When the Nurse Becomes the Patient: What I Learned Sitting on the Other Side of the Triage Desk

[LibraSunCNM, BSN, MSN, CNM]

Love your story.  I've never worked ED, but it is definitely hard to turn off your "nurse" brain and just be "mom."  I think it's a fine line between wanting to be a "good patient" and advocating for your kid when necessary.  I have two and so far, we've only had one ED visit, also for sutures ?  I know more visits are in our future though.  Being on the other side of things does help put things into perspective and make us reflect about our care as nurses.  Ultimately, we're all humans, and most of us are doing the best we can.

[JBMmom, MSN, NP]

I enjoyed reading your story. You are very hard on yourself, though. When necessary, I'm sure you were doing your best as a nurse, and now you're doing your best as a mom.

[spotangel, DNP, RN, NP]

Beautiful! We get it! Been in those shoes on both sides of the triage desk! Compassion is what people remember the most not expertise! Getting both is a bonus! 
 Those little gestures mean a lot to the receivers. I always pray that us nurses remember that we treat people not symptoms!

[TeeKay12]

I have a slightly different experience: my daughter was severely injured at age 6.  For years, we were in and out of EDs, ICUs, and rehabs.  I went to nursing school for a 3rd career, after being a SAHM for 20+ years.  I did ED, Med/Surg, and ICU.  I always treated my patients and their families like I either had been treated or who I would have liked to have been treated.  Either way, we're always trying to make others know that we 'get it'.  

[RuralMOSchoolRN, ADN, RN]

My son had to have major hand surgery at 1 year old for bilateral syndactyly.  I was an ER nurse and this was a totally new field for me--my husband was always waiting for me to ask the right questions or asking me his questions because he was afraid to sound dumb.  I finally told him this was all new for me too and there aren't any dumb questions.  I did the same as you--tried to be the good mom while advocating for my kiddo.  Luckily my nursing allowed us to do a lot of bandage changes and wound checking from home.  But theres something about holding your own kid when they're in pain that makes you want to "just" be a mom for them.  I know I probably annoyed the PACU nurses-we were the last to recover and I know they were done with their day-but my son was vomiting and we were three hours from them once we went home.  Luckily they understood I was scared and also a nurse and took time to explain it was normal for young kids to come out of anesthesia this way and to also call the doc for an onsite RX for medications so I could treat him at home once we were safe to leave. 

I too left the ER shortly after our second was born and am now in school nursing for the better hours until they are older.  But I find myself missing the traumas and bustle of the ER and have recovered my compassion as well.

[FNPtobe2020, MSN]

I was at the ER with my husband the day after Christmas this past year. That was after we had already gone to an urgent care center who referred him to the emergency department where I work in the CCU. He sat in the waiting room for six hours before he got taken back to an ER bay. Once it got to the ER bay things went relatively quickly, he got the CAT scan on his head that he needed which was why the urgent care center referred us to the ER to begin with. Then when they drew his bloodwork they discovered and abnormally  high glucose level. 

come to find out my husband has been diabetic for a while but until we were seen in the ER for something completely different we would have never known. he was admitted to the hospital but sat in the ER bay until the 28th when he was taken to surgery to have the infection drained and cleaned out on the back of his neck. The ER was absolutely overwhelmed. Holding many patients that are awaiting an inpatient hospital bed except there just aren’t enough RN staff to take care of everybody. I overheard the ER physician on duty literally say that to one of the patients that was awaiting a bed on one of our nursing floors.

I would’ve gladly helped out the emergency room staff with taking my husbands vital signs and then giving them to his nurse to write down and chart. Except I could never find their Dinamap.

once my husband got an inpatient bed after his surgery, I assisted the floor staff in their duties, programming his IV pump 

To make sure he got his full dose of the Vanco he was on…helping him to the bathroom getting him washed up at the sink changing his bed linens because the wound on the back of his neck leaked blood and stuff on the pillowcases I took his meal trays back out to the cart for dietary. And on his last day I helped the surgeon change his dressing because he was now on MRSA Precautions I told every nurse that I work there and what department and shift and not a single one of them didn’t appreciate my assistance because there are far too many patients and not enough nurses.

[JKL33]

I bet the staff appreciated you as much as you appreciated them.

I probably wouldn't extrapolate your experience to excuse some of the things (attitudes, behaviors) we deal with in the ED. I do not believe that everyone is having their worst day, or even a particularly terrible day when they come in. I do not believe that nurses may need to step away and find something else to do for awhile unless they can perfectly take it all in while smiling. You see, even though your apologies were not necessary they probably went a long, long way for the people who are routinely disparaged, insulted, yelled at..(sometimes worse). So did your patient waiting and your general pleasantness and cooperation during the visit.

That said, I appreciate that you spent some time mulling this over, and I do agree that it's generally good to try to find compassion; to realize that no matter what the core issues are, no one dreams of living the lives some of our patients are living, some of them are facing terrible daily struggles. I kept my frustrations in check by reminding myself of these things and focusing on how I could treat them with respect and general kindness to help them through some little portion of their struggles.

Hope you get a reprieve from the ED visits! ?

[Susie2310]

On 1/3/2022 at 4:25 AM, echmorrill said:

As I drive home, I wonder why I was so embarrassed to use the ER.  Why I was so anxious to appear calm, helpful, reasonable.  Of course, we hope that all our patients will be calm and reasonable, but the reality is that my time in a very rough, very understaffed ER had left me wary of each new patient walking through our door.  I’d become callous.  Thank goodness these nurses hadn’t.

I realized that with every “I’m sorry,” what I was really trying to say today was “I’m a good person.  I’m a good mom.  I love my kids, and today is a real rough patch.”  And of course, that leads me to wonder what my own patients had been trying to say to me through their cries, their threats, their own nervous laughter.

Maybe the guy who incessantly googled his symptoms was saying, “I’m smart, and I’m scared.  I’m doing my best to educate myself, but I just don’t understand this stuff.”  Maybe the teen mom, who called an ambulance from her pediatrician’s waiting room -- for her baby’s minor cold symptoms -- and who was now trying to bully me into getting her a prescription for diaper cream, was really saying, “I’m overwhelmed and I care about my baby more than I can express.  I’m scared I’m going to screw this up.  Please help me.”  Maybe the drug addict who purposely shoots up in the hospital bathroom was saying, “I want help.  I don’t want to die, but I can’t do this on my own.  Please watch over me.”

I did the right thing by leaving the ER when I did, I decide.  Patients need nurses who treated me the way I was treated today – with compassion, understanding, and respect.  I had lost that perspective in my old job, which meant that no matter how competent my care had been on a skill-level, I had no longer been able to provide comprehensive care.  And that meant it had been time to walk away.

Maybe being a good nurse is knowing when it’s time to step down or switch gears for a bit.

Maybe being a good nurse is knowing when to take care of yourself and your family until you can come back to the bedside with a clear head and a genuine smile.

We all end up on the other side of the triage desk, sooner or later.  If I should end up putting on my scrubs again, I hope that I can remember this feeling the next time it’s me in the triage seat, faced with a long line of tired, hurting, and scared patients who come to me, looking for help, for safety, for answers.

My baby received three stitches today.  I received support, understanding, and kindness.  Our family needed both.  

Thank you for your insightful article.

These are all very good points.  Becoming wary of each new patient; becoming callous; understanding that nurses' perceptions of patient/family members' behavior as being being sinister or inappropriate may not be accurate when these behaviors may simply be due to reasons such as fear, a desire to learn as much about their condition as possible in order to make the best decisions about their care that they can, feeling overwhelmed, and wanting to be helped but not being able to use the conventional method of saying:  "Please help me."  

I think it's very necessary for nurses to keep an attitude of humility, compassion and kindness towards patients and family members.  As you eloquently said, you were hoping to find understanding and kindness in the nurses at your visit, and you took a lot of trouble to communicate to the staff that, as a fellow ER nurse, you were "one of them" in the hope that your own behavior as a family member would predispose the staff to treat both you and your baby well.  For a number of reasons, but not necessarily the lack of desire to be a good patient, many patients and family members are unable to be as accommodating as you were.

It's very important  for both patients/family members and nurses themselves that nurses are self-aware enough to recognize when they are unable to behave towards patients and their family members without prejudice, judgment, and compassion, and discern what they need to do to remedy this and take the appropriate action.

[mmc51264, BSN, MSN, RN]

My son had to be taken to the ED this past Summer. I had NO idea what was wrong. He is T1 diabetic and it was not a hypo event. I really thought it was a seizure. 

The triage nurse was great with him and discovered he had tried someone's "vape" that turned out to be marijuana, not tobacco. I was def in mommy mode, not RN mode. 

When we were in the back, it was obvious that our nurse was on orientation. He was great, but had some trouble with "breaking the glass", I helped with the printer for labs. 

I don't like to have people know that I am a nurse because then they assume I know what is going on. If it isn't an ortho problem, I defer ? 

[KalipsoRed21, BSN, RN]

While I liked your story, I would say the staffs’ reaction and support were more feed back from you than anything. Yes, being a nurse ,in general, does run the risk of being less empathetic at times, but I find that frustration to be do to overwhelm and unsafe working conditions than RNs just lacking empathy. 

[NursePages]

Thank you for your article. I worked in an ER as a registration clerk more than 20 years ago, and I can say that I definitely got a little jaded to all of the frequent flyers by the end. Ten tears later, after having lived in a few third world countries and experiencing the ER in a foreign land/language, I went through nursing school. 

I always tell my parents not to let the staff know that I am a nurse because I don't want the staff to assume I know everything about that particular situation. I want to know everything important to help my parents not be in that situation again if possible, but they are too proud of me to keep quiet. I, like you, try to ask intelligent questions without trying to sound like Dr. Google or that I know more than I know. I just want to take good care of them while I still have them around because I know that won't be forever.

It IS scary to be on the other side of the bed. Try listening to the surgeon talk about your Dad's survival chances when discussing his stage IIIb cancer after having been an oncology nurse that took care of chemo patients. I tried to play it cool when we were on the floor waiting for my husband to have surgery the next morning on his broken ankle after we laid the motorcycle over thinking of how many times I had criticized riders for their accidents when I was an ER clerk--ashamed of myself. (We had slipped on some gravel we did not see making a turn at dusk just trying to get home.) Not every motorcycle accident is completely avoidable.

I, too had felt guilty for not being "in the thick of it" when the pandemic started, but I had a FT job that I absolutely loved and had just begun to start working on my MSN-ED. I justified that I was still contributing to the pandemic because I was multiplying my nursing efforts by teaching the next generation of (younger) nurses to take my place on the floor. I really miss that job, but I am back on the floor trying to finish up my degree because I am too old and in too much chronic pain (exacerbated by the floor work) to keep doing this forever.

However, I have found a definite need to be filled, and I am working towards that goal. Because we nurses have way too many tasks to accomplish to take the best CARE of our patients by properly educating them in hopes that we can truly improve their lives, I have started writing-- "Health education...plain and simple"--in plain language for the average layperson to be able to understand while I work the floor and complete my degree. nurse-pages.com/blog