Dear nurse, I really don't want to bother you - page 5
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... Read More
Jan 10, '07Occupation: Pediatric Nurse Practitioner Specialty: 2 year(s) of experience in Pediatric pulmonology and allergy ; From: US ; Joined: Feb '06; Posts: 1,947; Likes: 1,348Thank 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.
Jan 10, '07Occupation: RN Specialty: 10 year(s) of experience in ICU,ER ; Joined: Jul '03; Posts: 614; Likes: 299Quote from ChayaNI 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.
Jan 10, '07Specialty: Critical Care ; Joined: May '04; Posts: 163; Likes: 260Perhaps 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.
Jan 10, '07Joined: Oct '00; Posts: 8,764; Likes: 8,498Hellard- 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."Last edit by canoehead on Jan 10, '07
Jan 10, '07Joined: Dec '05; Posts: 860; Likes: 105This 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.
Jan 10, '07Specialty: Critical Care ; Joined: May '04; Posts: 163; Likes: 260Quote from canoeheadAs 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."(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.)
Takes only 1 minute post-code to solve a huge problem with families being angry during code due to lack of care.Last edit by hellerd2003 on Jan 10, '07 : Reason: typo
Jan 12, '07Joined: Feb '06; Posts: 118; Likes: 16OP, 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.
Jan 20, '07Occupation: Director Specialty: 25 year(s) of experience in Critical Care, Public Health, College ; Joined: Nov '06; Posts: 6; Likes: 4To 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.
Jan 20, '07Joined: Nov '06; Posts: 30; Likes: 1i don't work in a e.r. but do work in ltc. i have had customer service crammed down my throat to the point of vomiting. some people you can't please no matter what you do. i'm responsible for 30 residents, usually with 4 cnas. my cnas a excellent and i rely on them, since i can't be everywhere. sometimes we are so busy, residents and family have to wait. i actually had a family member walk in on a code blue and demand a pillow now!! i wanted to rip her face off.:angryfire
Jan 20, '07Joined: Jun '05; Posts: 1,745; Likes: 2,511I wish we had volunteers in our ER. Unfortunately there are none, ever. Even though we have asked for them. We are also chronicly short staffed as they doubled the size of the ER and did not hire any more staff. Our CNAs have to help out a lot during codes. We buy boxloads of pillows by the week and in just a couple of days they are all missing. I don't know where they go because when we take patients to the floors we make sure we take our pillow back. And I don't see people walking out to go home with them, but they just disappear. It is rare that I ever have a good night where I can take care of anyone in a timely manner. Seems like we are always playing catch up.
As bad as we have it tho, there is no comparison as to how awful the floor nurses have it. At least I usually only have 4 patients, they have six. And our docs are near by, we don't have to call them on the phone.
We are always clogged up though by people who come in for totally inappropriate things. Once had a lady come in by ambulance for a paper cut on her finger that we couldn't even see. Had a mom bring her daughter in on Sat at 0200 because she had a tummy ache on Thursday and wanted to know why her tummy hurt her on Thursday. We asked her why she didn't come in then and she said because she didn't want to leave work, she likes her job.
I wish we could be warmer and fuzzier for all our patients but the system definately makes it impossible. Say a prayer for all us ER RNs we are trying to do the best we can with the little bit we have to work with.
I once had a 6 year old boy die in my arms and had to go right on into the next room and take care of my other patients like nothing ever happpened because we don't have decompression time here.
Still, in all I don't want to work anywhere else in the system, at least not right now.
I am sick but will be going in to work tonight with my nose running, carrying my box of puffs plus with lotion around with me. If I am lucky I will get to be in fast track so I won't be sneezing on too many people.
Jan 24, '07Joined: Jan '07; Posts: 2Wow, some of you really have strong opinions! (Please accept my apoligies as I realize this reply has gotten very long, please be patient and read the whole thing, I make my point at the end.) I would just like to say that a few years ago I was on the other side of this, my mom was a very sick patient, in one month she got very ill and we didn't really know what was going on with her. Finally it got to the point where she couldn't walk from her bed to the bathroom without getting very winded, SOB. I was an RN at a nursing home and I worked nights, my mom would call and ask me questions about how she was feeling and I would give her my best guess. I told her it sounds like CHF, but that didn't make sense to me, she was only 57, and always took good care of herself as she had been deathly ill in the late 60's with colitis and illeitius. She was miss diagnosed with this for 10 years and finally had surgery in 1971 at the Mayo Clinic where my dad drove her to the ER one night they did tests and by the next AM she was in surgery. Her regular doctor, who was a small town physician, told her she was crazy, the pain she had was all in her head and gave her Valium to take regularly. But, she kept going back because the pain continually got worse over the years. So the MD sent her to a Psych Dr., who said he agreed with her MD and gave her more paych meds. She finally OD'd and thats when my dad drove her to the Mayo clonic, he said "I didn't marry a crazy woman, she is sick, something is making her sick, please help her". After the extensive surgery, the surgeon walked into the waiting room where my dad was and he was holding a large metal pan. He told my dad, "You were right, your wife was very sick, this is 3 feet of her small intestine we removed, this is what has been making your wife so sick all these years". My dad said it looked like hamburger laying in that metal pan.
After that, my mom did all she could to educate herself about her illness and wellness. So for her to be so sick and not know what was going on was really scarry for me.
She called me on a Wednesday morning, she didn't feel good and wanted me to come over, I talked her into going into the ED, my sister would go with her and they would call me later, as I had worked the night before a needed sleep.
Mom called me about supper time, she said, "they finally figured out what's wrong with me..."
I felt instant relief and in the same breath felt instant terror as she finished by saying, "...my heart is very enlarged".
I was sick.
To make this long story a bit shorter, and to try to get my point across, we ended up at Abbott Northwestern Hospital. A well known cardiac hospital in Minnesota, where we live, in the northern part of the state. Mom got there on friday, and nine days later, she died. My mom lived with a heart the size of a dinner plate, thats no lie, I saw the x-ray, and the silhouette of her heart was enormous. The doctors couldn't believe she was still alive when she came in. She put up with this most of her life, thinking it was probably nothing and she was weak or whining. But, I'll tell you, the nurses who took care of my mom, also had to take care of us, us being me, my dad and five sisters, and some grandchildren and spouses at times throughout that week. We needed care as much as mom did, we were lost, I was a geriatric nurse and really didn't know cardiac very well, either did my family. We are a very close family, and there were no less than 3 of us there around the clock from friday to friday when she had surgery, after surgery, none of us left, or was going to leave until she woke up. She never did recover after surgery and never woke up. She died on Sunday evening, two days after surgery. It was Mothers Day, 1998. The ER and ICU staff were wonderful, eventhough I know it was trying for them to take care of us too. No one ever blew us off, or ignored our requests.
I am now a cardiac nurse on a critical care unit, I know what my patients families are going through, and I am there to help them just as much as the patient. Please, when things seem insignifigant to you, just remember, you are the Nurse, they need you to be understanding, helpful and compassionate. If you can't do something, send someone else. Or tell them, I really can't get that right this second, but as soon as I am finished with this, I will do my best. They will understand if you don't make it back to them, but be honest.
Jan 25, '07Occupation: RN Specialty: 10 year(s) of experience in ICU,ER ; Joined: Jul '03; Posts: 614; Likes: 299Sue, I am sure that most (ER) nurses feel the way I do when I say that I love to take care of people that are truly sick. I will run my feet to nubs taking care of people that really need me.
But, unfortunately, a lot of times it is the ones with "clinic" type of problems that make the most noise and that are the most demanding.
I am so sorry for the loss of your mother.