Though these aren't uncommon, the ones I'm writing about now obviously bothered me enough that I'm clarifying a few things.
1) As a Registered Nurse I cannot make you do anything you don't want to do. You have rights as a patient, I am here to help you know/understand those rights and help you make the best decision for you and your health.
The friends of one of my patients this weekend did not understand this concept. Even after multiple attempts at explaining we cannot keep a patient if they have the mental capacity to refuse treatment. She asked multiple times "what if the patient is sick, what do you do then?" to which I responded we cannot treat her, regardless of how sick she is, because she is refusing treatment. I also explained she would have to petition to judges and doctors to remove those rights from this patient. It is against the law for me to keep the patient if they refuse to stay. It is that simple.
2) Going with the right to refuse treatment, if you are going to refuse treatment, why come to the ER? Honestly, why are you wasting your time and mine? A patient today was obviously struggling to breathe. His oxygen saturation on room air was 75% (it should be 93% or higher). Due to his smoking habits his primary doctor refused to give him home oxygen (fire hazard) and this guy was literally not breathing well at all. He was given a Bipap to help him breathe and he pulled it off. He claimed he has anxiety, to which we gave some ativan to treat. He continued to be noncompliant and removed the mask, refusing treatment, and even refusing to be admitted to the hospital because he did not want the treatment to help him improve. I kid you not when I say this guy would probably be dead by tomorrow that's how bad his breathing was. Why waste our time? I even told him this, to which he did not respond. After he signed out against medical advice the patient was in the lobby and our charge nurse (leaving his position without telling me for over an hour and I haven't been properly trained to be a charge nurse and he always does shit like this) and convinced him to come back and sign in. This guy continually called out and asked for his bipap be removed because he was done having it on. I flat out explained to him if he did not want to continue with the treatment he could sign out AMA again and stop wasting everyone's time (not one of my prouder moments as a nurse but sometimes it needs to be said).
3) In the ER you will get seen and treated, it just might not be in a timely manner. For crying out loud, it's an emergency department. Yes we understand it is an emergency to you but if you can argue with me why you need to be seen next while I have a patient who can't breathe, chances are you're going to have to wait. Please be patient, very seldom can I convince the doctor to skip over patients who have been patiently waiting their turn to help you out (unless you aren't breathing, I can usually pull someone away for that).
Also, if you are able to walk to the bathroom, please walk to the bathroom. Shitting yourself and expecting us to clean your ass because you "can't reach because you left your special tool at home" doesn't do us any favors (I gave him the wipes and "had to take a phone call". When I returned 15 minutes later he somehow managed to clean himself without his special too. A miracle has occurred!). In case you weren't aware, you aren't the only patient either. Yelling out every 2 minutes while I'm helping another person will only aggravate any nurse and you honestly don't need your gown tied around your neck, it's not high on the priority list.
Also, if you are able to walk to the bathroom, please walk to the bathroom. Shitting yourself and expecting us to clean your ass because you "can't reach because you left your special tool at home" doesn't do us any favors (I gave him the wipes and "had to take a phone call". When I returned 15 minutes later he somehow managed to clean himself without his special too. A miracle has occurred!). In case you weren't aware, you aren't the only patient either. Yelling out every 2 minutes while I'm helping another person will only aggravate any nurse and you honestly don't need your gown tied around your neck, it's not high on the priority list.
4) To the RN I'm giving report to, I don't have to secure the IV the way you want me to. As long as it is secure and won't fall out, what does it matter? Access is access. If it bothers you that much how I'm securing the IV, you can secure it however you want after it is your patient.
5) Live patients come before dead ones. Yes I understand I have a ton of paperwork that needs to be completed and a bunch of phone calls to make but when you give me an assignment with 2 live patients, 1 deceased, and tell me to relive a lunch (giving me 7 patients when I should only have 4), the documentation on the deceased doesn't have to be done immediately. In the words of Izma (Emperor's New Groove, great underrated Disney movie) "Well, he ain't getting any deader!" I will finish the paperwork as soon as possible. I will take care of the live patients first, they actually need help and I don't want another dead one to do paperwork on (or actually give me the support I need to care properly for all the patients you gave me).
6) Going back to #2 and #5, just because your patient has finally stopped playing games and agreed to be admitted doesn't mean I can stop everything I'm doing to take him to the ICU. Right as he finally stopped playing games and agreed to go upstairs, an overdose arrived. I have managed several overdose patients in the past, this isn't my first one. I understand you have managed several overdose patients as well. You're not going to convince me to take your patient upstairs just because "administer narcan and he'll be fine" usually works. You didn't hear the full report on the overdose. That report was "narcan was administered and the patient is still unresponsive". This means your patient, as bad off as he is, is still breathing on his own and doesn't take precedence over the overdose. My patient has already been intubated while yours can breathe freely (loose terminology on the breathing freely part, remember he is sitting 75% on room air while sitting, drops lower than that when exerting himself).
7) Patient care comes first, dead or alive. All those techs working in my ER stocking shelves instead of getting the EKG on the chest pain, way to save lives. That STEMI can wait, those shelves won't overstock themselves. I don't need help cleaning up the 300lb dead patient to prep him for the morgue. The overdose next door, hey your help isn't necessary in there either. You make sure those shelves are overflowing with supplies because that's what is important.
8) To the overnight staff planning and prepping all the potlucks, thanks for helping us feel like we're part of a team. Purposely waiting until all the day shift people have left yet having all the staff know what's going on makes us feel great. Pushing back the time just to make sure any day shift stragglers are gone is also wonderful (they stopped serving their potluck meals at 7:30pm, pushed it to 11pm and about 2 weeks ago it is now served at midnight). This is such a great team building exercise and helps us feel so included. Forgive me if you invited everyone else and somehow I didn't get the memo for the baby shower and didn't bring anything. Thanks.
This concludes my list of things I needed to clarify after a long weekend of work. I do work with some great people, unfortunately I'm not always scheduled to work with them. And as for the techs not helping patients, we've attempted to have our boss explain what should be done first to no avail.
6) Going back to #2 and #5, just because your patient has finally stopped playing games and agreed to be admitted doesn't mean I can stop everything I'm doing to take him to the ICU. Right as he finally stopped playing games and agreed to go upstairs, an overdose arrived. I have managed several overdose patients in the past, this isn't my first one. I understand you have managed several overdose patients as well. You're not going to convince me to take your patient upstairs just because "administer narcan and he'll be fine" usually works. You didn't hear the full report on the overdose. That report was "narcan was administered and the patient is still unresponsive". This means your patient, as bad off as he is, is still breathing on his own and doesn't take precedence over the overdose. My patient has already been intubated while yours can breathe freely (loose terminology on the breathing freely part, remember he is sitting 75% on room air while sitting, drops lower than that when exerting himself).
7) Patient care comes first, dead or alive. All those techs working in my ER stocking shelves instead of getting the EKG on the chest pain, way to save lives. That STEMI can wait, those shelves won't overstock themselves. I don't need help cleaning up the 300lb dead patient to prep him for the morgue. The overdose next door, hey your help isn't necessary in there either. You make sure those shelves are overflowing with supplies because that's what is important.
8) To the overnight staff planning and prepping all the potlucks, thanks for helping us feel like we're part of a team. Purposely waiting until all the day shift people have left yet having all the staff know what's going on makes us feel great. Pushing back the time just to make sure any day shift stragglers are gone is also wonderful (they stopped serving their potluck meals at 7:30pm, pushed it to 11pm and about 2 weeks ago it is now served at midnight). This is such a great team building exercise and helps us feel so included. Forgive me if you invited everyone else and somehow I didn't get the memo for the baby shower and didn't bring anything. Thanks.
This concludes my list of things I needed to clarify after a long weekend of work. I do work with some great people, unfortunately I'm not always scheduled to work with them. And as for the techs not helping patients, we've attempted to have our boss explain what should be done first to no avail.
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