room, but please know that we are full, I can't tell you how long you will wait, but there is a wait" Then at least an intervention (Gauze for the bleeding) and a call bell. Not being there, I don't know for certain what occured, however, there was probably just as long of a wait for an x-ray of Grandma's hip--and any other interventions. ER's do get nutty, but there is by most standards a policy about checking on a patient every hour at least. If this did not happen, then I would be the first to make note of it--that may allow some pause as to wait times, and a good place to start for the nurses to ask for more assistance.
    Ir15hd4nc3r_RN and samadams8 like this.
  6. 6
    Quote from BlueDevil,DNP
    No disrespect intended, but what I can't help but wonder is, "what difference does it make?" In other words, who cares? Why do you care? I assume your grandmother fine now. So why does someone else's busy day, that you have no first hand knowledge of, several weeks ago merit worrying about today?

    Everyone knows if you go to an ED with a non emergent condition you are going to wait. Being reminded that your condition is non-emergent and you are not at the top of the priority list should not be deemed offensive. It is not the nurses responsibility to deliver this news in some super sensitive touchy feely manner, but rather matter of factly: "Every one gets a turn in order of priority, this is not your hour. Sit tight, we will get to you when we get to you." That is all she needs to say. Any thing else is gravy. Getting all butt hurt about being given the facts of the situation is silly.
    Because she is a student......because she is trying to understand.....because she loves her Grandma.....because her Mom is upset and she loves her Mom.

    I will tell you that as an Emergency Room nurse with complete understanding of the why's and what for's......a little kindness and patience goes a LONG way...
    Every one gets a turn in order of priority, this is not your hour. Sit tight, we will get to you when we get to you.
    I feel lacks the compassion that people need to hear...that they aren't just a number, that someone cares, that someone physically seen. That their humanity is still important and intact.

    I truly hope that when you or a loved one is frightened and in need that the response you hear
    this is not your hour....... we will get to you when we get to you.
    is not this one. It is just as easy to say...."I'm sorry....I know you are concerned...we are aware of your Mom, she has been assessed and she will be seen....we have an emergency....we will be in as soon as we can."

    When my BIL was fighting his last battle with cancer at the young age of 59 and was rushed to the ED....I intellectually get what might be a priority and I will wait my turn but if I ask a question and I get.....this is not your hour....... we will get to you when we get to you.....we WILL have a lengthy discussion about this at a later date.....with the patient advocate, the CNO and whomever else I invite to the party. The rudeness of the staff was inexcusable.

    While we are busy and overwhelmed it should not replace the compassion for humanity in their time of need. A simple I''m sorry....a touch of your hand can go a long way. Manners matter.

    I know there at the impossible families....in 34 years I have met them all. But patience and kindness shold not be the last option we resort to becasue we are busy....JMHO
  7. 3
    Quote from Esme12
    Because she is a student......because she is trying to understand.....because she loves her Grandma.....because her Mom is upset and she loves her Mom.

    I will tell you that as an Emergency Room nurse with complete understanding of the why's and what for's......a little kindness and patience goes a LONG way...I feel lacks the compassion that people need to hear...that they aren't just a number, that someone cares, that someone physically seen. That their humanity is still important and intact.

    I truly hope that when you or a loved one is frightened and in need that the response you hear is not this one. It is just as easy to say...."I'm sorry....I know you are concerned...we are aware of your Mom, she has been assessed and she will be seen....we have an emergency....we will be in as soon as we can."

    When my BIL was fighting his last battle with cancer at the young age of 59 and was rushed to the ED....I intellectually get what might be a priority and I will wait my turn but if I ask a question and I get.....this is not your hour....... we will get to you when we get to you.....we WILL have a lengthy discussion about this at a later date.....with the patient advocate, the CNO and whomever else I invite to the party. The rudeness of the staff was inexcusable.

    While we are busy and overwhelmed it should not replace the compassion for humanity in their time of need. A simple I'’m sorry....a touch of your hand can go a long way. Manners matter.

    I know there at the impossible families....in 34 years I have met them all. But patience and kindness should not be the last option we resort to because we are busy....JMHO

    Exactly, unless you are working in literally an inner city war zone with back-to-back GSWs or critical medical disasters, every minute is not like this. People get into a justified or rationalized "war-zone" mentality. As if every moment it's appropriate, ethical, or right to give short, harsh answers. It's not. The excellent nurse or physician must be able to adapt and adjust to each particular situation, and to it's own individual requirements and needs.

    Please don't misunderstand some of us. We know the ABSOLUTE ABUSE ED nurses and docs have had to take REPEATEDLY from certain patients and families. But it doesn't justified checking into permanent hard-azz-mode. Adapt to the particular needs of the situation, and don't take a one-size-fits-all, burned-out approach.

    Nurses and docs that work in EDs need systems for regular debriefing and stress relief. I understand the psychological defense mechanism of dark humor, for example. But what I am saying is a person that is not getting regular relief from the stress, or if a said person is just plain lazy-minded, they can take on this general, one-size-fits-all approach. So belting out curt comments that show lake of care, respect, and empathy can get built-in to them--especially if it is part of the "acceptable" culture of an ED or unit. People that are doing that and making it part of their regular behavior, IMHO, need support counseling, education, reminders, or just a break from their area of work.

    Ultimately remember, justifying a harsh response and promoting the behavior in yourself or others only make it tougher for you to plead your case about how EDs have to function. Find a reasonable balance, and openly consider all things. Don't just get stuck in a behavior that may well become a fixed, bad habit.

    Know what I'm saying?
    Last edit by samadams8 on Jan 12, '13
    Susie2310, Ir15hd4nc3r_RN, and macawake like this.
  8. 1
    Quote from BlueDevil,DNP
    No disrespect intended, but what I can't help but wonder is, "what difference does it make?" In other words, who cares? Why do you care? I assume your grandmother fine now. So why does someone else's busy day, that you have no first hand knowledge of, several weeks ago merit worrying about today?

    Everyone knows if you go to an ED with a non emergent condition you are going to wait. Being reminded that your condition is non-emergent and you are not at the top of the priority list should not be deemed offensive. It is not the nurses responsibility to deliver this news in some super sensitive touchy feely manner, but rather matter of factly: "Every one gets a turn in order of priority, this is not your hour. Sit tight, we will get to you when we get to you." That is all she needs to say. Any thing else is gravy. Getting all butt hurt about being given the facts of the situation is silly.
    Every medical professional most likely knows that you have to wait if you come to the ED with a non emergent condition. However, does every patient and every familymember understand that?
    Are patients and familymembers expected to have the medical knowledge to be able identify what is potentially life-threatening or which conditions or injuries may lead to permanent disability if treatment is delayed? A family member whose elderly mother has suffered a fall resulting in bleeding and a fracture is most likely quite stressed out in that situation. To most people it is an ordeal to watch a loved one in pain.


    Isn't there a middle ground between "matter of fact" and "super sensitive touchy feely"? I believe that a matter of fact reply worded the way you wrote may be interpreted as uncaring by a patient who's scared and in pain and will perhaps result in conflict with the patients loved ones. I think that as nurses it is our responsibilty to assuage our patients fear whenever possible. Of course we prioritize in an ED, non emergent patients will have to wait but often it doesn't take more time to explain why they have to wait in an imformative way and with empathy than it does in a matter of fact way. To me it's a matter of attitude.
    Ir15hd4nc3r_RN likes this.
  9. 3
    I think that when working in a high-stress environment like an emergency department it is easy to become jaded and perhaps burnt-out. Mixed in with the life-and-death situations are the more mundane cases. Patients and their family members who want to be seen right away. Throw in shift-work, inadequate staffing leading to no breaks and a huge workload no wonder we aren'r always at our most polite.

    I think it's helpful to remind oneself of why people act and react the way they do. At least I've found it helps me when dealing with an irate patient or relative/friend of the patient. People who are sick or have been injured are under stress. Having to go to an emergency room is not the highlight of most peoples existence. The release of cortisol and catecholamines has many effects on the body. Catecholamines activate the amygdala, triggering an emotional response to a stressful event/situation and catecholamines also supress activities in the front part of the brain dealing with concentration, inhibition, short-term memory and rational thought. Given these physiological facts and ignoring the percentage of the population with narcissistic or anti-social traits I'd say that it's no wonder that the rest of the population who are normally well-behaved do indeed sometimes act somewhat less than stable and reasonable in an emergency setting.
  10. 3
    I'm sorry but if the nurse was dealing with people who were literally dying right that moment of course she wasn't thinking about how to placate the op's mom, are you kidding me? Op didn't say if the mom stopped the nurse while she was getting supplies for the coding pt or what the actual situation was. If someone tried to stop me during a code situation to talk about something nonemergent then I would probably be short with them too.
    OCNRN63, Tina, RN, and canoehead like this.


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