Attitude and Activity-question

Altra, BSN, RN · Jul 24, 2006

I've questioned the same thing: after a year in an urban Level I ER a lot of things no longer make me bat an eye ... but at times I wonder if that's a good thing. In other words, I'm somewhat shocked by the long list of things that no longer shock me ... :uhoh3: Does that make any sense?

I also struggle to keep cool & professional when I have one or more patients who are critical and the family of the guy with the sprained shoulder follows me down the hall to tell me that he's cold and he needs another blanket NOW. Oh please ...

I can't say exactly what patient population you'll find in your new ER, but where I am it's definitely a mix of trauma, bad stuff and clinic stuff. There are people who, even when they have the means to, will not ever take the responsibility to 1) develop a relationship w/a PCP 2) watch out for their own health or 3) go to the corner store & buy some TYLENOL.

Best of luck to you in your new position! :)

Joe B1 · Jul 24, 2006

Hey Always,

I have to agree with MLOS. It can be a struggle sometimes to maintain your cool. I have to remember that their problems are about them and not about me. I have to remember that many of these people have no real idea what it is we are trying to do and no real sense of what is truly nonurgent, urgent or emergent. I've had people raising a fit over their untreated dental pain when I'm running back people who are having MI's or arresting in the waiting room. I've had a coworker driven to a rage by a person ranting that his sunburn is every bit as bad an emergency as the heart attack that went back ahead of him. I've had my triage decisions questioned by people who've never even been in a emergency room, but have seen "ER" on television and think they know what we do. The thing to do is stay calm and not let them know that they've ruffled you. A guy once asked me why I had continually put his significant other's care on the back burner in favor of another patient, and I calmly told him that I had to because the other patient was more seriously ill and that person's situation took priority, but that I hadn't forgotten his s.o. and would be back as soon as I could. That was enough for him and he apologized on the spot. Not everyone is as easy to deal with.

I've worked in about 3 level 2's now and you still see plenty of stuff that could easily be cared for in a doctor's office but won't be either because the patient can't afford a PCP or because they won't take the initiative to find one because we make it so easy for them to just pop on over the ER any ol' time they wish, for any piddly problem they have.

That's just my take,

Joe

RunnerRN, BSN, RN · Jul 24, 2006

The big joke in my family is that I used to be nice, before I got my ER experience. I've been in a Lvl 1 for over a year now, and I really did used to be nice and naive and kind to everyone. You'll just develop your thick skin over time. I had a lot of trouble at first being assertive and saying what needed to be said. Now, when I've spent the last 30 minutes in a room trying to get an IV on a dehydrated 4 month infant who is wheezing and hasn't peed since yesterday, and I come out to a ticked off dad because "the MD said you'd get my child Tylenol over 30 minutes ago etc etc" I just say "I apologize, but I was in with a child that is very sick. Wouldn't you rather I be in with your child if he was having difficulty breathing instead of a child with a sprained ankle?" Putting it like that usually calms people down and helps them to re-evaluate the situation. I have been known to tell people that "your hurt tooth isn't the biggest thing going on, people have died here this morning" when I get really sick of them complaining over and over. Usually a simple remark like "this is an EMERGENCY room, we triage our patients over and over again; feel lucky that you haven't been seen yet, that means we don't think you're going to die today" also calms people down.

I guess what I'm trying to get ac is that you have to get a thicker skin, but no matter how thick my skin has gotten, there are still times when you have to tell people like it is, and in terms they understand. The above responses may not be the MOST appropriate, but it usually gets my point ac .

Also, if you come out of a failed code and need a few minutes to compose yourself before dealing with other patients, say so. I can't imagine your coworkers would begrudge you 5 minutes outside to take a breath.

And yes, you'll see the minor "clinic" injuries nearly as much in a Lvl 1 or 2 ER as you will in a rural/community ER.

"In the ER, everyone's an idiot" is something we say sometimes, just because most people don't think rationally - almost everyone who comes to the ER comes because they think they're having an emergency. It doesn't matter if we triage them as a Level 1, 2, 3, 4, or 5 - they still think they're having an emergency!

Best of luck to you! Hope my little rant has helped some :)

EricJRN, MSN, RN · Jul 24, 2006

"In the ER, everyone's an idiot" is something we say sometimes, just because most people don't think rationally - almost everyone who comes to the ER comes because they think they're having an emergency. It doesn't matter if we triage them as a Level 1, 2, 3, 4, or 5 - they still think they're having an emergency!

One of my old profs used to say, 'An emergency is something out of the ordinary that happens to YOU!' :)

irmaRN · Oct 6, 2006

i pray a lot!!!

noc_owl · Oct 7, 2006

feel lucky that you haven't been seen yet, that means we don't think you're going to die today

I just love that. I'd like to make it into a huge sign to hang in the wait room!

I also struggle sometimes to stay positive, with some patients/family more than others. I try to remember that everyone has their own perception of "emergency". And I also try to keep in mind that if this was my family member, how would I want them to be treated? Not that that works with everyone, but I can stay civil alot longer by keeping those two things in mind.

Also, there are always those small percent of complaints that you think are going to be nothing but BS, but end up biting you in the butt! Had one the other day that both me and the doc didn't give much thought to because the complaints were so vague, and that patient ended up being my sickest one. Sure helped me to remember to consider the worst possible thing that could be wrong until it is ruled out, rather than thinking the patient is not really ill.

I work in a level II and we still see plenty of clinic stuff. I don't think you can ever escape it working in the ED.

allnurses Guide · Oct 8, 2006

almost everyone who comes to the ER comes because they think they're having an emergency. It doesn't matter if we triage them as a Level 1, 2, 3, 4, or 5 - they still think they're having an emergency!
Best of luck to you! Hope my little rant has helped some :)

I found a couple of research articles comparing the differences in MD/NS/Pt perceptions of level of acuity (just how much of an emergency if this?).

Many patients justified their claim to have a "real emergency" because they called their PCP, and were told to go to the ER, so OBVIOUSLY it is a real emergency.

Can't tell you how many people have come to my triage window and expected to get taken straight back because Dr. So&so should have called about us coming in! What, now we take phone in reservations? "Bed and chair for two, at 7:26, have the dilaudid chilled and waiting" :jester:

Jennifer, RN · Oct 11, 2006

Every now and then I lose my cool, but for the most part, I stay very calm and caring to ALL my pts. I apologize profusely if a pt c/o about the wait, because 4, 5 and 6 hrs (to see MD) is a long time and I empathize with them. Granted, I probably wouldn't bring my 3 year old who vomited once today in to the ER for eval, but, heh, some people just don't know better. If I have a critical pt, and another less urgent pt is pissing and moaning about something, I calmly explain that I have a critical pt close to death who needs my assistance at this time and I will be with them as soon as I can. This usually shuts them up without me sounding too mean and nasty. And I totally agree with not taking pts too lightly. I had a pt (young, in early 30's) who came in with abd pain and fatigue diagnosed with acute leukemia. A friend of mine had a 2 yr old with "fever" diagnosed suddenly with leukemia and, while transferring to childrens hospital died in route. You never know who may be really sick. Sometimes they don't look, or act appropriately, sick, but then end up in the Unit.

alwayslearnin · Oct 12, 2006

Greetings all!

Just wanted to thank you for your replies. I appreciate your experience and observations. I am just taking it day by day and trying to be of service regardless of diagnosis or why the person is here. Sometimes I do well, othertimes-not so much. But I have noticed that when I am getting judgemental etc. I am usually very busy, tired, and need some support-than I am much more tolerant. So I am trying to be more aware.

Bless all of you for what you do!

alwayslearning

ps I would love to get the link or find out the studies done on perceptions of what is an emergency by Dr./Pt.

That would be so interesting.

CoolhandHutch, MSN, RN · Oct 12, 2006

Sometimes they don't look, or act appropriately, sick, but then end up in the Unit.

That's the most dangerous part of our job. I try to "leave the baggage" at the door before I assess a new patient- but how many times have you read the triage note and thought, "A sore throat? At 0300?" only to have the trop come back 5.0? (His complaint was a sore throat, but- Oh yeah! A few days ago I had pretty bad back pain- I got all sweaty and pretty sick to my stomach...I thought it was just the flu... and have been really fatigued since......:trout: )

Somedays it's easy, other days it's not so easy. You'll find your grove and try to empathize- if we were all nurses the ER would always be empty...we'd all be direct admissions to the morgue.

teeituptom, BSN, RN · Oct 12, 2006

I dont let anything faze me

I just go golfing