Monday, August 21, 2017

In the ER.......

The following story was published here on Digital Doorway in July of 2010. The issues of nurse burnout and compassion fatigue have not changed in the last seven years, and this anecdote from the ER is as salient today as ever.

Stretcher in hospital hallway

The emergency room is busy, but we're ushered in quickly after registering. My client was having liquid diarrhea and vomiting after I arrived to his house this morning, so I called the case manager and she came right over. She agreed to transport him to the ER in her car as I followed close behind.

It's the usual ER scenario: the same questions asked multiple times, a desultory exam by the attending Physician Assistant, and a long wait for blood to be drawn and an IV started. As the nurse starts the IV and draws the labs, we chat about nursing.

"I've been a nurse for thirty years, and it's just gotten worse and worse," she says as she pokes my client and draws five vials of blood before starting the IV.

"I almost always work without a break, and when I complain, they tell me that this is the ER, and if I don't like it, I should go somewhere else." She places the vials of blood on the counter near the sink and fingers the IV until it's running at the rate she desires.

"They treat us like shit," she continues, "and there are always new grads ready to take our place. I don't know why I put up with it. I don't even have time to eat, and you'd think the management would care that their nurses' basic needs are met. But they don't. They just don't."

She leaves the room, the vials of blood still sitting by the sink. Contrary to safety protocol, she leaves the rail down on the side of the bed where she's been working. She also leaves all of the detritus and trash from the blood draw and IV setup in my client's lap, and dirty gloves on the floor. It's the end of her shift and she's ready to give report and go home.

I overhear a conversation in the hall, the nurses paying no heed to the fact that patients and visitors can hear their every word.

"How's your day going?" one nurse asks her.

"Terrible. It's one of the worst shifts ever. I can't wait to get out of here. I hate this."

She shuffles off to give report, my patient's blood vials still on the counter by the sink. I try to catch her eye but she's already down the hall.

Almost an hour later, she's back, and the blood is finally sent off to the lab, and then she's scribbling madly in charts as the new nurse comes on duty.

The eight hour ER shift has obviously taken a toll, and our original nurse seems fried beyond reason. I quietly excuse her lapses and hope that she can go home and rest.

The new nurse who has just come on duty bustles into the room, greets my client, introduces herself, asks some questions, and shakes her head as she realizes that the previous nurse failed to hook up an automatic heart monitor and oxygen saturation machine on my client when he was first admitted. She untangles the IV, smooths his forehead, offers me a drink and a snack, and bustles out as cheerily as she came in. Meanwhile, I wonder how she'll look and feel in eight hours.

With telephones ringing, bright lights, loud conversations and the constant beeping of monitors, machines and intercoms, the emergency room is no place to rest. In fact, it's not a place anyone ever wants to be, even most of the people who work there. Still, it's an essential place, a human place, and a place where the ill, the broken and the traumatized come for succor and emergent care. But if the nurses and others who staff these emergency rooms are truly treated like so much expendable waste, then how can things ever really change?

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Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is co-host of RNFMRadio.com, a wildly popular nursing podcast; he also hosts The Nurse Keith Show, his own podcast focused on career advice and inspiration for nurses.

A widely published nurse writer, Keith is the author of "Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century," and has contributed chapters to a number of books related to the  nursing profession. Keith has written for Nurse.com, Nurse.org, MultiViews News Service, LPNtoBSNOnline, StaffGarden, AusMed, American Sentinel University, the ANA blog, Working Nurse Magazine, and other online publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, online nurse personality, podcaster, holistic career coach, writer, and well-known successful nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives.

10 comments:

JC said...

I was quite moved by your account of the ER nurse. Although none of us would want to work in a place where we felt so unappreciated, I wonder if that particular nurse is burned out. The ER is a “special kind of craziness” not knowing what is coming in the doors, not even the age of your next patient. However, putting aside the unprofessionalism of speaking to a patient and family/friends/visitors/other nurses, in that manner, some of the safety issues I have trouble getting past. Simple safety measures such as bed rails up and infection control measures such as trash in your patient’s lap and dirty gloves on the floor. No doubt after 30 years this nurse has seen much of the good and bad. When you can only focus on the bad times, it may be time for a change.

Keith, RN said...

JC,

You are quite right---I think this nurse is indeed burned out, and her lapses vis-a-vis safety and infection control are inexcusable. 30 years is a long time, and she seems to be someone that has been eaten up and spat out one time too many.

Kim said...

I've been a nurse for 32 years and have been burnt to a crisp more than once. That is no excuse for slipshod nursing care and lapses in safety.

Yikes.

N. Colella R.N. said...
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N. Colella R.N. said...

I have been a nurse for 11 yrs (peanuts compared to others) but I too have been burnt beyond recognition onmany days and i would never behave like the ER nurse did!! Unacceptable!!!! That's the problem though, the unacceptable has become the accepted!!!!! Somethings gotta give!

Julie said...

As an ER nurse, I can say that this woman's report is so true of sooo many ERs. While her indiscretions and commiserating with a patient's visitor are definitely not great, you cannot judge without having been in her shoes. It is a tragedy when damn good nurses are not even allowed to meet their basic life needs at work.

I cannot count the number of lunches I've missed, the number of crackers I've eaten in a hasty rush just to keep my sugar high enough so my patient didn't notice my shaky hands as I was placing that IV, or the number of 12 hour shifts that led to 14 hour shifts where I haven't even had time to pee. There is so much more that can be said for the conditions that emergency nurses work in every day. Be careful when you judge your fellow nurse - If you walked a mile in her shoes you may just start taking up her cause.

Nurse Me said...

I pretty much echo the sentiments of everyone else's comments. It's hard not to get beaten down by the ER/management/politics/the human (ill) condition. It's almost, almost humorous that we don't realize the beautiful stripped curtains separating ER booths aren't sound proof. Sometimes I'm relieved when a patient of family member speaks up to remind me of that fact. Keeps me in check.

Anonymous said...

I'm starting nursing school in January. This will be a change of careers for me. I'm 48. I worry about starting a career in which I'll have to work under the conditions that the ER nurse describes. What can be done to insure that nurses can meet their basic needs during a work shift? I don't think I would function well without a meal break and I don't think anyone else does either. This is not to excuse the described nurse's behavior but still how can it not take a toll when nurses are not given the time to use the bathroom, eat or take a break? For those of you that are working nurses, is the description here reflective of your normal working conditions?

--Jen

The Platypus said...

Bad management breeds bad nursing in a positive feedback loop which ends when all they have is agency workers and staff that can't get hired on anyplace else. My take on this individual nurse is that she's not burned out: she was just always a lousy and lazy worker.

I'm thankful that I work for managers who know how to staff an ED while not busting balls over the little things. Some days are harder than others, but it doesn't have to be bad all the time.

Catherine said...
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