Are We The Problem?
I've encountered an issue here of late with patients, not just my own patients in the ED (and no I won't break any HIPPAA laws, haha) but patients who have concerns during pregnancy.
I get a lot of messages from different people across all walks of life, not just pregnant people but people with questions about their children, spouses, parents, etc. I guess because I'm a nurse. Of course I am obligated to always tell everyone "I would go in and get checked out just in case" because I couldn't live with myself if I had given the advice that everything 'sounded' okay to me (not allowed to do that anyway if I was at work, so why would I do it at home?) and then it turned out not okay and I had played a hand of them staying home and not going in for something.
These people are always worried about inconveniencing the staff at the hospital. They're worried that if they go in for 'decreased fetal movement' even if they are before or after the 28 week threshold that most doc monitor for a movement pattern, that they will be treated like a bother by the nurses and doctors. They're worried that if they take their kiddo in because they've had a nagging barking cough for 3 days, even though the child is afebrile and playful, that they will get 'the look' from the provider and the nurses. They're worried that if they take their elderly father in because 'he's just not acting right', that they'll encounter cocky doctors and tired nurses who are just OVER you being in there for something obviously not important.
What exactly is the problem here? The fact that people are caring for themselves or their loved ones enough that they want to come in and seek help? I as well as anyone else know that there are always exceptions to every rule and every circumstance, like the people who come in looking for pain medication and their next fix, or just because they don't have anything better to do. But that is part of working in healthcare. You have your 'regulars' and 'those people' and you can see them coming a mile away. I would suggest that you as a provider treat them the same as you treat the rest of your patients, as it just makes your own life easier.
I keep trying to figure out who exactly it is that makes some patients feel like they can't come in for care or when they're worried about their health, their family's health, or their unborn child's health. I keep trying to figure it out so that I can place blame on who's to blame for a mother sitting at home with decreased fetal movement until the last minute and when they get there, its too late. They're forced to deliver a silent, sleeping baby just like I did. Granted, I never had decreased fetal movement, never did kick counts, etc (this is a whole other blog about how providers just don't stress this enough)...but if I DID, I know that I would be thinking to myself "ahh, they'll just think I'm crazy and I'll get the eye rolls and such when I get there. I recently went in for some discomfort and was hooked up on the monitor for safety reasons, myself one night after a long shift of work. Turns out, it was just exhaustion from work and no breaks, no time to sit, and not enough time to eat or drink properly. Even then I STILL questioned whether or not I should go, because I 'didn't wanna be a bother'.
THAT...has got to stop. I am not sure where providers got off making patients feel like they are an inconvenience. After all, they are the reason we have a job. I am not saying that we all don't get frustrated, I do, on the DAILY!!! And I get angry and I talk smack, and I do see certain situations where my eyes couldn't roll back in my head any further. But I NEVER EVER EVER let the patient see that, or hear anything like that. Because although *I* might think they're FOS, they're obviously convinced they aren't (or they're just seeking, and again, still makes no difference) enough for them to be seeking 'care' from somewhere. Nobody, especially the actual real patients who are actually REALLY worried, should ever have the thought cross their mind of NOT going in when they feel the need to, because they're afraid they'll be met at the door with this attitude of "oh, you look real sick." (eye roll). Do I want to roll my eyes? Yep. Do I roll my eyes? Yep. Do I cuss and talk smack? You betcha. Does the patient ever see or hear it? NO. Do I treat Johnny who wants fiorcets and percocets any different than Jimmy who is concerned that he might have a heart problem (even though its just anxiety) or Jeff who is having a MI right in front of me, or Jenny who is only 8 weeks pregnant and having cramping and bleeding and is just convinced she's having a miscarriage, or God forbid, Joe over here who is in active cardiac arrest while I'm pumping epi into his veins in an effort to save his life with my faithful team of nurses, docs, and other staff? No I do not. I know its easy to get burnt out. Especially in the ER or specialized care like ICU, OR, OB, etc. But if in the event you are that burnt out, please for the love of all things holy...find another job. Find another facility. Go work at McDonald's or something for a while. Take some time off. Go work the corner. I know some nurses are a little more stern and strict than others, and end up coming off as a mean nurse or like they don't care, but that's not what I'm talking about. Or the nurse who just tells you how it is. We need those nurses, too, because you better hope that's your nurse if there's really something wrong with you.
There are the ones who are making real, sick, or scared people... not come in to get help from us. We are getting paid the SAME amount hourly if the ER/OB/floor is 100% empty as we are if it is 100% full or even flowing over.
The point I'm trying to make is that, we should never ever make someone feel stupid for coming in. No matter how many people we've seen that day that should've never been there. I always tell people when they say something like "I hate to bother y'all but I just couldn't take it anymore"; "don't you worry about that, its what we are here for and there isn't one person here who's working for free today!" You'd be surprised the amount of people who say something like that, that they feel like they're bothering us or 'in the way' or taking up our precious time (hello we're at work anyway) or what have you.
The recent thing that gets me the most is staff who basically tell a patient they're over reacting for coming in for decreased fetal movement and makes them feel like they're just in because they SO wanna be in that uncomfortable hospital bed with all the stuff hooked up to them. Or that nurse who puts the extra long BP cuff on a patient who has complained of elevated BP just so they can make SURE their BP is within normal limits so they don't have to address it at some point. Or the doctor who just asks "do ya need any refills?" and doesn't address any of the expectant mother's concerns or problems or questions and just brushes them off til next week. Everything seems to be all fine for now after these issues, but what if in the event that one time...that next time...its not. Or its too late. You check the doppler and hear no sound. You put the transducer on the mother's belly and view a very silent, still 4 chambers. It'll be you that has to deliver a lifeless baby and place its limp body in the mothers arms. The person that sits at home thinking they'll get the eye roll, and when EMS gets there, its too late. There's no longer any heart rhythm to code. It'll be you who has to read it in the paper. The mother keeps her child at home for just a few more days because they think they're going to get the "seriously, you again?" look, and they end up hospitalized and septic, and several days later the hard decision to remove them from the vent has to be made. It'll be you who has to stand there while the doctor calls time of death and the mother leans over her now lifeless child as it takes its last breath and its heart beats its last beat.
My question is -- do you want that on your conscience? I don't. But listen, if you are one of the people that are making patients feel this way, the blood IS on your hands. Step away if you have to. Do whatever it takes to NOT make them feel that way. Because I know its hard. Yeah I've only been a nurse for roughly not even 3 years yet. I've only been in critical care for 2 years and 15 months of those being ER, so yeah, I'm still super fresh. I'm only a little jaded yet. Like I said, we all feel the same way, but we should never make the patient see us doing or saying anything to make them feel anything but important and safe. There are always exceptions to these situations and there are always people who we want to stab in the face with a fork.
If ever I get to the point to where I can no longer provide this service... then I hope that I can step away. Whether it be permanently or temporarily. Because I would then need a serious reality check.
xoxo
I get a lot of messages from different people across all walks of life, not just pregnant people but people with questions about their children, spouses, parents, etc. I guess because I'm a nurse. Of course I am obligated to always tell everyone "I would go in and get checked out just in case" because I couldn't live with myself if I had given the advice that everything 'sounded' okay to me (not allowed to do that anyway if I was at work, so why would I do it at home?) and then it turned out not okay and I had played a hand of them staying home and not going in for something.
These people are always worried about inconveniencing the staff at the hospital. They're worried that if they go in for 'decreased fetal movement' even if they are before or after the 28 week threshold that most doc monitor for a movement pattern, that they will be treated like a bother by the nurses and doctors. They're worried that if they take their kiddo in because they've had a nagging barking cough for 3 days, even though the child is afebrile and playful, that they will get 'the look' from the provider and the nurses. They're worried that if they take their elderly father in because 'he's just not acting right', that they'll encounter cocky doctors and tired nurses who are just OVER you being in there for something obviously not important.
What exactly is the problem here? The fact that people are caring for themselves or their loved ones enough that they want to come in and seek help? I as well as anyone else know that there are always exceptions to every rule and every circumstance, like the people who come in looking for pain medication and their next fix, or just because they don't have anything better to do. But that is part of working in healthcare. You have your 'regulars' and 'those people' and you can see them coming a mile away. I would suggest that you as a provider treat them the same as you treat the rest of your patients, as it just makes your own life easier.
I keep trying to figure out who exactly it is that makes some patients feel like they can't come in for care or when they're worried about their health, their family's health, or their unborn child's health. I keep trying to figure it out so that I can place blame on who's to blame for a mother sitting at home with decreased fetal movement until the last minute and when they get there, its too late. They're forced to deliver a silent, sleeping baby just like I did. Granted, I never had decreased fetal movement, never did kick counts, etc (this is a whole other blog about how providers just don't stress this enough)...but if I DID, I know that I would be thinking to myself "ahh, they'll just think I'm crazy and I'll get the eye rolls and such when I get there. I recently went in for some discomfort and was hooked up on the monitor for safety reasons, myself one night after a long shift of work. Turns out, it was just exhaustion from work and no breaks, no time to sit, and not enough time to eat or drink properly. Even then I STILL questioned whether or not I should go, because I 'didn't wanna be a bother'.
THAT...has got to stop. I am not sure where providers got off making patients feel like they are an inconvenience. After all, they are the reason we have a job. I am not saying that we all don't get frustrated, I do, on the DAILY!!! And I get angry and I talk smack, and I do see certain situations where my eyes couldn't roll back in my head any further. But I NEVER EVER EVER let the patient see that, or hear anything like that. Because although *I* might think they're FOS, they're obviously convinced they aren't (or they're just seeking, and again, still makes no difference) enough for them to be seeking 'care' from somewhere. Nobody, especially the actual real patients who are actually REALLY worried, should ever have the thought cross their mind of NOT going in when they feel the need to, because they're afraid they'll be met at the door with this attitude of "oh, you look real sick." (eye roll). Do I want to roll my eyes? Yep. Do I roll my eyes? Yep. Do I cuss and talk smack? You betcha. Does the patient ever see or hear it? NO. Do I treat Johnny who wants fiorcets and percocets any different than Jimmy who is concerned that he might have a heart problem (even though its just anxiety) or Jeff who is having a MI right in front of me, or Jenny who is only 8 weeks pregnant and having cramping and bleeding and is just convinced she's having a miscarriage, or God forbid, Joe over here who is in active cardiac arrest while I'm pumping epi into his veins in an effort to save his life with my faithful team of nurses, docs, and other staff? No I do not. I know its easy to get burnt out. Especially in the ER or specialized care like ICU, OR, OB, etc. But if in the event you are that burnt out, please for the love of all things holy...find another job. Find another facility. Go work at McDonald's or something for a while. Take some time off. Go work the corner. I know some nurses are a little more stern and strict than others, and end up coming off as a mean nurse or like they don't care, but that's not what I'm talking about. Or the nurse who just tells you how it is. We need those nurses, too, because you better hope that's your nurse if there's really something wrong with you.
There are the ones who are making real, sick, or scared people... not come in to get help from us. We are getting paid the SAME amount hourly if the ER/OB/floor is 100% empty as we are if it is 100% full or even flowing over.
The point I'm trying to make is that, we should never ever make someone feel stupid for coming in. No matter how many people we've seen that day that should've never been there. I always tell people when they say something like "I hate to bother y'all but I just couldn't take it anymore"; "don't you worry about that, its what we are here for and there isn't one person here who's working for free today!" You'd be surprised the amount of people who say something like that, that they feel like they're bothering us or 'in the way' or taking up our precious time (hello we're at work anyway) or what have you.
The recent thing that gets me the most is staff who basically tell a patient they're over reacting for coming in for decreased fetal movement and makes them feel like they're just in because they SO wanna be in that uncomfortable hospital bed with all the stuff hooked up to them. Or that nurse who puts the extra long BP cuff on a patient who has complained of elevated BP just so they can make SURE their BP is within normal limits so they don't have to address it at some point. Or the doctor who just asks "do ya need any refills?" and doesn't address any of the expectant mother's concerns or problems or questions and just brushes them off til next week. Everything seems to be all fine for now after these issues, but what if in the event that one time...that next time...its not. Or its too late. You check the doppler and hear no sound. You put the transducer on the mother's belly and view a very silent, still 4 chambers. It'll be you that has to deliver a lifeless baby and place its limp body in the mothers arms. The person that sits at home thinking they'll get the eye roll, and when EMS gets there, its too late. There's no longer any heart rhythm to code. It'll be you who has to read it in the paper. The mother keeps her child at home for just a few more days because they think they're going to get the "seriously, you again?" look, and they end up hospitalized and septic, and several days later the hard decision to remove them from the vent has to be made. It'll be you who has to stand there while the doctor calls time of death and the mother leans over her now lifeless child as it takes its last breath and its heart beats its last beat.
My question is -- do you want that on your conscience? I don't. But listen, if you are one of the people that are making patients feel this way, the blood IS on your hands. Step away if you have to. Do whatever it takes to NOT make them feel that way. Because I know its hard. Yeah I've only been a nurse for roughly not even 3 years yet. I've only been in critical care for 2 years and 15 months of those being ER, so yeah, I'm still super fresh. I'm only a little jaded yet. Like I said, we all feel the same way, but we should never make the patient see us doing or saying anything to make them feel anything but important and safe. There are always exceptions to these situations and there are always people who we want to stab in the face with a fork.
If ever I get to the point to where I can no longer provide this service... then I hope that I can step away. Whether it be permanently or temporarily. Because I would then need a serious reality check.
xoxo
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