Thursday, April 21, 2005

A nurse rants

Today's must-read is a full-throated, no-holds-barred rant from an ER nurse: "Emergency Room Manners." This nurse works in "Triage," the first stop for anyone seeking emergency care. She must rapidly assess all comers, and determine their urgency. While illness may not bring out the best behavior in any of us, some behavior makes her job much more difficult, if not (almost) impossible.
Do NOT come up to the front desk of the Emergency Room, fling your health insurance card at me, tell me that your doctor told you to come in, stand there with a bored expression on your face and cross your arms over your chest. That is not helpful. When I ask what you are specifically here for do not repeat that the Doctor told you to come in. When I ask what SYMPTOMS caused you to come in; Do not say that it’s in the computer. Ahem;
And she's just warming up. She's had it. Patients react, over-react, and under-react to their crises. She meets denial and procrastination; threats and intimidation (er, attempts at intimidation). She meets prevarication, and she won't tolerate it.

She rails - as most of us do - at "peoples' sense of entitlement and instant gratification. Folks might as well say 'I have abused my body for decades and I'm here for you to fix me.'" (I have actually heard patients say that.)

Geena has also blogged about a patient's entitlement: "I felt like a handmaiden..." One feels the tension rising as she tells of her frustration with him, and his withering criticism of her. The interaction becomes so intolerable that a hasty change in caregivers is arranged. One lesson: if a caregiver's ego depends on patients' appreciation, then that ego will at times be bruised, or worse. (See Dr. Sanity's posts on narcissism, in this week's Grand Rounds.)

Some patients won't understand that you may be actively trying to save several lives, as well as changing the dressings on their toes. Does it help to say to these patients, "I think we have to try to see the situation through your eyes, and find out what you need"? (That's an "empathic" and problem-oriented phrase from my vault. It might defuse a battle of egos, by directing attention to the actual business of getting better and working together.) Such phrases might bring temporary relief - to the patient, if not to us - if we follow through, trying on the patient's perspective.

Geena trades away her frustrating patient. Will the triage nurse stay put? The nurse knows that this rant won't change anyone's behavior. There's no "pre-triage" desk, where patients are told, "Don't mess with the nurse." It doesn't take a shrink to diagnose the rage and burnout in this post. I wonder how this nurse does it, day after day, and how it could be better...

(via Gruntdoc)
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