I saw this on an ER thread and I feel it needs to be discussed. Before anyone flames me, this post is not intended to attack nurses, especially ER nurses. I feel that I do need some clarification about what nurses consider to be a "bother."
Originally Posted by RunnerRN
14) Just because you or your family member says "I know you're busy" or "I'm sorry to bother you" before making another dumb request (another blanket, when will my room be ready, etc) does not make me less busy or you less of a bother.
OK, not to be another scolding student, but this one did bother me. It is natural to want to make your family member comfortable during their stay in the ER, even if their need perhaps isn't as urgent as the dying patient down the hall. The family member is at least showing some politeness and sensitivity for the nurse. They are not trying to be a bother. It's just that their family member is sick (even if there are other people there who are sicker) and they are trying to get their needs met.
Trust me, if I knew where the blanket/clean sheet/washcloth/emesis basin was, and I was allowed access to the supply closet, I'd get it myself and not bother you. But I'm a "guest" in the ER, so I have no choice but to bother the nurse or leave my family member cold/wet/dirty/thirsty etc. So to all you hardworking ER nurses, I'm sorry to bother you, I know you're busy, but I will advocate for my family member when I accompany them to the ER.
Point is, from a patient's perspective it's hard to know what will be considered unreasonable. I don't think it's unreasonable to want to be comfortable if you're really not feeling well. I'm not talking about patients who have no reason to be in the ER. I'm talking about patients who truly are sick, but are stable and not about to die. Should their need for comfort be ignored because there are patients who are so much sicker? As a family member, I hate to bother the nurse because I know how much she has to do--but as I said, I'm a guest in their facility and I really don't know where things are. If I could take care of it myself, I would.
It's not just in the ER that this is an issue. I'm one of the least demanding people you'll ever meet, yet I have been in hospital situations where I was made to feel like a "bother." That's one reason I chose to have my babies at home. The OB nurses during my first birth were great, but the postpartum nurses acted like I was a big pain. When I have my babies at home I'm on my own turf and can look after my own comfort, and the midwife is there to assist me. I am not a bother to anyone.
I don't really know what the resolution to the problem is. I know nurses are overworked as it is and can't be all things to all people at all times. I also know that there are whiners and unreasonable people out there who demand all sorts of things that are not their right at all. But should a patient with a legitimate (although not desperate) need be ignored simply because other people have bigger needs? Maybe hospitals can have the most necessary supplies readily available so family members can provide the comfort care when nurses are too busy to do so? I really don't want to bother the nurse, but it's frustrating to be so dependent on people who have much more important things to do than tend to you.
Telling them to sit tight is totally appropriate. It is not a matter of "better things to do" it is a priority list. Child with breathing difficulty takes priority over water and warm blanket for grandma.
Precisely. Many of the times, the people who say "I hate to bother you, but..." are the ones who ask for more water, then five minutes later need a blanket, then five minutes later need to go to the BR, etc. Some requests can be clustered, e.g. getting a blanket and water.
And yes, sometimes it is absolutely appropriate for a pt. to have to just sit tight.
I would hope that when you are finished with your studies you could work in an ER and maybe come up with some better solutions on how to run a more customer friendly environment. :uhoh21:
I'll go you one better...come up with a more "nurse friendly" environment.
Poor Chaya. She tried so hard to ask her question without sounding judgmental.
Thanks Susesquatch and Roy for seeing what my point is. We are not adversarial at all in this case, but unfortunately we seem to be speaking at each other rather than to each other. I think I'll continue along my own path to becoming a nurse and just pray that I won't be encountering the ER anytime soon (not because ER nurses are uncaring, but just because ER is not a place I'd want to be, a priori.)
Chaya, I can understand that you want to be there for your family. And it is natural to want to get your relative a blanket if they are cold. Through your training and as you get more experience you will find family and friends will take great comfort if you are there for them in the ED. So don't let that deter you from not going to the ED or even having a prac placement there. Then you can compare the two experiences.
I have taken friends and family to the ED many times, mainly as a comfort to them. It is easy to have someone interpret medical jargon that understands it. I have an 'emergency' bag in my car that has a jumper, change of clothes, toiletries, a book and some dried food (usually BBQ shapes, and its all for me!!) It doesnt hurt to have a bottle of water and a blanket in the boot of the car just in case. (also because I live in the country, miles from anywhere!)
Try to understand that those of us who have worked in emergency departments dont see a request for a blanket as a priority. Its just that simple. I have been abused left and right by family members for not doing this or that, when I really just want to say a cough/cold for 4/7 is not an emergency, take a panadol and go home. Its not being nasty, its just that you cant drop everything in the middle of a resus to grab a blanket.
You can do alot of things to help a relative in the ED and not use the "I hate to bother you but,,," sentence.
Really only 1 relative should be with the patient in the ED, and never in a resus. Keep other family members informed so that there is 1 contact person. Family can contact you and not the hospital. If you are taking a relative to the ED (obv not in an emergency) take a spare rug or cardi just in case. Even a soft pillow can help in those hard backed chairs. You can explain to your relative that ED can get really busy, and that they really shouldnt eat or drink until they get the ok from the Dr. Sympathise, say 'I know its a bugger you cant drink but better to be safe than sorry hey?' (or does that really sound occa Ozzy?!) Give them some reasurrence and hold their hand. Make sure you have a list of their medications/medical problems/allergies ect to speed up the triage process. And always explain that a 2 hour wait in the ED can quickly lead into a 6 hour wait if there is a priority. Are they happy to wait that long?
Being a nurse your family may expect alot of you. Anything from explaining medical jargon, to maybe knowing the right things to say to get into ED quicker. (My advice, never tell anyone that chest pain will get you seen quicker. If you havent got it then God help you!) I have been on both sides of the fence as have many other nurses. But I have trained my family and freinds quite well. If you are not dying its not an emergency and dont dare yell at the nurses or you will have me to answer to. ED's get clogged very quickly, and I have told off a few relatives (in jest) for wasting 'the good nurses time' (Sorry Uncle Bob, dont care if your ingrown toenail is giving you curry,,,, will you die from it? No? Then take a panadol next time and you wont have to whinge about waiting in a hard cold ED for 6 hours,,, Serves you right. But then he gets up big hug, so all is forgiven!)
Good luck with your studies, have faith and confidence in yourself. Be there for your family, ED can be a scary place, and I am sure they will need you. Give ED nursing a try. I never thought it was something I was cut out for but it turns out I am. Though I dont fluff as many pillows in ED as I did on the wards, my patients get their treatments and their care on a priority basis, and in the ED it shouldnt be any other way.
Thank you Storm, that was a very helpful post. Bringing along a care package with your own paper towels, extra blanket, washcloths etc. is a great idea, if I ever need the ER again (provided that I have the peace of mind to pack a bag before heading to the ER--not always a given.)
I understand why the nurses can't always help. I just wish there were more staff available who could help keep patients comfortable once they're out of danger but waiting for surgery/admission etc. Just because they're not dying imminently doesn't mean they're not sick, even very sick, and still need the same caring and comfort measures as any other patient in the hospital. It's not their fault that they're stuck in the ER for hours where it's noisy, no privacy, no rest, no regular schedule, etc. I'm not talking about the hangnail, I'm talking about the patient with pneumonia, or ruptured appendix etc. who might be stuck in the ER for 24+ hours until a room /OR becomes available.
I understand why the nurses can't always help. I just wish there were more staff available who could help keep patients comfortable
You just spoke volumes there.
Instead of writing a letter (or calling) to complain about the staff as many do, why not call and complain about the UNDERstaffing? Maybe if the public realized and addressed the real problem here, administration may listen.
Perhaps I'm naive, but I think that as nurses, we have to suspend our own notions of what is "RIGHT" to do or not do based on visual exam.
As a nurse, when I go to the ED, I only go when I feel I can't take care of things at home. Most recently, I was in the ED because I had a nasty bout of gastroenteritis. I was severely dehydrated, was passing out at home, and couldn't keep a sip of water down without vomiting.
My husband drove me to the ED on that day, and after being lectured by the ED doc for coming in for the stomach flu, I was left alone. Granted, I knew that the reason they left me alone was due to the fact that they had a code running next door to me, and I understood that (although my poor husband was livid at my "lack of care").
What I didn't understand was that after the patient was taken to ICU, and I knew the ED had only 4 patients, why my husband had to run and get me a warm blanket from the warmer himself, when nurses were standing outside my cube and joking around. I don't understand why, prior to IVF and after my DH left, I was allowed to walk to the bathroom independently, and more importantly, why, when I passed out in the bathroom, woke up, and then pulled the emergency cord, why I had to lie on the floor for 5 minutes before crawling to the door, opening it up, lying half in the hallway, and calling for help 2 minutes before I made it to bed, and was finally given 4 L of IVF and given the option of admission due to lack of "road test" pass-- I couldn't walk more than 10 ft without nearly passing out (which I refused, because my husband would take far better care of me than I obviously would have received at my own sister hospital). But, heck-- I was a simple case of gastroenteritis in an over-reactionary RN, with overbearing family, right???
Perceptions can completely cloud judgement. I've had it happen in my position as an RN. You know-- the pain in the butt ICU patient who can actually use the call light, and pushes it incessantly. Usually, they're scared-- scared of dying; scared of merely being alone. If I've got 30 minutes to sit with them and my other patient is stable or being watched by another RN, I'll do it to ease their discomfort. Hospitals are terrible places in which to be a patient.
So, you know what? Sometimes familiy concerns about care are legitimate. Should I have sat in the ED bed after the 1- hour code was completed and further dehydrated until my electrolytes were out of whack and I needed further intervention? My EKG showed a long Q-T, which wasn't even addressed . . . UNTIL I passed out in the bathroom. Should I have stressed my body out more by not requiring care? Perhaps I should have crawled my way the extra 20 feet to my bed, hoisted myself up, and waited for care. After all, I was not coding or losing a limb . . . right???
Sure, a blanket seems like a simple thing, but either let the family know where to get misc. supplies like warm blankets, or just give one to every patient upon assessment, if they don't have a temp. If they do, explain right away why they can't have a blanket to family. Simple enough, huh? If ONE person would have taken 1 minute to either get me a blanket, or answer my bathroom emergency light, or merely explained WHY they couldn't help me . . . then I would have been ok. My HUSBAND would have been ok. Seems to me like half of the time, the issue is lack of time explaining WHY we as RN's do things, rather than families demanding stuff.
Hellard- you are absolutely right. I think you would have qualified for the "sick" category without even trying at my hospital. You deserved prompt and thorough care. For myself, I find it hard to defuse an angry family member who has waited through a code. Postcode, I'm less able to be calm for a few hours, and even if family are justified it just drives me mad to be in a situation where I'm expected to do the impossible. Save every life, accurately triage every incoming patient, and provide simple comfort measures at the same time? Sure, I can do that!
(If the staff at that hospital was involved in a code the opportunity to take even one minute to explain what was happening had long passed. They were counting on the 15 people in one room and shouts for supplies to tip you off. That doesn't excuse their neglect afterwards though.)
At the same time I am glad to have involved family members at the bedside. when it gets busy their attentiveness can really become part of the nursing care. " If x, y, or z happens let me know, and I'll be back in 30 minutes."
This is when it becomes time to delegate and what nurses have the hardest time doing. Yes I am busy with the chest pain patient but it does not take a nursing license to get a blanket...I will tell the visitor I will get someone to get it for them then ask the tech, secretary or housekeeper whoever else is around to get the item for the patient most of the time these people are just as eager to be of help . Then be sure to follow up with the visitor when you get the chance to make sure the need was met.
(If the staff at that hospital was involved in a code the opportunity to take even one minute to explain what was happening had long passed. They were counting on the 15 people in one room and shouts for supplies to tip you off. That doesn't excuse their neglect afterwards though.)
As an ICU RN, I've had situations where I've had to yell at a family member to leave a room so that we can have confidentiality and space while running a code in the room next door. I've never had a family member yell at me later about that, as long as once the code is done, I explain, "the patient next door needed life-saving measures. Your loved one was stable and watched over by our monitor tech and we continued all care as planned. I'm so sorry for the inconvenience, but I had to help this other patient. I would do the same for your relative if it were them needing life-saving care."
Takes only 1 minute post-code to solve a huge problem with families being angry during code due to lack of care.
OP, I do not think your post was offensive or poorly worded as some have mentioned. I understand what you are asking and it's a totally appropriate question. My suggestion would be something along the lines of, "I know you are busy and am wondering if mom/gma/etc may have a blanket/water/whatever. If so, I'd be happy to lighten your load and get that myself if you'll point me in the right direction." Granted, blanket or whatever may not be allowed for that loved one for reasons you may not understand and if the nurse hasn't the time to explain that because she's taking care of a critical patient, that's going to be frustrating but once the dust has settled, I'm sure the nurse will also be willing to explain why the request was denied. For some people, it won't matter but from reading your post you aren't one of those folks.
As far as a volunteer doing things such as getting blankets, water or other requests, that really is dependent on nursing judgment in some cases and there would need to be a system whereby the volunteer could know if the request was allowable in order for that to be a safe solution to the problem.
Specializes in Critical Care, Public Health, College.
To answer the dear ladies question...What can she do? I suggest carrying a small bag with a clean blanket (a light weight wool quality) and bottle of water and tissues and anything else you can think of on your way to the hospital. As a nurse of 25 years, people act so helpless in these situations when really all you need is a little common sense. Regression into a dependent child-like state when we are sick is really a cultural responce not an intelligent one. All Americans need to take CPR and first aid in this day and age so they can be empowered to respond to their loved ones needs and not behave like they have no caring skills whatsoever. That is the root of the problem. You see the nursing staff as your only solution when really you can take some steps to prevent these kinds of awkward encounters. When I had patients with familes who came prepared to the hospital like this, I always praised them for stepping up and let them know where the limits of their care should start and end. I have had children in the ER, and as a nurse I still need to receive instruction. But that doesn't mean I take a complete "hands off" attitude and act like the sweaky wheel when the request is a 2 on a scale of 1-10 in the ER setting. Well that's my 2 cents.
PANurseRN1
1,288 Posts
Precisely. Many of the times, the people who say "I hate to bother you, but..." are the ones who ask for more water, then five minutes later need a blanket, then five minutes later need to go to the BR, etc. Some requests can be clustered, e.g. getting a blanket and water.
And yes, sometimes it is absolutely appropriate for a pt. to have to just sit tight.