Getting burnt out with non urgent patients

NO50FRANNY · Jul 23, 2013

I have an answer for you but I don't know how helpful it will be. In our department we kill them with kindness. Food is not something we will often dish out regardless, but when being snarled at with the ever so common "she hasn't eaten since yesterday, and we've been here for hours!" (that's our fault of course) most of my colleagues and I will respond as sweet as pie... "Oh, I know how frustrating that is, I will check with the doctor for you and I'm sure we have some snack packs in the fridge but if it is going to impede or delay treatment we need to be very careful."

We once had a patient who called an ambulance and was transported from an engagement party, a well-to-do insulin dependant diabetic. The hospital was close to the party and he figured we would give him some insulin so he could go back and party. After being sat in our corridor with our Saturday night friends for an hour he found his own way home. People disgust me. The best advice I can give is to be as nice and accommodating as possible within reason, it's hard to do, but wasting your energy on it is even harder. I had a patient at triage present saying "I just need a dressing for my leg". I looked at it, she did indeed need a dressing, nothing more. She was rude, dismissive etc. I just gave it to her, wasn't worth the effort of triaging, arguing and so on, the end result would have been the same. I behaved like an ATM though, emotionless.

For me, I feel like if I deny undeserving patients my good energy, I save it for the ones who do. They may get a lunch pack, or see a doctor for the pimple they've had for two years, but they didn't get my good stuff, I save that for the sick people. Knowing that gets me through. For the record, I have a little fight every now and then, just to make myself feel better, the rest of the time I let it go and think about all the time I've saved. Nonsense presentations drive me up the wall and I also have trouble after many years, I just vent to my colleagues, and keep my small victories.

Sassy5d · Jul 23, 2013

I'm getting tired of the theatricals. Whether the waiting room is full or empty.. The pts who thrash at the triage window... And or course, can't walk and need me to pick them up out of wc lol

VICEDRN, BSN, RN · Jul 23, 2013

Frankly, most of the non urgent visitors to the er actually don't have coverage in my experience.

I feel sorry for them a little bit. They come with high but unrealistic hopes of getting care. Because they won't get it and end up with a huge tab, they are nasty to work with if you don't manage them the right way.

How to deal? Well, lets be honest. Only a handful of us would have jobs if the er only got actual emergencies in the er. Further, it's probably a great basis for a variety of practical skills. What icu nurse knows the sound of various coughs, knows which insect bites need i&d and which don't, what needs sutures and what is obviously broken. Those are skills you take everywhere with you but most importantly straight into an np program. Haha

mcknis · Jul 23, 2013

I completely agree and there are many times where the jaded and cynical feeling creeps up throughout a day. "I have severe abdominal pains and need that medicine that begins with a D-------." As they sit there eating their Cheetos and soda from the snack machine in the lobby. Oh, and when they leave... "We will need a cab slip because we have no money to pay for it. We used it all on the snack machine." Ugh...it's times like these that get under our skin as ER nurses, but keep us coming back anticipating our next code. Like VICEDRN stated, we learn so many valuable skills that make us better people and help us be better nurses. Cynical? At times yes, but I would choose our nurses in a trauma or code over our ICU and other critical care nurses. Do we do better than others? Of course not, but when fight or flight hits the fan, we can usually remain more calm than others.

Keep on working and smiling! Even if we must grin and bear it :)

ezgreazin · Jul 23, 2013

if you're not jaded by the demanding seekers and frequent fliers you're an android from outer space, or a psych nurse...

its part of the job, don't let em get you down...just appreciate the REAL emergencies more when they come around, the price we pay.

hiddencatRN, BSN, RN · Jul 24, 2013

I had to take a break from ER nursing, to be honest. I was getting so burned out with all the non-sick people that I started lowering my index of suspicion and was mentally under-triaging patients. I think I'll come back eventually but more than being not nice, I was worried I was becoming a bad nurse :/

Anna Flaxis, BSN, RN · Jul 24, 2013

I had to take a break from ER nursing, to be honest. I was getting so burned out with all the non-sick people that I started lowering my index of suspicion and was mentally under-triaging patients. I think I'll come back eventually but more than being not nice, I was worried I was becoming a bad nurse :/

That is very interesting. I, too, left ED nursing, but I don't think I was under-triaging, I was actually pretty right on the mark most of the time. What I found happening was that I was really resenting people just for being there, plus I was bored with the routine, and I felt my workplace was becoming more and more unsafe due to staffing policies. I got the heck outta there before someone died on my watch.

I still think about coming back eventually, but last I heard, my old workplace hasn't changed and has in fact gotten worse.

One of the things I noticed was that behavior is directly proportional to how sick you are. If you have the energy to act like a jerk, you're not very sick. Really sick people are too busy just fighting to keep breathing to be acting like a-holes. That's why I preferred the critical patients most of the time. They're just nicer to be around.

Is that jaded?

hiddencatRN, BSN, RN · Jul 24, 2013

I had a couple of patients where my first thought was "they are full of doodoo" and I wasn't as on top of them as I could have been and they ended up having legit, emergency room problems.

I also struggled with unsafe staffing. I had a 6 patient assignment once and got a chest pain with cardiac history and a patient in shock at the same time, while the charge nurse is asking me if I can discharge one of my patients. Uh, no, not at this moment.

Guest219794 · Jul 25, 2013

Hello all I just want to throw out the question. What do you all do to remain sane with the ever increasing non urgent patients? I have been an ED nurse for 10 years and love my job level 2 trauma center. Lately I am becoming more short and basically irritated with the rude demanding patients that are presenting for nonsense care. I am probably one of the nicer nurses at work and I don't want to become one of the non caring type but I see myself heading down that road.

I see it as 2 separate issues.

1- Rude and demanding. I have no patience and limited tolerance for this. Essentially, I try not to reward the behavior, as the more it is rewarded, the more it is repeated. "I am so sorry you had to wait for this blanket. I got caught up in an emergency."

2-Misuse of the ER for trivial complaints. I try not to focus my frustration at the patients. The ER is free, and more convenient. Even when the complaint is ridiculous, we give it a name and provide a treatment, thus validating the complaint. Of course people use the ER- why wouldn't they?

Look at it this way: Let's say on your commute, you had two choices of bridges. One bridge is time consuming and inconvenient, but no toll. the other is fast and efficient with an exorbitant toll, but you don't have to pay it. Which bridge would you take?

As long as the ER provides the end user what he/she wants in the most convenient manner, it will be the first choice.

I try to focus my frustration at the ridiculous system that encourages a patient to come in at 2300 on a saturday night for a rash x 2 months. Blaming the patient isn't energy well spent.

And- I would rather deal with a polite frequent flier (they exist) than an obnoxious person with a legit problem.

SherriJones · Jul 25, 2013

The United States Air Force used to teach a certain nursing fundamental to its nurses; that even if you were lower ranking, if someone of higher rank was making your job harder or impossible, it was expected of you to take back control for the good of the patient. I loved that. It gave me permission to order four star Pentagon generals to take their heart medications, in the way doctors to give the nurse back their chair, computer, etc., and permission to lean down to a "slug" and whisper my cuss word rich lecture into their ear (our slang for patients who refuse to walk or get out of bed after surgery). It went something like this, "Before I start in on you, I want you to know I am a Christian woman, the utmost nursing professional, and normally don't swear at my patients, but the other nurses are referring to you as a slug. It is my duty as a nurse to lean down in your ear and tell you to get out the **** out of bed, and WALK, NOW, before you ******* die of pneumonia." Then I would stand up, point at my red hair, and say, "Mother Nature uses bright colors to warn others of a dangerous animal. Venomous, poisonous, etc. As a red headed nurse I thought it my duty to remind you that you might not want to **** me off." Then I would top it off with, "You are NOT going to say no to me. Get the **** out of bed." The way I did it, professional but firm, and ready to back up any question or objection with solid medical science, they would always be amused, oblige me, walk, and within 48 hours would be thanking me for making them get moving, that they finally had less pain, felt better than ever, etc.

It is in this spirit I have no problem telling a patient that the delay in their care was due to a fresh EMS patient, or some critical change in another patient requiring rapid response. I remind them that if they were that patient who was having the real emergency, that they would appreciate the other patients being understanding and for waiting. Works every time. Patients really do understand and appreciate a nurse with professional control. It represents humanity, it reflects on us doing our best, and in my opinion, it is a key in preventing burn out. Do everything you can to KEEP YOUR HUMANITY. When I did prison nursing, everyone who worked there said the same thing, whether a nurse or correctional officer, the second you lose your humanity is the second you start on a downward spiral to burn out, ******* up, and losing your job. Since leaving correctional nursing, I appreciate every patient. Even if they're non-urgent and a real ****, at least they're not a serial killer.

Let's cut the crap, be assertive, and be straight shooters. Let's be authentic, genuine, develop our own style as individuals, and be ourselves.

Editorial Team / Moderator · Jul 25, 2013

Then I would stand up, point at my red hair, and say, "Mother Nature uses bright colors to warn others of a dangerous animal. Venomous, poisonous, etc. As a red headed nurse I thought it my duty to remind you that you might not want to **** me off."

Hahahahaha!! Preach it, ginger sister!

nitenite · Jul 25, 2013

Man, oh man, I remember the time I ALMOST quit because of a jerkface patient lacking in compassion.

A person(Patient A) came into the ER complaining of chest pain, saying he didn't want to call an ambulance and take up somebody else's emergency spot. He collapsed as he was trying to sign in. I jumped on him and started CPR and got a code going. The butthole with a small laceration on his arm(Patient B) came over and he actually started yelling at me. "That loser is dead. Work on me! My arm hurts!"

I firmly believe hearing is the last to go. We did lose Patient A despite everything we did, and I'm still heartbroken thinking the last words he heard on Earth came from somebody calling him a loser. I wanted to punch Patient B in the face SO bad.

I took care of Patient A's family by telling them what to expect when they saw him because of tubes and stuff. I made sure to clean him up the best I could under the circumstances. His hair was combed and I put the rosary I found in his pocket in his hands when I folded them on his chest. His wife cried on my shoulder and I brought his daughter a glass of water. I even cried with them(I am such a sympathy crier!) and told them how nice he was when he came to the desk.

They sent me flowers a few days later with a card that says "God made nurses special" to thank me. That restored my faith in humanity.

Don't let the nasty patients blind you to the nice ones. You have to drill deep in the dirt to find diamonds. :)