Advice - I'll need a meal tray too

Klimpys · Mar 15, 2012

Like a previous poster mentioned, when my kids were born (12 to 18 yrs ago) we were told to take everything off the cart as well. However, we did that at the end of our stay, we did not wipe it out every day and then take what was restocked.

I mentioned previously about going to a big city children's hospital when my son was in DKA about 1.5 yrs ago. When I left there I did not take the cheap toothbrush or shampoo stuff. I had my husband bring my stuff from home the first day. Back to the food though. We were in PICU. There was an area where I suppose I could have gotten some free snacks, but I felt weird about helping myself. I think I did take a pack of crackers. Again, I was very grateful for the food vouchers. My husband had to stay at home with our other two kids, and I was alone with a very sick kid in a hospital two hours away, with no vehicle since I had ridden in the ambulance. I had no idea what the hell diabetes ketoacidosis or type 1 diabetes was (I had to Google it, I was still doing pre-reqs for nursing school and hadn't gotten to the endocrine system yet). I am sure I probably asked my nurse for some stupid stuff, but at that point I was is some kind of weird emotional state. I know there are people who abuse the system, but there are also some people who may have just been given some crappy diagnosis and their life just changed drastically. They might need a little compassion.

allnurses Guide · Mar 15, 2012

Klimpys - believe me, they aren't talking about you. In fact, most of the ED nurses fall all over themselves in gratitude when someone uses the system appropriately. I've been a patient many times with asthma and I appreciate the warm blanket and the sandwich, too. I've been hanging around allnurses for 7 years and have read hundreds of vents like this. It is a very tough job, and not one I would presume to pass judgement on. I'm so glad you got the support your family needed at such a trying time.

ed to add: I had a homecare patient who literally had her caregiver unscrew some of the hospital room equipment from the wall and bring it home. :/

hiddencatRN, BSN, RN · Mar 16, 2012

Klimpys, I think we're more venting about those patients who act entitled to things and then get really loud and angry when they don't get the *service* they want (versus the care they need).

At my hospital, we've had to put locks on the kitchen doors on the floors because we've had multiple instances of family members going in to the kitchens with bags and clearing out everything edible in the place, things that we don't get restocked on instantly, things we need for all the patients. I've had adults throw temper tantrums because I didn't bring them multiple diet sodas ("but the patient in the next bed got a 'bunch'"). Well, the PATIENT in the next bed is diabetic and the diet soda is the only drink we have to offer that isn't loaded with sugar, and we're trying to PO challenge the patient, plus they're a PATIENT, and you are an able bodied adult). I've had people get angry with me because they think it's the hospital's responsibility to get them home in style (often have parents complain about the FREE bus tokens I paged social work to get for them because they really wanted a cab voucher and they don't need bus tokens because they already have a bus pass, they just wanted a cab ride).

I do not mind doing a little TLC with patients and families who need it. When I bring a patient juice I'll bring their siblings (who've been dragged along and are healthy and bored out of their minds) juice too, or a popsicle, or stickers. If you're too distracted by the situation you're in to thank me for the warm blanket or taking the time to listen to you vent, that's ok. If you ask me for some ice water or formula for the baby or diapers because you've run out/didn't grab the diaper bag in the rush here/had a major brain fart, that's ok too.

I think we're all pretty good about identifying the folks who are needy because the situation they're in is disorienting to them versus the ones who believe they do not have to take any responsibility for their continued existence in the world. I generally give the benefit of a doubt too, but there are situations where you just want to ask them how they manage to function in the world since their basic, basic life skills are so minimal.

sapphire18 · Mar 16, 2012

This is why I love my intubated/sedated/unconscious patients

nowim clean · Mar 16, 2012

I am the RN who once my pt is not NPO will get the coffee, soda meals for pt and spouse. I want my pt comfortable. I have been the pt it is no fun lying in a bed with IV fluids ..... so if I can address their needs and make them feel better I will. I treat every patient like I would treat my mom and I'd never tell my mom the canteen takes debit cards. I mean really what is a meal tray if they can eat? That's me and if I'm taking care of you or your spouse you may find that the little extra fluff made your stay more bearable.

guest464345 · Mar 16, 2012

I sympathize with the OP....having worked as an ED social worker for years, I would be happy to never see another bus token, cab pass, packaged sandwich, hospital sock, or free soda with or without ice. Klimpys, this is nothing like your experience. I've had patients flagrantly malingering, the wristband from an earlier visit still on, packaged sandwich still in their backpack, demanding another sandwich, asking for bed 10 instead of bed 11. There were some patients I saw every single week, sometimes two or three times in a DAY. I realize that at some level this is survival behavior, but it's maddening nonetheless.

My technique is to just say no very matter-of-factly. "A cab pass is not an option. The bus stop is close - I can show you where." "As soon as you're medically cleared, you'll be able to get food for yourself, as you normally do. Or I can give you a list of free community meals." If they argue, I'm a broken record. If "another social worker" gave foot massages and limo rides last time, I say only "that's interesting." And I try to remain calm and pleasant even in the face of ridiculous assertions like, "If I you make me take the bus home, I will have suicidal ideation."

Some RN's and MD's just want the person OUT and pressure SW's to hand out goodies....I want the patient gone too, and it would be much easier, but I won't do it. Basic principles of behavior modification. I'll try to remember that when I become an RN myself :)

NewGoalRN - if you haven't worked in an ED I don't think you can really appreciate how much this grinds you down. You just never see the same concentration of these folks on inpatient floors (because they don't get admitted, because they have no acute medical problems). It can send a gal into existential despair, in my case along the lines of: "Why the **** did I have to get a master's degree to argue about bus tokens all day??"

boyfactory · Mar 16, 2012

A bit OT but I wanted to throw this out there. When I had my girls (they were born at two different hospitals) I was told by various nurses and the nurse manager to take the diapers, wipes, cooling pads, and formula every time the cart came in. I questioned it, but was told that if the products/packaging is open then they can't reuse it or bring it in/out from the room. We were told that all of that was billed to the insurance company so since we were paying for it anyway we might as well keep it. I am not sure how true that is, but that is what we were told.

That is the stuff on your little cart...not the stocked supply cart in the hallway. You are fine.

brandy1017, ASN, RN · Mar 16, 2012

Maybe you were a waitress in a past life and got stiffed with the tips! I usually just accept playing waitress at work, getting drink orders etc, but last night I was really irritated, got the same thing, family member asking for special treatment bring me this drink concoction, what am I the local bartender? Family members staying the night when the patient is totally stable, just because, then want to be waited on, or stay so they can go out and smoke together and there with COPD. What is the world coming to!

boyfactory · Mar 16, 2012

I am the RN who once my pt is not NPO will get the coffee, soda meals for pt and spouse. I want my pt comfortable. I have been the pt it is no fun lying in a bed with IV fluids ..... so if I can address their needs and make them feel better I will. I treat every patient like I would treat my mom and I'd never tell my mom the canteen takes debit cards. I mean really what is a meal tray if they can eat? That's me and if I'm taking care of you or your spouse you may find that the little extra fluff made your stay more bearable.

You obviously work in the Beverly Hills of ER's. We saw over 200 patients last Sunday night. We got 5 sandwiches, 12 popsicles, 6 Sprites & Sprite Zero's, and juice to last the shift. Getting more requires an act of congress by contacting the House Supervisor to bring more in an hour or so...or whenever she gets around to it. The cafeteria is only open from 7 am to 7 pm. If I gave a sandwich to everyone who asked, there would not be one for the diabetic patient who comes in at 28. I will bring coffee or water to patient's visitors, but that is exactly why there is a vending machine in the ER. It isn't for the staff...we wouldn't dare go up there and face a waiting room full of people to retrieve a personal snack.

Where I used to work, the cafeteria was open 24 hours. We could send a paper down for family members to pick up a tray for the patient, but there was a limit on the amount they could spend. I was impressed the new ER had sandwiches! I want to work where you do so I can have food for everyone. I bet you real have pillows too...

nerdtonurse?, BSN, RN · Mar 16, 2012

Yup...you never see them turn two folded blankets into a "pillow" on Grey's Anatomy because housekeeping didn't bring any and you've got two vented patients who've got ten pillows in the bed because of the breakdown they came in with. Or we've got dualing GI bleeds in a competition to see who can a) have the lowest hgb and survivie or b) go thru the most bags of PRBCs, FFPs and platelets in a single shift, the sweetest little lady in the world who's pacer has gone toes up and she keeps having periods of vtach that are so long it's making me sweat, while allergic (truly "red man" style allergic) to amiodarone, a psych patient on a medical hold who is now in twice as tuffs because he has broken the rails off your bed, and nothing -- not lithium, haldol, adivan, phenobarb, nothing -- is breaking the hallucinations and calming him down, and you're doing an emergency intubation on someone who's gray and going down the tubes, all while you've got someone wanting the temp turned up, the temp turned down, another blanket, a 'softer' blanket, a sandwich, a different sandwich, Dr. Pepper instead of Coke, and whining that their preferred cable channel isn't on the hospital's package. If you're well enough to whine about meaningless minutae, take your overpaid, overrated, overself infatuated backside back to your McMansion and leave us alone, we all know your "chest pain" is just your way of winding up your spouse to get what you want.

Sorry, it's been a rough week.

Altra, BSN, RN · Mar 16, 2012

Guilty as charged. I'm sorry, I'm learning.

OK, you get one pass.

Next time though ... it won't be pretty.

hiddencatRN, BSN, RN · Mar 16, 2012

I am the RN who once my pt is not NPO will get the coffee, soda meals for pt and spouse. I want my pt comfortable. I have been the pt it is no fun lying in a bed with IV fluids ..... so if I can address their needs and make them feel better I will. I treat every patient like I would treat my mom and I'd never tell my mom the canteen takes debit cards. I mean really what is a meal tray if they can eat? That's me and if I'm taking care of you or your spouse you may find that the little extra fluff made your stay more bearable.

In my ER meal trays are only available to patients who are being admitted and who are waiting for rooms. You cannot get a tray from dietary for anyone else. For patients who need to be fed who aren't admitted, we have a LIMITED supply of snacks. Tons of saltines. Some juice, and a couple of sandwiches. And the sandwiches are really to be reserved for the patients who have been admitted and will be going upstairs who aren't going to be getting a meal tray because the kitchen is closed. We usually have a box of popsicles for PO challenges on stubborn kids. I've never seen more than 6 mini cans of soda in our fridge at a time, some of which will hopefully be diet.

When we operate with finite resources, we have to prioritize who gets them. But it must be nice to make meal trays appear for everyone in your ER. And to not have to worry about patient flow so that you can let your patients hang out in the rooms eating instead of moving them towards discharge as soon as they're ready to go home.