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

echmorrill

It’s the day after Christmas, and the ER is packed. The line to register is 10 patients deep, and I take deep breaths as traumas and critical patients rush to the front of the line. A mother comes in, hysterical after her own toddler has apparently ingested some of grandpa’s medications. I flag down a nurse for her, biting my tongue to keep from jumping in – this isn’t my ER, after all, and this time, I’m here with my own kid.

My shoulders are aching from holding my 18-month-old and pacing the floor for an hour. I know if I set him down, he’ll start touching everything and putting who knows what into his mouth. He’s too young to wear a mask, so I’m doing my absolute best to at least minimize the risk of contact infections during a global pandemic.

Finally, it’s our turn. We enter the triage room, and I ease down into the patient’s chair, trying to balance both child and enormous diaper bag in my lap.

"What brings you in today-- " the nurse begins, then pauses. “Do I know you?”

“Um, we were here three days ago, with my three-year-old.” I blush and shift my crying one-year-old to a more comfortable position. “And, um, a week before that, with my six-year-old.”

It’s never a great sign when the triage nurse recognizes you. Especially when you’re back in the Peds ER for the fourth time in a month. Especially when it’s not the ER where you used to work. Where I worked before it all became too much, that is.

A combination of bad luck and clumsy kids had landed us back in the ER yet again for another round of stitches. The jokes about when we’ll earn our VIP frequent-visitor punch card are sounding thin. I’m only half-joking when I ask when they’ll be sending CPS to our door.

As an Emergency Room nurse myself, I try to picture what my family looks like from the other side of the triage desk. If I were assessing this kid, would I smile and joke along with the obviously distressed mother? Or would I sigh under my breath, wondering how I was going to pull two nurses to burrito-wrap this baby while the doctor stitched the laceration, when we already had 12 in the waiting room and all beds full.

The nurse starts asking questions, and I find myself wanting to explain, to justify why we’re here yet again. I cut myself off. I picture the triage form and adjust how I answer the questions – just give her what she needs to triage and assign a room, I remind myself.

“I would have gone to urgent care, but you guys do PO Versed before sutures, and I think the outcomes are so much better,” I find myself justifying anyway.

I want them to know that I’m sorry for taking their time, that I know these sorts of injuries could be handled in urgent care. The thing is, my baby is acting lethargic and I can’t tell if it’s because it’s nap time and the ER is hot and his head hurts, or if it’s something I should mention. I don’t want to be one of those moms. I know what it’s like to bite your tongue at the dooms-day patient – after all, it wasn’t that long ago that I’d had to stifle a laugh when a patient told me, “I googled it, and it’s either leukemia or Celiac disease.” (It was gas.)

I decide that my duty to my kid trumps my own embarrassment, and I mention that the baby is acting a little dazed. As if to support my statement, the baby droops back into my arms and closes his eyes.

We get a room right away. But by the time we get there, the baby has perked up, curious about the equipment and the hustle of nurses and doctors. His neurologic exam is normal. I can’t stop apologizing, can’t stop saying, “I know you’re busy, December 26th is the worst day to come, I swear he was acting differently before, I’m so sorry…”

When the doctor comes in to suture the laceration, they raise their eyebrows when they see the bandage on my son’s forehead.

“That’s a good dressing. Did we do that or did you?”

I pause. Do I say I’m an ER nurse? I don’t want to be an ER nurse right now. I just want to be a tired, anxious mom. I want to be able to ask stupid questions. I want to be able to ask for help.

But the ruse is up as soon as the doctor asks about the last time my son was here, just before Thanksgiving.

“He slipped getting out of the bathtub. It was a minor lac, but urgent care wouldn’t touch it because it crossed the vermillion,” I explain.

That raised eyebrow again, as soon as I say “vermillion.” I nod when they ask if I work in healthcare.

“I used to be an ER nurse, but I switched to remote work after my second child was born. It was…really hard.” In that one sentence, I try to communicate everything: the work. The leaving. The shame that I'm not in the thick of it anymore.

Everyone is beyond kind. One nurse brings in a stuffed bear, delighting my son. Another holds him for me while I run to the bathroom. They laugh when I tell them how, last week, my three-year-old threw a tantrum until we unrolled her from the burrito wrap and re-rolled her “like an enchilada,” per her request. When we get our discharge instructions, the doc slips me a suture removal kit after I admitted I'd been using my (sterilized) eyebrow scissors to remove the sutures rather than dragging my kids to the pediatrician's office.

After four hours, we’re discharged and I strip the bed before we leave. The nurse waves “bye-bye” to my little one and hands him a set of matchbox cars from under the Christmas tree behind the nurses’ station. They couldn’t have been kinder.

Could I have been kinder when I was working a packed ER, too many patients, too many frantic parents, too many hysterical kids? Had I gotten jaded? Sometimes it felt like I was on auto-pilot when I was on the other side of the nurses’ station, the smiles forced, the jokes perfunctory. I loved my patients, but that light dimmed somewhat under the crush of too many critical patients and too few nurses. It was a big part of why I left.

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 think about all of this as I rock my baby to sleep, safe and warm back home. I think about how I’ve had the application to work at this ER open on a tab on my laptop for three weeks. I think about finally sending in my resume.

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.

But here was a new ER, a new staff. After three years of being the patient or the patient’s parent, I was increasingly inspired by the multitude of staff who hadn’t lost their perspective. Maybe I had finally regained mine.

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.

*LibraSunCNM, MSN* · Jan 3

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 · Jan 3

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 · Jan 3

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 · Jan 5

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 · Jan 5

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 · Jan 6

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 · Jan 6

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 · Jan 6

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.

Edited Jan 6 by Susie2310

mmc51264, ADN, BSN, MSN, RN · Jan 7

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 · Jan 16

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.

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

Our patients are talking to us. Are we listening?

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