new RN, first job, having tough time, need advice

Sassy5d · Mar 31, 2014

Maybe you need to find a different ER to work at?

MedicalPartisan · Apr 1, 2014

I feel like I'm reading a post of mine from an alternate timeline.

Welcome to 'emergency' medicine. It's so sad, pathetic, and frustrating, but there's nothing you can do about it. I'm hoping in the next few years or decade that some laws start to change. But right now just tough it out. I'm not yet a nurse but I've been in the ED for five years now and I'm just now (as of the last few months) learning to play the game, kill them with kindness, and smile and agree with management who wants to chastise you on behalf of the 19 year-old back pain with no known injury for being 'rude' to them. It's tough, it really is. And I feel your pain.

Perhaps try informing charge when you get to work of your preference and they might work with you. In our ED they're usually pretty good about placing and avoiding people in the places they like and dislike.

I've been overly nice the past few weeks and I can honestly say it feels amazing. I was never rude before but every patient greeting begins with a cheerful 'good morning', 'good afternoon', or 'good evening' and are discharge in the same manner. When patients are irrational and loud, let's say about wait times, for example, I simply inform them that I'm doing the best I can and that's just going to have to be good enough. I too was letting their behavior get to me and came home stressed after each shift and I knew something had to change. Soon. I knew I couldn't possibly change our patients and their entitled attitudes so the only thing to alter was my own. And it has help considerably.

I hope things get better for you. :/

Esme12, ASN, BSN, RN · Apr 1, 2014

Emergency medicine has it's downfalls. Those other nurses are "jaded" because they have to be for survival....or it will eat you alive.

I have been called everything under the sun except blonde and white....which is my hair color and race. I have been armed robbed for narcotics. But.... I also had gang members come to my wedding to give me a gift. (let me tell you that caused a sensation). I can rock a baby to sleep and forearm a gang member to the floor.

You appreciate the little things and the rest......You just let it go.

You can't take everything personal. You can't take everything to heart. Celebrate the small victories. Realize defeat. You can't fix stupid. Move on to the next day. This is the life of of an ED nurse.

I actually have a tougher time adjusting to the privileged. They have the money to back up their side of the story. I cared for children with better manners that lived in a box on the street than the ones who went to a private prep school. I broke up a fight in the waiting room at this affluent hospital with a fire extinguisher. I was attacked by a commercial pilot to leave marks on my neck because he waited 10 mins to see a MD for his daughters chin lac.

It is what it is.

((HUGS))

1fastRN · Apr 2, 2014

maybe you need to look into employment at another facility....

personally i try to "kill em w kindness." I am always super nice to the meanest of patients...sometimes it works and my positive and empathic attitude (although im "faking" it) works, sometimes it doesnt. all i can do is try. dont let miserable people drag you down!

nolaEDrn · Apr 3, 2014

Maybe try a different department? Having to change the scene does not make you a bad nurse, not everyone is meant to be in the ED.

You need to be both stern and empathetic at the same time. If you can't find more meaning in the help you provide to the 1/10 people that really need it instead of the 9/10 people that challenge you, then you are going to have a tough time in any ED. The ED is a stressful place for everyone: staff are always prepared for the worse case scenario and every patient thinks their problem is an emergency. That's just part of being in the ED.

Hope things get better for you!!!

SalamICU · Apr 9, 2014

Well, I am not even sure where to start...

It is evident that you are, indeed very unhappy with your position but remember, as a new grad without any experience at all, you are blessed to have been offered a chance to begin your career. Your perception about the patient population is not appealing! As a professional, you should understand that nobody chooses to visit the ED just because they are drug seekers or drunk as you have classified your patients. I also believe that you knew beforehand the type of hospital you were going to work. You should also know that pain is subjective and you have no right to determine wether they are lying. If patients are cursing...guess what? Suck it up and kill them with kindness. That is unfortunate our patients have not had the same opportunities we have had. Do not discriminate them. I am an ICU nurse, and I have had patients who wanted to kill me, and sometimes make my work miserable. I deal with it easy & breeze!

So, if you're loosing your hair, having nightmares, diarrhea and psoriasis bursts all over, I highly suggest you to look elsewhere. Another RN would snap that position with passion and dedication in a heartbeat!

utadahikaru · Apr 9, 2014

There's only one way to handle patients who are extremely rude or suffer from FMPS (Fluff My Pillow Syndrome): Get in and out of the patients room as fast as possible, engage in conversation with them as little as possible.

If that doesn't do it for you, try working in another ER

edmia, BSN, RN · Apr 9, 2014

Sounds exactly like my first ED job! I loved the learning I accomplished, but it was too much for a new grad to take in. And there were some awful colleagues who wouldn't even talk to me because I was a new grad and hadn't paid my dues ...

I moved to a level 2 facility and everything changed for the better.

I still really miss the nightly GSWs and stab wounds. That was exciting ;-)

Guest219794 · Apr 10, 2014

Well, I am not even sure where to start...
It is evident that you are, indeed very unhappy with your position but remember, as a new grad without any experience at all, you are blessed to have been offered a chance to begin your career. Your perception about the patient population is not appealing! As a professional, you should understand that nobody chooses to visit the ED just because they are drug seekers or drunk as you have classified your patients. I also believe that you knew beforehand the type of hospital you were going to work. You should also know that pain is subjective and you have no right to determine wether they are lying. If patients are cursing...guess what? Suck it up and kill them with kindness. That is unfortunate our patients have not had the same opportunities we have had. Do not discriminate them. I am an ICU nurse, and I have had patients who wanted to kill me, and sometimes make my work miserable. I deal with it easy & breeze!
So, if you're loosing your hair, having nightmares, diarrhea and psoriasis bursts all over, I highly suggest you to look elsewhere. Another RN would snap that position with passion and dedication in a heartbeat!

nobody chooses to visit the ED just because they are drug seekers or drunk

Of course they do.

You should also know that pain is subjective and you have no right to determine wether they are lying.

You do actually have a responsibility to use good nursing judgement, and advocate for what you believe to be in the best interest of the patient. Part of good nursing judgement involves evaluating both verbal and non-verbal communication, as well as lab values, hx, etc.... and, patients lie all the time. Do you believe somebody who appears drunk, but claims to only have had 2 beers? Would you give that patient a medication that negatively interacts with etoh?, or would you check labs, breathalyzer and hx?

To the OP- A patient's rudeness or hostility has nothing to do with you- no reason to internalize it, or let yourself be negatively affected. And, bullies sense weakness and exploit it. If you can't develop coping strategies, consider moving, or at least to a different hospital. I see my share of a--holes, but it certainly is not the majority. Yesterday, I had two older gentlemen on separate occasions look me in the eye and shake my hand when they thanked me for my care.

Guests · Apr 10, 2014

As a professional, you should understand that nobody chooses to visit the ED just because they are drug seekers or drunk as you have classified your patients.

I don't know about your ED experience but I can definitely say that after five years of work in three different EDs, tiny to large, that some patients do visit "just because they are drug seekers or drunk."

Pretty routinely, actually.

You should also know that pain is subjective and you have no right to determine wether they are lying.

Quite the contrary... I have every right to determine whether they are lying. Narcotic abuse is reaching epidemic proportions in our country and kills more people than do the illegal drugs. For sure, part of good nursing care is performing a comprehensive assessment and not just doing what the patient demands.

If patients are cursing...guess what? Suck it up

Nope... abuse is not part of the job and not to be tolerated.

That is unfortunate our patients have not had the same opportunities we have had.

Still doesn't give them the right to be abusive.

Do not discriminate them.

Nope, of course not... but neither are they permitted to act like animals and while simultaneously demanding respect... it's a two-way street.

I highly suggest you to look elsewhere. Another RN would snap that position with passion and dedication in a heartbeat!

Or, perhaps it would be another one of us professional, competent, skilled nurses... who is also jaded by the reality of what we daily face.

Passion? Bah!!

OP: There's nothing wrong with being jaded... SO LONG AS YOU GIVE PEOPLE A CHANCE.

I am jaded as all get out and yet I still get many compliments from patients about my excellent care and personable interactions...

I give everybody a chance, every time they present... even if they've been weenies before... but I remain jaded because I see people as they are... and some people are... disrespectful creeps...

But I echo Esme's experience... some of the most trying patients I've had are also the most affluent and powerful... and some of the kindest have been strung out street people with scarred up veins.

Personally, I dig the ED, and I like working at an urban trauma center... all of its warts notwithstanding.

I think you need to decide what you really want and start to toughen up. Not too many softies make it in the churning waters of the ED.

Gabby-RN · Apr 10, 2014

As a professional, you should understand that nobody chooses to visit the ED just because they are drug seekers or drunk as you have classified your patients. You should also know that pain is subjective and you have no right to determine wether they are lying. If patients are cursing...guess what? Suck it up and kill them with kindness. That is unfortunate our patients have not had the same opportunities we have had. Do not discriminate them. I am an ICU nurse, and I have had patients who wanted to kill me, and sometimes make my work miserable. I deal with it easy & breeze!

I see patients almost every shift that are seeking drugs, many hospital hop and have narcotic contracts or orders to not give narcotics except in a case when surgical intervention is necessary. I also frequently have drunk patients that are just looking for a warm place to sleep and a sandwich to eat while they sober up. I am indifferent to it and as long as they are polite and follow the rules. Pain is subjective but I am sorry if a patient is crying out in pain stating they have 10/10 abdominal pain while you are in the room but chatting on their cell phone and eating chips when you leave, then they are probably lying. I will treat them with respect regardless as long as they do the same but I will also inform the doctor of my observations and chart the same in an objective manner. In the ICU things are different. Every patient you have NEEDS medical care. If they swear or treat you poorly it is probably because they are having a tough time dealing with their illness. They maybe deserve understanding for their bad behavior. Every patient that I see in the ED does not need to be there. Many do obviously but not all and in my experience, most people that are truly ill are not the ones being rude and disrespectful.

The patient I have seen 4 times this month for their left lower quadrant abdominal pain that is demanding dilaudid now, is refusing to use their call bell because they prefer to yell, and will only refer to you as "hey you, come here now". Killing them with kindness does not work, it only makes it worse. Staff that let patients like this walk all over them and be disrespectful set that patient up to continue the bad behavior next time they come in because they know it gets results. There are tactful ways to let patients know how you expect to be treated. I don't care if the patient is rich or poor, I treat them with respect and expect the same in return.

Or what about the patient who overdosed on heroin that came in unresponsive with a weak thready pulse that you gave narcan to who is now cussing you out cause they want to leave now since you wont give them any morphine for their killer headache, telling you that you better get the $&@* over there and talk to the doctor or else. Do you think killing them with kindness is going to help? They don't hear anything you are trying to say. All they know is their high is gone and they feel like crap. That sucks for them it does. But I'm not the one that injected the heroin in them. I am the one that saved their life and I would do it again. I hope they get help. I will try to encourage that even if they don't listen. They will not yell and scream at me or call me names.

I think you were a little harsh to the OP. I don't think she is discriminating. She is describing the harsh reality of the patient population she treats. She needs to decide if she can handle working in that reality because it is tough and not for everyone.