An open letter to the ER triage nurse

[laurasc]

I wrote this letter to a Triage nurse. I don't know her name as she did not introduce herself to me. I haven't decided what I am going to do with it...but I figured I would post it here to start. It's an interesting experience being on the other side of the gurney for a change.

Let me know what you think.

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I write this letter to the ER triage nurse who was on duty May 11, 2011 at a local hospital.

On that day I was taken to the ER by ambulance. I had experienced sudden neurological symptoms, was having trouble standing and walking and was very frightened even though I was trying very hard to stay calm. Anyone who's been in that situation knows how awful it is and how your mind races thinking up the worst case scenarios. I had chosen your hospital because I had been there in the past and know it to be an excellent hospital.

When you called me in (the ambulance attendants had to take a number and wait to be called) you sat down in front of your computer and started to take the report from one of the ambulance attendants. You barely looked away from your computer screen, and from my perspective didn't make eye contact with the ambulance attendant. You did not look at me or acknowledge me.

When you were done, I asked you if it was possible for me to go to the bathroom. You waved past the triage room towards the waiting room and said, "There's a bathroom over there, you can walk there."

My friend, who had accompanied me, responded, "But she's having trouble walking."

You responded, "That's not my problem. I can't go to the bathroom for her. There are wheelchairs all over the place."

The ambulance attendants helped me into a wheelchair and my friend took me to the bathroom.

You didn't know this at the time, but I will tell you this now....I am a Registered Nurse and have been for 26 years. I know what it is to be overwhelmed, overworked, undervalued, underpaid and frustrated. I know what it is to be stressed and I know how it feels to burn out. I've been there, done that and have the t-shirt so to speak.

I truly understand that your job can be difficult at best, But let me ask you something....how is all that my fault?

What did I, as your patient, do to deserve to be treated so rudely? Do you think I wanted to be there strapped to that ambulance gurney? Do you think I timed having my bladder being so full it was painful right for that moment? How much would it have cost you to turn to me and actually look at me? A nursing assessment consists of at the very least looking at your patient and not just relying on the report of the ambulance attendants. How difficult would it have been to simply tell me that you would get me a wheelchair once you were done? (There was one right next to my gurney) How difficult would it have been to crack a little smile? I wasn't asking anything complicated, all I wanted was to pee.

Remember, I am one of you. I too have been on your side of the bed and I too have felt the sting of the profession we chose. So I think it is safe for me to say, with some authority borne from experience that there is never an excuse for a nurse to treat his or her patient the way you treated me.

I'm writing this to put a voice to this problem. I know I'm not the only patient who's had to go through this or worse. Sadly, this kind of behaviour has become rampant. I see examples of that everywhere. Our current health care system with all its problems has put our profession is in crisis. The lack of funding, lack of resources and lack of staffing means that nurses are shouldering a huge burden. I get that! But our patients are in crisis as well and we are the professionals who are caring for them. That's why we are nurses, to care for people. Caring means kindness, not rudeness.

My friend, who is not a nurse, was aghast. She later told me that while we were in the triage room she witnessed another nurse yelling at a very elderly woman and dragging her down the hall by the hand. My friend was going to say something but was told by the ambulance attendant not to say anything because the nurse would "make a spectacle of her."

That is a sad statement considering we are talking about a profession known for caring. Have some of us really forgotten who and what we are and why we are doing what we do? Maybe we should all spend some time on "the other side of the gurney" for a change.

I do have to add one thing however, the ambulance attendants were phenomenal. They were caring, gentle, patient and knowledgeable...literally everything a health care professional should be and more.

[NurseLoveJoy88, ASN, RN]

After all these posts i am still waiting on the OP to explain to me what great harm was done to her by the triage nurse. Yes the nurse's comments may have come across as rude, but it was a comment ..get on with your life. I would have done the same thing as the triage nurse, may not have used the exact words but if she was able to be triaged to the lobby her friend could certainly have helped her to the bathroom. If you are coming into the ER expecting it to be a calm and soothing enviroment you are going to be greatly disappointed. We are there to handle emergencies, yes we should be considerate of our patients and treat them with compassion but sometimes the situation doesn't allow the fluff your pillow stuff.

There may have been no physical harm done, however there is still no excuse for the nurse's rude actions. NO one expects for ER to be soothing and calming and for the pillows to be fluffed. We do however, expect for nurses to act in a professional manner. Being rude is NOT professional.

The OP will get over it, part of her getting over it is giving this letter to the triage nurse. Sometimes we need to be an advocate for ourselves.

[FF-PHRN]

If the OP finds this offense to be so serious, as most of the posts here indicate it should be, then she should go back to the ER and talk face to face to the nurse or the manager. The manager knows the nurses, the situation and the offending nurse, who may have a viable explanation. The manager will make the appropriate course in changing the behavior.

Do not send a letter. Its just one sided emotion and easy. Do what nursing 101 tells us all to do with our pts and find out the entire story so an appropriate action can be taken.

For those who said defending the triage nurse shows I need a new job and I am burntout. I say I evaluate the situation with the one side I was given and try to EMPATHIZE with the other NURSE and her position to find the real problem and the real course to correct it. There is another side to this we aren't hearing. Suggesting the other nurse act with only the side she saw is to do so uninformed and vindictive.

I have no apologies for defending the triage nurse and for giving possibilties for her actions. As a nurse, I am a problem solver by profession, not given to emotional and uninformed decisions. Isn't that what we all do, as nurses? So...it seems the OP should give her information to the nurse and her manager face to face so an informed decision can be made. Not an emotional decision! The behavior then can be explained, changed, reprimanded or possibly even excused.

So, I am not burned out or needing a new job. I think situations like these need to be looked at thoroughly without jumping to emotional conclusions. Kinda like the way I triage in the ED.

[Altra, BSN, RN]

I think situations like these need to be looked at thoroughly without jumping to emotional conclusions. Kinda like the way I triage in the ED.

And I would call that the height of professionalism -- the ability to calmly, dispassionately evaluate situations and act accordingly.

[Hardy6]

It's interesting how we excuse rude behavior!

[NurseLoveJoy88, ASN, RN]

If the OP finds this offense to be so serious, as most of the posts here indicate it should be, then she should go back to the ER and talk face to face to the nurse or the manager. The manager knows the nurses, the situation and the offending nurse, who may have a viable explanation. The manager will make the appropriate course in changing the behavior.

Do not send a letter. Its just one sided emotion and easy. Do what nursing 101 tells us all to do with our pts and find out the entire story so an appropriate action can be taken.

For those who said defending the triage nurse shows I need a new job and I am burntout. I say I evaluate the situation with the one side I was given and try to EMPATHIZE with the other NURSE and her position to find the real problem and the real course to correct it. There is another side to this we aren't hearing. Suggesting the other nurse act with only the side she saw is to do so uninformed and vindictive.

I have no apologies for defending the triage nurse and for giving possibilties for her actions. As a nurse, I am a problem solver by profession, not given to emotional and uninformed decisions. Isn't that what we all do, as nurses? So...it seems the OP should give her information to the nurse and her manager face to face so an informed decision can be made. Not an emotional decision! The behavior then can be explained, changed, reprimanded or possibly even excused.

So, I am not burned out or needing a new job. I think situations like these need to be looked at thoroughly without jumping to emotional conclusions. Kinda like the way I triage in the ED.

I am willing to bet that if the story was flipped then you would not have responded as you did. What if this was a rude patient? Would you still try to see if the behavior can be explained , changed or reprimanded or possibly excused ? I think NOT. What if this was a rude doctor ? Would you still feel the same ?

I think those who did defend the triage nurse was probably looking at themselves in the mirror while reading about the nurses' behavior. Truth hurts doesn't it ? Go ahead and flame away.

[NurseLoveJoy88, ASN, RN]

And I would call that the height of professionalism -- the ability to calmly, dispassionately evaluate situations and act accordingly.

Which was something that the triage nurse possibly did not do. I do believe that there are 3 sides to a story. The OPs side, the nurses' side, and the truth. With that said we can not be oblivious to the fact that rude, nasty, and un-empathetic nurses exist.

[hiddencatRN, BSN, RN]

The manager will make the appropriate course in changing the behavior.

The manager can't do that with the letter but only a face to face visit?

[FF-PHRN]

I am willing to bet that if the story was flipped then you would not have responded as you did. What if this was a rude patient? Would you still try to see if the behavior can be explained , changed or reprimanded or possibly excused ? I think NOT. What if this was a rude doctor ? Would you still feel the same ?

I think those who did defend the triage nurse was probably looking at themselves in the mirror while reading about the nurses' behavior. Truth hurts doesn't it ? Go ahead and flame away.

Actually, I explained that I would have responded exactly that way especially if it was a rude patient. A variety of medical conditions make patients act rude or inappropiate. It more often needs to be looked past to see if someone has a condition or has just had situation that puts them in their condition. Rude Dr., same thing.

I told you the truth. It does not hurt. I also said everybody can have a bad situation that leaves one responding in a rude manner. Imagine having just pronounced the 10month old code pink pt you had and going back to the 25yo pt with a cough x3weeks who is upset at what took so long to get that cup of water......It just might take a minute to compose ones self. Does that make sense as a possible reason one makes a rude comment but not necessarily make that nurse cold and heartless? I am not excusing it, but the environment can be a bit much at times. This triage nurse may have had something outrageous just prior to the OPs arrival and didn't have the opportunity to compose yet.

Rude patients are practically the norm, medical condition or not. I am not rude back. Simple as that. No flames needed BTW.

[Fribblet]

And I would call that the height of professionalism -- the ability to calmly, dispassionately evaluate situations and act accordingly.

You would be correct. However, the prevailing line of thought here at allnurses.com (and with upper management) is that nurses must be all smiles, super-duper compassionate, willing to stroke a patient's hair, rub their furrowed brows, and listen intently and with concern to every word a patient says.

As some have said (to paraphrase): Patients don't care what you know, until they know you care. (And your employer doesn't either. PG scores are improved by nurses smiling and focusing on patient satisfaction rather than patient outcomes. Remember your scripting, girls!)

This thread has entirely reinforced my opinion that patients (even nurses who are patients) ultimately don't care about the quality of actual care they get, just as long as the nurse was nice.

[FF-PHRN]

The manager can't do that with the letter but only a face to face visit?

Sure, a manager could do with just a letter. Isn't that like giving a medication and not reassessing the results. If this is as outrageous as everyone is making it out to be, then go in and make sure the problem is addressed and solved.

Does this nurse have a pattern, I would want to know. Was it just the only bad 5minutes of her career? Is she new and overwhelmed, or old and burnt out, maybe floated from another unit and just uninformed. There is possibly alot more to this than an old rude burnt out nurse, right? at least possibly.

I would go in and find out instead of writing a letter. To me, it means more and will get better results.

[yfloridanurse]

I am a former ER nurse, done triage many times and almost everyday at the end of the shift and overwhelmed like any ER nurse would get when they have 75 patinets on triage waiting to be seen but the attitude no toward another nurse but to a patient like the one describe is not institutionalized. That is not nursing. I would not only write the letter to the entire hospital but I would definitely would send the letter to the manager of the ER. Not only does she needs to be aware of her attitude and her lack of care but also her lack of professionalism and how she is endagering patient life by not doing a proper assessment. A report is a good communication tool between the team but the best assessment is the one we as nurses make of our patient at time of entrance. That is unacceptable and whoever thinks that a system create nurses that way is wrong, our health care system is in need of some reform and we may get cynical at times among ourselves about the use and abuse of the ER but we can never show that cynism or careless attitude to our patients. Not only are we failing to honor our code of ethics and failing to do our job but we are failing to patients in need and to all nurses outhere who think that nursing is an everlasting job let me tell you is not, is about caring, customer service, the day we forget what nursing is, is the day we lose the customers and we lose our job. Always remember not only that person in the gurney can be your family member but also yourself and like the bible says treat others like you like to be treated.

:redbeathe:nurse:

[thehipcrip]

We are there to handle emergencies, yes we should be considerate of our patients and treat them with compassion but sometimes the situation doesn't allow the fluff your pillow stuff.

When did refraining from being rude and dismissive become equated to "pillow fluffing"?