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.
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.
"ER's are designed to save lives in acute emergencies". Wouldn't someone who just tried to kill them self be an acute emergency?
"We can not make a suicidal patient's many needs over medical emergencies". So doesn't harming oneself or possibly harming oneself at some point become a medical emergency?
No one is asking you to break or bend rules.. just give a damn.
I am completely dismayed at all the justifications ER staff are coming up with to defend their ways of treating mental health patients.
These ARE people who ARE in crisis.. It may not be the glorious big trauma that came in.. but it's a life just the same.
When I worked in ER it amazed me how it was all about the adrenaline rush cases.. and everyone else were just.. gurneys to get in and out. I absolutely hated the disassociation. Even when it's insane chaos, it doesn't take any extra time to let the person on the gurney know you SEE them.
Possibly because at the time of assessment they no longer met criteria and it was possible to put a safety plan in place. She may have verbalized suicidal thoughts, but had no plan or intent. Not uncommon. There are occasions when 5150 holds placed in the field are broken in the ER, for not meeting criteria
"ER's are designed to save lives in acute emergencies". Wouldn't someone who just tried to kill them self be an acute emergency?
"We can not make a suicidal patient's many needs over medical emergencies". So doesn't harming oneself or possibly harming oneself at some point become a medical emergency?
No one is asking you to break or bend rules.. just give a damn.
I am completely dismayed at all the justifications ER staff are coming up with to defend their ways of treating mental health patients.
These ARE people who ARE in crisis.. It may not be the glorious big trauma that came in.. but it's a life just the same.
When I worked in ER it amazed me how it was all about the adrenaline rush cases.. and everyone else were just.. gurneys to get in and out. I absolutely hated the disassociation. Even when it's insane chaos, it doesn't take any extra time to let the person on the gurney know you SEE them.
I agree with your viewpoint that these people are in crisis that is just as serious as any other medical crisis.
And I do know what you mean about ED because seriously "adrenaline focused", but I think that's kind of a byproduct of their training and day-to-day work. They are adrenaline focused because they need to be. Because I know that, if I have a friend that needs "urgent" medical care but there is nowhere available except the ED, I always encourage them to go to a smaller hospital rather than the local trauma center because they will get seen faster and have more attention paid to them - not because the trauma center's nurses suck, but because they are busy with traumas. Its just how it is.
If I have two people in crisis and one is actively bleeding out and the other isn't actively bleeding but might bleed out if I don't keep them safe....I am going to make sure the second person is safe and then attend to the active bleeder. Its not because I don't care about the second person...its just that I am only one person. Triaging - thats the name of the game in the ED.
As for the "giving a damn", I think that is a different issue and I hope (and believe) that most would agree that they do care about the suicidal patient. Again, they are just constantly triaging. I know that there are some people who are very callous though (I once saw an ICU doctor tell an overdose patient that they should use a gun next time), and those people make me really sad. Some people need more education, others simply refuse to consider these people with kindness. But I think that is the exception, not the rule.
"ER's are designed to save lives in acute emergencies". Wouldn't someone who just tried to kill them self be an acute emergency?
"We can not make a suicidal patient's many needs over medical emergencies". So doesn't harming oneself or possibly harming oneself at some point become a medical emergency?
No one is asking you to break or bend rules.. just give a damn.
I am completely dismayed at all the justifications ER staff are coming up with to defend their ways of treating mental health patients.
These ARE people who ARE in crisis.. It may not be the glorious big trauma that came in.. but it's a life just the same.
When I worked in ER it amazed me how it was all about the adrenaline rush cases.. and everyone else were just.. gurneys to get in and out. I absolutely hated the disassociation. Even when it's insane chaos, it doesn't take any extra time to let the person on the gurney know you SEE them.
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 can't believe the OP has not come back on to check in on this topic that all of us have thrown our time,hearts and minds and internet hits into. Then we get divisive bully-like insulting comments like,"... what's wrong with you lady...get over yourself", ...and that is considered fine. This thread seems awful suspicious. It quacks quite like a duck actually.
Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.
I think the OP has been through a horrible trauma. Facing a mental health crises in your own child's life is heart and soul crushing. I'm sure she probably can't/couldn't even think straight. If venting her fear here is therapeutic for her, then I completely support her decision to post her feelings. We all know how awful mental health care is in this country and how terrifying it can be to become stabilized/cured. A physical disease is often much easier to fight than the pain in a loved one's own mind.
All nurses realize that the ER can only provide safety and a psychiatric evaluation for treatment or placement in a suicidal patient. The ER can't cure it. But safety and compassion are so needed by these patients and families. That is the basic prescription in SI visits; safety and compassion. This is as important an intervention as is insulin in hyperglycemia.
To the OP, I've been there with my child and have the PTSD to prove it. I hear what you are saying between the lines. Please know that my thoughts are with you and your daughter.
Unfortunately this is more common than one would like to think. I work in a hospital as a nursing assistant and am frequently called to the ER as a "sitter" for SI (suicide intention) patients. The treatment of them is appalling. I'm so thankful that when I went through my suicide attempt, my husband didn't make me go to the hospital. I got the help I needed, but I cringe every time I go to the ER to sit. There has to be change. It is completely inappropriate for staff to make ignorant comments like "people who say they want to kill themselves are just seeking attention and if they really wanted to they would just do it". How sad is that. This comment was made to me a mere 2 weeks after my attempt. They didn't know about my situation and I sure as heck was not about to make it known. It's so sad that this is the experience that people have in our ER's. As a nursing student, I know how I want to nurse, and this is not the example I will follow.
I can't believe the OP has not come back on to check in on this topic that all of us have thrown our time,hearts and minds and internet hits into. Then we get divisive bully-like insulting comments like,"... what's wrong with you lady...get over yourself", ...and that is considered fine. This thread seems awful suspicious. It quacks quite like a duck actually.
I'm sorry, I don't quite follow what you are getting at? Do you mean that OP was only posting to try and stir the pot?
"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."
I find this statement the most troubling and offensive. So you judge the whole of today's nurses on your encounter with this one nurse? And you elevate, what I am assuming is your generation of nurses, above what would be mine. Its dowright absurd. Yet you request others not to judge you.
I'm sorry, I don't quite follow what you are getting at? Do you mean that OP was only posting to try and stir the pot?
Internet hits~It did get people on here who haven't been on in a while. Got us all thinking and supposedly 'healthy' debating that's for sure. Was it healthy? The OP hasn't responded. Maybe she felt unsupported or is just taking it all in before replying. Who knows at this point. Where is our ghostwriter?
Specializes in Psych, Addictions, SOL (Student of Life).
Many patients who present to the ED for evaluation r/t SI-related concerns are not found to be in need of inpatient hospitalization. The ED performs a medical screening and basic process of r/o medical cause for presentation after which the patient is evaluated by MH professional (MSW usually) - which can basically be described as an additional screening for need for psychiatric hospitalization. It's not uncommon at all to be screened out during this second part of the process. If there is disagreement, the physician usually has the final say in my experience. I will not attempt to speak about this particular case, but generally-speaking, just as with medical concerns, the fact that someone presents to the ED for evaluation is not in and of itself an indication that hospitalization is necessary or even what's best for the situation at hand. Feel free to PM.
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.
5150rn2
32 Posts
"ER's are designed to save lives in acute emergencies". Wouldn't someone who just tried to kill them self be an acute emergency?
"We can not make a suicidal patient's many needs over medical emergencies". So doesn't harming oneself or possibly harming oneself at some point become a medical emergency?
No one is asking you to break or bend rules.. just give a damn.
I am completely dismayed at all the justifications ER staff are coming up with to defend their ways of treating mental health patients.
These ARE people who ARE in crisis.. It may not be the glorious big trauma that came in.. but it's a life just the same.
When I worked in ER it amazed me how it was all about the adrenaline rush cases.. and everyone else were just.. gurneys to get in and out. I absolutely hated the disassociation. Even when it's insane chaos, it doesn't take any extra time to let the person on the gurney know you SEE them.