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.

[Fribblet]

I would be willing to bet money (something I don't have a lot of) that what is "highly indicative with what's wrong in healthcare" is inadequate staffing.

And why do you think that is?

[gypsyd8]

I second the exasperated emoticon.

[Fribblet]

Some observations:

-- There sometimes seems to be, esp. in ER, ICU, etc., an abyss between the physical part of care and the human part of care. I know. I know. It's all the same -- theoritically. But too often in some situations, the body becomes separated from the person.

There isn't a whole lot of time for "holistic" care in an emergency. Sorry.

-- This idea of "equating" the ER with a restaurant, and then the comment: "A lot of people consider them to be equivalent." Oh, really? Are patients that stupid? Professionals in the ER often see the worst of humanity and they get jaded. Patients aren't stupid. Thus...

Do you work in an ER? I get told all the time by patients what they want, when they want it, and how I'm supposed to deliver it.

-- Whether ER people (and everyone in medicine) like it or not, what they do is a "service." There is an economic transaction that takes place. They don't do it for free. I know -- you don't like the word customer or perhap seven client. But the caregiver/patient relationship, though a complex one, still has economic elements to it. You can't get away from that. People pay for a service. Now, don't give me this "They have insurance" stuff. Many people "pay" for insurance, or have earned it over the years. So...just because they're not paying out of pocket doesn't mean they haven't paid.

This make me LOL. Many of our patients don't pay, don't have insurance or have insurance they don't pay for. What you say might be true in a ritzy suburban ER, but it's not true down in the trenches. And, if what you're saying is true, then we, like a restaurant, should be allowed to refuse service to anyone for any reason, but....oh wait, we can't. Why? Because, unlike a fancy meal, we're not a luxury. I can cook at home. I can't bust the clot in my brain at home. And, actual, true emergencies often don't get a choice in where their receive their "service." They get stabilized at the close facility.

--- Yes, some patients don't understand the pressures caregivers, esp. ER people, go through. But some ER people don't understand the very personal aspects of certain conditions, like what it feels like to have (or think you're having) a stroke. More empathy is needed from both sides.

If I think I'm dying, the overall politeness of my caregivers is not going to register on my radar. After I'm calm and stable, then, yes I'll notice. But one barely notices what's happening around you when you feel an impending sense of doom. People are barely able to answer questions you ask them because they are so distracted and anxious. Fluffing pillows comes second, saving lives first. But we all have different priorities, I guess. That's why some people aren't suited for ER. In the ER we want to save your life. We'll fluff your pillow later. Now, that doesn't mean you have to be outright rude, but many people (who aren't having life threatening emergencies) think anything less than absolute sweetness is rude. I'm a nurse, not your stewardess.

-- Finally, as I said earlier -- what bothers me most, is that patients don't complain, then hold it in and let it all fester, and complain on threads like this. IMO, it's best to get that complaint out, make sure the right people get it, and then move on. Believe it or not, the rightly phrased complaint put in the right hands can cause changes for the best.

No argument from me regarding this ^^.

[caregiver1977]

And why do you think that is?

Okay, now this is one I may not have made clear.

When I say inadequate staffing, I mean there are too many patients and not enough nurses. I am not saying that the people hired are inadequate. Having to handle too many patients is one of the reasons my mom quit being a CNA (many years ago), why a cousin of mine who had 30 years of experience quit (and that may have helped cause her disabling back problems), and just about every nurse I know personally or have talked to in passing has talked about...having to handle too many patients.

Unless the OP has something to add I think this thread is done.

[Spidey's mom, ADN, BSN, RN]

Wow - just read this whole thread and it took awhile.

The triage nurse was rude.

But I would not send the letter.

I might go try to talk with her one on one. As a manager, I usually ask people to talk over their issues with each other before going up the chain of command, so to speak.

My thoughts keep drifting to whether this incident is that huge a deal to write a letter to the editor or to the CEO?

I'll bet none of us are innocent of being impatient. We need to work hard not to be but I wouldn't jump to such a huge consequence when this happens.

We have no idea if this woman is a chronic rude person.

Glad the OP is ok.

[Fribblet]

Okay, now this is one I may not have made clear.

When I say inadequate staffing, I mean there are too many patients and not enough nurses. I am not saying that the people hired are inadequate. Having to handle too many patients is one of the reasons my mom quit being a CNA (many years ago), why a cousin of mine who had 30 years of experience quit (and that may have helped cause her disabling back problems), and just about every nurse I know personally or have talked to in passing has talked about...having to handle too many patients.

Unless the OP has something to add I think this thread is done.

I know what "inadequate staffing" means.

Let me rephrase:

Why do you think there is inadequate staffing? It's easy to say, "There's not enough staff!" It's more difficult to understand WHY there is too little staff and how to rectify it.

Since you seem to have such insight, I want to know your opinion on why staffing is so poor (hint: it's not just as simple as "the hospitals are greedy!", although that is a significant factor.) and how to fix it.

[Fribblet]

Wow - just read this whole thread and it took awhile.

Damn, I'm impressed.

ETA:

That may come off sarcastic. It isn't meant to be.

That "damn" is more of a daaay-um!

[Spidey's mom, ADN, BSN, RN]

Damn, I'm impressed.

ETA:

That may come off sarcastic. It isn't meant to be.

That "damn" is more of a daaay-um!

That's the way I took it even before you edited.

This thread read like an unfolding docu-drama

Re: Inadequate staffing - I left the bedside for many reasons but part of it was the insidious insertion of bureaucracy into patient care and the focus on making the patient feel happy vs safe patient care. (edited to add - when ratios came to CA, they took away our awesome CNA's).

I work hospice now and while we still have bureaucrats and paperwork, most patient care happens in the home with a lot of autonomy.

[Fribblet]

duplicate post!

[Fribblet]

Re: Inadequate staffing - I left the bedside for many reasons but part of it was the insidious insertion of bureaucracy into patient care and the focus on making the patient feel happy vs safe patient care.

BAM.

This is what lay people are just simply ignorant about. And it seems no matter how matter how much we preach it from the mountain tops, they just don't get it.

Satisfaction over outcomes.

THAT is why I said the comparison of the ER to Restaurants is absurd. And, patients (and non-clinical management) DO equate them.

[Ashkins529]

From reading the entire thread, I see that most of the posters agree the triage nurse didn't sensor her words and as a result offended the OP. We don't know what was going on behind the scenes. I would have grace and write the nurse herself how it made me feel in a short and simple letter. Sometimes, you don't realize how you are coming across until someone points it out. It *might* make her reflect on different ways of handling different situations, or not. Things happen and are said we are all human. What ever the OP poster does you can't make someone apologize or change. That can only come from the person themselves.

Most of the ER nurses that have responded in what could be said as uncaring or brash are exactly the nurses who *I* would want as *my* ER nurse because I know the patient *I* am. I need someone who will clearly and with authority give directions to me when I am in pain or sick.

[caregiver1977]

BAM.

This is what lay people are just simply ignorant about. And it seems no matter how matter how much we preach it from the mountain tops, they just don't get it.

Satisfaction over outcomes.

THAT is why I said the comparison of the ER to Restaurants is absurd. And patients DO equate them.

There may be patients who expect the ER to run like a restaurant, but I don't think the OP was one of them. Neither am I. I only mentioned the restaurant because restaurants provide a service where you judge the product and the person providing the product. Whether you like it or not, that happens at hospitals too. I know that a hospital is NOT a restaurant and nurses are not waiters (how many times do I have to say that:uhoh3:). Sometimes in the hospital you are not going to "Have It Your Way" (Burger King) because your way may not be good for your health. Heck, your way might kill you.

I completely know the difference between restaurant service and a hospital ER. Let's not go there.

I think that people in whatever profession can do there job, taking care of patients or whatever their profession, without being rude. And no, I don't support patients being rude to staff just for the he11 of it. You don't have to have a nursing degree to know that.