ER Nurse Attitude

Nurses Relations

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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.

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? ;)

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.

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.

Specializes in Emergency Room, Trauma ICU.

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.

Specializes in LTC,Hospice/palliative care,acute care.

[quote=macawake;7114742

Isn't there a middle ground between "matter of fact" and "super sensitive touchy feely"? . There really doesn't seem to be a middle ground between the two and in customer service oriented medicine the emphasis seems to be on the latter.Personally I would rather have a competent nurse or doctor then a touch feely one but the general public has no idea what we really do and they would not agree.I remember being called into the office for doing my nails at the nurse's station-I was actually reading tele strips.To add insult to injury the family member reported me because he wanted his grandmother's hair shampooed.It was after 2pm on a Sunday afternoon and his smelly bedridden grandmother was writhing in pain because he lived with her and had been stealing her morphine.He kept her bedbound so she couldn't see how much of the furniture and appliances he was selling.Her hair ended up being cut off of her head in one piece because it was so matted and she had pressure ulcers on every single boney prominence.She was a MESS.The office of aging got involved and she was in the hospital for a LONG TIME and the grandson was finally escorted off of the premises after he had disrupted the unit for several days. I never did get an apology from my nurse manager.

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.

Yea, we really don't know exactly how things went down.

A point of discernment for me, however, was the comment made re: bleeding. At the very least, you have time to say all that, you have time to maturely think and limit the response respectfully, while moving on. Personally, I think the comment was totally needless and lacks some maturity. It sounds like a young or immature nurse, or that "I've been there long enough to feel like an expert nurse," when they really aren't--i.e., that sophmoric kind of confidence of a nurse that has been there a year or couple may come off with, which can get them in trouble if they don't have the maturity and humility to step back and re-think things. You see it in interns and residents at times too. That comment was a clue.

Also, again, I have seen this become a general attitude with some nurses, regardless of what is really going on. Not saying that was the case here per se, but you wonder, given the comment. It's something that nurses and docs need to be cool and mature about and keep in check. . .all I am saying.

Not excusing this situation, because I wasn't there, but one day this week, we a full arrest and two CVA's at the same time, as well all the usual stuff going on in the ER. It is all hands on deck, and everyone else has to wait. Sometimes it takes almost everyone in the ER to try to save someone' life. Rest assured, if it were your loved one, it would be the same and everyone would be trying to save your love one. While running from the room to pull a med from the pixis, a family memeber of someone in a room jumps in front of me to tell me his Mom has to go the bathroom!

Yea, we really don't know exactly how things went down.

A point of discernment for me, however, was the comment made re: bleeding. At the very least, you have time to say all that, you have time to maturely think and limit the response respectfully, while moving on. Personally, I think the comment was totally needless and lacks some maturity. It sounds like a young or immature nurse, or that "I've been there long enough to feel like an expert nurse," when they really aren't--i.e., that sophmoric kind of confidence of a nurse that has been there a year or couple may come off with, which can get them in trouble if they don't have the maturity and humility to step back and re-think things. You see it in interns and residents at times too. That comment was a clue.

Also, again, I have seen this become a general attitude with some nurses, regardless of what is really going on. Not saying that was the case here per se, but you wonder, given the comment. It's something that nurses and docs need to be cool and mature about and keep in check. . .all I am saying.

My thoughts exactly.

There are thousands of unemployed nurses out here who would love a chance to show our compassion and kindness, even when we are extremely busy and triaging emergencies. Couldn't someone have given the grandma some sterile gauze and advised her or the mother to keep gentle pressure on the cut? At the same time letting them know that their concerns are important and we will do our best to see you as soon as possible. No need to mention the other emergencies, that goes without saying and suggests that particular customer is not as important to you as the others (even if it is true).

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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? ;)

I certainly do.......I worked at one of the number one trauma centers for YEARS. South Side Chicago.....Cook County.....and Downtown Gary Indiana. I have triaged GSWs to the waiting room.....all depends on the night. Working in a DMZ zone is no excuse for being insensitive and rude. If necessary....I can get in your face or take you down. But you really should be never too busy for a kind word.

I have found a new...ish attitude about the emergency being only for the "real emergencies" and the rest should figure out where to go. Emergency departmets have always been to "catch all" for the public. This is NOT new.....however....this population has gotten larger. The sense of entitlement accompanies ALL demographic backgrounds. That is just bad manners.

I think that all I can say is that it would have been nice if the nurse had been able to be more reassuring and polite. Patients and family can't be expected to know the workings of the ER or the triage process. An attitude of respect and consideration on the part of the nursing and medical staff goes a long way.

I wonder if some of the disconnect between the staff and the clients doesn't stem from the difference in knowledge between the two.

Sure, you (think) you know that Gramma's arm lac is going to be okay for the next hour, maybe you even think the hip fracture is going to hold for an hour or two.

But Daughter doesn't know that. All she can see, if she's a lay person, is a gash in Gramma's arm that won't stop bleeding, and Gramma is crying and lying stiff as a board because something is stabbing her every time she even *thinks* about moving. Add Gramma's possible fragile health, and the fear and disorientation being tucked away into a room and left waiting can leave, and well, Daughter is overwhelmed, undereducated, and looking for answers.

If Gramma got that assessment when she was tucked away into the room, why couldn't the nurse inform Daughter and Gramma that Gramma was going to be patched up and whatnot, and give a sense of the time and priority before she hustled out of that room?

A little heads-up beforehand would prolly smooth things over wayyyy more than being a snippy Ratched in the hall later.

Having been in the ER quite a few times due to small adventurous boys on a farm, I can honestly say that the nurses I remember best were the ones who laid it out for me and didn't treat me like I was a burden because my son was running a temp of 104 for 8 hrs with Tylenol on board at 2 am. (Do they ever run high temps during office hours? Of course not.) The nurses I was hellbent on reporting? They would be the ones who gave me two 4xs and told me to take my son back to the waiting room and wait my turn, when I brought him in with a sev lac to his distal ring finger. As in, it had cracked the bone and was steadily dripping. 2 4xs and to wait my turn. After leaving a nice coag puddle on their carpet (waited 2+ hrs with just those 2 4xs long gone, and a small child wailing and fighting the whole time), I came steamrolling in, demanded a new nurse, who promptly unwrapped his hand from the paper towels I filched from a bathroom, and rushed us to a room, calling for the Dr all the way.

I see a lot of bitterness and anger towards clients who can't know any better. How are they to know that a hip fracture and gashed arms are "non emergent". Non Emergent?! Would you rather Gramma waited until 8 AM and see her PCP, instead of bothering you with her pesky pain and stitches?

I hope that I can remain caring and connected to humankind, and my clients, as I begin my career, but more importantly, as I progress into it. I can't imagine why someone would continue to work in a place where all they do is cluck and roll their eyes at the very people they are supposed to be caring for.

For those ED nurses and aides who still remember what it was like to be on the other side of that name badge, scared and overwhelmed, I hope your codes resolve and your clients remember your face with a smile.

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