"Send my girl down here now"...(Please.....)

[Jason-ACNP]

I was writing a progress note today on a cardiac step-down unit when my concentration was shattered by a booming voice coming through the patient-call system. An 60 y/o gentleman (for lack of a better word)exclamied, "Send my girl down here nawh! (southern slang for "now"). The nurse at the nurses' station, who was working overtime to cover a shortage of nurses, looked puzzled. She replied, "Sir, I was not aware that you had a daughter. Anyway, she isn't here just now". He shouted back, "Don't be a dumbass! I ain't talkin' bout my daughter! Send me that damn nurse!" Now before I go any further, I should explain that this patient was alert and oriented, and could ambulate easily on his own. He could easily feed himself, (although he was NPO) and could walk to the bathroom without difficulty

He was scheduled for a cardiac cath later that day. So what did he want so desperately? He wanted the nurse to hand him a damn magazine that was sitting in a chair five feet from his bed. I couldn't help but intervene, and I'm sure I'll catch criticism for this. I walked down to his room and without introducing myself, I said, "Lets get something straight! This person is a highly respected RN within this hospital, and she is not AND WILL not be addressed as your girl! It is clear that she is of no relation to you! Secondly, THIS IS NOT A FIVE STAR HOTEL! You can and will ambulate on your own!! That means that when you have to go to the bathroom, get a magazine, or scratch yourself, YOU WILL BE THE ONE WHO DOES IT AT THIS POINT IN THE GAME! These nurses are not your handmaiden, and they are NOT at your beck and call. Each nurse cares for 12 patients with very little assitance, and every patient on this floor is in far worse shape than you are! Am I absolutey clear?!

Now before I catch hell for that, let me say this. I know that the concepts of "compassion", "going the extra mile" and "giving that patient an extra five minutes even though your feet are aching and your back is about to break" are all very sweet and are inherent traits of the "genuine" nurse. But lets be realistic. I worked as a critical care nurse in several states (as a traveler) before I pursued an advanced degree. Thus, while it may seem that patients like this are the exception, I know that they are rapidly becoming the rule. Although being a hospitalized patient is not fun, there is absolutely no excuse for patients or families to treat nurses with disrespect. The "turn the other cheek" rule is crap. Verbal abuse and condescending attitudes towards nurses have become worse every year for the past several years. Regardless of the nursing shortage or other factors, there is no excuse for this. In fact, the nursing shortage should generate more respect for these nurses. However, I feel that the general public perceives staff nurses (and particuarly floor nurses) as handmaidens and mindless recorders of blood pressures. This mentality is unfounded and very unfortunate. Maybe I'm crazy, (and if you read this far, let me know if I'm wrong), but I think that part of the problem is a image problem of nursing that stems from the media. Medical shows such as E.R. and Gideon's Crossing have become the rage over the years. Particuarly "E.R.". How many times has that show ever portrayed the nursing profession in a positive light? I honestly can't remember one show. I do remember shows that illustrate nurses as being jealous of physicians, and a show that illustrated nurses as "gossip queens". Numerous shows have shown the general public as being "authoritarian" and certainly condescending, but not one time have I seen one of these nurse actors make a stand. Does a movie such as "Meet the Parents" do much for the promotion of nursing? Please..The bottom line is this. The public, (in general) associates nursing with bed pans, bed baths, and "fetching some water". While these are all a part of nursing, other aspects include critical thinking and excellent skills. Yet, rarely, if ever, is this noticed. One more thing. I know that there are numerous patients (and families) that appreciate the care that you provide, as well they should. But this type of patient (and family) is a malignant tumor that continues to grow with time. If you read this far, thanks. If I'm way off base, don't be afraid to let me know.

[NurseMark]

Okay, enough is enough. Stop this, "Oh, how was the patient feeling that day? Is he always like this? Maybe we should break thru the fear barrier and find out what we can do to help!" What a load of crap!!! I'm not paid to be disrespected, abused, or to have to put up with nasty people. Scared or not scared, THERE IS NO REASON NOT TO TREAT SOMEBODY WITH RESPECT!!!!!!! And yes, I am yelling!!!!! Drop the nursing theory act, and step into the real world. Why can't you nurses just agree with a post without sounding condescending. People deserve to be treated the way they treat others. This man got what he deserved. So leave Jason alone.

Originally posted by lkushen:

OK, I fully agree with the emotions and anger you experienced. However, the question that comes to mind is this: Is this man always like this or just today, maybe there was an ulterior motive to getting the nurse to the bedside before you rightfully let him have it. Maybe this patient was not coping well with the thought of undergoing a cardiac catherization. Just a thought. I will admit though that I have been in similar situations by abusive and demanding patients before and it just makes you want to SCREAM!!!

[canoehead, BSN, RN]

I tried to email the tonight show but got a reply back that the address posted was no longer in use by the show. If someone has a valid email address could they post it?

Thanks

[nurse1201]

Way to go Jason. I work in a burn unit as a tech right now but in January I will be a full fledged nurse. I get abuse from patients heaped on me all of the time. Most often it is during dressing changes. We get a lot of drug and alcohol dependent people in our unit because they did something stupid and got burned. Of course these people get over the amount of required pain med because of their high tolerance. I get called all kind of names and have had people put their fists up at me. Thank God we have Doc's who will stand up for us and tell these people that if they do not like the treatment that they have to have and are getting, that they can leave AMA. But that in no way shape or form will they verbally or physically abuse the staff. Most of the time this settles these jerks down although we have had some who did leave, but were back a few days later because they could not stand the pain. They are more compliant and apoligetic when they come back.

[Robin61970]

Go to the LEno topic for addresses

[cmggriff]

I have to agree with Wildtime on the government issue. This is the same government that fired the all Air Traffic Controllers when they treatened a strike.

[journeyy]

When faced with situations like this, I always smile and tell the patient that 'moving those limbs' (ROM), is an important part of their care, then leave the room. It isn't rude, and, they always get the point.

[Jason-ACNP]

I see your point, and of course the government is not going to support a strike. I don't remember the air traffic controllers being fired (although I'm sure they were) but I do remember Regan pulling rank in the eighties when he fired a large number of airline stewardesses (and maybe pilots) during the eighties when they went on strike.

However, there is a difference here. There aren't 2.5 million stewardesses (or even 5% of that) working in the airline industry, and thus their political power through votes is miniscule. Secondly, the nation is not going to go into a crisis if they don't receive peanuts or drinks on their flights.

However, can the government really afford to fire nurses who are threatening to strike or walk-out? Are they going to turn the duties over to the environnmental care techs? It wouldn't be feasible for them to do so (to say the least). Even if 250,000 nurses (10% of nursing population)were striking, there is no way that they could fill those positions with scabs. There simply aren't enough to fill the positions. It would send many hospitals in this country into a severe crisis. I've heard the argument that MDs, PAs, pharmacists, and paramedics could take over nursing duties, but lets be realistic. How long could that last? Many would cringe at the thought of carrying out "nursing duties", and thus I doubt that they would do it very long. Besides, they have their own roles to fulfill.

The bottom line is that while I agree the government will never be close friends with the nursing profession, they would have no choice but to respect the power that nurses wield if this profession became more organized. I don't doubt that the ANA could desperately use a change of leadership(i.e. someone with a backbone). I think that they may be out of touch with reality. Yet, even if we had effective leadership, it wouldn't do much good if we don't come together as one. It's really simple. You go to X, Y, and Z politicians and tell them "Here is our agenda. If you geuinely support this agenda, then you will have the endorsement of this organization. With that comes "X" amount of PAC money, and a large number of votes. If you accept our agenda and then renig on this deal, then you may very well be committing political suicide. WE WON'T WAIT for the next election. Instead, we will organize a walkout across this state (or the country)which will generate more than enough media attention to let physicians, hospital administrators, and the general public know that "Enough is enough". Again, the AMA and the general public would go into an uproar if the government attempted to fire nurses. With all due respect to nurses aides and other ancillary staff, do you really think that physicians would allow them to manage vents, adminsiter chemo meds, push intravenous meds, hang blood products, etc? It would never happen. That's why some hositals are having to pay some (in-house)agency nurses $95/hr.

The questions (im my mind)are this. How much more are you willing to take? How much longer are you williing to take it? What is your breaking point?

Originally posted by cmggriff:

I have to agree with Wildtime on the government issue. This is the same government that fired the all Air Traffic Controllers when they treatened a strike.

[Sue D]

One of the recent admissions to my ward was a known IV drug abuser. Although he had a heavily exuding wound and was known to be both HIV+ and hepatitis B+ he refused to stay in his side room and inisted on walking around the open ward, often after pulling his dressings off.

On one occasion when we had run out of methadone and his dose was twenty minutes late he used his mobile phone to complain to pharmacy about this. He constantly verbally abused staff referring to us as "bitches" and worse and physically assualted one of our doctors, inflicting a bite wound.

On discharge (after we had successfully healed his abscess) he complained to the NHS trust about the "discrimination" he had suffered on the ward due to being an IV drug abuser. Needless to say the Trust wrote a grovelling apology letter and totally failed to support its staff.

This is disgraceful. I acknowledge that IV drug abusers may have complex needs in the healthcare environment but this patient's behaviour was totally unacceptable especially since his dependency needs were fully addressed. NHS staff deserve better

[mustangsheba]

I'm amazed that he stayed long enough for his wounds to heal. How could management allow him to endanger other patients by taking off his dressings out of his room? I'm going to steal the ROM line to add to my repertoire. A class in recognizing abuse and responding appropriately should be taught in nursing school. I worked in a prison and didn't see the degree of abuse some have described here.

[Jason-ACNP]

Yet another perfect example that healthcare is a buisness, not a mission. It's all about customer service, and the concept "The customer is always right" is clearly evident in your situation. God forbid that patient choose another hospital next time! (although I'm 99.5% sure that YOUR and EVERYONE else's tax dollars paid for the bastard to be there).

One more thing. When patients act in that manner, "acknoledgement" of their disease process no longer exists. I'm sorry (no I'm not) but I really don't give a damn that he's an IV drug abuser. He's not coming on my unit, imposing his tyrannical demands on to a staff that is already overworked as it is. No one on that floor shoved a needle of dope into his veins. He did that all on his own.

Originally posted by Sue D:

One of the recent admissions to my ward was a known IV drug abuser. Although he had a heavily exuding wound and was known to be both HIV+ and hepatitis B+ he refused to stay in his side room and inisted on walking around the open ward, often after pulling his dressings off.

On one occasion when we had run out of methadone and his dose was twenty minutes late he used his mobile phone to complain to pharmacy about this. He constantly verbally abused staff referring to us as "bitches" and worse and physically assualted one of our doctors, inflicting a bite wound.

On discharge (after we had successfully healed his abscess) he complained to the NHS trust about the "discrimination" he had suffered on the ward due to being an IV drug abuser. Needless to say the Trust wrote a grovelling apology letter and totally failed to support its staff.

This is disgraceful. I acknowledge that IV drug abusers may have complex needs in the healthcare environment but this patient's behaviour was totally unacceptable especially since his dependency needs were fully addressed. NHS staff deserve better

[Jason-ACNP]

You are right. CNAs are included.

As far as the NP salary goes, that is appalling, but it's all about supply and demand.

Originally posted by wildtime88:

Do not leave out the CNAs in this, they also get the same treatment we do if not worse in many cases. We need them and they need us as well.

This is off the topic subject a bit, but did you see the posting from the NP on another topic who reports NP wages around 35 an hour. That is simply appalling. I can make that much easily as a agency RN.

[Sue D]

Under the UK healthcare system we had no choice but to treat this patient. We also had no choice about tolerating the abuse. All patients deserve the best care we can provide IV drug abuser or not. My point was that my employers, the NHS Trust should have backed their staff up in an intolerable situation. I was not suggesting that we should not have provoded the best care possible given the difficulties.