Odd ER visit

[inshallamiami]

Well, my husbands Doc (actually his staff) told me to bring him to the ER. It's a SMALL hospital, and we get seen fairly quickly. The triage nurse asks me to wait in the waiting room while he talks to my hubby and that's cool, but my husband doesn't feel good and doesn't have a lot of his own info easily "at hand" but hey, I figure the triage nurse doesn't want to ask him questions and have the wifey answer. Perfectly understandable. Sure enuf, ten minutes later he comes out and asks me to come in to provide med info etc. later my hubby says that the triage RN kept asking a lot of questions which he couldn't answer and kept telling him to get me. All of this is fine and dandy, and of course I don't tell him I'm a nurse but boy this triage nurse seemed unhappy and bored and po'd. I'm sure he would have preferred an interesting trauma.

Ok so we get to the ER and that nurse was FANTASTIC but the ER doc, sheesh! He spends a t least five minutes GRILLING us about whether We spoke to our doc. I say no, repeating several times all my calls to the dr and how eventually his staff spoke to the doc (Presumably). they told us our dr says GO TO THE ER. I would have preferred at trip to the office but I wasn't given that option. Well the ER doc seemed to have a bug up his u know what about this but again I try to go with the flow.

Hours later the ER doc then asks if my hubby ACTUALLY passed out, which my hubby wasn't 100%sure but the doc didn't like that response and again seemed to give us a hard time. I felt like we were treated like criminals trying to take advantage of the ER or something. Hey my hubbie was I'll, couldn't walk, probable passed out, and our doc TOLD us to go to the ER.

Well we felt awful how we were treated, like criminals or morons or something (and he does have an underlying condition requiring chemo) It was like they were all in bad moods (except for one great nurse)

God I've been a nurse for years and years and I at least TRY not to make my patients feel bad or guilty. Ah well, thanks for listening to my vent.

[ComeTogether, LPN]

I was once treated badly by one snotty ER nurse. A quick email to the hospital and the next working day I received a phone call from a patient representative telling me they were sorry I was treated badly and they would talk to the nurse. I also received a letter in the mail saying how sorry they were. Granted it was a nurse and not a doctor but I would imagine that most hospitals aren't accepting of a nurse or doctors personal feelings influencing how they act towards a patient. That applies to those who think all patients who come in seeking medication for pain are drug seekers or those who are upset because doctors send their patients to the ER. You might not like it but the hospital isn't paying you to treat someone according to your personal feelings.

That is what I suggest to anyone who is treated badly at a hospital. Forgot the Press Ganey survey-just complain to the the hospital and a patient liason/representative will get back to you. I keep reading that nurses are supposed to be patient advocates but after experiencing just how little some of them do advocate for their patients I've learned that I have to advocate for myself when it comes to medical treatment.

From many of your previous posts it is clear to me that you don't like people who work in healthcare and that you are a chronic complainer. I just want you to know that simply making a phone call and complaining about a nurse or doctor does not mean that nurse or doctor will get in trouble. Maybe they'll look into it if it is a severe enough complaint, but there are chronic complainers in this system and most of us know it. Most of the time when I have come across family members who did nothing but complain and try to get staff in trouble absolutely nothing came of it, other than us being glad to see them go as well as administration.

Just to be clear for everyone else, I'm not talking about the rare cases when someone actually does do something warranting being disciplined. There is no excuse for treating a patient badly for real, but I know for me, I've had many patients perceive me to treat them badly when all i was doing was my Job..... I'm talking about "she didn't fluff my pillow" "she had an attitude" or "she won't give me information about my Dad over the phone" kind of stuff that family member's think is a big deal, and to them probably is, but in the scope of things is small potatoes.

[canoehead, BSN, RN]

And that...in a nutshell...is what happens. My husband had a serious STEMI and was having chest pain about a month later. He did exactly what he was told..."if you have chest pain (he did) unrelieved by 3 nitro (he did) especially with SOB (he did) go immediately to the er (he did)". They treated him like a drug seeker and sent him to the waiting room, scared to death that he was dying, to wait for (and I quote) probably about 3 -4 hours. He left after an hour.

Rudeness is not excusable, but your husband may not have been being brushed off.

When the ER is slam full, and I triage a chest pain, we do an EKG and get a set of labs initially and then they end up in the waiting room if there are no monitered beds available. I'm not saying it's right, but we have to triage. I can keep an eye on a cardiac patient as I triage, but in an unmonitered bed when they're busy the patient may not be visualized by anyone. He's better off with me. The initial labs come back, and we can then pick out who is sickest, and needs the first bed. At my hospital it takes about an hour for those first labs to come back. If I do that the patient is not being brushed off, I'm taking them very seriously, but we just don't have a spot.

[svdestiny]

Posted in error

[inshallamiami]

Thanks to all who have replied. Venting here truly helped! I was so upset but I didn't want my feelings to effect my husbands care so I came to Allnurses to "let it out". Frankly I was surprised how strongly I reacted to the jerky er doc. I didn't use ANY of my people skills, or diplomatic skills to make the situation better. I just shut my mouth and tried to think.

Eventually the patient representative or whatever called but I told her I was too upset to talk so I gave her no details. I did tell our reg dr about it ( an edited version) and he cryptically responded that the er doc is known to be "different" whatever that means!

So I am working on dealing more effectively with my caregiver stress, listening more, saying less and trying to find the "happy" in everyday life! Thanks to all who posted, I appreciated being taken seriously. And please, don't fight among yourselves :)

[bwhiddon74]

I understand what you're talking about. I've been an ER nurse for ten years and I can't stand to see my co-workers having bad attitudes. Whether we believe the pt is sick or not is not our job. If the pt is in the ER, then treat them. If you (nurse, docs, etc) don't believe they have a valid reason to be there then tell them respectfully. For instance, I've heard doctors tell the pt that " in the future, this is something you may consider going to your doctor about." Or I've even told pts, "We can treat you tonight, but your doctor will be able to give you what you need better because he will keep close eyes on you and your health." The point is that we (nurses, docs, etc) are not judges, but caregivers. And if we don't care then we should be in another line of work.

[inshallamiami]

I understand what you're talking about. I've been an ER nurse for ten years and I can't stand to see my co-workers having bad attitudes. Whether we believe the pt is sick or not is not our job. If the pt is in the ER, then treat them. If you (nurse, docs, etc) don't believe they have a valid reason to be there then tell them respectfully. For instance, I've heard doctors tell the pt that " in the future, this is something you may consider going to your doctor about." Or I've even told pts, "We can treat you tonight, but your doctor will be able to give you what you need better because he will keep close eyes on you and your health." The point is that we (nurses, docs, etc) are not judges, but caregivers. And if we don't care then we should be in another line of work.

Our dr TOLD us to go to ER! In fact TWO drs told us to go to ER! Pcp and gi doc. That is partly why I was upset, I wanted to have an office visit, and not necessarily right away. And I explained the problem in depth to the staff of both my doctors and it was midweek around 10 am. Frankly it is possible we WERE turfed but that is not my fault so no lecture is necessary ( to me, maybe the docs could use one)

Let's face it, Doctors, like all people, come in different varieties. Some are very capable, some are jerks, and some are both.

[Altra, BSN, RN]

..........

[SweetMelissaRN]

Our dr TOLD us to go to ER! In fact TWO drs told us to go to ER! Pcp and gi doc. That is partly why I was upset, I wanted to have an office visit, and not necessarily right away. And I explained the problem in depth to the staff of both my doctors and it was midweek around 10 am. Frankly it is possible we WERE turfed but that is not my fault so no lecture is necessary ( to me, maybe the docs could use one)

Let's face it, Doctors, like all people, come in different varieties. Some are very capable, some are jerks, and some are both.

I don't think bwhiddon74 was trying to lecture you or directing the "can see your doctor for this" comment to you, but was maybe generalizing. Everyone knows chest pain unrelieved by 3 nitro with a prior history of MI should immediately go to the emergency room. Those caregivers were out of line. Plain and simple.

[NO50FRANNY]

A few years ago, early evening, I discharged myself from my hospital in the city following an umbilical hernia repair that morning. I was adamant that my pain could be managed at home with oral analgesia and was determined to be at my mothers' place and not burden the ward with my presence any longer than absolutely necessary. The charge nurse tried to talk me out of it, but I did it anyway - mum dutifully drove me the 3 hours back to her place. It was a very foolish thing to do and around 2am I was battling. At the time, I was an oncology nurse and had no idea how I was about to be perceived by the staff at the regional hospital ER. I knew I needed narcotics, so mum took me to the local hospital. I was lucky my physiological signs reflected the pain I was in and I'm fairly certain if I didn't have a surgical wound I wouldn't have been given anything. It was only many years later, after becoming an ER nurse and dealing with rubbish for 7 years that I understand the appalling attitude I was subjected to, I won't go into it but it wasn't pleasant. At the time I didn't realise that all the things I was saying made everything worse. I was from out of town, I told them that pethidine IM had worked really well post op, I told them that I had taken tylenol, digesic and tramadol and nothing had worked... I was distressed because I had put up with the pain for so long and it would have looked like I had an enabling mother. She was getting angry because the nurses were ignoring me- I needed a pan, I couldn't get off the trolley, I was crying and my bladder was full (after 2 stat bags of saline). Possibly the most humiliating experience of my life. I filled that pan... I know my fellow ER nurses reading this are cringeing....

What makes me so sad, is that I know why ER nurses can become unkind, why so often I hear stories like the OP. The malingerers and non-genuine patients, crippled, understaffed, overcrowded and overrun Emergency departments, tiresome complaints that are truly non-urgent, flagrant abuse of EMERGENCY services. People complaining to you about how long they've waited with a minor complaint not seconds after you and your team have given up resuscitating someone. It upsets me that genuine patients become the victims and I agree that there is absolutely no excuse for rudeness and poor attitude, but sledging ER nurses isn't going to fix it. I've watched some of the most caring and devoted nurses lose their cool with patients on occasion and assigning blame doesn't get us anywhere. You did well not to lose your cool, I didn't lose mine completely thanks to some IV MS04 but I've never forgotten that night. Give appropriate feedback to the facility, and vent on AN- I wish I had. Hope your hubby is ok :)

[Anna Flaxis, BSN, RN]

Since syncope can have life threatening causes, plus he is on chemotherapy, it's really possible that his PCP does not have the resources readily at hand nor the clinical expertise to rapidly diagnose and treat life threats, and so instructing him to present to the ED for evaluation was the safest course.

Regardless of whether or not he was turfed or whether or not his complaint was appropriate for an ED visit, there isn't a valid excuse for treating him poorly that I can think of.

From the information provided, it does sound like morale at this ED is low, which can be for a lot of different reasons. When staff morale is low, it can be easy to take it out on the patients. That's not meant to excuse it, but just to point out that ED staff are only human.

I'm sorry you had a bad experience in the ED. At least you had that one good nurse that you liked. Maybe instead of complaining about the things that were upsetting, you could write a letter to the ED thanking that nurse.

[green34]

I don't know just going by a big white board and what I could see. I actually I didn't mind the wait at all, I brought iPad and books etc. my complaint is not the wait, I didn't feel ignored, just felt that when they DO interact not to be nasty. Is that too much to ask? I didn't need pillows or food or accommodation. And I didn't need sarcasm and being caught in this turf war. And again our nurse was great! Just the Snotty triage and ***** ER doc

An ER dept can clear out really fast. It also does not rule out the possibility of someone being seriously sick in one of the rooms. If you are a small hospital, they could have had a patient who was crashing and they were busy stablizing to transport him to a larger hospital. I worked in a rural hospital and we would often have serious patients that we would need to transfer out to another ER.

I don't get all the people siding with the ER. If you're mad because a doctor consistently turfs his patients to the ER, that has nothing to do with the patient who is just following recommendations from his physician. Yes, syncope is a frustrating complaint, but generally you can rule out serious causes fairly quickly, hydrate and fix electrolytes and such to make them feel better, and refer for further work up as an outpatient if necessary. That is all the ER needs to do. I'm sure the syncope is still more frustrating to the patient. We all have busy days, but being rude doesn't make your day any less busy.

I'm just inherently skeptical of what constitutes as rude. A lot of patients feel like the staff is rude when they are not. Also, when a family member or patient is stressed, anything can seem like an attack. What could be grilling could be the doctor trying to make sure that the story is consistent and not a "well, I don't want to make a big deal of it so I will say no to passing out." Or "I am not sure so I probably didn't pass out so I'll say no." Did your husband state that he passed out to the doctor just the triage nurse? I try to put down everything the patient tells me in the triage notes so in case they forget to tell the doctor something.

This has saved me time and time again, especially if the story changes between triage and the time back to the room.

Well sure, you probably are a nice person and wow that the complaint is frivolous, but this doc doesn't seem to be a nice person and my complaint is a little more serious than salad dressing. Of course he may have been having a bad day but I can't take a chance with my hubbies care and assume the doc will thoughtfully consider my complaint and aim to do better

Another consideration. Were you giving them an attitude when you did not mean to? A lot of people give off an attitude when they are stressed. Some people can take that personally.

That way things can be resolved faster. And be careful about taking out your family member's IV's--you've stated that you were happy with your nurse. What if another IV med was ordered and now there is no access? Your nurse would be taking the fall for that one, not the doc.

Also, did you really take out your husband's IV? That should have been a big no right there. No offense, but why would you do that? Yes you are a nurse but you are not employed there. They do not know that you are a nurse. If you make that a habit, they may begin asking you to remain in the waiting room if he is to be seen there because you become a liability. Yes you are a "nurse," but you are not working. They also do not know you are truly an RN.

[Altra, BSN, RN]

What could be grilling could be the doctor trying to make sure that the story is consistent and not a "well, I don't want to make a big deal of it so I will say no to passing out." Or "I am not sure so I probably didn't pass out so I'll say no." Did your husband state that he passed out to the doctor just the triage nurse? I try to put down everything the patient tells me in the triage notes so in case they forget to tell the doctor something.

This has saved me time and time again, especially if the story changes between triage and the time back to the room.

Bingo.

Feeling dizzy/woozy/near-syncopal vs. actual loss of consciousness is a key assessment point, and in the absence of anything else that emerged during the workup -- most likely the key decision point for admission vs. discharge.