other side of the coin. again.

12rn · Mar 29, 2017

Oooops

12rn · Mar 29, 2017

So I had this really long, drawn out response that I spent the better half of an hour formulating from my cell phone, only for allnurses to delete it when I went to post.

Bottom line is this...

It sounds like you had a really horrible experience. Whether the events of that ER visit actually happened as you recounted or not, doesn't matter. What matters is how you perceived your son's care.

There were some things that are inexcusable, like a nurse wanting to give insulin IM. There are some things that are forgivable, like a nurse forgetting to bring blankets or pillows. And there are somethings that you are being unreasonable about, like being upset that you had to squeeze on the stretcher with your son to sleep.

It sounds like the ER staff really dropped the ball in meeting your expectations, however, as a mother, as a member of the profession and as an employee of that hospital, I am disappointed in your inaction.

If my son needed a blanket and the nurse forgot, I would kindly remind her... Again... And again... Until he got his blanket. If I watched a nurse attempt to give my son a sub Q injection IM- especially one as common as insulin- that would be it. My faith in that nurse's competence would be gone and I would be demanding a new nurse. If I had such a horrible experience as you described, I would be talking to the charge nurse, to a patient advocate and to the administrator on call. If they couldn't mediate the situation, I would be requesting a transfer to a different hospital.

Let me just say this... all of you non ER nurses were very hard on the poster that tried to give you the ER point of view, but consider this...

In the last 6 hours of my last ER shift, I cared for 5 patients at a time. Three of them were ICU patients. One had a stroke. After recieving the normal results on his head CT, we started tPa. 10 minutes into the infusion, the radiologist called back to say he made a mistake and the patient had a bleed. Another patient of mine was 2 weeks post op after a liver transplant and had a K of 7. The third ICU had altered mental status and a Na of 165. The other two patients? I don't know. They were alive. They were breathing. Their vital signs were stable. I am only one person and I had to prioritize my care. I am sure those families felt neglected and dissatisfied with their care, as you did. This is the situation ER nurses deal with on a daily basis.

Before you cast stones at us, think about this. Your child is laying lifeless on a stretcher. Do you want the nurse to start CPR or go get the lady next door a pillow (or a sandwich or draw blood, or assist her to the bathroom, or hang IV ABX or insert any other task that comes after the ABCs)?

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN · Mar 29, 2017

So I had this really long, drawn out response that I spent the better half of an hour formulating from my cell phone, only for allnurses to delete it when I went to post.
Bottom line is this...
It sounds like you had a really horrible experience. Whether the events of that ER visit actually happened as you recounted or not, doesn't matter. What matters is how you perceived your son's care.
There were some things that are inexcusable, like a nurse wanting to give insulin IM. There are some things that are forgivable, like a nurse forgetting to bring blankets or pillows. And there are somethings that you are being unreasonable about, like being upset that you had to squeeze on the stretcher with your son to sleep.
It sounds like the ER staff really dropped the ball in meeting your expectations, however, as a mother, as a member of the profession and as an employee of that hospital, I am disappointed in your inaction.
If my son needed a blanket and the nurse forgot, I would kindly remind her... Again... And again... Until he got his blanket. If I watched a nurse attempt to give my son a sub Q injection IM- especially one as common as insulin- that would be it. My faith in that nurse's competence would be gone and I would be demanding a new nurse. If I had such a horrible experience as you described, I would be talking to the charge nurse, to a patient advocate and to the administrator on call. If they couldn't mediate the situation, I would be requesting a transfer to a different hospital.
Let me just say this... all of you non ER nurses were very hard on the poster that tried to give you the ER point of view, but consider this...
In the last 6 hours of my last ER shift, I cared for 5 patients at a time. Three of them were ICU patients. One had a stroke. After recieving the normal results on his head CT, we started tPa. 10 minutes into the infusion, the radiologist called back to say he made a mistake and the patient had a bleed. Another patient of mine was 2 weeks post op after a liver transplant and had a K of 7. The third ICU had altered mental status and a Na of 165. The other two patients? I don't know. They were alive. They were breathing. Their vital signs were stable. I am only one person and I had to prioritize my care. I am sure those families felt neglected and dissatisfied with their care, as you did. This is the situation ER nurses deal with on a daily basis.
Before you cast stones at us, think about this. Your child is laying lifeless on a stretcher. Do you want the nurse to start CPR or go get the lady next door a pillow (or a sandwich or draw blood, or assist her to the bathroom, or hang IV ABX or insert any other task that comes after the ABCs)?

Of course we understand these things. But as a floor nurse who is floated to the ER, it is very disheartening to see nurses sitting at the desk on their cellphones while passing off unstable individuals as med/surg patients while necessary medications are simply collecting dust on a computer screen.

What you must understand is that these were our actual experiences. For me, it was experiences as a patient in the ER for only 4.5 hours, and as an employee in the ER for enough shifts to know that these were not isolated incidents. Working beside these 'nurses' replicated the care that I received during my one-time visit on the other side of the tracks.

If this does not apply to you, that is absolutely wonderful. But it does apply to many nurses. And from what I have seen, if some of these patients had been medicated, they might have been able to go home instead of spending the night waiting for a bed because they were not getting any better.

Of course they weren't getting better! How could they when the medications to make them better simply were not given to them? One nurse even told me, when I asked about why a Lovenox wasn't given to the patient with clots, that she would give it. Ten minutes later, she called back and asked why couldn't I give it. "Hello!!! You have the patient there with you"!! The medication could have been given in less than the time it took for her to call me back to ask that stupid question!!

One patient came into our ER with chest pain. Our policy, as with most places, include the initiation of MONA. Well the ER nurse decided to call report, found her error in that she had not given the (A)spirin, and said she would before bringing the patient over. Instead, what she did was to chart it as not given. No explanation; no reason. She just did not give it. I called the pharmacy to have him reinstate it so that I could pull and give it.

Another ER nurse handed a patient to me whose K+ level was 2.9 when she took over 5 hours prior. I specifically asked what was done about that and when is the repeat level due. She blatantly lied to my face about things that had been done. Nothing had been done, nor had a repeat test been ordered. In fact, when I called the doctor, he was livid when I informed him that nothing had been done since before 1845. And this nurse did not have all those issues going on because she was working with me on this unit. I took over her patient (Thank God!) because she was being pulled to the triage room. Her critical thinking was on vacation, apparently. Who knows what would have happened had she kept that patient for the remaining 7 hours of the shift.

The last straw was a malignant hypertensive crisis patient, whom the ER nurse wanted to pass off. I asked if he had treated the blood pressure and he said no. I asked that he get the pressure under control before bringing the patient to me. (He, too, lied about the patient not having PRNs on board for the blood pressure. He did not count on me looking through the patient's file as he gave report. But, things are so unreliable coming from that department that we've learned to not immediately take report when they call. We get to a place where we can sit down and open the file to verify what is being told because the outright lies flow like dysentery).

The ER nurse brought the patient to me anyway, medicated the patient on my unit, then clocked out and went home. That's not stabilizing a patient. (Had he medicated that patient 3 hours prior when the order was entered, he would have been able to follow-up, check the effectiveness of the treatment and notify the physician accordingly. But he chose not to).

Once he did that, it gave me a patient who I had to medicate and recheck every 10 minutes, along with another who I was bolusing and checking every few minutes, while trying to reach the attending residents, as these patients were not stable. Sometimes the run-of-the-mill sick person ends up in similar conditions as what you described because the ER nurse feels that they are stable enough that medicating them can wait, when in actuality, waiting is what expedites the decline after arrival to the ER.

If you wait to treat, then your relief waits, then they are handed over to whomever without having been treated for their condition, who is at fault when the patient tanks? Who dropped the ball? The first person who delayed treatment? The second? Or all of the above?

It does not matter whatever else was going on in the ER. These patients warranted and had a right to remain in the ER just as the others did until they were stabilized; not be transferred inappropriately because a nurse was going home, or because no one else wanted to do triage.

Again, these are actual accounts that were witnessed, complained about, reported, and still left unaddressed. There is no justification for what I saw.

As for the treatment that I received, I simply chose not to return there if ever I'm in need of care, nor do I recommend them to anyone who would ask. Do I bad-mouth them publicly? Absolutely not! I choose not to waste any of my time discussing this facility on my day off. I feel there are some wonderful people who work there. But there are also those employees who simply have watched entirely too much TV, and prefer to look the part instead of actually working the part.

mmc51264, BSN, MSN, RN · Mar 30, 2017

It sounds like you had a really horrible experience. Whether the events of that ER visit actually happened as you recounted or not, doesn't matter. What matters is how you perceived your son's care. These are not made up. And this was not the horrible visit.

There were some things that are inexcusable, like a nurse wanting to give insulin IM. There are some things that are forgivable, like a nurse forgetting to bring blankets or pillows. And there are somethings that you are being unreasonable about, like being upset that you had to squeeze on the stretcher with your son to sleep Just one of the observations. I don't think it is unreasonable to ask someone for one shred of decency and bring a freakin blanket. It wasn't the point of my post

It sounds like the ER staff really dropped the ball in meeting your expectations, however, as a mother, as a member of the profession and as an employee of that hospital, I am disappointed in your inaction. My inaction? You have no idea what my actions were. Not stupid enough to share everything.

If my son needed a blanket and the nurse forgot, I would kindly remind her... Again... And again... Until he got his blanket I am not going to keep ringing the call bell for a blanket when I know they are short staffed and, again, was not the point of my post If I watched a nurse attempt to give my son a sub Q injection IM- especially one as common as insulin- that would be it. My faith in that nurse's competence would be gone and I would be demanding a new nurse I left 5 minutes after that. If I had such a horrible experience as you described, I would be talking to the charge nurse, did that, to a patient advocate, doesn't change anything-been there done that and to the administrator-called endo, got discharged on call. If they couldn't mediate the situation, I would be requesting a transfer to a different hospital. Not another hospital that I am going to transfer to at 0300. I would leave AMA and take him home

Let me just say this... all of you non ER nurses were very hard on the poster that tried to give you the ER point of view, but consider this...

In the last 6 hours of my last ER shift, I cared for 5 patients at a time. Three of them were ICU patients. One had a stroke. After recieving the normal results on his head CT, we started tPa. 10 minutes into the infusion, the radiologist called back to say he made a mistake and the patient had a bleed. Another patient of mine was 2 weeks post op after a liver transplant and had a K of 7. The third ICU had altered mental status and a Na of 165. The other two patients? I don't know. They were alive. They were breathing. Their vital signs were stable. I am only one person and I had to prioritize my care. I am sure those families felt neglected and dissatisfied with their care, as you did. This is the situation ER nurses deal with on a daily basis. Yes, but do you CARE that they feel neglected?

Before you cast stones at us, think about this. Your child is laying lifeless on a stretcher. Do you want the nurse to start CPR or go get the lady next door a pillow (or a sandwich or draw blood, or assist her to the bathroom, or hang IV ABX or insert any other task that comes after the ABCs)?iThat is totally unfair. I was sharing an experience I had. My child WAS the one almost lifeless the last time. I never said I wanted priority over another. just some compassion. which seems you have none either. I am so glad you are so proud of yourself. Just remember, when one of your loved ones falls and breaks a hip and is on my floor. I WILL make sure they get fed, and turned, and pain assessed, and the doctor's paged because you, the nurse show up and demand to speak to him/her. this was not an indictment of the ER nurse. It was a sharing of an experience as a person on the other side with the hopes that someone out there would remember that patients are moms, and kids, and nurses. Yes, I felt let down by my profession, but some of you are taking it as though you were my nurse that night and taking it mighty personally.

audreysmagic, RN · Mar 30, 2017

I know the ER in the hospital in my town is known to be horrible. The staff is rude & judgemental. But the other departments (OR, L&D, ICU & med surg) have really great staff.

This is definitely the case with one of the hospitals in my area (not the one I work at, but we deal with them a lot re: referrals). The rest of the hospital is actually quite good, but you have to get through their ER first. There are a few staff there that are pretty nice, but so many of them just act annoyed to have to deal with patients.

RegularNurse · Mar 30, 2017

You guys were in a tough spot. I'm sorry you had such a bad hospital experience.

DiplomaNurseRN · Mar 30, 2017

Thank god the insulin im vs sq nurse didn't attempt a 'z track' or is that even done anymore...

cleback · Mar 30, 2017

So I had this really long, drawn out response that I spent the better half of an hour formulating from my cell phone, only for allnurses to delete it when I went to post.
Bottom line is this...
It sounds like you had a really horrible experience. Whether the events of that ER visit actually happened as you recounted or not, doesn't matter. What matters is how you perceived your son's care.
There were some things that are inexcusable, like a nurse wanting to give insulin IM. There are some things that are forgivable, like a nurse forgetting to bring blankets or pillows. And there are somethings that you are being unreasonable about, like being upset that you had to squeeze on the stretcher with your son to sleep.
It sounds like the ER staff really dropped the ball in meeting your expectations, however, as a mother, as a member of the profession and as an employee of that hospital, I am disappointed in your inaction.
If my son needed a blanket and the nurse forgot, I would kindly remind her... Again... And again... Until he got his blanket. If I watched a nurse attempt to give my son a sub Q injection IM- especially one as common as insulin- that would be it. My faith in that nurse's competence would be gone and I would be demanding a new nurse. If I had such a horrible experience as you described, I would be talking to the charge nurse, to a patient advocate and to the administrator on call. If they couldn't mediate the situation, I would be requesting a transfer to a different hospital.
Let me just say this... all of you non ER nurses were very hard on the poster that tried to give you the ER point of view, but consider this...
In the last 6 hours of my last ER shift, I cared for 5 patients at a time. Three of them were ICU patients. One had a stroke. After recieving the normal results on his head CT, we started tPa. 10 minutes into the infusion, the radiologist called back to say he made a mistake and the patient had a bleed. Another patient of mine was 2 weeks post op after a liver transplant and had a K of 7. The third ICU had altered mental status and a Na of 165. The other two patients? I don't know. They were alive. They were breathing. Their vital signs were stable. I am only one person and I had to prioritize my care. I am sure those families felt neglected and dissatisfied with their care, as you did. This is the situation ER nurses deal with on a daily basis.
Before you cast stones at us, think about this. Your child is laying lifeless on a stretcher. Do you want the nurse to start CPR or go get the lady next door a pillow (or a sandwich or draw blood, or assist her to the bathroom, or hang IV ABX or insert any other task that comes after the ABCs)?

There's a huge difference to what you describe and what the new grad poster described. We all understand that nurses prioritize care and sometimes the nonessential requests have to wait. It's quite another to say you will not do any nonessential requests or orders, regardless of how busy you are, because of the possibility of a miscommunication.

RNOTODAY, BSN, RN · Mar 30, 2017

Wow... so much to comment on!! But-- not so much as a simple BLANKET OFFERED??!!!!

RNOTODAY, BSN, RN · Mar 30, 2017

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.

Wow... yes, he most definitely was a trauma patient and should have been treated as such

Workitinurfava, BSN, RN · Mar 31, 2017

Some of it is short staffing and the heavy workloads that the nurses have to deal with. There is never a reason to not be nice or helpful but the stress of dealing with all that the job requires can take that out of people. I sympathize with you but also with my fellow nurses.

K9lover, ASN, RN · Apr 1, 2017

That is quite the list of things you don't do and, wow, you will not give a patient you do not know a BLANKET? Even with your endless rationales of thinking you have covered all your bases with adding patient may have a fever this one boggles the mind. I have worked as an ER float and your attitude is not unique though. I would never have switched to working primarily as an ER nurse not because of the patients but due to the callous and arrogant attitudes I witnessed in there among staff; that *special* ego stuff was just so non-endearing.

I don't go to ERs, either even if it would be in my best interest; was in a single vehicle MVA 2016, slid on the ice & hit a tree, both airbags deployed, rib fx, bruised lung & brutal pain. Told my husband I can breathe and ERs don't treat pain so not going to ER; my PMD got me in next day. The unfortunate experience OP had with her son in an ER along with your statements only confirm for me I made the correct decision.

Just reread your post and actually nearly laughed over the rationale for not giving a blanket' 'multi-step process'? Really? You are right on one thing, I don't understand the reason for a lot of your behaviors and pity the unfortunate ER patient who is not *your* patient ands asks for something...