Nurse sees worst, best of profession during daughter's ER visit

Respectfully, IMHO she threw aside her valuable knowledge of nursing care in a hospital or other institution (as a nursing instructor who prepares pre-licensure students, she has this knowledge, right?) for a woe-is-me-the-world-does-not-revolve-around-me-and-my-daughter immaturity.

Her column on her website, picked up by US News & World Report, was quite public.

Karen Madsen has replied to this thread and other responses to her column.

http://health.usnews.com/blogs/comar...o-critics.html

She completely fails to consider the possibility that ER nurses' "insensitivity" aka objectivity is what prevents more common ER waiting room deaths, and the unfortunate possibility that her daughter's acute abdomen was not the biggest crisis that ER staff was facing at that particular moment.

PASSIVE-AGGRESSIVE, she makes no apologies. Her response didn't take away my hostility-write a fair article, educate yourself, take time to educate the public with our healthcare crisis-do something positive or be quiet. Just don't blame nurses for all of your woes while seeking care for your daughter.

To those who responded, must work with her-all agreed.

Maisy

I'm curious how long it has been since she was a staff nurse... clinical instructors are wonderful (at least the ones I've had) but I know they also can live in "perfect textbook land" and forget the reality of the job (this comes from personal observation and discussions with my employed friends)

I wonder if things were really as bad as she claimed or was there some guilt and mother's fear involved as well?

"That never-ending night in the ER, I saw the very best of nurses and nursing—and I saw the worst. The worst wasn't that the nurses in triage were mean or unskilled; the worst was they didn't care about my daughter. They didn't care about the young woman across the room, also crying in pain, also waiting for hours. They didn't care about the young man who came in bleeding profusely. The initial nursing triage staff did the bare minimum required of them; they did it without a smile or a touch of concern. They did it quickly and efficiently and soullessly. They sat at their desk and ordered food and talked on their cells and told jokes within feet of my daughter who was in agony. How could anyone, let alone a health professional, be so insensitive? As a healthcare consumer, I was bewildered and angry. As a nursing instructor, I was horrified. And as a member of the nursing profession, I was embarrassed and ashamed. These were my colleagues. This was America in 2008. No one should be treated like we were that night, no one. Four hours after our initial check-in, we were admitted to the main emergency room and eventually, things got much better. We had a stellar nurse named Kristi, who came to our room with morphine in her hand for our girl."


Her rant is mainly over having to wait. Once she gets taken back and Kristi the saint brings her baby girl morphine, well then everything is just fine from there.


I am an er nurse and I am tired of triage nurses being demonized, even by those in the same profession. If you aren't taken to the back immediately, well then you aren't the sickest patient there. Yeah, you're sick, but not the sickest, and that's how it works in the ER.

What really did she want the triage nurse to do?????

Her quite slanderous comments that, none of the nurses cared because patients were suffing in the waiting room is preposterous. I am so sick of being glared at, distrespected, and the ricipient of aggressive behavior because people, obviously even nurses, do not understand the triage process.

In this response she states she used to work as an ER nurse. If that is so,.then she knows that the entire triage process is supposed to be done in 6 min or less! (not alot of time for small talk, wiping brows and hand holding) She knows that it isn't a first come first serve system! She should also know that comming up to the triage desk every 10 minutes does not bump up your acuity!! She should also know that a teenager with belly pain and stable VS takes a back seat to chest pain, stroke sx, SOB with sats in the 70%,.etc. She should understand that pts that could die or be severely disabled in the next 10 minutes w/o our intervention will go ahead of those that can wait 4 hrs w/o dying!

I wish I had a dime for every time I have to explain to someone that the pt's who are the sickest go first. I try to explain that not only do we have pts who walk in the door that require immediate attention but the EMS crews are bringing many very ill folks in "the back door". I've had pts stand at triage c/o ear pain and say "you mean I could sit out here all night?". Well in theory yes you could! It isn't that I don't believe your ear hurts. It isn't that I don't feel bad that you've been up all night in pain. It isn't that I don't want you to feel better. It isn't that I don't care,.but I have to help the man having the MI, or the lol with facial droop and slurred speech first!

If this woman has actually worked in an ER she should know full well the frustration we as nurses feel when there is 30 people waiting to be seen and we can't do a darn thing to speed things up. I do understand what it feels like to be sitting in an ER waiting room, in the middle of the night with a sick child. It sucks,.you're tired, your child is miserable and you just want to make everything better. I get it,..but again,..any ER nurse would understand that this is an ER. We are here to save peoples lives and we have rules to follow.

This triage procedure isn't something the nurses create on the fly to quickly place people in the waiting room so we can get on the phone and order pizza! An ER nurse would know that there is a protocol,.we have to take a class,.only experienced nurses are allowed to triage,.we are taught to start the triage process the moment the pt walks through the doors,.our assessment starts the moment we say hello.

I don't know how long it's been since this nurse actually worked in ER or what size of an ER she worked in,.but compared to many ER's 4hrs in the waiting room isn't that bad. I might understand her acting the way she did,..she is as she stated her daughters Mom first,.but writing an article bashing the nurses for things not going as fast as she wanted them to is only adding to the problem not offering a solution.

She refers to the nurses in the hospital as her "colleagues". To suggest that the nurses working that night need to find different jobs is not the way to communicate with her "colleagues". She appears to be proud to be "labeled a pushy, know-it-all, manipulative *****." As a Mom sometimes you have to be a *****,..as a colleague of mine,.not so much! To put her fears and frustrations as a Mom, in writing and equate them with uncaring, incompetent nurses is just adding fuel to the fire and one more reason we have many great nurses who have chosen to sell realestate!

Since Avery Comarow doesn't see fit to publish my comments, I will state them here.

According to Karen's profile at Cox College-no mention is made of ER nursing. I asked directly whether she actually worked in an ER, or just did student rotations in one...in addition, if she did work in an ER....usually one stays for at least a year to mention on their resume....I suggested that it may have been too difficult, or not a good fit if it wasn't listed....but asked for clarification.

I also suggested to Mr Comarow that just because an educator/academic (has letters behind their names) that their focus generally tends towards theory and utopian nursing(didn't use that term)-I further suggested that if he liked nurses with letters behind their names-he should look to the trenches for nurses (with letters)with real problems, and real solutions.

It's a shame I didn't save it....I can't remember all I said. All I know is that it isn't posted. Guess the truth will not set us free.

Oh, almost forgot-also wished a speedy recovery to DD.

Karen said it wasn't personal-she made it that way by making the nurse responsible for all of her issues-so many other factors play into hospitalization issues. Not one of them was addressed. She is no nursing advocate!

Maisy

Agree. Neither Ms. Madsen's faculty profile on her college's website (http://www.coxcollege.edu/NUR/bio-cv/Karen-Madsen.htm) nor her CV mention any position in an emergency department, as a staff RN or in any other capacity.

I noticed that she states in her original article that the staff was competent,.did the minimum they needed to do, but that no one cared about her daughter or any of the other pts waiting to be seen. Then in her follow up article not only mentions "incompetence" but states that the nurses working that night should find new jobs.

Which is it? Is smiling and holding hands really a requirement for quality, competent nurses? I tend to be a pretty easy going person and have a high tolerance for much of the drama that tends to envade the ER. I really do feel bad for the three year old with an earache that sits in the waiting room for hours at 2 am. I can sympathize with the person who's been up vomitting all night and just wants to feel better and get some sleep because he really needs to go to work in the morning. I've been known to cry with my pts,.pray with them and laugh with them. I've brought a warm blanket to the sweet little old lady who is sitting at her husbands bedside worrying about him. I've ordered sandwiches for the three toddlers waiting with Mom for Dad's C-Spine to be cleared after an MVI. When time permits I will go out of my way to make someones time in the ER a bit less stressful.

Does this make me a better nurse? It might make me more pleasant to be around. It might briefly calm a scared Mom. It might raise our Press Ganey scores! But does all this actually equal better care and outcomes for pts? I know many Dr's who appear to be short with their pts. Some who seem to have poor social skills,..but many of these same docs are the first I'd call if I needed a good doc now!

The whole "Spa" mentality of todays healthcare seems a bit of smoke and mirrors to me. Keep a smile on your face, fluff the pillows, keep the waiting room stocked with warm blankets, offer food and drink to guests,.etc. Keep everyone warm and comfy and maybe they won't notice that there are only 3 docs in the ER tonight,. or that their nurse has been on her feet for 10 hours without so much as a potty break because they are working 3 nurses short tonight. If you pamper everyone maybe it won't matter so much that it took 3hrs to get grandpa to the CT scanner or that in the middle of a septic work up someone notices Dad has a troponin of 7!

It seems to me that if I'm having an MI, I want the most educated, most experinced, well trained staff available. I want someone who know's what they are doing and will save my heart! I want a Dr that hasn't been working 20 hours straight, a nurse that's slept more than 3 hours in the last 24 and I don't want a warm blanket when what I really need is to get to the cath lab!

Do the "powers that be" that work 9-5 in an office, in a tie, with hour long paid lunches seem to think people are stupid? Does the general public honestly think that sleeping on 500 thread count sheets and serving Starbucks coffee is going to make up for the lack of competent, safe health care? Is it really ok that there are 4 new grads and one "seasoned" nurse working tonight, as long as grandpa gets cream in his coffee?

This whole customer service trend seems to be sugar coating the real problem and doing nothing to actually fix it! I can understand how all these "extras" might be nice from the pts point of view, but when did people start demanding that a trip to the hospital be a pleasant experience? I'm all for "extras" when the basics have been taken care of. If we are fully staffed, able to care for every pt that walks through our doors,.and care for them the way we were all trained to,. then by all means park their cars! Until then,.shouldn't we spend our very limited resources insuring quality care for our pts?

Karen Madsen should be advocating for pt care. She should note things of importance to the physical well being of her daughter. Was CT available in the middle of the night? Did her nurse give the appropriate meds, dosages, routes etc? Was a specialist available when deemed necessary? Was there a clean room to take her daughter to when it was requested? Was all the needed equipment available and in working condition? Was the staff able to recognize and efficiently treat an emergency situation? Was the staff well educated, trained, well rested and effectively staffed to care for the needs of a busy ER?

Smiles are great ,.but all the smiles in the world could not diagnose and treat a hot appy,.all while getting the MI to the cath lab,.the stroke to CT and the trauma to OR. THAT my friend takes excellent skills, communication, organization and great medical staff!! I'm sorry that her daughter was ill. I'm sorry that it took four hours to get her pain meds to make her comfortable. I very glad to here that she is recovering well. I do understand that when it is your child,.it is an emergency. As a former ER nurse,.she should have known that even if she came in with a sign that said "I have acute appendicitis" she still would have been seen after the MI,.the stroke and all the other acuity I and II's in the ER that night. It would have been nice if there would have been enough staff, time, space and equipment to rush her immediately back to see the Dr. It would have been nice if the staff had held her hand, given Mom et Dad a hot cup of coffee, warm blankets and a comfy recliner. Wouldn't we all love to be able to give EVERYTHING to our pts? But would any of those things have actually changed the outcome? Would she have recovered quicker, had less of a chance of complications?

I'm sorry her daughter was ill, and that she couldn't just rush to the ER and be immediately seen. To publicly bash the ER staff and some of her former students was very unprofessional, and as a "colleague" of Mrs. Madsen I find it insulting. As an educated, well trained professional I am appalled that one of my fellow "professionals" allowed her emotions to get the best of her and in a very public forum accused her "colleagues" of being insensitive and uncaring and even went as far as to suggest they need to find different jobs. I'm very curious as to where the Cox Health PR suits are right now!

I may not smile as much as I "should" but darn it, I do my job and I do it well. If someone is going to base an RNs performance on how much they smiled, then they are stupid. End of story.