ER Nurse Attitude - page 5

by Chlometov

8,725 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


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    [QUOTE=macawake;7114742
    Isn't there a middle ground between "matter of fact" and "super sensitive touchy feely"? .[/QUOTE] 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.
    Last edit by ktwlpn on Jan 12, '13
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    Quote from SionainnRN
    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.
    Last edit by samadams8 on Jan 12, '13
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    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!
    anotherone and canoehead like this.
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    Quote from samadams8
    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.
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    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).
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    Quote from samadams8
    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.
    Last edit by Esme12 on Jan 12, '13
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    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.
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    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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    Sorry I was rude. But the lac to her arm is at the bottom of my priority list as I am about to go do compressions/titrate pressors/assist with sterile procedures. Sorry I may have been a little rude to you but in times of distress, people remember things very differently and convey them to others as if the world was being destoryed around them while dear old grandma has a lac. While I try to make it in to every room in a timely fashion to assist in whatever injuries you/r family may have, please excuse my tardiness for attending other emergencies that required immeadiate attention first. As it was not an emergency, please kindly take your seat and wait your turn patiently. You would do the same at any other venue. My ER is no different.
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    Quote from Flatlander
    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).
    Not necessarily. If people were literally dying, as others have said, sometimes it takes everyone available to manage the situation and there just isn't time. It would be nice to get grandma a gauze, but not if it means risking a life.


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