An open letter to the ER triage nurse

Fribblet · May 26, 2011

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

When people started equating seriousness and a to-the-point attitude as rude.

Sometimes in nursing, especially in the ER, **** gets real.

CompleteUnknown · May 26, 2011

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.

I think that's a little bit harsh. I'm pretty sure that if patients had to choose whether they wanted safe care or a nice nurse, when it came right down to it they'd opt for safe care.

The thing is, these things are not mutually exclusive and patients shouldn't be expected to be grateful that they got safe care. That's sort of the minimum really, isn't it?

Fribblet · May 26, 2011

I think that's a little bit harsh. I'm pretty sure that if patients had to choose whether they wanted safe care or a nice nurse, when it came right down to it they'd opt for safe care.
The thing is, these things are not mutually exclusive and patients shouldn't be expected to be grateful that they got safe care. That's sort of the minimum really, isn't it?

You'd think so, but the focus no longer seems to be on outcomes, but rather satisfaction. I've seen too many patients on my own unit get, what I consider, sub par care (i.e. a CP not getting prescribed nitro, CEs not done HOURS after they've been ordered, important meds not given, etc) but the patient and family just LOVE the nurse. Can't stop talking about how great they are. I've also seen families and patients ***** and moan about a nurse that just didn't seem nice. The nurse wasn't rude, but they weren't the smiley, lovey-dovey type. Despite the fact that patient got excellent, timely care, all the family could talk about is how the nurse didn't seem to engage in enough small talk for their taste.

The nurse who gives excellent care, but doesn't jabber on with the patient/family about something insignificant gets called into the office, but the nurse who consistently provides care that's questionable (despite complaints from nurses who have to take over from them) never seem to be held accountable.

Satisfaction over outcomes. Ironically, it's the patients who've demanded to be treated like their at a resort when they come in for treatment that have ultimately shifted the focus away from what's most important.

"Customer service" is inherent in our jobs as nurses, but it's not our focus. The health and outcomes of our patients are the focus. But, the patient-as-comsumer model has taken over at the detriment of the patient. Unfortunately, the public is too ignorant to notice.

You may think it's harsh, but it's the reality. If it's not reality where you are, just wait. It will be.

CompleteUnknown · May 26, 2011

You'd think so, but the focus no longer seems to be on outcomes, but rather satisfaction. I've seen too many patients on my own unit get, what I consider, sub par care (i.e. a CP not getting prescribed nitro, CEs not done HOURS after they've been ordered, important meds not given, etc) but the patient and family just LOVE the nurse. Can't stop talking about how great they are. I've also seen families and patients ***** and moan about a nurse that just didn't seem nice. The nurse wasn't rude, but they weren't the smiley, lovey-dovey type. Despite the fact that patient got excellent, timely care, all the family could talk about is how the nurse didn't seem to engage in enough small talk for their taste.
The nurse who gives excellent care, but doesn't jabber on with the patient/family about something insignificant gets called into the office, but the nurse who consistently provides care that's questionable (despite complaints from nurses who have to take over from them) never seem to be held accountable.
Satisfaction over outcomes. Ironically, it's the patients who've demanded to be treated like their at a resort when they come in for treatment that have ultimately shifted the focus away from what's most important.
"Customer service" is inherent in our jobs as nurses, but it's not our focus. The health and outcomes of our patients are the focus. But, the patient-as-comsumer model has taken over at the detriment of the patient. Unfortunately, the public is too ignorant to notice.
You may think it's harsh, but it's the reality. If it's not reality where you are, just wait. It will be.

I take your point and I don't necessarily disagree with it.

Sadly, I also see 'questionable' or downright shoddy care at times, far too often really. I see patients and families complaining because their nurse wasn't 'nice enough' too. The thing I haven't seen (yet) is this idea that pleasing the patient is the only thing that matters.

I'm not in the US so I have to wonder if your health system is a big part of the problem. We don't have to attract patients to the hospital here, and we don't have to treat them like they're at a day spa so they'll choose us again next time.

nursemike, ASN, RN · May 26, 2011

When people started equating seriousness and a to-the-point attitude as rude.
Sometimes in nursing, especially in the ER, **** gets real.

There's nothing especially real about not being able to distinguish between going to the toilet and having ones hair stroked, between to-the-point and that's-not-my-problem. And how are we assuming that this triage nurse, who couldn't cope with a patient on a gurney who needed to pee, was somehow capable of providing quality care? Pt comes to the ED with what turns out to be a complex migraine and doesn't die. Hey, great job, everybody!!!

caregiver1977 · May 26, 2011

My local hospital is the only main hospital within a 40 mile radius. Not too long ago they had a bad reputation for being rude (my husband and I were treated rudely as well). The rudeness was all over the hospital, not just one area. Patients were routinely told that if they didn't like the care at the hospital that they could drive 40 miles away to another one. Because of transportation and gas prices, staff at the hospital knew that a lot of people would be stuck with our local hospital whether they were treated rudely or not.

I know many people who work all over this hospital. I was told that what really got the CEO of the hospital's attention was when his own child was treated rudely and their care was compromised at the ER. The CEO adopted children a different race than his own and the staff didn't know they were treating his child. I have noticed a difference at the hospital, and it doesn't mean that everyone is dripping with honey (nor would I expect them to, or even WANT them to).

And yes, the hospital also had problems with making glaring medical mistakes. I don't know if or how that has been handled.

I am sure none of you would want to be treated rudely at a restaurant, even if the food was excellent. You don't have to become a doormat to at least be courteous.

Turd Ferguson · May 26, 2011

I woulda just peed on the floor there in the triage room

kessadawn, BSN, RN · May 26, 2011

I am so sorry you had to endure such unprofessional treatment! From what your friend witnessed, it sounds as if the entire workplace may be unprofessional. So sad. I wonder if sending that letter to a hospital CEO or DON would make a difference?

Fribblet · May 26, 2011

There's nothing especially real about not being able to distinguish between going to the toilet and having ones hair stroked, between to-the-point and that's-not-my-problem. And how are we assuming that this triage nurse, who couldn't cope with a patient on a gurney who needed to pee, was somehow capable of providing quality care? Pt comes to the ED with what turns out to be a complex migraine and doesn't die. Hey, great job, everybody!!!

There is something real about being able to distinguish between a comment that is speaking very broadly, and one that is speaking about something very specific.

:uhoh3:

nursemike, ASN, RN · May 26, 2011

There is something real about being able to distinguish between a comment that is speaking very broadly, and one that is speaking about something very specific.

Of course, but I still think many posters who have an ED perspective are responding defensively as though their practice was being attacked, rather than the OP's criticism of one particular triage nurse. This is not a "Why are ER nurses mean?" thread. Unless you've done what that triage nurse did, you are only being criticized for defending what that triage nurse did. So, your comment about people with unreasonable demands (hair stroking, hand-holding) appears to imply you believe the OP was unreasonable for wanting to pee, and not being able to walk very well.

Some valid points have been made that do support some aspects of the cited triage nurse. I get that it was not her job to do a full assessment, but to focus on the chief complaint and decide quickly what needed done. You know, all nurses triage, all the time. Start of shift, I don't just assess by alphabetical order. Two call lights go off, I decide which needs answered first. And it isn't stress-free. But it also isn't the patients' fault--usually--and even if it is, you have to treat them with respect. A number of posters have made the point that the OP's situation was not the end of the world. Well, no, it wasn't. But it was hardly trivial. And while it could have been perfectly legitimate to let the OP pee herself while attending to a life-threatening emergency, there's no indication that that was what was happening. It's possible that if we knew the triage nurse's side of the story, we would understand why she didn't help the patient into a wheelchair and see that she was taken safely to the restroom. It's also entirely possible that she was just too lazy or full of herself, as her dismissive words suggest. The quoted poster recognized, way back in post #19, that rudeness was not called for. Some other aspects of the incident have been explained. Even the apparent failure to acknowledge the patient by making eye-contact might be understandable. Sometimes we do get focused on what we are doing. But "I can't go to the bathroom for you?" Do you seriously think the patient was out of line for needing to pee? Would you react the way the nurse in the post did? Even if you were too busy to assist at that moment, would you answer the way that nurse did? I really doubt it. I've not seen that sort of treatment as a patient or son of a patient at my ED. Or is the patient wrong for objecting to sub-standard care?

We haven't discussed the hypothetical situation where the patient does as instructed, hops off the cart and walks to the restroom, falls on the way and gets a subdural bleed. No, it didn't happen, but from the information in the post, there is no indication that the triage nurse lifted a finger to prevent it. Are we supposed to pat the nurse on the back because the patient had better sense than to hurt herself? This isn't a story about simple rudeness, which in itself is inexcusable. The triage nurse's offense is her indifference to a patient's comfort and safety, and her lack of respect for a fellow human. I seriously doubt that anyone who has posted here would be nearly so understanding, had they been the patient.

Alnitak7 · May 26, 2011

As for the nurse yelling at the elderly patient, I was not there and don't know for sure, but some of these patients can't hear and you really do need to yell to talk to them. I am soft-spoken and I often find I have to raise my voice for some of my own patients to understand me. There is no hostility intended.

As for, "it's not my problem," well, yes it is.

She can delegate this task or say something more tactful.

QUOTE=laurasc;5142599]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.

*************************************************************************************

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.

Fribblet · May 26, 2011

I am sure none of you would want to be treated rudely at a restaurant, even if the food was excellent. You don't have to become a doormat to at least be courteous.

Apples and oranges.