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

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.

I'll bet there was nothing else they could do. You have to reserve hall beds, and triage nurse pushiness for patients that are in the process of dying. If we pull a doc to once over someone in pain in triage the doc is taken away from Joe Blow who finally made it out back after 5 hours. There are no stretchers to offer for someone to lie on (they are being used in the hall out back), no meds or labs until seen by a doc, and no sympathetic statement that would not be offensive when you've just told mum that her child in pain is not the highest priority.

I haven't found the magic formula for people who are in pain, but not dying, and have to wait. Other than telling them we are moving as fast as possible... warm blankets and cold/hot packs only cover the first 30 minutes, if you're lucky. Our NM encourages a reassessment with a conversation to validate their feelings, but if I can SEE they are OK, and I'm needed out back for people that are more acute...I'm loathe to spend time chatting. The faster we get out back cleared the faster triaged patients can come in, and that's what they really came for.

i think that this writer/educator could tell the differance between overworked, pushed to the wall nurses and those who were sitting around gossiping on the cell phone
item which caught my eye was the statement she made about floor nurses which she said she knew which nurses were incompenent and she refused to have them care for her dtr
what about the lay person who comes and wants/deserves the best of care, give him the dumbox?

Hello,

I have been on the other side of the bed with my mom several times and I got to say that I get a little worried with the lack of care that she received. I do not begrudge any one food or bathroom breaks, but when my mom does not get pain meds because her nurse was on lunch break and no one else would come in I get angry.

I was never asking for coffee or an extra blanket just good nursing care. A good IV site, pain control, post surgury - so maybe the incentive spirometer, ambulating. But I had to push to get those things. I did see the nurses sitting reading, and eating at the nurses station, not just on a break but lots of times

Well since we were not there we should not judge. But based on finite resources someone is going to have to wait. For example my ER has 33 beds, with the hall spots we can squeeze safely based on staff maybe on a good day another 10 for a total of 43 beds.. SO when on a busy night there are 60+ pts I guess someone has to wait, and sadly often that wait won't be comfortable.

As far as the staffs behavior sadly that happens. Unfortunately with the volumes we have to deal with telling us to take it to the break room or do it elsewhere and actually being able to are two entirely different things. Give me 2,3,4,5,6, more nurse and I might be able to do it. Then again we will have 20, 30, 40 more pts.

Though there is no excuse for the cellphone use at all. And as always once you are in a room no excuse for poor care. Also don't think we are not doing anything often we can't do something until the doctor sees you, yes we have protocols and yes we do follow them. But after that we cannot do much and often we may be sitting on our hand waiting on them.

RJ

again like alot of things you read, only one side of the story... but it does make me think about has the instructor lost contact about how busy and long a er visit can be. every staff er nurse will most likley tell you that the place is exploding with patients, and unless you are low sick your triage classification will make your wait longer. but i feel her pain just the same. nobody likes to see kids hurt...

I really want to know what she expected the triage nurses to do for her daughter. They weren't being insensitive, they were doing their jobs. You can't send someone who isn't trying to actively die to the back unless you got a bed for them.

Since when will a ruptured appendix NOT kill you, if not treated promptly? Believe me, if I had been this mother, knowing it was appendix, I probably would have been screaming at the triage nurse by the 4 hour mark. This had been going on for a couple of days at this point. This girl could have died in the waiting room. This WAS a case of someone actively trying to die.

If had been a broken finger, I would be saying things like "who does this nursing professor think she is". But we are talking about her child's life here. I forgive anything she said or did, including "helping" her daughter push the PCA button, lol.

thanks for putting me in my place.
It just always bugs me to hear "Well the nurses were laughing, or they were eating" I just know that there are times in your shift where you have to stop and be human and do things like eating or laughing in order to keep yourself from ending up on an ER cot next to her daughter. I'm just wondering the other side of the story.

Was her daughter mis-triaged, was she being proactive for her daughter in the waiting room? What was going on in the back?

Having been on both sides of the stretcher, I understand this nurse who is also a mother's frustration. I have been a patient in the ER of a local hospital where I have recieved great care, and a patient in another hospital where my triage nurse left much to be desired. The excellent care I recieved happened as a result of a dog bite (I was a vet tech prior to becoming a nurse), and the ER I went to had a "fast track" for non critical patients where I saw a PA, got my wounds cleaned, prescriptions for antibiotics and pain meds, and was out the door in under two hours. It was obvious to the triage nurse that I wasn't going to die as a result of the bite, and I was fully prepared to wait longer than I did to be seen.
The not so great experience was when I was having new, acute chest pain, and my fiancee rushed me to a closer hospital (run by a different company). After signing in, I sat for close to two hours before triage even saw me (meanwhile I was terrified, since I had never felt like this before), and I am convinced that the only reason the nurse called me was because my fiancee finally went to her and reiterated that I was having chest pain and trouble breathing. With that, she called me to the cubicle, and then proceeded to tell me how rude he was to her and that she knew that I was not "having a heart attack", at which point I started to cry since I was terrified and could not get my breath. I said to her "He is worried about me, can't you see that? I have never had a problem breathing before." Her attitude was that since I walked in on my own two feet instead of on a stretcher, I could wait.
I hate to say anyone of my profesion is incompetent, but I work now on a cardiac unit, and anyone having chest pain, or difficulty breathing is top priority.
Luckily, I just had a bad case of bronchitis, but if the nurse had taken the time to tell us that my VS were stable, etc, etc, then I wouldn't have been so scared, as well as kept her opinions about my fiancee to herself, and mabye had a little compassion when he spoke up because he was worried about me.
As a nurse, I now try to put myself in the patient's position, as well as the families. I then try to show compassion, and caring, even if they are upset. Most times I am able to turn a bad "customer service" situation around just by spending the extra few minutes explaining what the plan is, whats happening, what to expect, etc.
I have had family members yelling at me, not because they think I am incompetent, but because noone has taken the time to explain to them what is happening, that later will hug me, and thank me for caring for their loved one, because I didn't take it personally, and took the time to talk to them, and get past the anger, and show them I care.
Had a pt the other night who came in for chest pain, was put on telly, and twice I ran to her room (scaring the hell out of her and her family) because the monitor showed she was in V-fib. Each time, I printed out the strip to show her, and explained that although she was fine, her strip showed she was not (she was A-paced and if she threw a PAC, her pacer would increase her heart rate and it would show as V-Fib). I joked with her about it, and teased her that because she was watching the college b-ball finals, she was getting excited. She told me on discharge, that I was her favorite nurse there because I took the time to show her why I was concerned, and explain to her what was really happening (PM malfunction). She went home today, and told me if she neede to come back, she would make sure to request me specifically.
I am by no means a great nurse, I don't know everything, but I became a nurse to help people and make a difference, NOT for a big paycheck.
If the nurses in this persons experience had taken the time to talk to them, it may have been a completely different situation.
Amy

Joyce M. Allen, RN of MO
Apr 09, 2008 20:14:16 PM [permalink]

Understanding

While I can thoroughly appreciate Ms. Madsen's heart wrenching ordeal, I do have some concerns regarding where she appears to want to place blame for most of the witnessed behavior and the almost boastful manner in which she states behaved towards staff. As an Assistant Professor in Nursing, I also share her ambition and drive to ensure that the students who learn "at my knee" are very aware that technical skill and expertise without compassion makes for a substandard practitioner. Unfortunately, I too have also experienced the horrid frustration and abject fear of watching my children suffer and be placed in the hands of complete strangers who appeared, in the end, as either completely wonderful or woefully incompetent. As an ER nurse, I was exposed much too often to the worried parent role as my son was a severe asthmatic, and my daughter took her new car and license and wrapped herself around an innocent tree, injuring her neck. I hold a national board certification in advanced nursing administration. My point being that there are many variables besides a lack of compassion that she witnessed during her daughter's hospitalization. And I am disappointed that she chose to absolve herself of behavior that, while absolutely normal for a parent to want to display, probably stressed an already minimal staff. "I wanted what I wanted when I wanted it." Well, of course. We all do. But I'm wondering what type of behavior this has modeled for her students. "The nurses never yelled at me." Good grief! What is the norm for the area she practices in? What level of demands did she engage in that she would have an expectation of returned verbal abuse? When confronted with unacceptable timing or behavior, I never lost my professionalism or my ability to be a firm patient/family advocate and obtain what I needed. I see many, many wonderful nurses leave units in tears after a shift that was dangerously short staffed with patients that were dangerously ill. And they do care, but burn out is real and lethal. Encountering someone of Ms. Madsen's self-offered description of netting an immediate gain for her daughter, possibly at some other patient's expense, does nothing to improve being a patient's advocate or assist the staff in performing their duties. She needs to encourage her students to work at also being realistic and firm regarding the work place environment and what they should have in order to do their jobs safely, warmly, and effectively. Unfortunately, caring isn't always enough.

This pretty much summed it up for me!