Extremely Offensive ER experience

psu_213, BSN, RN · Nov 19, 2011

they should still never be talked about in the hallway outside their room with a statement like "The medical professionals always know the right things to say to get them."

In the OP's situation, it sounds like pain contol was poor and customer service was lacking, but a letter to the president is pretty extreme...even though I can tell you are upset.

The reason I quoted the above part...I'm not doubting that the OP heard this; however, does it not seem like in the many 'complaints' people post on here about their ER visits, there is almost always some quote that they heard about them from the nurses station or hallway. Again, I am not doubting the OP's account on this matter, but it seems like people post this way more that it is acually happening.

NickB · Nov 19, 2011

I'm not complaining about freaking water. I'm not offended by the fact that maybe they didn't know what else to do. I'm offended that I was labeled as a drug seeker because I complained of pain. I'm offended that they spoke loudly enough outside of my room that I heard them. I'm offended by the lack of communication. I'm offended by clear assumptions and a negative attitude because I declined a senseless test that carries its own set of risks. Of course I listened to my pcp. She's knows way more about me than an ER doc who has never seen me before. As a matter of fact, he was the ER doc at my first visit and he did an exceptional job. He included me in the plan of care and factored in my thoughts and opinions. It was the people at my visit later in the week that I have issue with.

In response to someone else's post. I have never had a baby nor will I ever have a baby so if someone tells me something they are feeling, I don't ever make biased assumptions about it. I listen to them and try to work through it with them. I'm sorry you have found a way to be okay with doing that. By the way. The ER doc did nothing for me. It was the pain doc two days later that did something for me. But at the time, I was experiencing a pain that I'm sure the majority of you have never experienced and I wish none of you will ever have to experience. That is why I went back to the ER.

NO50FRANNY · Nov 19, 2011

Hi there,

I couldn't help but make a comment after reading all the responses to the original post. I must admit I sit on the fence a little firstly because I am an emergency nurse but also because I have had a crappy ER experience myself for much the same reasons. I won't get too tied up in the diagnostics- but to clarify, the need for the LP is twofold, looking for xanthracromium (may have spelled that incorrectly) which confirms/rules out subarachnoid bleeding, or presence of bugs. I hope this clarifies, its the smoking gun. Negative LP we sleep well knowing that you are ok from a living/dying perspective (they should have explained this to you). It is often performed (and refused) in the context of a negative CT where I work. I can see your point about not having symptoms to correlate with meningitis/big bleed but I have been in the unfortunate position of talking to a young man with neisseiria meningitidus who presented with nothing but a headache similar to yours and watching him drop from a GCS15 to a 6 and develop a fever of 40c in 45 mins flat- ended up tubed in ICU within 2 hours (he was not even in an acute observation area). He had the headache for a week with no other symptoms. We need the smoking gun. You wouldnt let them have the smoking gun. I can totally understand having no alternative to going to emergency for your pain. We are nurses, we wait until we are half dead or insane before we ask for help, if that happens to be in the middle of the night on a Sunday well then it is. I think our knowledge and experience often works against us when we are unwell. We have worked with too many sick people, know our stuff and are very reluctant to throw over the game and relinquish control of our own health to others especially when we may indeed know better. I discharged myself against medical advice after a simple umbilical hernia repair, and sat in a car for 3 hours being driven to my mothers place to convalesce. The senior nurse went to great lengths to convince me to stay but I was convinced I could look after myself with the oral analgesia I had. I have no excuse, I just wanted to be out of the hospital and at my mothers home out of town. Of course 7 hours later in 7/10 pain my mother had to take me to the local ER quite simply because I had tried every imaginable pain killer and in fact said "I need to go to the hospital because I need morphine". You can imagine how well this went. To the staff in this department I was probably text book narcotic seeking and was treated very poorly. Of course I bloody knew what I needed! Im a nurse! Fortunately I had a surgical scar, admitted I was an idiot, had obvious physiological signs of pain (BP 160/100, PR 130) so was given the benefit of the doubt. It plagued me that they thought I was drug seeking but ironically thats exactly what I was doing!!! That bothered me for a long time. I have had a long time to look back at my behaviour then but you know what, I was in serious pain and had been putting up with it for so long that frustration got the better of me. I even told the poor doctor examining me "Im not having a bleed dude". The sad part of this is that I would never ever bother my fellow health workers if I wasnt truly in need of help. It was also part of the reason I left the hospital in the first place, I didnt want to burden our already overburdended system. My point is I thought I knew better if you catch my drift here. I totally agree that making comments about you "knowing what to say" are completely out of order. I can also understand the frustration from those who were treating you because there are only so many tools that can be utilised in the ER to determine the best course of action. I am not sure about practices where you are from but we often give largactil and short admission for the kind of headache you have described- combined with supportive therapy, fluids etc. until you have some relief. If suspicion is high for bleeding or meningitis and the patient is not keen for an LP we either convince them to have one under sedation or move to MRI or admit for observation. I know that there was very little to suggest that you had meningitis, or a big bleed but the CT is not 100% in picking these up more like 97%, the idea is that with the LP we have definitive rule out. We don't want to send someone home with the headache you have described without being pretty damn certain- How bad would your doctor feel if we didn't rule these things out and you expired quietly in your sleep with a slow moving subarach? I'm guessing the staff would be thinking "what does she want us to do for her?". You were looking for relief and frustrated and in pain, the staff were frustrated with you because they didnt know what to do with you, add to that, they didnt want to give you narcotics if you were in fact a person with an opiod issue. Narcotic seekers are my least favourite people in the world and I think I am pretty good at spotting them. The whole ketorolac thing is standard operating procedure and like it or not, if a pt. refuses its usually thought that seeking is the game being played. In your case it didnt work because you accepted it. Narcotic seekers will usually refuse, realise they won't get what they want and leave. Im thinking that the part that sucks the most is that you didnt get the help that you needed at the time because of assumption. I am truly surprised that they didnt collect bloods or address the severe nature of your pain, after all, things develop, get worse etc. and there is nothing wrong with a second opinion. I must admit I would be wondering what you wanted us to do diagnostically- but in terms of your pain im pretty sure we could have sorted it out (its tough work for us to get MRIs for pts without convincing neurology). I don't know how to fix this problem but I know that bagging out our fellow professionals isnt the way to do it. I try to take a step back most of the time, I know why the people in that ER were awful to me but it doesnt change the fact that it shouldnt be that way. Unfortunately emergency nurses deal with far too many people who arent sick. We also deal with substantial numbers of patients who have ulterior motives (including medical professionals). The trouble with this is case in point, but not your fault. In such a rushed environment I think ER nurses are predisposed to making quick judgements, its almost 80% of our job. Diagnosing from 30 feet or 30 seconds is what we do. We have to decide who needs us more. This is the way Emergency medicine is trending now- if you are not about to die we don't have time. Sometimes we get it wrong. I never sent a complaint to the hospital after what happened to me but I did request my notes so I could make sure there were no alerts placed on file to the effect that I was malingering for opiods. Fortunately there wasn't. I hope you are feeling better. As one doctor once said to me we do the best we can with what we have and unfortunately we cant catch them all. Im upset that you had to go through that, nurses should be VIP. Lets come up with a way to fix this.

psu_213, BSN, RN · Nov 19, 2011

I had an LP 2 years ago when the whole swine flu thing was going around because of extreme bilateral headache, 102.9 oral temp, and stiff neck. All indications of possible meningitis. I have had nothing like this. LP is for menigitis and for checking to see if there is a bleed that has been present for at least 12 hours or that may be so small that CT won't show it. I may not be an ER nurse, but I'm not an idiot either. I read and research a lot.

http://www.webmd.com/brain/lumbar-puncture

http://en.wikipedia.org/wiki/Lumbar_puncture

It seems to me the doctor definitely should have been more clear on why he wanted the LP...however, the the LP is used for more that just to diagnose meningitis and old bleeds.

Murse901, MSN, RN · Nov 19, 2011

They didn't bother with a d dimer (but they did do a pregnancy test even tho I had my tubes tied 12 years prior in that very hospital). They gave me a script for Motrin and sent my one my way. The pain in my leg was just the dull cramping, heavy feeling so I decided maybe they were right - no clot and not worth raising a stink over that they should have at leave also done the d dimer.

A D Dimer is not diagnostic of a clot. A D Dimer is only used to rule OUT a clot if the result is negative. D Dimer is not a reliable indicator of a clot, because many things can cause D Dimer elevation.

They followed the appropriate course of action. Ultrasound of your leg will trump the D Dimer. Maybe you didn't have a clot that day, and developed one later. Your treatment would not have been different if your D Dimer was high. You would not have been admitted for "Impending DVT". I'm betting that you were given D/C instructions to follow up with your PCP and to return to the ER if sx worsened or did not get better in 3-5 days. Check the papers they gave you. Am I right?

Nurses do make the worst ED patients AND visitors. I once had a 90-year-old LOL come in for severe SOB, O2 sats in the low 80's, very congested lungs, and her granddaughters come in. Unfortunately, our visitor policy is very lenient. Unless we are actively coding a patient, family can come back. Anyway, one of the two granddaughters proceeds to get all kinds of in my and the RT's way and proceeds to pinch up the skin on my LOL's chest.

"She's got poor skin turgor", the woman says.

"Okay, thanks," I say, as I continue to do my assessment.

"Her skin turgor is poor," the woman repeats, throwing a little attitude into her tone, "She's dehydrated. You need to give her some fluids right now".

I knew exactly where this was heading, and I was going to shut it down right then and there. I knew that she had some modicum of medical training, if she's using the word "turgor". I look dead at her with a glare that would probably kill a small grizzly bear and state flatly, "Your grandmother can't breathe. We're going to work on that first, because if she can't breathe, she's going to die. Once we get her stabilized to where she's breathing okay, we'll worry about adding fluids. Until then, let us do what we have to do, and we'll let the doctor make the final decision on orders".

The other granddaughter in the room with us smiled when I said that. After the nurse-granddaughter left, the other granddaughter quietly came up to me while I was charting at the nurses station and said, "Thanks for everything you're doing. You'll have to ignore my sister. She's an LPN and always thinks she's super-nurse". (sidenote: this is not in any way a bash on LPN's, as I used to be one - it's just the statement that she made)

So, point being -- if you're a nurse and you don't work in ED, please don't come to our EDs and try to dictate what we do and how we do it. We will welcome and consider any logical suggestions or insight into your condition, but we will make the final decision on treatment. You will make the final decision on whether or not you want the recommended treatment. But, don't get all ***** when you refuse said treatment and have a negative outcome. :twocents:

Altra, BSN, RN · Nov 19, 2011

Esme12 has been gracious enough to share a long, well-referenced post explaining the role of LP in differential diagnosis of headache. psu_213 has also posted a couple of more lay-person-oriented explanations. So I think that's been covered pretty thoroughly.

You have every right to refuse any test/treatment, as long as you are A&O, and I would go to the mat if necessary to support your right to refuse.

What I find offensive is the exercise of the right to refuse without acceptance of the responsibility for doing so, particularly from a professional nurse.

OP, what did you want the ER to do? Attempts were made to relieve your pain and to utilize diagnostics to rule out life-threatening causes of your headache. But you refused a number of offered interventions.

Saying that you went to xxx hospital because you know that the neurologist you had an appointment to see (but had not seen at that point) admits there indicates a lack of understanding of the unlikelihood of a neuro service admitting an ER patient without acute onset neuro symptoms.

It would be one thing to relate your recent experience with a painful condition. But you seem intent on blaming someone for the experience, and I find that troubling in a health care professional.

systoly · Nov 19, 2011

I'm not complaining about freaking water. I'm not offended by the fact that maybe they didn't know what else to do. I'm offended that I was labeled as a drug seeker because I complained of pain. I'm offended that they spoke loudly enough outside of my room that I heard them. I'm offended by the lack of communication. I'm offended by clear assumptions and a negative attitude because I declined a senseless test that carries its own set of risks. Of course I listened to my pcp. She's knows way more about me than an ER doc who has never seen me before. As a matter of fact, he was the ER doc at my first visit and he did an exceptional job. He included me in the plan of care and factored in my thoughts and opinions. It was the people at my visit later in the week that I have issue with.
In response to someone else's post. I have never had a baby nor will I ever have a baby so if someone tells me something they are feeling, I don't ever make biased assumptions about it. I listen to them and try to work through it with them. I'm sorry you have found a way to be okay with doing that. By the way. The ER doc did nothing for me. It was the pain doc two days later that did something for me. But at the time, I was experiencing a pain that I'm sure the majority of you have never experienced and I wish none of you will ever have to experience. That is why I went back to the ER.

As I see it you have two choices here. Stock up on paper and pens, you'll need them if you're going to write letters everytime someone offends you, or, the healthier choice imho, get over it.

mazy · Nov 19, 2011

Not an ER nurse, no personal stake here, and so I'm not offended (I don't think the ER nurses here posting are either, they're just questioning your interpretation of events -- at least I don't think they were offended initially).

However. I'm really not understanding the drug seeker piece of this. Why were you nervous about being labeled as a drug seeker? It seems to have dictated your entire experience and I'm not understanding why you would be worried about that.

Especially since it sounds like the drs. were the ones who were pushing the narcotics.

Also, as an aside, I grew up in a family of doctors and I can tell you from first hand experience, do not ever let a relative or friend who is a doctor get involved in your care. Just don't. Bad idea. Just say no. Seriously.

AppleRN4 · Nov 19, 2011

Sounds to me like you got exactly what you requested- no narcotics and no LP, however you're upset they didn't treat your pain? I don't undestand what the problem is, except their lack of communication & assumption that you're drug seeking. As many have stated, you can't go into a situation seeking help while dictating how/when you receive that help.

A lot of people assume that coming to an ER will give them a definitive diagnosis of their problem, and unfortunately, that's not the case. An ER visit is to RULE OUT an emergency- in your case, a head bleed, meningitis, etc. When the doctor is sure you don't have an emergency, then you're free to go follow up with your PMD, which is exactly what you got. HAD you been admitted to the hospital, how would they relieve your headache/diagnose you when you refuse narcs & further diagnostic exam? An ER is not Burger King and you don't get to place your orders and have it your way.....

Hope you continue to feel better.

NickB · Nov 19, 2011

i cannot believe you're serious. if you think writing "this letter" will further your desires of employment within this hospital, you are wrong. people are going to assume that the "wrong assumptions" were indeed correct and besides that, you're a troublemaker. don't want to work with one of those.

i don't care about working in this hospital. i said i thought about working there in the past. i have been a business owner in the past and would want to know if this is how people (especially fellow nurses) are being treated in my hospital.

NickB · Nov 19, 2011

Esme12 has been gracious enough to share a long, well-referenced post explaining the role of LP in differential diagnosis of headache. psu_213 has also posted a couple of more lay-person-oriented explanations. So I think that's been covered pretty thoroughly.
You have every right to refuse any test/treatment, as long as you are A&O, and I would go to the mat if necessary to support your right to refuse.
What I find offensive is the exercise of the right to refuse without acceptance of the responsibility for doing so, particularly from a professional nurse.
OP, what did you want the ER to do? Attempts were made to relieve your pain and to utilize diagnostics to rule out life-threatening causes of your headache. But you refused a number of offered interventions.
Saying that you went to xxx hospital because you know that the neurologist you had an appointment to see (but had not seen at that point) admits there indicates a lack of understanding of the unlikelihood of a neuro service admitting an ER patient without acute onset neuro symptoms.
It would be one thing to relate your recent experience with a painful condition. But you seem intent on blaming someone for the experience, and I find that troubling in a health care professional.

I went to the hospital because I could no longer stand the level of pain I was experiencing. Think of how humiliating as a nurse it is to admit that and than think how much more humiliating as a nurse it would be to be labeled as a drug attic. Then you will understand my frustration. All of you are basically saying "you should have stayed at home and sucked it up." When your step-father who has been an MD for 35 uswest says maybe you should go to the ER, you go. I didn't want to, but I also didn't want to die that night. I didn't expect to be treated like the pill head that they thought I was. If the LP was that important, they should have said so instead of talking about me in the hallway.

NickB · Nov 19, 2011

It's obvious the ER nurses are offended here. Maybe because they are being called out for their normal behavior. Fine. I didn't decline narcotics, I tried to use the least strength med that would work and when that no longer worked, I went back. Continue to treat your pt's this way and take nothing from this post. If I decide to write a letter to the hospital, its my freaking prerogative. I'm tired of all of the old jaded nurses labeling every pt in pain as a drug attic. It happens on my floor as well. The open minded nurses reading this may use it as something to think about. The rest of you will continue to walk around in your own little jaded world and complain about everyone who walks through the door. Peace out.