"Your ER sucks!" and other pleasantries...how you handle them?

[livingthedream77]

Hello, ladies and gentlemen of the ER.

It's happened to us all, and I would love to hear your experiences.

I work in a TINY 6 bed ER in the middle of corn town USA. There are 2 other hospitals of the same size near us, 5 miles, and 10 miles away.

Middle aged man comes in with his spouse, with c/o low abd pain for 2 mos, worse in last few days. Wife has a stack of test results, CT reads, etc, which is literally 1/2 inch thick, complete with CDs, mostly from nearby hosp.

She will not let him speak for himself, gets very angry when I speak to the pt, not her, concerning sx. He tells me he has trouble urinating, sense of incomplete emptying. Look through docs, US abd yesterday (at closeby hosp), states marked bladder distention consistent with bladder outlet obstruction, suspect prostate hypertrophy. Also seen is cholelithiasis.

Explain we will do UA, standard blood tests, will take approx 1 hr, will go from there. Super duper.

45 mins later, wife snaps on another RN that NOTHING has been done, we've been waiting here OVER AN HOUR, no one had bothered to check on them, he's hungry, hasn't eaten since yesterday.

Other RN talks to doc, he goes in, explains eating bad idea d/t abd pain, he's read US results, suggests bladder scan, and dependent on results, straight cath. Pt says "oh, yeah. They've done that before and I felt better right away." Wife argues with doc that it can't be urine retention, HAS to be his gallbladder.

Meanwhile, I go in with scanner, explain. Pt is cool. Wife starts with "I have to tell you. Your ER SUCKS! Your waiting room sucks! The staff here SUCKS! No one was in here. This should be like the ICU. You should be in here every 5 mins making sure he didn't fall out of bed!" ...etc.

Take the therapeutic high road. "Oh, I'm sure you are sick of hospitals, with your husband's hx of leukemia, etc. I wish it was like the ICU also, where there are only 1 or 2 pts per nurse, but being in the ER, we treat by severity not time of arrival.....blah blah blah."

Her response? "Well in (other hospital) they knwo what's wrong. They would've had an IV in already. What the hell is wrong with you? Why isn't he getting fluids?!"

Explain, "we suspect urinary retention, giving fluids isn't recommended..." etc.

*evil glare*....."are you going to scan or just stand there?"

Deep breaths...do scan... >725ml is result. OK, now please go urinate...nope, can't.Not at all.

OK, I'll tell doc. Insist they are going out for a smoke. Explain no smoking on grounds, you leave grounds, you're AMA, etc. They go anyway.

Should have signed them out AMA....but in the interest of pt care (didn't want his bladder to explode) did not do this.

Guess what?! Now go do a straight cath, doc says. I love my job, I says. Yeah....not happening. Curling up, can't get past prostate. Get OK for coude. That works, eventually. 825ml out, 100% relief of pain.

Wife now silent, her MD from Google University called for gallbladder, it was retention, now she's really ******. Go in to give dc papers, follow up with urologist, etc...."thanks for nothing. ("*****" muttered under her breath).

Wanted to say, if you think we suck it so hard, and X hospital is the place to be, why did you come here? But I didn't.

Thoughts? ****** me off. Solved your problem, but you're more worried that YOUR WebMD dx was wrong, than your husband isn't in pain anymore. I'm sure a complaint is coming, not that concerned, documented everything till Hell wouldn't have it.

Thanks!

[farmerjane]

I've heard similar things a number of times in the past, at each of my three jobs. I've made various replies but generally just ignore it.

Awhile back I had a patient making ongoing derogatory remarks about my care over a period of hours. He was critical of everything. Finally, I transferred him over to another nurse in the holding zone of our department. The nurse walked in and I said, "Sir, this is BillyJoeBob and he'll be your nurse. The good news is that he doesn't suck nearly as badly as I do" to which BillyJoeBob replied, "True dat" as I walked out. I was lucky to not have a complaint lodged but it sure felt good.

I love that. My old Nurse Manager would have loved it, but the new one, not so much.

[GM2RN]

Could be worse, she could be family!!!!!!

I had to actually chuckle out loud at this! :)

[midinphx, BSN]

Typical ER abuse!! When got verbally assaulted like that, I used to say how it was a free country and that I would not choose to go get care in a hospital I trust. Then smile and walk out.

[applesxoranges, BSN, RN]

Ten to one they were doing that stuff at the other hospital since they had to bring in a stack of results.

[PerfectlyNumb]

Verbal abuse is frustrating, better than patients taking a swing at you though....Some people will never be pleased and seem to thoroughly enjoy degrading hospital staff. I would loooove to hand the disgruntled patients directions to the several other hospitals in my city (damn EMTALA). There is no other job in this world like an ER nurse's. Through all the bad, I somehow still love it.

[Kalipso]

I hate the righteous response "They are hurting and in pain, you can't control them only yourself. Take the high road and be the understanding saint a good nurse should be. BLAH, BLAH, BLAH" Or some sort of craziness along those lines. We wouldn't post on these websites if we didn't take the 'high road'. We would unload on our patients like everyone else in the real world does and we would have a lot less to complain about. It is hard to be abused by your clients that you are trying to HELP. Furthermore, the line of poor decorum that patients have SHOULD be reprimanded more frequently by hospital staff. I think most of us are willing to realize that some of their behavior and lashing out is because of illness that they can't control, BUT this 'the customer is always right' attitude is not the right way to go either. Other things I think would help is allowing the nurses to have time to frequently, thoroughly update their patients on what we are doing and WHY we are doing it. And I also think it is imperative that someday we get to the point where nurses have to be at bedside when the physician is explaining a patient's diagnosis to the patient and/or family....or at least the doctor should have to verbally report to the nurse what he said and what the next course of action is. I know many a doctor who think that they have great explanation skills, and honestly they are trying to do right, but many of them are using medical jargon and educated words that are far above the average persons head. Of course patients care not to take up to much of the doctor's time and I've seen it happen so frequently where they will say they understand something when they don't and then I have to spend 30 minutes explaining it to them and going back to the doctor to make sure he/she answers any questions I have so that I can make it clear to the patient. That takes a lot of time and effort, it is hard to do that consistently when you are in another patient's room, doing other tasks, or you have a doctor that isn't the nicest. But lower patient ratios are never going to be a thing in most hospitals. So please continue to vent your frustration because I hear you and I agree.

[MedicalPartisan]

See you tomorrow, sir!

[suanna]

I wouldn't be shocked if the family or patient sent a long complaint letter documenting why it was your fault the patient got such "BAD CARE" followed, of course, by a counseling session from your boss about how you are not meeting the customers expectations.....

It would be so nice in these situations to just say-" You know, I couldn't agree more. I'd quit comming here if I were you!"

[mapagee]

I too work in a very small ER in corn town USA. Ours is actually one big room separated into 3 "pt. rooms" by curtains. We are also limited on the type of care we have available to provide for pt. care. I hear all the time how badly we "suck" and complaints when we have to send a pt. elsewhere for continued care due to our limitations. Despite all the negative comments we are constantly forced to listen to I try to keep a positive attitude. "Smile and nod boys!" We may be small, we may be limited, but we also save lives! We are sometimes the only choice our pt's have and in my opinion, we ROCK! So I guess what I'm trying to say, and my advise to you, is to let the little things roll away and focus on all the positive things you do! You were able to help your pt. and he walked away pain free, YAY!! That's what truly counts at the end of the day.

[happyinillinois]

We are not the only game in town. There is another similar sized ER 15 minutes away and 4 others within 40 minutes, plus all the major teaching hospitals downtown, less than an hour. That's why It drives me crazy when people ***** about how they hate it here, yet come back again and again. I am not customer service. I am an RN. It is the entitlement mentality that makes people act out. Any wait and they start complaining, as if we could pull some empty rooms and staff to work them out of thin air. Typically, these are complaints that could've been seen in a quick/urgent care setting, but they will require you to pay, so they come to to ER instead.

I hate the righteous response "They are hurting and in pain, you can't control them only yourself. Take the high road and be the understanding saint a good nurse should be. BLAH, BLAH, BLAH" Or some sort of craziness along those lines. We wouldn't post on these websites if we didn't take the 'high road'. We would unload on our patients like everyone else in the real world does and we would have a lot less to complain about. It is hard to be abused by your clients that you are trying to HELP. Furthermore, the line of poor decorum that patients have SHOULD be reprimanded more frequently by hospital staff. I think most of us are willing to realize that some of their behavior and lashing out is because of illness that they can't control, BUT this 'the customer is always right' attitude is not the right way to go either.

It also angers me that, at least at my facility, if a patient files a complaint -- it is presumed that they are correct and that the nurse must have behaved inappropriately -- and the nurse will receive a written reprimand from HR. This makes me very angry and distrustful.

And I also think it is imperative that someday we get to the point where nurses have to be at bedside when the physician is explaining a patient's diagnosis to the patient and/or family....or at least the doctor should have to verbally report to the nurse what he said and what the next course of action is. I know many a doctor who think that they have great explanation skills, and honestly they are trying to do right, but many of them are using medical jargon and educated words that are far above the average persons head.

^^^^^^^^

^^ Yes ^^

But lower patient ratios are never going to be a thing in most hospitals.

But only because the nursing profession chooses not to demand it. How many nurses on this board are anti-union? Quite a percentage from what I've observed over my 7 years visiting here. How many identify as 'conservative' and staunchly back Republican, Libertarian, or Tea Party candidates? Perhaps a minority but not a small one. In the present "corporations are people and money is speech" environment, as the power and influence of unions is steadily eroded via legislative and judicial means, the lot of nurses should be expected to worsen, not improve.

Coupled with the deliberate overproduction and saturation of nurses in the market, it's a pretty discouraging landscape. Simple supply-side economics will drive down the working conditions and compensation of nurses.

[duskyjewel]

Cute. We conservatives are the reason nurses have a crappy lot in life, and labor unions are the ONLY way to solve those problems.

Good that you didn't drag politics into it, though.