Do you believe that socioeconomics and educations are biggest factors?

[tarotale]

Hola to all and welcome to December. Call it a socioeconomic, or demographics, patient population, or clientele, I am one of those who believes that education and socioenomics are the biggest factors in how patient and family members will behave, which is actually the biggest factor that makes or breaks my day.

After transitioning to the ER I am loving it. The days that I dislike the most, however, are when my patients are consisted of low socieoeconomics and education. I'm sure you have had experienced these folks; demanding, doesn't know how to ask properly, doesn't do anything for grandma or grandpa at home but now suddenly wants everything done and toenails polished, impatient, no acknowledgement of authority, entitled, unappreciative, etc etc. For example, I was getting report the other day and some family member came by nursing station to ask for help. Instead of proper "hello, my dad needs help, may we get an assistance?", she snapped "we need help and yal just sitting there" and I can say I observed these kinds of behavior consistent with low education/socieoeconomics. I mean, a kid doesn't even speak like that.

After numerous encounters with different people of race, socioeconomics, and education, it seems very clear to me that those with higher marks in those two factors are most well behaved, proper people who makes my day smoother and not so much regrettable; family members eager to help their own, always uses proper english such as "please" or "may I", uses full sentences, not demanding, not entitled, patient, etc, and I can speak with my conscience clear that these were people of higher socioeconomics and education consistently.

So those of you who worked from all spectrum of education and socioeconomics in clientele, do those factors ever make a better working place? My goal is to move my way towards the area with higher marks in those two. Tell me your honest experiences. Thank you

[fawnmarie, ASN]

Thank you for this post. I have been wanting to ask fellow nurses their opinions on this topic, but was worried that I might offend some by asking. You stated it beautifully. Two weeks ago, I had an autistic patient from a remote, rural part of my state. When her family came to visit the first time, her mother pulled me aside and said, "I didn't realize y'all had so many patients that are black. My daughter is afraid of black people, so don't let them get too close to her." A ridiculous request, considering I work in a state hospital which serves all residents of the state, regardless of race. When the backwoods family made their second visit, they demanded that their autistic daughter be discharged immediately. Her mother threatened to call the local news and report the hospital for keeping her daughter on a unit with black patients. Our CEO came in and suggested moving the patient to another unit, but the family would not agree to have her moved unless it was to a unit with only white patients. To say that I was shocked is an understatement. Call me naive, but I didn't realize there are such completely ignorant people out there. I don't like to use the word "hillbilly" or "redneck", but these country bumpkin folks certainly epitomized the Southern white trash stereotype with their racism and ignorance.

[TheCommuter, BSN, RN]

the family would not agree to have her moved unless it was to a unit with only white patients.

If the family wanted their daughter to receive care on a unit with all-white patients, they'd better cough up the money and build their own private hospital to get what they're seeking.

But wait...since they were receiving care in a state-funded hospital, I doubt they had the money to make that happen. The sense of entitlement of some people is outrageous.

So those of you who worked from all spectrum of education and socioeconomics in clientele, do those factors ever make a better working place?

Patients from upscale backgrounds can be demanding and rude to nursing staff, too. They can be even more high-maintenance than poorer patients. Based on my personal observations, the major difference is that wealthier patient populations tend to be more involved in their care and, as a result, healthier than other patients.

[tarotale]

haha wow, that is pretty ridiculous, but I am not even surprised since that is a expected behavior from lower education/socioeconomic population. as commuter spoke, those kinds of people receive welfare care, meaning we pick up the tabs, yet have the thick face to "demand" things. This is what's wrong with our healthcare, you give too much options to those who don't deserve it, then people think a privilege is a right; imagine prisoners getting satisfaction survey and prisons being reimbursed that way. Hospitals should never have been treated like hotels back to the main point, I understand that even wealthy, educated folks can show ignorance and ugly behaviors, but most of my occasions have been very great. Also agree with commuter that those folks generally have a lot better health compared to the counterpart. A lot of paramedics who also work in these "better areas" tell me that their actual calls are actual calls, not like those free rides that lower socio/educated people enjoy for vag discharges, typical abd pain, foot pain, toothaches, etc because they don't pay anyways.

[Altra, BSN, RN]

I don't discount your experiences, OP, but your paramedic friends clearly work in different affluent service areas than my paramedic friends ... because mine have endless calls for "dad doesn't want to eat today" and "my child says she doesn't want to go to school because she is dizzy".

And regarding negative interactions with patients' families, by far my worst experiences as an ER nurse were in a small hospital where lack of enthusiastic response to any and all requests, no matter how medically inappropriate, could be met with family calling a friend/neighbor/golfing buddy who was an esteemed long-time physician, administrator, or on the board of directors of the hospital. JMHO, but better grammar and vocabulary don't do much to take the sting out of small-mindedness or selfishness. And it was from this population that I heard the most blatant racially-charged comments of my career, as well.

[emtb2rn, BSN, RN, EMT-B]

Like the flu, a sense of entitlement knows no bounds.

[Farawyn]

I like the "lower" socioeconomic and education people. They are usually more appreciative, and usually need the MOST help.

[CountryMomma, ASN, RN]

Well I guess I'm an anomaly 'cause I was raised dirt poor and was still taught my manners, to be humble, and that medicine is to be respected and conserved.

I'll try to remember your super-scientific anecdotal evidence that the "unwashed masses" are the font of horrible behavior the next time a elegant, coiffed, dressed in fancy labels daughters comes screeching in her upper class clipped tones that Mother or Father has been waiting TWO WHOLE MINUTES for her/his pain pills while I'm sitting on my wide behind staring at a computer screen (prolly surfing the net no doubt).

tl;dr - dickish behavior knows no bounds to class boundaries. Horrible people come dressed in Walmart and dolce Gabbana or *** it's called.

But if you feel better being Judgey McJudgeyton, rock on.

[MrChicagoRN, RN]

Bad manners & a sense of entitlement are free to anyone who wants to have them.

the rich and well educated may be using prettier words to say the same things that the poor and downtrodden.

OP, Every consider the effect of self fulfilling prophecy?

[tarotale]

I empathize what you're saying altra, as I also worked in rural setting once as well, and as small as the area was, I had the opportunity to care for one of those "I know the administrator, admin visits him/her, the admin him/herself" type of patients, and you know I don't know why I have consistent experiences but it never was unpleasant. Of course guaranteed, I get songs sung into my ears q shift how vip this person is and all that, but never encountered the vip patient or family member crossing their arms in unison and saying "hmmmph! I haven't got my pain med or my butt wiped" or this or that. I took care of doctors and lawyers here in ER and man I got to say they were actually the most pleasant patients I ever had! Maybe my theory/anecdotes are dependent on regions? I only worked in one state, so I don't know how it's anywhere else, but at least, that's the kind of experience that I have been consistently having; if they were educated, higher socioeconomics (not necessarily "rich in money"), I can't remember a case that was frustrating or downright p--ing me off.

and I don't discount all low ed, low socio folks, there are plenty I am sure who fit in my "undesirable" category and still maintain high dignity, respect and honor, but I am talking about consistency and frequency that happens based on my experience so things can differ from yours. Also just because someone has money to carry expensive stuff, for me that doesn't guarantee better behavior or attitude since one could be citizen ignoramus but buy glittering crap using credit or savings, so education, and common sense which usually follows through together, has to go hand in hand.

I know I could get some hostility if I posted my opinion on this one, but like I keep saying, this is based solely on my experiences and opinions of many of my coworkers; who knows, maybe it's just the area where I live? But it happens with very obvious consistency that I could not ignore it. I never had a well educated, higher socio person come up throwing temper tantrums to nurse station saying in childish way "we need help and you just sitting there!" during report or demand me to do this, wipe that, bring this, give me that, etc etc. Bottom line is, I haven't encountered bad behaviors that frustrate me from people of high ed, high socio compared to the ones from low ed and low socio (at least enough to remember)

[Farawyn]

Maybe you haven't had that "yet".

Or maybe YOU are reacting to the well educated/higher socio/VIP differently than you do the "low".

Maybe?

[CountryMomma, ASN, RN]

"Bottom line is, I haven't encountered bad behaviors that frustrate me from people of high ed, high socio compared to the ones from low ed and low socio (at least enough to remember)"

And yet, I have. Just last Friday, Saturday, and even Sunday, I got to experience three daughters of a sick elderly man unleashing a barrage of ridiculous requests and upper-class temper tantrums when no, I won't call the hospitalist at 1830 because you wanted to hear from him in person that there is no IV tegretol even though I explained it, my charge explained it, and even the f***** on-site pharmacist explained it. Times three, for each daughter who each had her own little crusade she'd picked. They just used bigger, fancier words to accuse me of sitting on my ass all day.

Actually, I had horrible behaviors from family and patients from all walks of life, and wonderful behaviors from the same broad spectrum.

Maybe its because I come into the room not knowing a danged thing about their "background" and I therefore don't have the chance to pre-judge the pt and give myself a lens in which to view them through.

Or you could be the first to prove your theory that low-income folks are horrible brutes. Maybe a Nobel prize. Margaret Sanger would be thrilled, I'm sure.