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.

[nuangel1, BSN, RN]

no the nurse at triage should not have said what she said.it was rude and not very professional.but the op is a nurse a professional and as she states is a supervisor with years of experience with clout.her word not mine.she knows she had and has avenues more appropriate to deal with this then come to a public forum.coming here does not change what happened.if she has concerns and wishes to write letters and/or complain about her treatment she knows what to do .she could have spoken to the nurse directly ,she could have asked to speak with the charge person ,supervisor etc.she also still can contact the nurse manager or director of the ed.then the triage nurse would be made aware of the situation and spoken too.

[canoehead, BSN, RN]

http://www.ncbi.nlm.nih.gov/pubmed/16239179

A stroke tool that can be used prehospital, and would send the patient to fasttrack on my hospital.

If I was the triage nurse and saw the patient move from EMS stretcher to chair I would want to see her walk to the bathroom. Especially if the EMTs reported no deficits but the patient/family said she can't walk. I would also be interested in family dynamics...who assists her, how much help does she need vrs want. The presentation OP describes gives me mixed messages, I would want to do a quick look in triage but there's some important data gathered after she leaves me. A crisis-like presentation with non life threatening symptoms...did the EMT's miss something (they called it a triageable case), is the family panicking, are there social issues, or is the patient having a physical crisis that's rapidly changing? A quarter hour of observation in the WR can reveal a lot. If I knew the OP was a long time nurse, and the family wasn't obviously strange I would guess there is a real rapidly evolving physical cause, even if I couldn't pin it down. Patients can be uptriaged and sent back based on what you see aftr the formal assessment. JMO.

I don't want to even suggest that rudeness is OK. (But) I've been that rude nurse she describes for about 5 minutes. I usually hear myself and cringe, and try to pull the fangs back in. No excuses. The OP is spending a lot of emotional energy on a stupid, rude remark. It's her choice, I'm not sure it's wise, but I wasn't there.

[morte, LPN, LVN]

CVA was my first thought, too. And I'm not sure how a patient is stable enough for routine triage, much less walking to the restroom, until you've ruled out the lethal stuff. I've been advising patients that if they have any reason to suspect a stroke, call an ambulance immediately. I'll continue to advise that, because I'm pretty confident they'll be treated better in our ED. R/O CVA is not a fast track, and it can't be ruled out in an ambulance or at a triage desk.

You know, we see and hear unreasonable complaints all the time. My Dad has a million of them--and a few legitimate ones--and finds it frustrating when I'm "always on their side." (You needed all those labs because you were on a heparin drip. The nurse didn't cook the food. Etc.) But "That's not my problem," is defensible? Seriously? Look, I've been stressed. The OP has been stressed. "The system" has problems. And, hey, the OP could be lying. But I think there has to be some minimum standard, doesn't there? If the triage nurse had taken a smoke break while the patient lay there, would we still be saying, "She's still breathing. Job well done."?

I've seen good nurses have a bad moment, drop the ball, say the wrong thing. I've done it myself. I can see how a sympathetic reader might hope that was the case, here. I can't see how anyone can condone it or minimize it as one rude remark. As the OP states, the lack of caring and professionalism is appalling. We can't know whether it was a momentary lapse, but in that one instance, the triage nurse was not acting like a nurse. For whatever reason, she either was not doing the best she could, or the best she could do was not good enough. That's not her (the OP's) problem.

Thanks mike, you are so calm and reasoned, your backing on this is appreciated!

[Cul2]

"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.”

We can't tell the tone of that response. But, from the OP's comment, it's clear that the OP considered it rude or sarcastic -- even if that wasn't intended. Quite often when we're frustrated or angry our tones reflect that even if we don't intend it. So, having said that --

Part of the problem is that situations like this need to be confronted immediately. Right at the moment. Instantly. Yes, I know, most patients won't do this. But patient advocates should, the spouse or signficant other. Or other caregivers who hear it. Here's a possible response to the above comment: "I'll just assume you're having a bad day,your busy, maybe overwhelmed, but that was a rude, unproffessional comment. Can we start this conversation over and try again?" Then, be willing to forgive and start over.

Now -- any real professional having a bad day will most likely appologize and start the conversation over. If that doesn't happen and things go from bad to worse -- then the patient or advocate or other caregiver needs to ask to speak to or get a supervisor.

Until these kinds of problems are stopped at the moment they occur, they will most likely continue and even get worse -- because most patients won't write a letter like the the OP did. And notice, the OP hasn't sent letter. Even those who do write one may never send it.

[nursemike, ASN, RN]

http://www.ncbi.nlm.nih.gov/pubmed/16239179

A stroke tool that can be used prehospital, and would send the patient to fasttrack on my hospital.

If I was the triage nurse and saw the patient move from EMS stretcher to chair I would want to see her walk to the bathroom. Especially if the EMTs reported no deficits but the patient/family said she can't walk. I would also be interested in family dynamics...who assists her, how much help does she need vrs want. The presentation OP describes gives me mixed messages, I would want to do a quick look in triage but there's some important data gathered after she leaves me. A crisis-like presentation with non life threatening symptoms...did the EMT's miss something (they called it a triageable case), is the family panicking, are there social issues, or is the patient having a physical crisis that's rapidly changing? A quarter hour of observation in the WR can reveal a lot. If I knew the OP was a long time nurse, and the family wasn't obviously strange I would guess there is a real rapidly evolving physical cause, even if I couldn't pin it down. Patients can be uptriaged and sent back based on what you see aftr the formal assessment. JMO.

I don't want to even suggest that rudeness is OK. (But) I've been that rude nurse she describes for about 5 minutes. I usually hear myself and cringe, and try to pull the fangs back in. No excuses. The OP is spending a lot of emotional energy on a stupid, rude remark. It's her choice, I'm not sure it's wise, but I wasn't there.

Thanks for the link. I wasn't aware of the Rozier scale. I'll study it when I have more time. And since I don't work emergency, most of the possible CVA pts I see are being admitted, usually to stepdown. I guess I may have assumed that since I don't see people told "You're fine, go home." that it doesn't happen. And, on re-reading, the OP's "trouble walking," didn't specify whether it was unilateral or bilateral, which would not be definitive, but would be of interest. Anyway, it sounds like a stroke was ruled out, which is good.

I've seen threads before that ask things like why are nurses so heartless, why are experienced nurses mean to newbies, yada, yada, yada. Sometimes I feel a little defensive seeing some anonymous nurse I can relate to being criticized. (See there: nurse unity...sorta.) Some posters can seem a bit whiney. And yes, as incredible as it may seem, my halo can occasionally slip a little. Usually, though, I've been pushed pretty hard before I got testy, and while I have been testy, I don't think I've ever been indifferent. The OP does not state that she is the kind of PITA patient who can push any nurse's buttons. Okay, she probably wouldn't if she was. But I just don't see a basis to read that into it.

So, it seems to me, one can believe the poster is being truthful, or not. If not, why waste a response? But if events occurred as she described, the question becomes whether her complaint is reasonable or isn't. The triage nurse wanted to assess her gait? I would, you would, but how can that be drawn from the post? "It's over there"? Is it so improbable that one triage nurse, somewhere, is a poor excuse for a nurse that the OP must be mistaken? Is it inconceivable that her friend saw another, elderly patient being abused? I wish it was, but it ain't.

I freely admit I know very little about the operation of an Emergency Department. The few times I've been called there to help out, before and after I became a nurse, I did transports. The times I've taken my dad to the ED, I wrote his symptoms on a piece of paper, as instructed, and gave it to the triage nurse, who sent him straight back. (Dad can be a PITA, but he's the kind that won't come until it's nearly too late.) The OP and some other responders may not be very familiar with ED nursing, either. But, you know what, anyone who wants to argue that none of us can know how stressful it is or how much pressure that triage nurse was under has, at best, a really serious lack of imagination, and more likely needs to grow up a bit. ED nursing is stressful? I don't doubt it a bit. Handle it, or do something else. Riding to the ED in an ambulance, I've heard, is also a tad bit stressful, and the ones doing it have a lot fewer choices in the matter. And, believe it or not, most areas of nursing--probably all--are stressful. Different levels in different mixes, sure. I'd love to get through the next few nights without a code, and there's a decent chance I'll get my wish. But I might find myself a few hours from now all jacked-up on adrenalin and wanting badly to spaz out, and I'll suck it up and do my job, as pretty much anyone who posts here would. And, really, who among us would excuse ourselves anything less?

[Horseshoe, BSN, RN]

“That’s not my problem. I can’t go to the bathroom for her. There are wheelchairs all over the place.”

I've read 9 pages of baloney and various lame attempts to either explain, excuse, or brush off this behavior. None of them are convincing defenses. Why? Because the statement above is indefensible.

The nurse should be called on it. Fired? Nope. But confronted, corrected, and noted.

[bsnanat2]

Horseshoe, that truly says it all. Great summary!

[laurasc]

"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."

Part of the problem is that situations like this need to be confronted immediately. Right at the moment. Instantly. Yes, I know, most patients won't do this. But patient advocates should, the spouse or signficant other. Or other caregivers who hear it. Here's a possible response to the above comment: "I'll just assume you're having a bad day,your busy, maybe overwhelmed, but that was a rude, unproffessional comment. Can we start this conversation over and try again?" Then, be willing to forgive and start over.

Until these kinds of problems are stopped at the moment they occur, they will most likely continue and even get worse -- because most patients won't write a letter like the the OP did. And notice, the OP hasn't sent letter. Even those who do write one may never send it.

I agree....but at that moment in time I was both terrified I was having a stroke and worried that I was about to pee my pants. At that moment in time I wasn't a nurse, I was a very frightened and uncomfortable patient.

Confronting her about her attitude was the last thing on my mind.

What's the old saying? "Better late than never"

[laurasc]

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

I've read 9 pages of baloney and various lame attempts to either explain, excuse, or brush off this behavior. None of them are convincing defenses. Why? Because the statement above is indefensible.

The nurse should be called on it. Fired? Nope. But confronted, corrected, and noted.

Thank you! Excellent post! A lot of people here asked why I didn't say something right away. I didn't because as I said earlier, I had other things on my mind and I didn't need the hassle. But even if I wasn't so distressed, I probably would not have said anything right way either. Why? Because I would be afraid of what would have happened to me. I know how nurses can treat nurses and I had no idea how she would react. That's the same reason my friend didn't say anything either and why the ambulance tech advised her to keep her mouth shut.

You can deny it all you want, but if you've been around (and I have) you've seen it.

[Fribblet]

Thank you! Excellent post! A lot of people here asked why I didn't say something right away. I didn't because as I said earlier, I had other things on my mind and I didn't need the hassle. But even if I wasn't so distressed, I probably would not have said anything right way either. Why? Because I would be afraid of what would have happened to me. I know how nurses can treat nurses and I had no idea how she would react. That's the same reason my friend didn't say anything either and why the ambulance tech advised her to keep her mouth shut.

You can deny it all you want, but if you've been around (and I have) you've seen it.

Right, but you had two ambulance attendants with you, who, since you stated were the epitome of what a healthcare worker should be, that should have advocated for you.

I'm surprised you have failed to notice this shortcoming. Also, your friend/husband could have said something as well. The onus wasn't on you in this situation, but you had at least 3 people with you who failed to advocate, and at least two of those (3 if your husband was present at this time) who are bound by duty to do so.

It would appear it wasn't just the nurse who failed in this situation.

[hiddencatRN, BSN, RN]

Right, but you had two ambulance attendants with you, who, since you stated were the epitome of what a healthcare worker should be, that should have advocated for you.

I'm surprised you have failed to notice this shortcoming. Also, your friend/husband could have said something as well. The onus wasn't on you in this situation, but you had at least 3 people with you who failed to advocate, and at least two of those (3 if your husband was present at this time) who are bound by duty to do so.

It would appear it wasn't just the nurse who failed in this situation.

But the point is, this triage nurse was rude when a more polite interaction would have cost the triage nurse no extra time. Talking about what the OP 's advocates failed to do doesn't change the fact that the triage nurse owns her actions too.

[Fribblet]

But the point is, this triage nurse was rude when a more polite interaction would have cost the triage nurse no extra time. Talking about what the OP 's advocates failed to do doesn't change the fact that the triage nurse owns her actions too.

I didn't say that it did.

ETA:

Let me explain further. Several people asked the OP why SHE didn't say anything at the time. The OP provides a legitimate reason: she was too overwhelmed (which also calls into question her observational and recall abilities at the time of the event, but that's something else altogether).

Regardless, the OP was surrounded, by her own opinion, two healthcare workers who stand as paragons. In summary: the OP should have said something if she was in a position to say something. She wasn't. She had at least three advocates who all failed. At least two of those advocates failed in their DUTY. Yet, the only problem the OP sees in the entire situation is that a nurse made a snippy remark.

Frankly, rudeness is unnecessary, but don't you think two medics who have only ONE patient, who witness a patient being so severely mistreated, and have a duty to protect their patient, should have stood up for that patient?

Failure to advocate is a much worse offense than rudeness.

But, hey, with all the problems with healthcare, and with all the problems in an ER, if rudeness is the only thing you can complain about, then I say "job well done!" to the ER.