Is a nurse in the ER joking to a patient like this appropriate?!?

[Laurenslovely]

I (a nursing student close to graduation) took my dad to the ER for chest pain last night. (He suffered a MI). He was immediately treated by a group of very pleasant doctors. The male nurse who was caring for my father quickly got too comfortable because my dad is a very calm and friendly patient. He rubbed me the wrong way when he quickly started advising my dad how he should eat, work out etc (as if my father was not already educated from this long standing condition and already taking very good care of his health to the best he could.) The male nurse then made a JOKE I did NOT think was funny: "I guess you were just born with bad genes!" my dad takes everything lightly and didn't get upset but I do NOT. Is this appropriate in the context of a joke from the "Nurse?" I seriously am developing ANGER towards this nurse today as my dad is still in the hospital. Should I let this go or report this? Also, he was sloppy when he inserted the IV and there was blood everywhere!!

[mama_d, BSN, RN]

I have to second the post a few above mine...she came on here, asking basically if she was right or wrong, was told that she was wrong, thought about it and moderated her response to the situation. How often are we beating our heads on brick walls on here with posters who get irate at the merest suggestion that they need to re-think things? Especially in the midst of such an anxiety producing scenario?

I'm on the IV team where I work, and I always come armed with towels...my hope every time is to hit a big juicy vein that will hold up for the full four days before needing to be restarted. And a little blood can look like A LOT of blood when it's on a background of nice bleached white linens.

I've told patients before that they simply have the cards stacked against them genetically. I usually lead into it with the fact that I'm going to get skin cancer and be six inches shorter in my 80's b/c I'm a short pale girl so that it comes across in a "we've all got crap to try to deal with" way (at least I hope that's how it sounds).

Best wishes for a speedy recovery for your Dad.

[P_RN, ADN, RN]

Sorry your Dad is ill. Over all it looks like the Nurse did his job. Except myabe DAD gould have said "yeah the "genes" are kind of raggy, I got them at a yard sale 40 years ago." Think of it as ships passing in the night...it will be better in the morning.

[Nurse SMS, MSN, RN]

OP, you have my sincere respect. One of the most challenging things about nursing is the need for honest self evaluation. I see you doing that here and I bet you are learning a lot as you experience this with your father. I give you huge credit.

[martymoose, BSN, RN]

Hope your Dad feels better soon.

The education thing is whats required to be documented.For your Dad the education would be marked as "re-enforced" as it sounds like he already follows the recommendations prior.I remember having an Indian patient who was complete vegan all his life, was actually underweight a little, but ended up with 3 stents and had triglycerides in the 500's.He was obviously handed the genetic card. Not much we can do about that one- other than let him know to continue what he is already doing right so as too maybe slow the progression of things.

I will admit as a nurse, it is very difficult to document sometimes teaching that you know might fall on deaf ears. But legally , we did our documenting - even if it means re-enforcing, etc. An example I had recently- Pt with BMI 52- 30 y/o, going home with lifevest(defibrillator)I had to re-enforce (and document as such) that we reviewed healthy diet, etc. while a bag of oreos is sitting on the table, and other family members are bringing in cookies and McDonalds.ughh.But it's reqired of our job to do pt education and document it every shift.Your nurse was just doing their job.

Regarding the IV- lovenox does tend to make people bleed easy- some iv's just do that- but I do think a bed change, sheet change, etc is in order if it is soiled, or a drssing redone if its soiled ( bloody)

Again, hope your father recovers soon. It is good that you are being his advocate.

[dudette10, MSN, RN]

I agree with you, that was NOT the time to educate your dad .

He is having a HEART ATTACK!

Teaching should be done after the event.

ER nurses should do no patient teaching whatsoever?

[eatmysoxRN, ASN, RN]

I just want to throw in there that:

1) if you've changed your mind about this nurse and think he did well, every nurse is super appreciative of a dollar store "thank you" card.

2) in the ER especially, iv starts are usually done as fast as possible. Every second counts with a MI. So what if blood got on stuff? If you ever see a code, you will see a mess. Codes get messy quick. No time for trash cans and linen changes when saving lives.

3) I think this situation will make you a better nurse. That nurse probably had several other patients and a list of things to do, but he took the time and cared enough to teach, which as others have said, many don't get to do much of. It should not offend you. The nurse doesn't know without asking. And if he teaches in the process, that's great! And although the joke wasn't comedy central material, it was probably all there is to say after hearing "I eat a perfect diet and exercise." what else could you say?

I hope your dad feels better soon. And seriously, cards are awesome. Best wishes :)

[GitanoRN, BSN, MSN, RN]

er nurses should do no patient teaching whatsoever?

at this level, i'm certain that the member "been there,done that" didn't mean that nurses shouldn't perform any education to their patients, she simply stated that on her view of the situation it should have be done after the event. in my humble opinion, is our responsibility to educate our patients since it's within our scope of practice. having said that, when the nurse considers it an appropriate time to offer this education is up to him/her....aloha~

[U RN ICU]

Ok, you start IVs throughout your career without ever dripping (sometimes pouring) blood and then you can judge others...won't happen.

[redhead_NURSE98!, ADN, BSN]

ER nurses should do no patient teaching whatsoever?

Is that what was said?

[Stephalump]

I didn't read through the responses, I just wanted to say I'm really sorry your father had to be hospitalized.

I don't think you're out of line in terms of being upset - you're struggling, your father has some health issues, it's tough. You're allowed to be as sensitive as you want to be.

Do I think the nurse was trying to be rude? No. It seems like he was just making light of the fact that your father says he's doing everything right and is still having issues. Kind of an acceptance that lack of routine patient education is obviously not the issue here.

I think it's just a lesson to take forward - different people have various levels of sensitivity to jokes like that, so it's best to err on the safe side. I personally wouldn't have been bothered by the comment. I have a high genetic risk for all kinds of health problems, and I've been aware that my odds of ovarian cancer are uncomfortably high since my mother had a hysterectomy when I was 8. I do, in fact, have bad genes, and I joke about being a walking cancer time bomb all the time.

I'm sure there are a ton of people who wouldn't dream of laughing about something like that, but it takes all types!

[dudette10, MSN, RN]

Is that what was said?

I appreciate another poster's explanation, but I'll answer this.

She said something like "patient education should be done after the event." Considering that ER visits are always in the midst of an event, I took it one step further with my question.

After thinking about it--and seeing the other poster's post--not all ER events are as serious, and I appreciate Been there, done that's sentiment. Some ER events are minor and require education prior to ER discharge. She/he wasn't talking about an event like that, obviously.

In other words, I spoke/posted too quickly, and for that, I apologize to BTBD if my question came off as rude.

I also appreciate, however, that we weren't there, and the nurse that night had to make his own judgement on whether education was appropriate at that time.

[VICEDRN, BSN, RN]

And though I am not the nurse in the OP's story, it reminds me of something that happened to me in my first year of nursing. it was almost the exact same situation only the patient did not have an MI but rather a different problem. the patient was happy with my care and said so when surveyed by management but informed the manager that his family thought my comment was "off color."

This is why I throw each and every family member out that I possibly can. If the rule says no visitors in this area (trauma, psych), you are out of here. If it says one visitor, that's only the patient gets in the area. Since I became a nurse, I have become convinced that families are toxic counter productive detritis in the health care setting. People are better off with one support person that they have carefully selected and no one else.

While I am glad the OP is open to new perspectives, I can also see that she sees herself as an important part of the nurse-patient relationship in this case which I think is an inaccuracy that we have perpetuated in health care with our family friendly NOISE that we put out there. If patient is not offended then OP shouldn't care.

And I agree...families and their impossible to please attitudes is another reason people leave nursing...