Close Encounter of the Nurse Kind

proud nursing student

I'm a nursing student and this story is truly an eye opening read. I myself have never been a patient or had to watch a family member be a patient but i'm sure I would have acted the same way. I love that throughout everything she was a mother, because that is the hardest job of all. This story is a great example of the highs and lows of health care and the areas that need more attention. I hope that story gets all the nurses out there thinking about the families that are dealing with these situations. They are scared and they need all the support they can get. I am so glad that I read this and I vow to be one of the nurses that did it right.

Way too common.....

Unfortunately, Karen Madsen's experience is all too common. There are people in nursing who seem only interested in a regular paycheck and who seem to leave compassion at the door when they come to work. Even scarier, there are people who look and act as if they are nurses but are actually unlicensed assistive staff. How can a health care consumer know who to trust, who really cares, and who will meet the professional standards of care delivery? How can we ensure our family members and others receive competent and caring care?

I am deeply touched by Madsen's passionate description and know without a doubt her teaching will now reflect her personal experience. I too am a nursing professor with a wife and kids who've needed acute care intermittantly over the past 25 years or so. My family has had some great care but also some substandard uncaring interventions. All of us in the teaching profession need to use these very difficult times to give a sharply defined real-world nuance to our sometimes dry classroom discussions - perhaps our best opportunity to shape health care delivery is to ensure empathy, self-awareness, caring, and genuine concern remain deeply embedded threads in all of our nursing and medical school curricula. We need to change care delivery one student at a time.

Nurse to be...

I have been in the emergency room before for my mother, let alone, the one I used to work in, and it is by far a traumatic experience. You truly try to care for them as a family member but all your thinking about are things like "cough, deep breath, and turn and repositioning." This is the joy of our profession though. We care in such a deep way not only for out patients but more for our families. This mother truly exemplified every aspect of being a nurse and a mother. As a nursing student its awful to say but I do see nurses who should not be in this profession anymore. To nurse is to care for, and if you cant care for, then you shouldnt be a nurse. On the other hand, their are nurses out there who go above and beyond for their patients. It is a remarkable profession and Im glad to hear that someone is as a caring mother as is a nurse.

similar experiences

I have been a nurse for over 20 years and I love the profession. Of course some days it is tough and I hate it, some days I have my own porblems and my compassion is stretched. Unfortunately I have had experiences similar to Professor Madsen and I try never to let a family member or loved one be alone in the hospital, the care and compassion is just so uneven. I cannot figure out exactly why this is the case. Are there too many pressures on nurses? Can we attribute some these attitudes to the value changes in our culture? I know that when I had the privledge to teach generic nursing students they were eager and compassionate for the most part. I wish I had an answer.

I remember

This reminds me of being a new graduate many years ago and caring for the grown son of the director of the nursing program I had just completed. As a student I saw her as a picky, old-fashioned, "we sharpened needles by candle light when I was a new nurse" perfectionist. As a mother she was terrified and hovering and her son was easier to deal with than she was. He had the most accurate I & O sheet I've ever seen. I was a caring, attentive nurse already but watching her made me realize how very different it was from the other side of the bed. I've been lucky to always have great care for my family and myself but I'm sure if I didn't, based on what I've seen in the past, I wouldn't be too shy about letting someone know. As I see it, one of the primary roles of nursing is patient advocacy and if we aren't being patient advocates we aren't doing our jobs.

close encounter of the nurse kind

I read with interest the story written by Karen Madsen regarding her experiences concerning her daughter's recent hospitalization and I would like to offer my comments from the perspective of an "old" ED nurse. Do you wonder why the ED nurses were so detached and uncaring? I don't, because I know how they got that way. They are overburdened with too many patients, not enough beds, caring for patients that should be 'upstairs' in regular hospital rooms, but instead are warehoused in the ED, working too many 12 hour shifts without food, breaks or adequate rest between shifts and the demands from administrations more concerned with public image than public service. I was and ED nurse for over thirty years and loved my job until our community hospitals were bought out by corporations more interested in the bottom-line than providing good patient care. I chose to leave the hospital environment and obtained an advanced practice degree and now practice with a cardiology group in the private sector. I still grieve for my lost career and I ache for those nurses trapped in an untenable situation. Do you have any idea how hard it is to go home every single day knowing that you didn't do your best? That you were not able to provide the kind of nursing care that you believe in? That no matter how hard you worked it was never good enough? That you never hear "thank you" from patients or from administration, but you hear very quickly if patient's complain? I was lucky. I was able to return to school and travel another path which is incredibly fulfilling and allows me to stay in the profession which I love. Many nurses do not have this choice. The only way they can stay sane is by becomming hardened to the pain and suffering they encounter and which they are helpless to alleviate. We are in the midst of a nursing shortage which is nearing crisis proportions. Unless the system of health care delivery in this country changes, and nurses become valued for the incredible skill and knowledge which they possess stories such as this will continue to be told. I do not codone the ED nurses behavior. However, I do understand from whence it came. Barbara Sutton ARNP, Florida

spirometry

you don't blow, you suck.

Comarow response:

The explanation link is to MedlinePlus, and I've seen a spirometer used both ways.

Truth sets you free

When I turned 36 I changed my life in many ways. One of them was to change careers. I started out CNA, then LPN, now RN. When I transferred from Cardiac/Neurology to ER-I realized TRUTH. I saw what Karen saw. I saw nurses judging others, not considering "human" circumstances. Not educating, not being compassionate. I saw it too from the physicians. I saw that older nurses were not willing to teach younger ones, I saw hopelessness. I walked away from that job too. I'm only into nursing 8 years now, and I am already exhausted. Long hours, no breaks, inhumane expectations from the corporate levels, low staffing. Even if there aren't enough nurses there should be more CNA's and other staff that can give blankets and water, etc. Greed in the industry, money, has pushed the compassion out of nursing. I too, like Karen, am often ashamed and embarrassed of some coworkers I have had. No professionalism amoung staff. In my education I was forced to take a spiritual, mental, emotional and moral, ethical appraisal of myself-an honest appraisal. The truth sets you free. I work on my character defects and wish others were so inclined. But you won't find that here, not in my county. Nurses are in it to pay their bills. Not many really care. When I am ill I don't go to the doctor without trying EVERYTHING else first, from herbals and vitamins to exercise and prayer with meditation. Albeit me, I will surely die a younger age as shoving pills down people is not treating root causes, sometimes pills are a masquarade. Yes, I am still working-a minimal amount, just enough to get by. The rest of my time I am volunteering and getting the real uplifting nursing has to offer, and helping those who really want it. The best don't last in the places where they are needed most, due to corporate greed. One person's opinion, the truth set me free, though it is sad.

Communication is Key

Thanks for sharing this heartfelt story. I'm glad your daughter is recovering.

I think that caring, communication and relationship are all critical components of quality and safe care. They are tough to measure but that does NOT mean we can't improve them.

We need to take a leap of faith and make sure that staff have training, time and organizational supports for respectful and effective communication.

ed

are you sure those were really rns and not just other members of the medical team? i know years ago when we brought our daughter to ED, the only time time an rn saw her was when we were actually inside the ED and my daughter was in a bed....

pain treatment and the emergency room

I am an advanced practice nurse and can feel the mother's pain in the story as I too have been helpless in the emergency room of the organization by which I am employed. I have had to watch as the very organization that provides my livlihood almost killed my son. He suffered from abdominal migraines and would frequent the emergency room with uncontrollable vomiting for which he was treated with vicodan. After he became addicted to vicodan it became a question of whether the vomiting was from withdrawal or the migraine. He spent over 6 years of his life this way putting off his development as he couldn't work or go to school. The emergency room personnel refused to look at his records in depth and chronicle the iatrogenic addiction. They fed the addiction. One time he was popping so many pills he was hallucinating so I sent him to the emergency room to find they shoved him off in a corner unattended while I pleaded for his psychiatric hospitalization ( and I work in the system) which took about 12 hours. By the time he was admitted he was delirious and needed to be detoxed in the ICU as he had been popping pills while unattended. It wasn't until I visited in the morning and determined the nature of his pill bottle content that they took action. I also by the way found a knife on him in the psychiatric hospital. He then was serendipitously discharged and never treated in the psychiatric hospital by a colleague who just didn't care or want to take the time. This was not just a nursing but a multidisciplinary failure over not just once incident by years of encounters. I wish professionals would be professional and scientific and complete in their care of our patients (and children). My son now is treated with sumitriptan (for migraine) and on methadone maintenance for his iatrogenic addiction. He seldom frequents the emergency room. He cannot get treatment still in psychiatry where he needs his ADHD medicine due to the later. So again he is struggling to develop.

been there

I've been in the nursing field in some capacity for 40 years--first as a CNA, then a LPN, and now as a RN. Over the years, I've set by the bedside of family and friends and felt many of the same feeling as Ms. Madsen and I applaud her for using these feelings to improve her teaching skills. As a profession, we need more nurses who show their care and concern for the patients and family. We need fewer nurses who see their chosen field as a job and more who see it as a calling. Over the years I have tried other aspects of nursing: management, administration, quality control, etc.....I always find myself coming back to bedside nursing, or as I call it the "core of who I am". I can think of no other field that I would be happy in. Looking at nursing "from the other side of the bed" allows all of us to be more, to be all, and to be what we should be to our patients and their families.

Understanding

While I can thoroughly appreciate Ms. Madsen's heart wrenching ordeal, I do have some concerns regarding where she appears to want to place blame for most of the witnessed behavior and the almost boastful manner in which she states behaved towards staff. As an Assistant Professor in Nursing, I also share her ambition and drive to ensure that the students who learn "at my knee" are very aware that technical skill and expertise without compassion makes for a substandard practitioner. Unfortunately, I too have also experienced the horrid frustration and abject fear of watching my children suffer and be placed in the hands of complete strangers who appeared, in the end, as either completely wonderful or woefully incompetent. As an ER nurse, I was exposed much too often to the worried parent role as my son was a severe asthmatic, and my daughter took her new car and license and wrapped herself around an innocent tree, injuring her neck. I hold a national board certification in advanced nursing administration. My point being that there are many variables besides a lack of compassion that she witnessed during her daughter's hospitalization. And I am disappointed that she chose to absolve herself of behavior that, while absolutely normal for a parent to want to display, probably stressed an already minimal staff. "I wanted what I wanted when I wanted it." Well, of course. We all do. But I'm wondering what type of behavior this has modeled for her students. "The nurses never yelled at me." Good grief! What is the norm for the area she practices in? What level of demands did she engage in that she would have an expectation of returned verbal abuse? When confronted with unacceptable timing or behavior, I never lost my professionalism or my ability to be a firm patient/family advocate and obtain what I needed. I see many, many wonderful nurses leave units in tears after a shift that was dangerously short staffed with patients that were dangerously ill. And they do care, but burn out is real and lethal. Encountering someone of Ms. Madsen's self-offered description of netting an immediate gain for her daughter, possibly at some other patient's expense, does nothing to improve being a patient's advocate or assist the staff in performing their duties. She needs to encourage her students to work at also being realistic and firm regarding the work place environment and what they should have in order to do their jobs safely, warmly, and effectively. Unfortunately, caring isn't always enough.

katherine

I have been in your position with my husband. However, the ED was very on top of things. It was the floor nurses that let us down. Poor communication, poor follow-through, and leadership that responded poorly. And I was one of 'those wives.' I dared not leave him for fear he would miss meds, bathing, fever control, and food. I wrote a letter about it to the leadership and hospital administration. Never heard from them.

ER triage rots from both ends

"The initial nursing triage staff did the bare minimum required of them; they did it without a smile or a touch of concern. They did it quickly and efficiently and soullessly."

I'll bet there was nothing else they could do. You have to reserve hall beds, and triage nurse pushiness for patients that are in the process of dying. If we pull a doc to once over someone in pain in triage the doc is taken away from Joe Blow who finally made it out back after 5 hours. There are no stretchers to offer for someone to lie on (they are being used in the hall out back), no meds or labs until seen by a doc, and no sympathetic statement that would not be offensive when you've just told mum that her child in pain is not the highest priority.

I haven't found the magic formula for people who are in pain, but not dying, and have to wait. Other than telling them we are moving as fast as possible... warm blankets and cold/hot packs only cover the first 30 minutes, if you're lucky. Our NM encourages a reassessment with a conversation to validate their feelings, but if I can SEE they are OK, and I'm needed out back for people that are more acute...I'm loathe to spend time chatting. The faster we get out back cleared the faster triaged patients can come in, and that's what they really came for.

__________________

Nursing Student

I can definitly sympathize. I myself has actually been THE patient IN the bed. My senior year of highschool I fell ill. And it took three trips to the hospital before I was finally diagnosed with meningitis. The staff I encountered my first two trips were mean and not understanding. I was complaining a massive headache unrelieved by rest or pain meds. The physician prescribed me Depakote (w/o even ordering a CT) and sent me home. Needless to say I got worst quick. On my final trip to a different hospital miles away from my home, practically on my death bed I found an excellant physician and nurses. I remember the physician being sympathetic towards me, he made sure I had a private room in order so that the lights could stay off (sensitivity to light). He made sure to check in on me frequently. The nurses were kind, smiled and told me jokes. They understood that I was in pain and scared. The were absolutely fabulous. I am now in LPN pursuing my RN degree. I try very hard to remember when I was the patient in the bed and I treat ALL my patients how I wish everyone had treated me....

ER triage changes

Some items I noted in the article were that the triage nurses did not appear to care, and were eating and on their cell phones. I did not notice her saying they took their lunch break, or the other two 15 minute breaks they should have been allowed.

It is also a matter of perception, were the cell phones connected to staff in the back? Possibly they were not on personal calls, but indeed working to get the patients from the lobby to the Main ER.? If the triage nurse did in fact have time to eat and have personal cell phone calls, she was not doing her job. Patients in triage should be frequently reassessed.

In the ESI 5 level triage system PAIN can lift a patients acuity level to almost life threatening, perhaps this poster is correct in her assumption of laxidasical nursing.

I noted one other NO-NO that was posted.....family members should be strictly informed that they are not to push the PCA button. The design of a PCA is to reduce the chance of a patient getting an overdose. If the patient is unable to push the button (most likely due to the effects of the narcotic) then another dose is not appropriate at that time.

There are several "innovations" in ER medicine that have been around for several years. One of them is standing orders. The physician group that mans that particular ER should sit down with nursing and develop orders that can be implemented when there is a long delay in the patient getting to an exam room.

Items can be those such as lab draws (might have shown an elevated white blood count, or a shift); the patient could have been preping for an abdominal CT (sounds like it was pretty obvious onw would be ordered); and pain medication could have been ordered.

I currently work as an agency RN and one of the facilities I work at has an "internal wating room". They took out two gurneys, and added about 10 geri chairs. A nurse staffs the area and starts IV's etc, in anticipation of the Dr.'s orders. If a patient has abdominal pain, a urine would be collected (definitely a nursing intervention, and as long as it is not sent to the lab is not an "order") Selected standing orders are in place, which allows for many results to be posted before the physician even sees the patient, which speeds the diagnostic course of the physician or mid-level provider.

Another option is to have a nurse practitioner in the lobby. He or she can give a screeening exam and order the tests, with similar results as standing orders.

the Emergency Nurses Association has several documents on their website to help the ER at the described hospital.

ER nurse and DNP student

quick and efficient not enough?

The initial nursing triage staff did the bare minimum required of them; they did it without a smile or a touch of concern. They did it quickly and efficiently and soullessly.

So they did their job but because they didn't fluff your daughter's pillows after they did it, you are still not satisfied. One of the greatest frustrations I encountered in nursing was the overemphasis on hand-holding while technical skill and expertise was completely ignored. How disappointing it is to see another member of the profession devaluing technical skill. In short, no one cares that you save a life, only that you tucked in their blanket with a smile after you did it. You were there to provide the care and compassion, they were doing their job. Do you know how many nurses out there who are unable to do their jobs at all due to poor staffing and lack of the tools need to get the work done, let alone quickly and efficiently? You should.

I don't disagree with the power of a comforting smile or a soft touch. I know how important kindness is to someone who is sick and afraid. However given the choice between a professional who does his or her job quickly and efficiently and one who calls me "honey", strokes me on the arm, and who cracks jokes all the while missing important changes in my condition, forgetting to give me certain medications and not making arrangements for important procedures in a timely manner; give me nurse "A". My friends and family will provide the smiles.

Ms. Henderson MSN RN

Nursing

Well you've seen the good and the bad of hospital nursing on the other side-isn't pleasant is it? ER nursing has become so crazy, dangerous, overwhelming, and packed with patients who need our help and those who just jam up the works-nursing is not a job for the faint of heart!

This is a second career for me, I like nursing and work in the ER. I am a nurse, but I am human. 13 hour shiftst tend to exhaust you, especially when you've been working like a dog and can't even get to the bathroom. The rest of the world expects and gets breaks, a nurse is not allowed to eat, pee, or even sit without interruptions. We are even on call throughout any pitiful break we may get! Administration, and patients(their family) believe that we don't need it or deserve it!

I have to sympathize with you regarding the care you had to provide, however, if anyone leaves a family member in a hospital alone, that patient is on their own. Even more so with a child. Nursing has become a charting, technology, doing the doctor's job, cya, game. I like being with my patients, but that is not my job. My job is to treat them, stabilize them, save their life, report on them, chart on them, give them medications and make sure that their condition improves, ends with education and final discharge. If you did incentive spirometer, kept notes, or anything else...you did your job...mother. No one will ever take care of your child better than you!. 15 year olds are not known for following orders without their parents anyway.

For all of you who think we are making a million dollars, get a grip! Not happening! Six figures are possible if you kill yourself and have no quality of life! It is the hardest job I have ever had, and I have been known to put in 50-70 hours a week as a manager.

Anyway, your situation would not have occurred where I work, however, I believe we need to change the way things are done. First, the hospital needs to be educated by YOU! Let them know so that another 15year old doesn't wait in an ER in pain for 4 hours. Tell your students what you experienced, and instead of being ashamed of nursing. Make yourself active and help fix the problems assailing us....starting with government officials...lack of affordable healthcare.....low staffing.....and closing hospitals.

Glad your daughter is okay, of course she is...YOU'RE A NURSE.

NURSING

On another note....really tired of articles that don't address the problems of nursing, only place blame on the nurses. I'd like anyone to walk a mile in my shoes....somedays it is 7 miles. Doctors are given great respect for their 1 minute visit....People better wake up, without us intervening, advocating, educating, and monitoring you all, they'd never have a clue! Don't blame the nurses, blame the administrators that don't properly staff units leaving us running willy, nilly to get it all done!

ECD RN

WOW. Where to start? Yes, ALL of the nurses (RNs, LPNs, EMTs- whatever) care, or they sure wouldn't be hanging out in an ER/Triage situation waiting for Ms. Madsen (and everyone else in the near-vacinity) to judge them. Do they act heartless, soul-less? Maybe. Any chance that they HAVE TO to DO THEIR JOB day in and day out??? EVERYONE who walks through triage thinks their situation is an EMERGENCY. That is what a triage nurse's job is- to act as gate-keeper for the ER. There are just not enough beds, nurses, physicians, radiology/labratory/ respiratory staff to care for EVERYONE who walks in the door the instant that they do so! And, nurses are human, believe it or not- we DO need to eat, to laugh, to make phone calls, etc. Should Ms. Madsen act as an advocate for her daughter? Absolutely! Unless that means picking out (judging) which nurses are "ok" to care for her daughter and which aren't.... The triage/er staff she encoutered weren't as much heartless as they were COMPETENT. They have her daughter's vital signs, symptoms, and a combination of their experience/education/and most importantly, their intuition, about the situation. If Ms. Madsen had a problem waiting to be seen, she needed to reapproach the triage nurse with her concerns. She might not have guessed this- but, I bet the ER staff was most likely taking care of other EMERGENCIES, just as important as hers- but they might even have been MORE critical!!! Yet, she remembers, and tells of, the "soulless" triage nurse and the 4 hour wait. Hmmm. I think she needs a day-in-the-life-of-an-ER-nurse educational seminar. I am not heartless. I do care. I do cry. I do bleed. I, too, have my own children. I go home and worry about what I wasn't able to do for patients each and every day. It is people like Ms. Madsen that make me resent my job rather than strive to better it. Bitchbitchbitch. That's all this Spoiled Rotten America can do{"This is America in 2008...") Throw out judgement upon each other- make assumptions so severe that NURSES (of all people) are UNCARING, SOULLESS, and on and on. Really? That's too bad if you feel that way. My paycheck alone sure as hell isn't enough to keep me coming back- but it is ungrates like this that make me wonder if what I do for NO CREDIT is worth it afterall.

If they don't got a bed in back, what do you expect the triage nurses to do other than assess your daughter and send her to the waiting room. What you see in the waiting room doesn't give you a good perception of what is going on in the back. For all you know they could have been getting ambulance after ambulance of teenagers trying to actively die. This maybe an exgaggeration, but you get the point.

Nursing

Having been a nurse for 24 years (med-surg,ER,PACU), I read this account and all the comments, with great interest. While I certainly can identify with a mother's concern for her child, perhaps her perception of the entire situation was more based on being a mother than a nurse. Maybe there were some uncaring nurses (let me know when academia figures out how to "teach" someone to really care on an interpersonal level), but a patient with a demanding, know-it-all nursing professor mother who is taking care of everything would intimidate and alienate many nurses charged with caring for her daughter. I'm glad it wasn't me.

Close Incounter of the Nurse Kind

It's a good thing to be able to identilfy the positive and negative things we do as nurses so that we can improve in our care. It might be a good idea for the mom here to write the hospital a nice letter, or even go back to that ER when these same people are on instead and speak to them. I once knew a nurse who worked in the ICU, a similar setting in some ways, who changed areas because she was getting very stressed out. It may be the constant stress ansd seeing so many seriously ill and injured people that has hardened them. This isn't good. One late evening I got up to go to work. I felt dizzy and like I couldn't walk right. Earlier in the day I'd taken the clear paper off of 2 lamp shades. It smelled really bad. I guess I should've taken it off before using the lamps a lot. I don't know if that's what did or something else. I barely made it to the hospital. If I hadn't met someone coming from there after dropping his girfriend off, I don't know if I'd have made it by myself. It was a small hospital that didn't have an ER. I told them I was sick, dizzy,SOB, and they had one of the nicest n urses sit with me. The symptoms didn't subside so they had me sent to a nearby ER. While I was there, they did some tests and didn't find anything. I voided about l liter into the bedpan! I went home, never knew what caused this. The nurses at my hospital and the ER hospital were very nice and caring. I'm so blessed and so greatful. At my hospital, she kept encouraging me that I wasn't going to die. I felt like I was. I haven't had anything like that since. I don't know the cause. I'm just greatful that t triage and the people who cared for me were great!

Nurses' comments more interesting that the story

Mary's comments about about blaming nurses instead of nursing are on target. Over the past 25+ years, the profession has continued the same circular discussion of what is nursing and what makes a nurse a nurse. What other profession has so many levels of entry into practice? If the need for nurses is as critical as ever, nurse leaders had better get their act together or nursing as we've known it will cease to exist.

On the other hand, I take issue with Nurse Henderson's comments on "devaluing technical skill." Competent nurses don't just perform procedures efficiently, they read and interpret cues to make priorities related for nursing actions. Effective communication is key to building a therapeutic relationship. A little communication goes a long way,and can that minute taken to allay a parent's anxiety in a crisis or to "fluff a pillow" can make a big difference to someone and his family (whatever happened to including the family into the equation?).

I've got to agree with the people saying you don't know what was being treated in the back room. I work on a med/surg floor, and just last eve. I called over to the OBS floor with a question about a pt we had on an oxytocin drip. (had miscarriaged) They didn't answer their phone, found out why a couple minutes later when there was a "code pink" called. You just don't know. If you only had to wait four hours, consider yourself lucky. I work in a hospital in a large town, where the average wait is four-five hours. The city, thirty minutes down the road, is at least an eight hour. Over the past year, 70% of the time, our emerg is half full with "in patients"...there's just no more beds on the floors. That certainly creates a longer wait in emerg.

A large percentage of nursing is learned after you graduate. The hardest thing I have had to teach any student that I have had during their consolidation is time efficeincy. If you spend half your shift "fluffing and puffing" one pt. you can't care for the other pt's that you have been assigned. If there's time at the end, that's when you "fluff and puff".

And yes, nursing has become a very big "CYA" profession. If I spend 10min with a pt or their family, I might spend 20min. charting. Especially if I don't get a good feeling.

"I wanted what I wanted and I wanted it right now. Bless their hearts, her nurses never yelled at me.”

So you had to act like a complete jackass to get your way? At who's expense? Another patient? And why would you assume the nurses would yell at you? You are a nurse. You should know how overworked nurses are. God forbid they eat, let alone to take a break to relieve themselves.

Peer Thoughts

It might be interesting if the author of this article and the general public took a look at allnurses.com...specifically this link. I think they'd be surprised. I would also be interested to know if her school has cleared her articles prior to publishing them. She and the world needs a reality check of the problems facing nurses in critical care and on the floors. The general public also needs to be educated-hospitals are big business interested in making money. They appear to cater to the consumer, BUT DON'T. This is especially evident with staffing-more nurses =better outcomes. That's safety 101. if we all know this....why isn't it happening? Because those at the top need to get their stock options, golden parachutes, and stay in power (boards get paid).

Don't blame the nurse - blame the system!

Don't blame the nurse, blame the administration. It's a systems problem and also a political problem. The ER has become the "dumping ground" for people without insurance and for psych patients (IVC's). Most ER's are woefully UNDERSTAFFED and the nurses are doing their best TO KEEP PATIENTS FROM DYING. At the same time, ER's are OVERLOADED with patients who simply shouldn't be there (non-emergent), but have no primary providers or insurance and can't be turned away (due to EMTALA). Sometimes there just isn't enough time or space for anything else.

Again, don't blame the nurses! I am a nursing instructor myself who also works part-time in an ED. I am also a very compassionate nurse and a patient advocate.

We have to support each other

I've been an ER RN for 17 years. It get's harder every year. One of the things that make it so hard is the lack of support from nurses in other specialties. ER nurses don't usually have the luxury of sticking to patient ratios. We constantly have to juggle and do the best we can in a broken system. Yes we eat at the desk, what else to do when you can't get away while caring for the 3 intubated patients on propofol and levophed drips with CVP catheters. Rather than beating up on each other, we have to look at the big picture. Is it any wonder why we have such a big nursing shortage when we're always sniping at each other? As for triage, when your the Triage RN in a bigger facility, you always are in fear of someone dying in the lobby waiting for a bed. Hard to be warm & fuzzy. ER RN's are getting prosecuted now when people die in the lobby.

physical assessment

My stepdaughter also tends to be a drama queen, but I never dismissed any abdominal pain as mere acting until I have done at the very least a thorough abdominal physical assessment and history-taking (also considering her mother's history of Chron's disease). Abdominal signs and symptoms are very vague, as there are a lot of organs inside that cavity, but usually a very good PE can EASILY rule out appendicitis. I only read in your article about symptoms (subjective, coming from patients), but not signs (your own objective assessment). However, appendicitis also could only be definitely diagnosed as soon as signs become more prominent (which is usually when it reaches the point of rupture or almost). Until such a definite diagnosis, (or until appendicitis has been ruled out), it is not really a good idea to administer pain meds lest it masks the progression of pain symptoms that will point to a more definitive cause. (just so you know, I used to be a general physician in my country of origin, then chose the nursing profession when I came to the US, so what I am telling here is more based on my prior experience; I am not quite sure yet how it is in the US, but soon I will be working in the ER as an RN and it is nice to have this insight coming from a nurse (educator)-patient's mother like you.

I wonder, though, if you teach about physical assessment to your students as well (coupled with a good H&P. I have had such good experiences with those to come up with a working (medical) diagnosis, but I heard that US nurses do not do that -- ER MD's do, and we just do DARs.

I might find myself getting mixed up with both roles...

Close encounter of the Nurse Kind

I am very pleased to hear that your daughter is recuperating well from her surgery. I believe that ultimately this is the goal that everyone was waiting to hear at the end of your rather long and drawn out whining tale. It never ceases to amaze me how nurses (especially educators) "eat their own." I must agree with the comments that were shared by the other ED nurses. Unless you have worked in the ED or a critical care environment, you don't know what is going on behind closed doors. It was rather presumptuous on your part to assume that the nurses were not caring to you or your daughter's emotional needs. There are many other cases going on simultaneously. The demands in the ED are continually growing. If you haven't realized that some of the more serious issues at hand are overcrowding, short staff, minimal space, and lack of inhouse beds...just to name a few. So, instead of finger pointing and playing the blame game, let's identify what the real issues are here. No one ever wants to be on "The other side of the stretcher." The next time you have to visit an ED, instead of blaming the soulless nurses and increased wait time as a result of your bad experience, look to your left, then look to your right, one of those patients don't need to be in the emergeny department. Many people tend to misutilize the ED as their PMD office. Be upset with those people. As usual, it's easier to take out frustration on the nurses. I truly hope that your attitude of this experience has not spilled over onto your students. I guess the old addage is true, "Those who can, do...and those who can't , teach."

Close encounter of the Nurse Kind

"they sat at their desk and ordered food", I guess this educator shares managment's opinion that nurses unlike the rest of the human race do not need to eat

This is unheard of amongst physicians

I'd like to add another comment. If nurses want to be revered as professionals, then publicly denouncing each other is not going to get us there. It is unheard of for a physician, lawyer, dentist...etc. to publicly degrade their colleagues. Public venues are usually utilized by uneducated or disgruntled patients. After reading your soliloquy I surmise that you are combination of both. Did you ever think to have a dialogue with the nurses and attempt to escalate up the chain of command instead of opting for the route of temper tantrum? I believe all nurses are taught this process in nursing 101. Communication is key. The more I share your dramatic saga with staff nurses, managers and colleagues, it turns my stomach. I am embarrassed to say that we share the same profession.

missing something?

"... but is rarely pouty. I should have known nothing was up". "checked her forehead and wrist, my trusty mother thermometer." As a professional nurse and a mother, I am appalled that an instructor of nursing, in assessing her own child, would be so careless as to not use a thermometer to gauge a fever. Need I say more.......

close encounters of the nurse kind

Ms Marsden appears to be yet another academic without a clue to how things run in the real world. I think most of us can agree that US healthcare is in crisis, and the ER is the front line. I am an ER nurse in a north Dallas hospital, and we encounter many of the problems the inner city hospitals have... large populations of patients with no insurance, no money, and often no legal citizenship, who all need care. Insufficient staffing ratios mean that people will have to wait longer for a bed. I find it appalling that Ms Marsden chose to throw her weight around and make such demands of the staff. Perhaps Ms Marsden should have used her writing "talents" to advocate for change instead of attacking the nurses. Otherwise she will be part of the problem, not part of the solution.

How about an article that does into the detail of what an ER nurse does in his/her day? That way both sides of the story are presented and we are not just getting Ms. Madsen's story. There are two sides involved.

Anyhow, shame on her for blaming the nurses. I'm an ICU nurse and sometimes I realize that I don't smile often but I do give my patients words of encouragement. I do what I need to do for my patient so that they stay alive and get well. I'm sorry if I don't smile enough.

Triage RN

I use a cellphone in triage. I call the charge nurse and beg them to get the doctors to discharge patients because I can't stop staring at a neonate I triaged - I am afraid he is going to crash in the waiting room. I don't have proof, just nurse's intuition.

I have a flat affect while I triage an 8 year old with a fever because 2 hours ago I sent a 10 year old asthmatic to the waiting room who is getting q 2 hour nebs at home and he was still retracting in my booth. I stare past this 8 year old to look at the neonate again, but the baby is wrapped in a blanket and out of my sight. I get a bad feeling in my stomach. I try to remember I must go out and see the baby while at the same time I document a list of allergies, meds, pmh, psh, etc... I see a 4 year old with a bloody bandage who is crying, but at least he is breathing better than the 8 month old bronchiolitic with a borderline pulse-ox sitting 5 chairs away from him.

After the 8 year old leaves the triage booth and I finish my documentation, I hear a trauma stat called over our communication system, "16 year old female assualt victim, head trauma, unresponsive," and I think, "I forgot the allergy band on the 8 year old". I leave my booth to find him, but the family went straight to the cafeteria. I glance at the neonate and he is still breathing regularly. The 4 year old with the gross and bloody bandage on his head (that his parents would not let me change) is really crying now, and the families are asking me why I will not do anything for him.

I ask the asthmatic child how he is doing, but he can't speak because his airway has gotten so tight. The charge nurse calls me on the cellphone to ask me to help in the trauma room because there are 2 other children crashing in the department, I tell him to make room for 1 more. I think of the 15 other children I triaged who I can't take a second glance at and the 15 more left to triage.

My eyes well up with tears. Someone says something ridiculous and borderline inappropriate knowing I am about to cry. I laugh out loud instead. I ask somebody to order me some food because I am 10 hours into my 12 hour shift and at least I can take some food home. (The ED only gets worse at 5 pm because everyone starts coming home from work). I laugh one more time at the craziness of this place and I press on.

Have you seen this?

All I can add to this is: Have you seen Glenn Beck's report of his ED experience after recent surgery? Check it out on CNN.com These reports make me ashamed of even more of my fellow ED Nurses.

I don't care what you call it, Burn Out, Compassion Fatigue or any other buzz word. If you act like this, please leave bedside nursing! If you no longer actually "Care" about and for your patients, LEAVE!

Before you write me off as a goody two shoes, newbie nurse, I will tell you I have been a Nurse at the bedside for 33 yrs. 3 yrs in ICU/CCU, 30 yrs. in ED. I am a Clinical Nurse IV at a Metropolitan Medical Center (Trauma Center).

I still love what I do, and I believe I make a difference to my patients. I get as much as I give to my patients. If you do not, do all of us a favor, especially the patients, and find something else to do as a job. Nursing isn't a job, it is a profession.

a better experience

I am sorry your daughter had such an ordeal with her appendix. I hope she is feeling better now! I too am a nurse with over 20 years ICU experience, who ended up at my 14 year old daughter's bedside in the ED and pediatric ICU late last year. We were far more fortunate in our experiences with hospital staff. My daughter's illness was sudden and I too blew her off as being overly dramatic. My colleagues at the hospital where I work immediately recognized that she was in impending shock, took the appropriate actions, and battled to successfully save her life. ALL were professional, effecient and courteous, but also sympathetic and comforting. When she was transferred to the children's hospital 99% of the staff there were also excellent, professional, and compassionate. That being said, either myself or my husband was at her bedside 24/7, watching, asking and helping with her care.. As a nurse who tries to always give 110 percent, I recognize that I am human, get tired and hungry, and can even be judgemental (though I try to never let this affect my care), and realized that the nurses and doctors caring for my daughter could possibly be human too! But I would like to take exception to the responders "scolding" Ms. Madsen for publically criticizing our profession because other healthcare professions don't. The opposite should be true. Other healthcare professionals should have the courage and ethical standards to hold up the failings of their professions to public scrutiny, as she has done. The public is us, and in the end, how well we serve "them" is truly how well we end up serving ourselves.

Fair Reporting

Erika feels that Ms. Madsen has been scolded for criticizing nursing.....that is not the case. The truth is that if she wants to play journalist, then all of the questions: who, what, where, why, when and how must be answered. Credible journalists present all of the facts. She didn't do her homework! What was written was an emotional piece that was extremely skewed, and illuminated nurses as the reason for any problem she or her family encountered during her hospital experience. This was a perfect opportunity to showcase the failures of the healthcare system, and the varied reasons behind them. Instead, she chose to throw her peers and former students under the bus.

I take exception to anyone who thinks nurses should've born the brunt of her criticism and comments. I also take exception to her comments about aiding in her daughter's recovery. That is what family education is all about! Since recovery will start and continue through discharge and beyond, it's important that the significant people in the patients life are initiated into their routines while in the hospital-it was better that her daughter used the tools necessary to recover with her mother, than with strangers. Again that is the mother or father's job-parent, advocate, associate healer.

Again, I have to wonder what type of nurses are the "outraged nurses", I suppose if I had a 1:1, or 1:2 patietn ratio along with a tech....I'd think that every nurse had time to rub feet, brush hair, or whatever else. However, the majority of us are running around to provide ADEQUATE, LIFESAVING, LIFE SUSTAINING CARE, in an environment that does not support us or the patients.

Get with the program!

Compassion=Nursing

I to have been on both sides of the bed, one as a hospice nurse, the other as a granddaughter, neice, mother and wife. I to have had to agrue with MD's who insisted that my Husband did not have a TA, but all the signs/symptoms pointed to it. After arguing with the MD, he fineally did do a CT.....guess what....One Hospital I was in for my daughter who has intermittent seizures, the MD gave 3xs the amount of antiseizure meds when I was out of the room! With Grandma, the nurse gave an extra dose of ativan bacause shewas to figity and did not want to deal with her.......ON the other hand, I have come across many Nurses whom I work with and deal with on the "other side of the bed" that deserve Nurse of the Year.....My hope is that as time goes by, Nursing does not lose the Tenderness that is needed.

Nursing and what it means...

I read this article with interest. I have been on both sides of care--myself, my husband, our son, and various family members and nowI am a first semester nursing student, who is married with 2 children. I am amazed that the instructor behaved like she did. Tantrums? Yelling? God forbid if I as my children's mother acted like that. And how do you not see the signs and symptoms? I have drama queens but as a mother, you just have a gut feeling when something isn't quite right...and you are to teach us? And then the comments about caring--evidently she should have a chat with my clinical instructor as well as one with one of the primary nurses on our floor--med surg.trauma. You are not to be friendly or caring as the pt. will stay here longer, or you are a walking lawsuit--these people are vulnerable (duh) and consequently, can form unhealthy attachments therefore leading to a lawsuit. I have been told by my clinical instructor --to stop caring and to stop smiling. Since when is nursing not the caring profession? IAnd why can't you smile, care and still be efficient? The power of a smile is an amazing thing. I am appalled at some of the 'care' I have seen and have vowed not to be one of those nurses. Jeeze lady, I think you were the one to get a wake-up call. On another note, I think its a sad day when the charting takes longer to do than the assessment...

Poor quality of care

I too have just experienced basically the same situation, several times over. Not just the ER but also in the ICU. My mother was in the ER 11 hours and still had not been seen by a doctor. And because she needed the bedpan more than once (she is on Lasix) they took her call bell away because she was ringing too much!!!! When my sister questioned this the nurse managers response was, She did not believe that and where were you? My mother was in the ICU prior to this for 7 days, and was sent home with an abdomen that looked like she was 7 months pregnant, and yes she ended up back in for emergency surgery for an obstruction less than 24 hours after she was sent home. I do not live close by so I could not be there everyday so I had little control and even though I was listed on her records they refused to even talk to me on the phone so it was useless to even call. In the last two years I have been on the other side of the bed and the experiences I have had leave me with a very bad taste in my mouth for the nursing profession. I could go on and on but suffice to say there is definitely a great deal lacking in the care given not only to the patient but even in just communicating with the families.

er care

I have been an ER nurse for 35 years. I can say for a fact that all of us feel terrible about the long waits. We beg for beds and are told none are available. We are constantly being verbally abused by waiting patients and their family members.

What can one do when there are 5 or more squads standing around in the halls waiting for the same stretchers you are waiting for? I must agree that those who aren't "living it" have no idea what's going on. We care! Management and CEO's are only looking at the dollar signs! It takes an act of God to go on diversion so we can just get caught up! We are understaffed! We have been doing protocols; but, these patients go back for their IV and labs and end up right back in the waiting room. I feel badly that another nurse would have the nerve to complain and not try to look at the whole picture.

when was the last time you were the nurse!!

you know i read this article and happen to have worked at the particular ED you are speaking about. I do understand that you felt a lack of concern shown by the ED staff however there are reasons that people sit in a waiting room, and trust me if the nurse behind the desk acted as if everything was a lifethreatening emergency then no one would see the doc, cause lets just face it there wouldn't be enough!!....most of the time the ED at cox is very busy and people wait for hours if you have a problem with it go up the street to st johns where the wait is just as long and at times longer.....most of us out there at triage are very concerned about the patients that we triaged, but what can you do when the upper management cant move people in the back so that you can get your sick waiting room of pts to the nurses and docs in the back????......it is the same no matter where you go this day in age in the emergency room, lets face it we could have a 100bed ER there and we would still have people waiting, i have been places where there have been deaths in the waiting room and i remember when i used to work and came in for another shift and saw some of the same people in the waiting room as when i left, its not that bad in springfield yet but in some places it is......hope you can turn this around and use it to educate future nurses, but lay off the one of us that are on the front lines of the hospital system when we are doing the best we can with what we have!!!!!!!

hope your daughter continues to improve and get back to her normal self, and relax your a mom first and a nurse second!!!!

When was the last time you were the triage nurse?

You know the sad thing is that you are a nurse and you feel this way, but have you ever been the one to triage the patients, and when was the last time?? You know we are the front lines of any hospital in the Emergency Room at Cox we are seeing over 250 patients a day in a facility built to see 125 per day. We see almost every patient that enters our system, and unfortunately at triage we have the task of choosing who gets the one bed an hour that we can open up in the back, because we can't get beds upstairs because some departments don't have the staff to take patients. In the ER we can't close our doors if we are understaffed, it just means that people hold over or managers come in until we can survive a little better on our own. I hate making the decisions that we have to make at triage, but you know it is a combination between gut instinct and nursing intellect. Unfortunately until our society realized the ERs are not meant for primary care, and the use of Urgent Cares or After Hours Clinics becomes more utilized the problem is only going to get worse. I happen to work at Cox ER and have to tell you that there are some nights more and more now that when you come around the corner and see the department in total upheivel you just want to turn around and go home, but the nurse inside you as well as the compassion for your patients and your fellow nurses makes you stay. You put on your running shoes and take care of as many as you can, more and more places are starting to board patients because we can't move them upstairs or send them home!!........Its a shame we can't find a way to let you in triage see this, I know that you emergency is worse than everyone elses, but its always very difficult to tell you politely that its not. We do attempt to make rounds in the waiting room on the patients that we have triaged and we do start your labs while you are waiting so that your time in the back is decreased, but after you make a couple of attempts and get yelled at, spit at, or even things thrown at you! You don't even care for the rest of the shift. All I have to say is that I am sorry that this happened to you where you work, however you are in a position that you can help make changes, both in education of new nurses and in the politics of the facility. We are all supposed to be advocates for our patients and now you have more fuel than most of us to do so.

Invitation to this "nurse educator"

Why don't you go to the administration of this ED and ask to shadow one of their nurses for a full shift? You obviously didn't go through the proper "chain of command" to remedy the situation, you just felt the need to take a public forum with your limited knowledge and hateful opinion. You are taking out your guilt of "not being mom of the year" because you missed the signs for over 36 hours that your baby was ill, so that makes your incompetence an ED nurses failure? ED nurses wade through hundreds of patients a day to take all the life-threatening possibilities first, the severe illnesses second, and the bullshit at the end. Your daughter was in the second category. We don't use our personal feelings to assess our patients or our situation, we use our knowledge and skills. You used your personal feelings, not your knowledge. You probably haven't been out of the classroom in years, so you have no skills left. I am an ED nurse. I do have a soul and I usually feel horrible that people have to wait so long, but I also have to weed out who can die, and who can wait. YOU SHOULD PUT YOURSELF IN OUR SHOES LITERALLY....ASK FOR A SHIFT WITH AN EXPERIENCED NURSE IN THE ED, and put your words where your pen is...

Bewildered

I am also a nurse who has seen, not only both sides of the floor, but also both sides of nursing and administration. While I wholeheartedly support the profession of nursing, over the last 2 years I have seen an increasing number of nurse's who do not seem to care, and have stated they only became nurses for the money. Until we start to be honest about ourselves, as well as the business aspects of management, we will never be able to fully evaluate and try to implement changes in our health care system.

I believe Professor Madsen was honest and forthright in her description of her experience. I have sat with friends and family members after surgery, and have discovered what could have been a very serious interaction/effect of medications/treatments that have been provided. Not only do we need to understand the nurse's difficulties, exhaustion, but also not forget the other side of what might happen.

There are no easy answers, so I simply take it one day at a time. Attempting to support each other as nurses, while also holding each other accountable for poor behavior when it occurs (and by this I do not mean taking time to eat), would be a step in helping nurses towards a better tomorrow.

Let's all just take a deep breath!

I have been a nurse for 11 years and am a mom of 3 beautiful children. This scenario makes my heart ache for both sides. However I don't think it is hopeless. For sure it opens up a whole host of issues that need addressing. First of all glad the pt is now doing well that is the most important thing. Let me just say in defense of the mom that yes, sometimes between working, raising a family, and running a household we can feel emotionally and physically exhausted. I bet there are more women out there (than are wiiling to admit) would have initially chalked the symptoms up to the flu. But I hope we all learned a valuable lesson to at least take a proper temp and call the family pediatrician to arrange a sick call. No offense Mom, but if a school nurse had taken your childs temp with her wrist and blown the complaints off I think you would have called her tx. inappropriate and lax.

However, if we can all calm down long enough to get to the deeper issues maybe some good can come of this whole ordeal. I just finished my R.N to BSN degree and during one of my clininacl rotations I was fortunate enough to do a semester at the ED at Union Hospital in Lynn Mass. Up until this time being a floor nurse I used to get annoyed when the ER nurses would call for a bed and recall us 15 minutes later if we did not assign a bed yet. (We do need to get out of report and at least look in our our other 5-6 pts before taking on another). HOWEVER! Here is where I learned what these nurses are up against in a daily basis. The ER coordiantor warned me on my first day of clinical "I know you have been a nurse for years, but you have not been an ER nurse so wear comfortable shoes, pee before you come on the floor and try to keep up.".I thought she was being overly dramatic but wholly cow she was probably making an understatment of the century! Although I fully understand and sympathize with how pts and their families may feel (and yes I have been at both ends of the bed and so have my loved ones) I must say between dealing with traumas, understfaffing, overcroding and everyone feeling like they are the most important pt in the world I see why these nurses don't smile a whole lot or have a lot of time to offer more TLC. Those nurses who truly do not care are very far and few in between. I think many are just overwhelmed and try to be stoic so as not to have a nervous breakdown or leave the profession all together. As part of the solution I would like to stress to every floor nurse the importance of never delaying in assigning a bed for an ER pt or delay taking report. If I am not done seeing my pts I at least get them a bed assisgned and either have another nurse take reoprt or check on my remaining pts til I get report. By speeding up the admit process we can help cut down on ER overcrowding and borders. At the same time the public needs to be TAUGHT when it is appopr to use the ED and when to use their PCP so everyone can get the care the need in a timely fashion!