New Grad in the ER

TheCommuter, BSN, RN · Jul 13, 2016

Welcome...your thread's been moved to our Emergency Nursing forum for more replies. Good luck to you.

EDRNCCmom, MSN, RN · Jul 13, 2016

Any advice for a new graduate about to work in the ER? Specifically on how to deal with extremely rude and irate patients (I.e. Drug seekers). I know I can't take things personally, but sometimes it's hard not to. What's the best way to handle these tough situations?

I just got home after a 12 hour shift in the ED. The last four hours I was in triage without a tech. And the patients kept coming. I had on lady sign in for "tripped over a toy." When looking over the triage slips, I called back a older patient with chest pain. Patient with a "leg injury " yelled "excuse me." I calmly told her that in the ED patients are seen based on acuity and that we see those first who have potentially life threatening conditions. I told her if she is patient she will be seen. Moving on ... get "leg injury" into triage. She said injury occurred this am and the pain was "10 out of 10." Note she walked into triage and no swelling, bruising, or deformity was noted. When I asked what OTC pain medication she took to help with the pain, she said - of course, none!!! I ordered a extremity xray and did the blameless apology for the wait time. And then she went back out to the waiting room to wait for a room. I was nice and pleasant to her and she was tolerable. In my experience, most patients will treat you how you treat them. It's not worth getting upset and allowing patients to get skin. I tend to use the blameless apology a lot and educate patient on how the emergency department works. A large part of being an ED nurse is open communication with patients and honesty. And when that doesn't work and you feel it all getting to you, I stepped away from the situation and take10 minutes.

Welcome to the wonderful world of emergency nursing! I started out in the ED as a new graduate nurse, and now I train new nurses. It's a wonderful world..... Most days!!!! [emoji57]

Editorial Team / Moderator · Jul 13, 2016

I was nice and pleasant to her and she was tolerable. In my experience, most patients will treat you how you treat them.

This, right here. It's that old golden rule â€” treat others as you would be treated. I am nice to everyone, I don't get visibly upset when someone gets snippy, they just make themselves look bad. Some people are simply miserable humans, whether they are your patients or even your coworkers. The best part is that at the end of the day, they are still miserable but you don't have to live with them or live their lives. :)

I am reminded of a saying: "Everyone you meet is fighting a battle you know nothing about. Be kind always." That's not to say I allow myself to be bulldozed by a screamer or a rude person; I will hold up a hand and invite them to start over, and sometimes if they are being intensely ugly I will calmly invite them to get their voice right so that I can try to help them. Keeping you own voice low and calm is helpful. But if they are irrational and threatening, walk away. Or call security, and your charge nurse. We don't go to work to be abused, though it happens more often than we'd like.

jessc16 · Jul 13, 2016

This is a great thread! I too will be starting in the ED as a new grad, and I would love any advice I can get!!

rearviewmirror, BSN, RN · Jul 13, 2016

I left ED for UM, sweet good ole 8-5 M-F, no weekends, no holidays, no short staffing, no abuse from management, patients, and all the crap that comes with working at the bedside. No wonder why these nurses at office never leave until they go into a conffin ha! I have a militaristic, discipline-based mindset, and when all these trolls come in for non-sense stuff and they don't even pay or are on medicaid, I don't owe them anything. That's right I said it, I don't owe them anything. And eventually I couldn't deal with the ED trolls no longer so for my own best, I parted ways and probably will never set my foot in the hospital again, but that's OKAY! Better hours, better treatment, better insurance, better pay, better environment, how can I not stay in this?

My resolution to your situation was getting the hell out of hospital, hope you find yours.

lasarazen · Jul 13, 2016

Learn to be confident in saying "I'm sorry, but there are more critical patients ahead of you. Your wait time will be according to the severity of your emergency." Or some version of this if I am in the back with fussy, stable, non-emergent patients while also caring for not-so-stable patitents. It took me almost a year to get there, but now I actually enjoy saying this with my straightest face and most unctuously professional tone to the - ahem - more vociferously difficult patients. It's the truth, and we need to educate the public on what is and is not an emergency or it will continue to be abused like it is as an urgent care/primary care office! I just made it through my first year as ER RN pretty damn successfully I must say, it was an insane journey, but it was worth it for what I was able to parlay that experience into

Sarama · Jul 13, 2016

Thanks for the reply! And yes, I'm starting to realize that that more confident I look and sound, the more likely the patient will listen to me, no matter how angry they are

Sarama · Jul 13, 2016

Congrats! Maybe we'll be able to vent to each other about our bad days :up:

Sarama · Jul 13, 2016

Thanks for the words! I think some patients get upset from a lack of understanding what's going on, so I'll try and be as upfront as I can. I know it'll be tough some days, but I'm excited!

Editorial Team / Moderator · Jul 13, 2016

Thanks for the words! I think some patients get upset from a lack of understanding what's going on, so I'll try and be as upfront as I can. I know it'll be tough some days, but I'm excited!

Smiling helps too. Sometimes it's all Jedi mind tricks! Good luck and keep your enthusiasm up! :)

RN70BSN · Jul 14, 2016

I worked in the ED for a while before I went to nursing school. ED is not an easy place to be if you do not have patience, empathy, and the heart of giving, and I am not talking of material things. I saw both sides. Nurses acting like they were God, looking down on patients, talking about patients as though they were objects. Some took matters into their own hands. Then there were patients who were just as terrible. No matter what you did for them, they still complained, they still reported you to the supervisor. they were insulting, and sometimes abusive. Onetime a patient throw urine at a nurse. That was an extreme case. I prayed a lot. I smiled a lot, and I always believed, that difficult patient has a story. How can I impact this life positively today?

Bottom line is, you don't know everybody's story. Everyone has a story. Some people are fighting what I call "personal demons" beyond physical pain. We all do. It could be financial, emotional, lack of control, abuse they can't relate to anyone, but hoping someone finds out, and maybe you. It could be hopelessness, discouragement, and I can go on. You might be the one to make a significant difference in that one person's life, guess what? it could be that very difficult patient.

We are nurses, were are givers, and we are healers. We heal with our words, touches, smiles, embrace, sympathy, empathy, tears, attitude, and so much more. Yet, that might not be enough. But we still give our all.

I encourage you to go to work everyday with the attitude of "I am here to impact someone's life positively today"

Good luck!!!!!!!!!!!!!!!!!!!!!!!! :nurse: