How honest are you?

[Anna Flaxis, BSN, RN]

Venting on another thread got me thinking about this. In our ED, all the rooms including the trauma bays are private, with both curtains and doors that close. Because of this, it's very easy for the patients, in their private rooms with curtains drawn and doors closed, to be completely unaware of the chaos that is unfolding around them.

Most people are pretty nice, and are very understanding, when asking what's taking the doctor/scan results/blood work so long, when you explain politely that there are a lot of sick people here today, and your doctor is taking care of the sickest first, the sickest people go to the scanner first, the lab is backed up because we've had a lot of really sick people, etc.

But some people just don't get that. How honest are you when communicating with such an individual?

Normally, I just give my standard response about the sickest taking priority, and they either get it or they don't. Only once have I been more blunt than that.

It was a well dressed middle aged woman in for a medication request; very low acuity. She didn't want to wait until her PCP could see her and adjust her meds, so she had come to the ED. She kept complaining and complaining about how long it was taking for the doctor to come back, how rude the doctor had been by taking a phone call and then leaving the room (the phone call was the charge nurse letting the doctor know that her pediatric patient had gone into respiratory failure).

After my standard response failed repeatedly to appease her, I finally told her that the doctor was with a very sick child. She said "Oh, my grandson was really sick once. He had a really bad cold. We took him to the doctor and got him some cold medicine.", then went right back to complaining.

I just walked out of the room and implemented the BNPOC- Benign Neglect Plan of Care.

Now, I realize it's not all about me, it is about the patient. I totally get that. And each patient is in a different place. Some are actively trying to die, some are nowhere near dying, and some are somewhere in between, and they all have individual emotional responses to where they are.

I question how much value it really has to be completely open with the less/not sick about why things are taking longer than they would like.

Have any of you Emergency Nurses been completely candid with a not-sick patient about this? Have you ever told them that the reason they are waiting is that everyone is in with a teenager who is bleeding out internally from a car accident, or a father/husband/grandfather who slumped over at the dinner table from a massive MI, or that their doctor is intubating a child?

Do you think there is any therapeutic value in communication this direct? Do you think there are some people that need to hear this, so they can put their own situation into perspective, or do you think it is more of a self serving move on the part of the nurse?

[FancypantsRN]

I have found myself being pretty honest a couple of times. Sometimes it matters/helps, sometimes it doesn't.

I have told an adult pt who was in for a stuffy nose that I am delayed d/t a baby trying to die.....

I got kitty blinks in return, followed by an official complaint by her.

I usually try to be up front if things are bogged down.... hoping they will understand that the ER runs on acuity level. I don't think a majority of them get it. How can they get it, with all the advertisements with the "fast, no wait" ER visits. This is what they expect, they want in and out - I don't think a lot of them care that others are actually having an emergency. I think the "emergency" aspect of the ER escapes them (since some of them use it as a pcp/walk-in clinic).

[StrwbryblndRN]

I am upfront. EX: I hear a bed check alarm go off, as I am about to run off I will say to the pt I am dealing with that I have a confused lady who forgot she can't walk.

Most times I get a very understanding pt.

The only ones who are not understanding are the ones who are not happy with anything.

It has a lot to do with how you handle the situation also. If any sarcasm if noted in your voice that will be the problem instead how long everything is taking.

[eneil_ddd]

Be as direct as you feel you have to be If need be tell them the truth. You'll never be able to satisfy everyone.

Keep up the hard work we need devoted people like you

Thanks

[MinnieMomRN]

I don't work in the ED, but on the floor. We also get many of those questions -- why aren't I going to the Cath lab, to US, to CAT scan now, why hasn't the doc come to see me yet today, why must I wait?? My typical answer is that the hospital is the one place you DO want to wait. This is because those who get bumped up on the list of patients to be seen are those who are a step or two from dying. You don't want to be at the top of THAT list! Means if you are still waiting, you are lucky. Usually gets a chuckle and gives a bit of perspective.

[imintrouble, BSN, RN]

People who are that self centered, really don't care about anybody but themselves. You can tell them the person in the next room is dying, coding, bleeding out, it doesn't matter. Their response would be "Does it take all of you to be in that room?"

Had a pt say that to me as we were moving her bed because her roommate was coding.

[VICEDRN, BSN, RN]

I have been honest with people, sometimes overly so. I try to stick with vagaries and broad statements but its not always enough.

For example, I will tell people waiting in triage: "People who have unstable vitals, psych complaints or who have been assaulted can not wait here, they must wait in the back. This is because assailants like to follow their victims to the hospital, psych patients can not patiently wait sitting next to you and people with unstable vitals must be monitored by someone--unless you would like to--no? Ok then I apologize for your wait."

Because our ER is crowded and not as private, I have often asked patients, "did you see that guy that ambulance brought in? Yeah, its his turn before you- sorry! And I am sure you would want it to be your turn first if you were him."

In another ER I worked at that was more private, I would be vocal if I really really had to be--"we are intubating someone." Like another poster, I found a heartless woman who walked right past the room of a struggling for life patient (doors wide open, throngs of MDs, RNs, PTs around, two code carts cracked and CPR in progress and said to me, "That's not my problem. I am just here to be an advocate for my family member and you should just staff the unit better if you can't handle the work load."

When she followed it with, "I am sure you think I am a heartless b$*#&"." I cut her off and told her I think its better if you let health care workers make decisions about what's best for each patient in the department but it broke my heart the way she said it. Whenever I think of her, I remember all the patients and families who patiently waited and then told me they were praying for the family of whatever sick person they saw/heard about. Ugh. Some days, the ER sucks.

[DixieRedHead, ASN, RN]

More honest than has worked out well for me. On several occasions. If you want to know the details, pm me.

[maelstrom143]

I have been very lucky (but then again, I have not had too many years experience yet) because most of my patients are very understanding and willing to deal w/a little wait time since when their turn comes I will strive to give them as much attention as I give the other patients.

One time I had a patient start crashing and we took an hour to stabilize him...we finally managed it. I turn to see a family member of a patient across the way at the door hesitating. I moved toward her and asked what was wrong. She stated, "something is not right with mom...she just lays there and has stopped talking." This was an acute CVA we had admitted earlier.

Well, my patient was now stable and good to go, so I let the charge nurse know I was going to check on my other lady. I walk into the room, lady turns to look at me...and proceeds to seize. Later on it was determined she had also had another stroke! Daughter was right to come get me, but when I first saw her at the door, for a split second I was annoyed...lol. I am so glad it only lasted for that split second. Thankfully, Rapid response was still across the way.

Oh, and I forgot to mention: the daughter was very grateful and kept apologizing for coming to get me.

[Mom2boysRN]

Years ago when going to the er, pre nursing days, I would feel annoyed at how long I had to wait. I never complained but would think I knew there were people sicker than me or my child but still couldn't they hurry it up a little. I had never been to the er for a life or death situations, but for ones where my children or I were sick and didn't feel it could wait till the next day or Monday. Then we had a truly life or death situation with my son... He was bumped to the top of every list. As he recovered we realized how nice it was when you aren't the priority. Now if we have to go to the er and wait and wait and wait we smile and think of how lucky we are to not be a priority. I share this with people too when they complain about the er wait.

The moral... People don't really get it sometimes until they have a reason to get it... Though I'm sure there still are some that don't understand.

[JeneraterRN]

I vote for honesty without breaking HIPAA. I've never had too much trouble with visitors or patients, but some auxiliary staff have complained about certain things not being done. Once in particular we were involved with an extensive code with utter chaos coming from the rest of the patients. The head of the housekeeping department had to cover the med/surg floor that day and was complaining that we didn't have things done to make things easier for her. I looked at her and said, "Would you like us to stop CPR to finish stripping that room?". She shut her mouth and didn't say another word.

[JustaGypsy]

I have been known to tell an acutely ill patient, when thanked by them or family, to tell people what we are actually doing that kept us so busy the next time they hear someone complain about the wait in the ER.