Please don't judge me and my daughter

The night my daughter told me she wanted to kill herself was not an easy night. I drove her to the Emergency room that I used to work in, thinking they would care for her best. What I found was not true, and as a nurse and Nurse Practitioner I'm going to tell my story in hopes of making a change to the world I thought I loved, the world of nursing. Nurses Announcements Archive Article

The night my daughter told me she wanted to kill herself was not an easy night. I drove her to the Emergency room that I used to work in, thinking they would care for her best. What I found was not true, and as a nurse and Nurse Practitioner, I'm going to tell my story in hopes of making a change to the world I thought I loved, the world of nursing.

I now want to leave the only thing I've ever known because I don't want to be associated with cold, judgmental nursing with cold punishing eyes. I didn't ask for my daughter to be so depressed that she couldn't find another solution. The cold look in your eyes at me and my daughter spoke volumes.

I hope you never are faced with this fear or with the overwhelming feeling of failure that I felt as a mother that night. Your job wasn't to pass judgement or to be so cold-hearted that my skin crawled. Your job, my sister, was to look at me and feel empathy and understanding. Your job, my fellow nurse, was to accept that I was in crisis and going through my routine was the glue holding me together. That included bringing my meals with me because, besides nursing, my life in fitness was the only thing that made sense to me and filled me with the same passion nursing used to.

Your cursing under your breath at the TV showed that you didn't see nursing as an art. To you, it was just a job that paid the bills. Your lack of compassion and not introducing yourself before you drew my daughter's blood showed me you thought my daughter was weak; while in my eyes, she is very strong because she reached out to me so she was able to get the help she needed.

And to you the nurse who said it looked like we were camping out. Did you consider not everyone lives the same lifestyle and some of us may need food because of our way of life? Did you notice I kept everything neat and then cleaned up before we left? Did you consider that I needed that food and water to keep me from falling apart? How do you know that it wasn't for my daughter who has food allergies? As far as my daughter's belongings we had hoped she was coming home with me and she did. But you made us put them in my car and she walked out in the lovely paper scrubs provided for her.

You didn't touch a life that night. Your lasting impression left me cold and disheartened for nursing. You left me embarrassed to tell others of the profession that I so dearly loved for so many years. If it's true nurses eat their young, it's also true that the nurse of today is not doing what the nurses of yesterday set out to do.

Yes, I realize that my daughter may have been your tenth suicidal patient of that particular shift or week. I also realize she may have been your first. Either way, she deserved understanding and gentleness in your care, not detachment and cursing and rude comments passed. I deserved professional courtesy and maybe a distracting conversation.

Again I pray that no one in your families suffers from such depression that they see no other way out. I hope that they go on to live beautiful productive lives. As my daughter will not because a nurse in the Emergency Department touched her life and changed it for the better but because her mother, also a nurse, never stopped looking at nursing as an art.

I get that many people may not meet criteria to be placed on a hold but in my area it seems that holds are written and patient passed on the a behavioral health setting more often than not because the ER physician and/or social worker don't want the liability of stating the patient is ok to go home. I get patients on some of the weakest holds I have ever seen.

Hppy

Interesting. I haven't worked anywhere that we would even be able to secure a bed in such a scenario.

1) With all due respect that was not the presenting complaint.

2) Of course. Which is why this is ESI 2 regardless of whether or not there was an attempt - that is, for safety reasons.

3) I'm not so sure about that. The author of this vitriolic "article" seems fairly upset about at least a couple of things that are procedures which may not be overridden by a staff member. Which is part of what destroys the credibility of the article as far as I'm concerned.

You're right, it takes no time to show someone that you care. It only takes a couple of seconds to make good eye contact, give reassurrance, and respect the patient by explaining procedures and expected course of care. It takes a little longer for "active listening," but it is very, very important and I always do it...every single time - mostly because it is one of the best ways to show care/concern.

But raging against thousands of nurses about whether or not the staff was able to make a patient (or the patient's visitor) feel a certain way is not okay. There have been a couple of times over the years when people experiencing MH crisis didn't like my most careful, and considerate efforts (or, they didn't like the ED policies but they included me in their dissatisfaction). What shall I make of that? I could try something different the next time, but the policies aren't changing and the next patient may not like anything any better.

Second major issue that I don't believe has come up yet: The ED's rapport with the patient experiencing MH crisis such as this needs to be handled carefully. I've heard from a number of MH professionals the average number of times a patient has to "tell their story" before getting to definitive help (friend > parent/spouse > registration clerk > triage nurse > primary nurse > ED physician > MSW). I don't remember the exact number but I think what I've been told is that they will have to "tell someone" an average of 8 times - - without yet having met the person who is going to help them manage their problem. This is an issue in the ED - we are not the definitive help, and we need to be very careful with our handling of the rapport. It is for this reason that, except in rare circumstances, you will not see me holding anyone's hand in such a scenario or expressing "how much we care about you," because the overall effect of this would be that 5, 6, 7, 8 people tell you how much they care, and then they exit the relationship. Not therapeutic. I will show respect and concern, but an emotionally-laden, "hair on fire" overly-doting concern that adds drama is not appropriate and not therapeutic for many reasons.

The correct and therapeutic way to handle this in the ED based on everything I've ever been taught (and my own experiences/observations and trials-and-errors), is to maintain a pleasant and appropriately-concerned rapport and be efficient at moving the patient toward definitive help. That's it. And I have a suspicion that would not have been enough in this particular situation.

I absolutely agree with what you said as far as what you said about pleasant and appropriately concerned.. that's really all there is to it.

As far as triage, I also understand that as well, everything is about priorities and no one would fault a nurse for that. What's bothering me is the dismissal of these patients like they shouldn't even be counted and all they do is pull time away from pts that are really "sick". That's unfair.

These patients can challenging like no other pt I have worked with. You begin to think in terms of little victories.. and gosh knows sometimes you are working with someone whose reality or train of thought is slightly askew shall we say. So often they aren't happy with things that are done( that opens a whole new can of worms). Buecen if you have to be firm, set boundaries, a person can tell if they are being dismissed or shrugged off.

I also refer people away from ER's for their not so emergent emergencies.. and we do have a little hospital nearby that has a great non trauma ER..

I am not trying to dismiss a specialty, I have seen these things happen...

My only only thing is connection.. "see" people when you are caring for them, however brief that encounter might be...

Specializes in Pediatric & Adult Oncology.

I'm so sorry to hear this story and what you endured. Sending much love to you and your daughter - and commending your strength. Thank you for sharing such a personal story and let it serve to a reminder for all HCPs. Our actions and attitudes matter to our patients more than we sometimes realize. While it can be difficult to always be "on", this is what each & every patient we encounter deserves - empathy, caring and compassion, always.

Specializes in ER.

Being warm and friendly is part of the job for every patient, but then I have to remove their belongings and ask them to change into hospital clothes. They feel cold, vulnerable, and I've taken their belongings (and likely their coping mechanisms) away. They want a cigarette by then, and there's no smoking on hospital property. Everything becomes a negotiation, with no way to say "yes." Then they have to wait in a confusing environment that they don't understand, and understandably feel neglected and ignored. Another kick in the self esteem they didn't need. I can explain the procedures as much as I want, they are still cold and dehumanizing. In our hospital, the psych unit expects the ER to complete all the objectionable procedures before the patient goes to their unit, so they can start on a positive note. We give a terrible experience to our psych patients, but I'm not seeing options that stay within policy.

The OP was upset about judging nurses. Assessing comes very close to judging, and it's part of the job. Psych patients don't come with objective lab values and Xrays, all the info comes from observation and inferring reasons behind actions. If a nurse said "looks like you're camping out" she's seeing a behavior that is unusual, and hoping you'll enlighten her. If you said "I have a lot of allergies" and moved on to your daughters troubles, that's one response. If you took each bag and explained why your health requires each item, and a bit of the history behind it, well, that's going to lead her to a different conclusion. But a good nurse will ask the question.

1 Votes
Specializes in Psych, Addictions, SOL (Student of Life).
Interesting. I haven't worked anywhere that we would even be able to secure a bed in such a scenario.

without going into detail that would violate HIPAA I get 5150 holds all the time that simply state "You said you wanted to kill yourself." There are no details with regard to lethality of intent or plan and feasibility which is what I was taught is necessary to place a hold on someone. People are often wrongly designated as Danger to self when they are actually gravely disabled and with suicide being the number one cause of death among the 13 to 21 age groups almost any teen will be placed on a hold for with very little criteria. In several hospital ER's that send us patients if an adolescent makes suicidal comments. they parents are escorted out and a security guard called in case the parents are part of the reason for the ideation. Parents often tell be how scary and disturbing their ED experience was. We try to make it better once they get to the psych facility but in my experience disturbed teens don't fall far from the trees.

Heck we get homeless who will outright tell us that they aren't suicidal but said that to get 3 hots and cot for a few days. We are often happy to oblige as they do need many of the services we offer.

Hppy

without going into detail that would violate HIPAA I get 5150 holds all the time that simply state "You said you wanted to kill yourself." There are no details with regard to lethality of intent or plan and feasibility which is what I was taught is necessary to place a hold on someone. People are often wrongly designated as Danger to self when they are actually gravely disabled and with suicide being the number one cause of death among the 13 to 21 age groups almost any teen will be placed on a hold for with very little criteria. In several hospital ER's that send us patients if an adolescent makes suicidal comments. they parents are escorted out and a security guard called in case the parents are part of the reason for the ideation. Parents often tell be how scary and disturbing their ED experience was. We try to make it better once they get to the psych facility but in my experience disturbed teens don't fall far from the trees.

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Hppy

Wow. And Wow! Thanks for sharing. I can only say it has to be differences from state to state (?). That does sound very disturbing.

That is a typical ER nurse response. Mental health emergencies aren't your problem because you can't see the injury. Suicide is one of the top five causes a of death in many countries and that doesn't even consider all the near misses. Your comment that psych patients usually come out if the ED feeling worse but at least we didn't let them have things to harm them is just part of the problem. It's the same as saying well you had one broken arm when you walked in and we didn't fix it for you. But at least we didn't let you break any other bones while you were in the ED.

Cat_Albrecht, paging, Cat_Albrecht. Please report to the nurse's station...

Specializes in CCRN, ATCN certified.

As someone with an anxiety disorder and a strong family history of depression, including several family members attempting (but thankfully not completing) suicide, it saddens me that there is still such a stigma surrounding mental illness. I worked as a tech on a pediatric behavioral floor for a year during school and many of the kids were more worried about what everyone else thought of their illness than anything else. So yes, it is very true that not everyone, even nurses, are understanding of or compassionate toward people undergoing a psychiatric crisis.

However, using the fact that they made your daughter wear paper scrubs or didn't approve of you bringing in food as evidence of mistreatment is sadly misinformed. There are precautions which have to be followed for the good of patients like your daughter. I can't count the times I had to explain to annoyed and angry parents why it wasn't acceptable for their children to wear their new sneakers while on our unit or why they couldn't have knives and forks in their rooms. It truly is for the safety of the patient and nothing else. Perhaps the nurse said it rudely or perhaps you were (rightly so) worried about your child and read into what she said a little too much.

On a side note, as a "nurse of today", I find it ironic that in an article asking others not to judge, you make such a sweeping accusation that it's "also true that the nurse of today is not doing what the nurses of yesterday set out to do". What facts support this? I try my hardest every shift I work to offer care and kindness to my patients, many of whom are dying, and I think that is exactly what the nurses of yesterday set out to do.

Specializes in Peds/outpatient FP,derm,allergy/private duty.

These nurses most likely were not rude to the OP's daughter. The woman has provided several examples of incidents illustrating examples of what nurses need to stop doing.

Is it fair to say that a nurse who forgets to introduce herself before performing a procedure is guilty of telling the mother that her distressed daughter who expressed suicidal ideation is weak?

I've cursed under my breath at a malfunctioning TV, when actually I would rather yell curses at it, because I want it to work. I could call a person who deals with stuff like that, and maybe you'll still be there when they show up, but probably not.

"It looks like you're camping out in here". I've said that. It isn't laden with strong opinions about your diet at home. I don't think you're a slob, I'm glad you're there for your daughter.

Why would I single out your daughter for cold- hearted judgement when my family has been touched by suicide and major depressive disorder, too. Most families have. Yes, we know how it feels.

Honestly, unless it's possible to control someone's thinking, connecting "don't judge my daughter" to the above is not constructive at all.

These nurses most likely were not rude to the OP's daughter. The woman has provided several examples of incidents illustrating examples of what nurses need to stop doing.

Is it fair to say that a nurse who forgets to introduce herself before performing a procedure is guilty of telling the mother that her distressed daughter who expressed suicidal ideation is weak?

I've cursed under my breath at a malfunctioning TV, when actually I would rather yell curses at it, because I want it to work. I could call a person who deals with stuff like that, and maybe you'll still be there when they show up, but probably not.

"It looks like you're camping out in here". I've said that. It isn't laden with strong opinions about your diet at home. I don't think you're a slob, I'm glad you're there for your daughter.

Why would I single out your daughter for cold- hearted judgement when my family has been touched by suicide and major depressive disorder, too. Most families have. Yes, we know how it feels.

Honestly, unless it's possible to control someone's thinking, connecting "don't judge my daughter" to the above is not constructive at all.

Thank you for this. It's exactly what I was thinking. Not only that but sometimes we say things to lighten the mood a little in a difficult situation. Sometimes it works, sometimes it falls flat. I don't think this nurse was being judgmental at all. Could she have been a little warmer? Perhaps but given the tone of the OP I'm not sure anyone would have been acceptable.

actually, she WAS breaking the rules...you can't take food, drinks, utensils, whatever, into a room with a suicidal pt...and she didn't say her daughter had 'just tried to kill herself'. you cannot equate a pt having a massive MI with a pt who is feeling suicidal. one will die if you don't actively intervene, the other must be kept safe until we can get them to a psych facility. don't pull the 'don't give a damn' stuff. and the notion that all ER rn's want to work crazy traumas all the time. there's precious little that is 'glorious' in the ER. we care just as much as you do. we are still very, very limited in what we can offer.

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