Last week I turned this space over for a day to Karen Madsen, an advanced-practice nurse and nursing instructor. As "Sister Nurse," a regular columnist for the Stressed Out Nurses Web page, she had written about the good, bad, and ugly of her 15-year-old daughter's recent hospitalization with acute appendicitis. Madsen described the insensitivity of the front-desk ER nurses. She also told of her own failure to pick up evident signs of Grace's illness, the warmth and skill of the clinical nurses, and her demanding, sometimes over-the-top behavior as her daughter's parent and advocate. I was struck by the honesty and tone and posted a slightly compressed and edited version.
It's drawn quite a reaction, mostly from other nurses (as well as some 70 comments on allnurses.com, an online gathering place for the nursing community). Many who weighed in here echoed Madsen's observations. Others were biting. Her reply:
First and most important: Grace is continuing to improve, slowly and steadily. She's back to school half days and is eating again. We are very, very thankful, as we are for your expressions of concern, best wishes, and prayers.
I have been fascinated by your responses—and angered and uplifted and bewildered. All these emotions and more have run through my mind and heart as the responses have continued to come in.
As I've read them, I must say that it's very tempting to try to defend my actions during Grace's hospitalization. I want so badly to sit down with each one of you and say, "See, this is what happened." Unfortunately, that's not possible. But I can address some of the points that were raised.
"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.
You're right, I'm not satisfied. You and I obviously have very different ideas of competence. When a nursing staff can do the bare minimum required and not offer one word of comfort, one touch of caring, it's time for that nurse to find a different job. It is the human elements of touching and kindness and caring that set nurses apart from any other profession. Without those elements, nursing can be reduced to a series of technical skills that can be done more efficiently and cheaper by a robot. Is that what we want?
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 probably did stress the staff. But you know, their stress level was not my first concern. My daughter was. If they were stressed, it wasn't because I threw my authority around or demanded special treatment. They were stressed because that is the basic definition of working in the ER, isn't it? It's a stressful place; people are sicker, staff is shorter, beds are fewer. I realize this because I was an ER nurse. What I did that night was to try to obtain basic medical care for my daughter.
As to my stating that "I wanted what I wanted when I wanted it," here's the deal. Remember Terms of Endearment, when Aurora stormed the nurses' desk for pain medicine for her daughter? That was the attitude I was trying to convey—I am the mom here, my daughter is very ill, she is in pain, and I am trying to get the best care for her that I can. I wanted Grace's medication on time, every time; I wanted her to be taken care of in a professional manner; I wanted what I wanted, not for myself but for her.
Then there is one nurse's post I could quote pretty much in its entirety and disagree with almost every sentence. Yes, I recognize that ER staffs are human beings, entitled to breaks and lunch and laughter. But no, I do not think that taking personal phone calls at the desk, discussing food orders, and laughing at off-color jokes have any place at the front desk, where the general public can hear and misunderstand. Sorry, no matter how "human" it is, I don't think it is appropriate.
Yes, I did look at the staffing on the floor and "pick out" who I would rather have take care of my daughter. Nursing is like any other job. There are people who are inspired, skilled, warm professionals, and then there are those who are less so. If given the choice, who would you pick for your flesh and blood? This commenter asserts that the ER staff that night was competent. How do you know that? Were you there?
You stated that I should have approached the triage nurse again if I was concerned that Grace's condition was deteriorating. You know what? I did. Over and over and over. Her vital signs were never reassessed; no one ever came out and looked at her. Instead, the staff's attitude was something like yours—go sit down and quit freaking out.
This nurse thinks I need an ER educational seminar. I think this nurse needs a fundamental nursing refresher seminar. She sums up my article as bitchbitchbitch. If bitchbitchbitch is what it takes to engender changes in that ER, then bitchbitchbitch is what I'm going to do. If anyone seriously thinks that an over-four-hour wait with an acute abdomen is acceptable, then I think that "acceptable" needs to be redefined.
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.
I'm glad it wasn't you, too. Fortunately, there were mature, caring nurses on the floor to take care of Grace—nurses who were able to see beyond my fear and see the person they knew under it. They were able to take care of both my daughter and my family. They were brilliant.
And to the nurse who accused me of pushing Grace's PCA button to give her pain relief, a definite no-no: I did not push her PCA button. I found it for her in the covers, I encouraged her to use it, but I did not use it for her.
It distresses me a great deal to read that many of you believe that I am bashing nursing generally and ER nurses specifically. Please hear me. I love nursing. I love all types of nursing. Nursing has given me a wonderful career. My best friends are critical-care nurses, two of my nieces are nurses, and my current colleagues are nurses. I worked all over the hospital, including the ER, maternal-child, and labor and delivery before beginning my teaching career. I loved labor and delivery so much that I always said I would do it for free, and sometimes I did.
But let's be real—there are good nurses, there are great nurses, and there are nurses who need a different occupation, just like there are great policemen and OK mechanics and "stay away from that guy" contractors. Why is it so difficult for some of you to believe that regardless of the policies in place, regardless of my attitude, regardless how busy the ER was that night, there might simply have been some staff in that ER on that night at that time who need a different job? Why is the fault for what went on that night being laid primarily at my doorstep by so many of you?
In retrospect, do I wish I could go back to that night and do something different? Yes. Could I have acted a different way during some of Grace's hospitalization? Yes. Could I have written more passionately, communicated more clearly, described what happened in greater detail to eliminate the judgments that have been articulated in some of your responses? Probably not, judging from the tenor of some of those responses.
So, am I sorry I spoke up? Sometimes. Am I sorry I've risked my reputation, risked being disliked, risked being labeled a pushy, know-it-all, manipulative bitch? Sometimes.
But am I sorry that I acted as our daughter's advocate that night, in a situation in which she sorely needed one? No. Not then, not now, and not ever. Before I am a nurse, before I am a nursing professor, before I am anything...I am Grace's mom. And as her mom, my sole aim that evening was to obtain help for her as quickly as I could. She was in trouble. I knew it, her dad knew it, even Grace knew how ill she was. We entered that ER looking for help. We needed the medical profession desperately that night. We trusted that someone would be there to help us.
And the good news is, we did get help. But it took over four frustrating, fearful, pain-filled hours for that help to arrive. Is that truly the best that an emergency room in 2008 can be? Is that truly all we as a society could hope for? Is that truly the best nursing could be as well?
I don't believe it. I can't, I won't accept that. Can you?
It's been an interesting week for sure. And perhaps the best part of all of this is that we're talking. Finally, a real conversation about nursing and nurses and attitudes and real-life conditions. Have your comments encouraged me? Yes. Have they angered me? Yes. Have they made me proud and embarrassed and resentful and proud again? Yes, yes, yes, and yes. Keep it up. Our healthcare system is broken, and nursing is a huge part of that. The first way to fix it is to define the problems. Let's keep talking. People are listening.