other side of the coin. again.

[mmc51264]

I wish I was a gifted writer to write a profound article about being on the receiving end of care.

My son was hospitalized for the second time this year for dka. This was a very mild case and really wanted to come home. His anion gap was just high enough that they wanted him to stay. So I agreed.

He got there at 1600. I was working so my husband brought him in-I met them in the ED. They don't mess around with dka so we went back to a room in less than 5 minutes. They got vs, BG, labs, IV started etc. First red flag was the float nurse rambling on about what a crappy place it was to work (I have my badge on, too-plus I am dealing with a sick child). I almost had to tell him to SHUT UP. I let it go.

revolving door of residents and the finally endo comes in. This was about 1800. Still ok. tells us of the plan, very nice man. Tells us one more CBC/BNP to make sure heading in the right direction. Child is NPO at this time. Last meal was lunch.

2100, they tell up we are not going home, get the "don't worry your pretty little head about it" from the resident. Starting to get upset that this "doctor" will not be straight with me. Did not dawn on her that as a nurse AND the parent of two Type 1s that I know the drill as far as anion gaps, bicarb levels, pH, etc. Send hubby and son #2 home.

Sick child is hungry. Has not eaten in 9-10 hours. they have no food for him. I have to outside to go back into the main hosp to get subway-only thing available at this time.

Every time child needs to void, I have to ask for a urinal. Found the used ones under the sink in the room (wth?)

0300 "Admitting team" comes in to complete the admission. Point out to them that child has not had ordered fluids running for about 3 hours. "Oh!" I guess we need to fix that. duh,

Then we have a random 4 unit dose of insulin and no one can tell me the rationale as to why child is getting it. it is not a mealtime or SS dose. Do you give meds that you do not know why? I do not.

By 0530 cont glucose monitor is alarming for low BG (67) call for food They bring him an appropriate snack to bring it up, but I wanted breakfast for him. I get a menu, call dietary and get a lecture that ED pts don't get fed no matter how long they are there. I explain that my child has been admitted, there just were no beds available. They tell me the nurse has to place the order.

Now it is 0645. SHIFT CHANGE! call HUC for help and get yelled at again that he can't order a tray, they just send whatever up. I explain that is not what I was told-continue to get fussed at. Asked to speak to Charge so I could get food for little boy who has eaten very little, slept very little and been stuck a bunch of times. 0830. no one has shown up.

I call ped endo on call as the last time I was there was a HUGE fiasco and they asked me to call them if I had issues. get the same nice gentleman Dr. from the night before, at this time I am crying. I am crippled from trying sleep on a stretcher. I wish someone had taken a picture of the two of us curled up on this stretcher using his hoodie for a pillow and the cloth chucks pad as a cover (no blanket or pillow offered).

Doctor tells me he is going to get me out of there. Child eats stale turkey sandwich that they rustled up for him at 2100

Now I ask about insulin coverage for the food he did eat. They only have SS ordered.called endo again

Straw that broke the camel's back this time-day nurse does not understand that child has eaten, gave her the carbs, mind you doctor's orders are in. Finally she understands that he is getting 5 units. Went to give it. IM. just started to cry again. and asked fro d/c papers.

Charge nurse comes in and I tell her it is not worth it to speak with her. The problems are so systemic no where to begin. She saw the urinals on the floor, I told her about the food issue.

My issue is this: how do nurses and providers treat patients and families this way? I cannot believe that I am the exception to the rule. Not only was my child offered anything to drink, as a courtesy, not one person asked me how I was doing. I was visibly upset. What kind of nurses are being turned out these days?

I have been a nurse for only 5 years, but I am older. I have compassion for pts and family. I felt totally abandoned.

I just wonder for those of you that have been on the opposite side of nursing, have you had good experiences? This is the second time in 3 months and the first time was worse than this one. there has been one or two nurses that were great, but the majority acted like they couldn't care less that my child hadn't eaten in 9 hours, that he needed breakfast, how to give a SQ insulin shot.

Sorry this is so long, but I feel so defeated that the place that I work at, treats patients so poorly. And of course there is nothing to be done. Hollow apologies. I hope that someday, those that had little concern for my child, do not have to go through what I have to go through and get let down by one's own colleagues.

I am supposed to have surgery there later in the summer and now I am worried.

If you lasted this long, thank you. Please remember that that mom, or child, or grandma, or brother, is a person. They are scared. They are uncomfortable. Please help someone like me next time.

[quazar]

Personally, I think you need to blow up the line at patient relations. You are not only a nurse, you are a fellow employee, and you were treated HORRIBLY. I had a bad incident at your hospital with one of my children from a nurse with a really bad attitude. You can bet I called patient relations and let them absolutely have it. I made sure that they knew A) I was a nurse so I knew the score of how things SHOULD be done and B) I was a former employee at that hospital so I wasn't exactly an idiot with regards to how things worked within their particular system and did NOT appreciate her snotty/flippant/rude attitude and comments towards me, a scared mother.

What happened to you is unconscionable. I am so sorry.

[nursej22, MSN, RN]

I am so sorry for your experience. I agree with having a "go bag": I would include a meter and strips, and snacks, including simple and complex carbs, and a notebook. I used to hate the families with notebooks, but it did make me more consciencious and follow through on my promises better.

I have a T1DM son, who is now an adult. He crashed his bike and made the mistake of driving himself in. I am certain if he would have let his friends call EMS, he would have gotten better care. Son thought he had a broken shoulder, but triage thought it was a broken rib, with shortness of breath. 1 hour later he got his x-ray, and then roomed, and an IV placed, and a dose of IV dilaudid. Broken rib, small pneumo confirmed. 2 hours later gets chest tube in ED (that was ugly). Usually a very stoic person, he screams while they place and remove the x-ray plate, and gets a dirty look from the tech. No pain med, because, not ordered yet. Triage nurse stopped by to gloat that he was right about broken rib.

Son's continuous glucose meter starts to alarm for low. 1/2 hour to get an order and some juice. And how about some pain med? Uh, sure. Asked 2 more times. And now, 4 hours after last dose, time to move.

The trauma surgeon follows us to room, I was so happy I wanted to kiss her. She orders more dilaudid stat, 'cause son just can't take a deep breath. Chest tube wasn't taped, so it came apart while transferring off stretcher. Surgeon notices RUQ firm and tender, wants a CT, but no labs were done in ED. Also wants to give toradol, but needs labs for that too. And meter starts to alarm, again.

Blood drawn, CT shows 3 broken ribs, 2 in 2 places. Can he get something to eat? Hasn't eaten in 7 hours. Oh, cafeteria just closed. Offers of 1/2 turkey sandwich, for a guy who eats 5000 cal. a day. I had to drive to get him some food, then stand in line for security to let me in, so that took an hour.

I spoke about this to a friend who works in that same ED, but was off that day. She couldn't believe that he wasn't treated as a trauma. And she also attributed his many delays to new nurses who don't know what they don't know. They seem to pick up the cynical attitude from the seasoned nurses, but few of the skills.

[gemmi999]

Speaking as an ER nurse, as an new grad who went straight to ER, and as a person who has taken care of many "pt holds" in the ER that should be on floors, I have a couple things to say.

1) Absolutely right--insulin should never be given IM. On top of which, insulin should never be given without checking BG first. It's a POC test that all nurses can do w/out an MD order

2) Being an admitted pt. on an ER hold due to lack of beds is challenging for a number of reasons. I understand your frustration and a large part of your frustration is systemic, but a couple of things to keep in mind:

- ER nurses aren't floor nurses. We can do all the same tasks that floor nurses do, but our mindset is *very* different. A baby that's screaming their head off in pain? Hey, patent airway. Check. Pt's able to ask for food--well, if it's not your patient, you don't know the dietary orders/restrictions/what's available/what's been given. ER is such quick turnover that we try not to get food/drinks for pt's not our own. If I get a pt a glass of water and they're there for DKA? Maybe their orders are NPO, maybe they need Zofran first, maybe there is a fluid restriction.

- Additionally, in my ER, we have 4 hrs before we are to start *floor* orders. This is to prevent duplication of care/medication pass and to ensure that the pt's nurse is aware of everything that has happened. My ER has a completely different charting system then the floor and a lot of times when I try to be helpful and start floor orders--they just get re-done. I had a pt w/ a 1L NS bolus ordered yesterday due to lowish BP. I started it, got about 400mL in, and got a bed. It was still infusing when I got to the floor. The floor RN already had the bolus primed and ready to go, so she simply d/c the bolus i started and started her own. When I pointed out renal pt, CHF, fluid overload, she basically said it was her pt now and it was a floor order. I shouldn't have started it. I told the Charge RN and she said she would make sure pt only got 1L, not more, but not much else can be done.

- Blankets? Again, if it's not my pt I have to track down original RN and ask because a lot of times pt's don't have blankets due to fever at admission, etc. It seems like a simple request but it's actually a multi-step process. And in the middle of this is other pt's asking for things as well.

- Fluid? I don't give out water in the ER, period, unless it's my pt. I did it *once* to a pt that was WNL vitals, no pain, there for diarrhea. I was trying to be helpful. Pt. surgery ended up delayed by 4 hrs because I broke the NPO and pt had SBO.

- Urinal's on the floor. That one is tough. Normally I leave at least 1 urinal, filled, at bedside in case MD orders urine labs after admission/after initial order set. Again, you don't want to be the RN that discarded urine because you were being helpful and then the MD orders a Culture and Sensitivity on urine due to pt meeting "SIRS criteria" and it being protocol.

I'm not trying to make excuses for your bad night. I've been there, as a daughter caring for her mother. But there are a *lot* of different things going on in the ER that can make even simple tasks be more complicated then pt/pt family realize. And minor requests are just that, minor. The RN might have another pt that she's helping intubate, one with hypotension that is on a vasoactive drip to monitor and chart q15 minute vitals on.

And sometimes it's just a nurse that is overwhelmed/tired/not necessarily all there at the time. And it sucks when it happens to you and your family member. So definitely complain, just understand that there is a reason behind a lot of behaviors that you might not know.

[gemmi999]

Blood drawn, CT shows 3 broken ribs, 2 in 2 places. Can he get something to eat? Hasn't eaten in 7 hours. Oh, cafeteria just closed. Offers of 1/2 turkey sandwich, for a guy who eats 5000 cal. a day. I had to drive to get him some food, then stand in line for security to let me in, so that took an hour.

and

Chest tube wasn't taped, so it came apart while transferring off stretcher. Surgeon notices RUQ firm and tender, wants a CT, but no labs were done in ED. Also wants to give toradol, but needs labs for that too. And meter starts to alarm, again.

I'm sorry you went through that. I hope your son is okay!

-- 1 ) I wouldn't have given food, either, sorry not sorry. Not until I got a verbal order from ER doc or admitting MD. I keep all pt's NPO if possible surgery candidates. If your son needed emergent surgery and I didn't know it yet, I'd rather not risk it. I would have checked his sugar, got him some D50 or fluid w/ dextrose in it depending on his BG level.

-- 2) If no MD orders pain medications, the RN can't give it. And it doesn't matter how much the RN want's to give your son more pain medicine, wanting doesn't correlate to an order. Maybe the MD was worried about respiratory depression, maybe he or she thought the dilaudid would have taken the edge off and left it at that. Maybe it was the ER policy due to constant drug seekers not to give more then 1 dose of narcotic prior to admission, which sucks, but a lot of ERs are going narcotic free due to current drug seeking climate.

--3) A lot of "simple" broken bones don't get labs ordered until after x-ray's are done/etc. It's a matter of resources and beds available. For an x-ray, your son could be made a lower acuity level and get x-ray's done immediately. If he needed bloodwork too, then that means the acuity level went up and if there weren't enough RNs or beds for that acuity level, he would have had to wait longer for everything, including pain medicine and the initial x-ray.

--4) Units don't stock as much food as they should. 1/2 a turkey sandwich might have been all that literally available. If the food isn't there and cafeteria is closed there isn't much the RN can do. They can call other units and see what they have available, but given time of night, etc, that might have been just as fruitless.

Again, not trying to make excuses. It's just--ER has different priorities. Airway, breathing and circulation. A pt being hungry isn't necessarily part of that list. Low BG should have been, but it sounds like that was addressed (or at least the RN tried w/ juice).

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

mmc, looking at your location and the description of the hospital, I swear, we have got to be employed by the same hospital! What you have described is only part of the reason I have submitted my notice and leaving the bedside. I'm floated to the ER, bust my *** while there, only to watch the main ER nurses sit and surf the Internet.

A sick patient receives very little medications while under the care of 'ER' nurses at my facility (apparently, they're only moved to action when blood and guts and bones are visible), and I, too, was told that patients were not fed while in the ER. When I told them that I am there as a med/surg nurse caring for 'supposedly' med/surg patients and as such, the patients needed to be treated as if they were on the floor, it did not make a darn bit of difference.

And you are correct, reporting this to the charge made no difference whatsoever. I walked to another unit when I had the chance an grab a sandwich box much like what you described to give to my patient. I draw the line with working with OB and pediatric patients, though, because I have never worked with them in nearly 31 years of nursing.

Prior to this, I was on the receiving end of these same nurses only once due to an incident that happened just as I was about to walk in to begin my shift, and ended up in the ER due to "policy". I told them that as soon as I started feeling better, I was going to be leaving and would not spend one minute as an overnight patient in that ER or on the floor. This was at 1830; the did bloodwork, repeated the tests (which I refused to pay for since the first set was normal), and at 2330, I insisted that they hand me my discharge instructions so I could be on my way.

The nurse that I had couldn't care less that I was wearing the exact same uniform that she had on. Her rudeness had no boundaries. I had not been there before, so I didn't know where the restroom was located. So I called for assistance; she stormed in, took the gravity bag of IV fluids down off the IV pole and dropped it in my lap, and said in such a gruff tone of voice, "the bathroom is around the corner". When I asked which corner, you'd think I'd just ran over her dog.

It is such a disappointment there and I can't understand for the life of me why people return when there are two other hospitals within a mile of it. Had I not been in the parking lot and unable to stand, much less drive away, I would have gone somewhere else. The only reason I returned there to work PRN is because no other facility matched their pool pay and had the amount of flexibility with scheduling that I needed. Now that my car is nearly paid for, thank God I can say it's a wrap at this place!

[mmc51264, BSN, MSN, RN]

gemmi999 Are you really going to try and defend the care my child got (err didn't)????

I am a nurse and the mother of 2 T1 kids, this one was diagnosed 11 years ago (he's 13).

YEAH you saved a life!!! So do I on a med/surg floor when it comes up. Does that mean that I don't care for the other patients?

I don't understand why you keep saying that what we were asking for was out of line. I was asking the nurse that was assigned to us for the night. We only had one.

If you are going to "have a different mindset" because you are too busy saving lives, but then have to deal with patients that have to stay in the ED because there are no beds, you better learn to change that mindset because people like me fill out surveys and calll charge nurses at incompetence and send emails to the president of the hospital.

I just reread your answer above. How long have you been a nurse? I sure hope you never get a nurse like yourself to care for you.

My child was NOT NPO and I am SO glad that you know insulin is not given IM. My son was on an insulin schedule AND he wears a CGMS. That was not the issue.

You totally missed the point of my post. MY CHILD WAS NOT CARED FOR AND NO ONE CARED. You are the kind of nurse that gives nurses a bad name. Half my class are ED nurses and they are nothing like you. I would guess that the ED nurses on this site would be embarrassed at

your attitude toward a child.

I should have left AMA. I feel sad for you. you are missing out on the beat part of nursing: CARING for and about people.

[mmc51264, BSN, MSN, RN]

BSNbeDONE Sorry you went through that. It is very frustrating at the lack of compassion of others in this profession. Hope things are better for you now.

[3ringnursing, BSN]

I am totally horrified and enraged with the experience you and your little boy went through - again.

I have to admit that every inpatient admission I've ever had, with the exception of one, was a nightmare. I couldn't wait to leave. The fact I was an RN made no difference.

The only admit I had that was honestly great was S/P hysterectomy. The nurses treated me like royalty - it was actually embarrassing how well they treated me. And when they were off duty I got hugs before they left - same when I was D/C'd to home.

But that was 1 admission out of 7. Not good odds.

I agree with you - if people need help be the catalyst to make whatever they need happen. It costs so little to be kind to others.

Maybe the board of directors would appreciate hearing your story? If staff are treated so poorly imagine how the regular populace is treated?

[cleback]

That's really scary to me... such poor care. How do nurses work in acute care without knowing how to give insulin, leave iv fluids off for 3 hours, store used urinals in a patient room? I guess I am blessed to live by a superb healthcare system because I am speechless by all of that.

I hope this post is unidentifying enough for you that your employer doesn't recognize it's you.

[cleback]

Speaking as an ER nurse, as an new grad who went straight to ER, and as a person who has taken care of many "pt holds" in the ER that should be on floors, I have a couple things to say.

1) Absolutely right--insulin should never be given IM. On top of which, insulin should never be given without checking BG first. It's a POC test that all nurses can do w/out an MD order

2) Being an admitted pt. on an ER hold due to lack of beds is challenging for a number of reasons. I understand your frustration and a large part of your frustration is systemic, but a couple of things to keep in mind:

- ER nurses aren't floor nurses. We can do all the same tasks that floor nurses do, but our mindset is *very* different. A baby that's screaming their head off in pain? Hey, patent airway. Check. Pt's able to ask for food--well, if it's not your patient, you don't know the dietary orders/restrictions/what's available/what's been given. ER is such quick turnover that we try not to get food/drinks for pt's not our own. If I get a pt a glass of water and they're there for DKA? Maybe their orders are NPO, maybe they need Zofran first, maybe there is a fluid restriction.

- Additionally, in my ER, we have 4 hrs before we are to start *floor* orders. This is to prevent duplication of care/medication pass and to ensure that the pt's nurse is aware of everything that has happened. My ER has a completely different charting system then the floor and a lot of times when I try to be helpful and start floor orders--they just get re-done. I had a pt w/ a 1L NS bolus ordered yesterday due to lowish BP. I started it, got about 400mL in, and got a bed. It was still infusing when I got to the floor. The floor RN already had the bolus primed and ready to go, so she simply d/c the bolus i started and started her own. When I pointed out renal pt, CHF, fluid overload, she basically said it was her pt now and it was a floor order. I shouldn't have started it. I told the Charge RN and she said she would make sure pt only got 1L, not more, but not much else can be done.

- Blankets? Again, if it's not my pt I have to track down original RN and ask because a lot of times pt's don't have blankets due to fever at admission, etc. It seems like a simple request but it's actually a multi-step process. And in the middle of this is other pt's asking for things as well.

- Fluid? I don't give out water in the ER, period, unless it's my pt. I did it *once* to a pt that was WNL vitals, no pain, there for diarrhea. I was trying to be helpful. Pt. surgery ended up delayed by 4 hrs because I broke the NPO and pt had SBO.

- Urinal's on the floor. That one is tough. Normally I leave at least 1 urinal, filled, at bedside in case MD orders urine labs after admission/after initial order set. Again, you don't want to be the RN that discarded urine because you were being helpful and then the MD orders a Culture and Sensitivity on urine due to pt meeting "SIRS criteria" and it being protocol.

I'm not trying to make excuses for your bad night. I've been there, as a daughter caring for her mother. But there are a *lot* of different things going on in the ER that can make even simple tasks be more complicated then pt/pt family realize. And minor requests are just that, minor. The RN might have another pt that she's helping intubate, one with hypotension that is on a vasoactive drip to monitor and chart q15 minute vitals on.

And sometimes it's just a nurse that is overwhelmed/tired/not necessarily all there at the time. And it sucks when it happens to you and your family member. So definitely complain, just understand that there is a reason behind a lot of behaviors that you might not know.

There's a lot you seem not to be able to do. If you waited 4 hours to start admitting orders, you would have to deal with some very po'd physicians at my hospital. Maybe it's because you're a new grad who only knows one er, but your stance of "can't do it" to almost every simple request is pretty extreme. A lot of it can be solved by good ole fashioned communication. I get that some nights the poop hits the fan, but to routinely do what you described to this nurse seems more like laziness, honestly. I hope you are introduced to a different work culture.

[mmc51264, BSN, MSN, RN]

cleback I have notified people that I work for about my experience and it is not the worst one. I was trying to describe more the sadness and frustration I feel for my child than an indictment of the facility. I am trying to present a nursing perspective and the reaction from our new grad nurse explains it all to me. It's the attitude and mentality of some nurses. Like I said, I am sad that these "adrenaline" nurses don't get the joy of caring for a human being. Saving a life is GREAT. My child's life was saved the first time, but then you have to understand that there is a process afterward, emotional healing too. Doctors are the ones that are trained to distance themselves emotionally, nurses are not. I am still going to use my facility and I would still recommend it. It is the best by far. But there are always ways to improve care.

[FolksBtrippin, BSN, RN]

I just want you to know that I am very touched by your story.

I want to give you a big hug.