Saturday, September 20, 2008

Dear Mrs. Floor Nurse

I'm a really nice guy, and most people I meet like me a lot.  I think that perhaps if we had met in circumstances other than those of tonight, we would get along just great as well.

But I have a couple points that I think are important for you to hear.  First of all, I had thought that we as nurses were over calling our patients "hon" and "sweety" and "darling."  And maybe I'm just a little sensitive, but if I were an octogenarian and admitted that I was now several inches below 5 feet tall, I probably wouldn't appreciate your comment about all those "cute geriatrics" who are all "hunched over" and keep "shrinking."  And maybe when you giggled and said "you're so cute" I may have felt a tad belittled.

But that is not really why I am writing to you.  I'm really writing to you about your attitude and your waste of my time.  Yes, I'll admit that I'm a little upset.  You see, in the Emergency Room (or department, if you are WhiteCoat) we have a little rule of thumb when it comes to vital signs that are a little off, and it goes something like this: TREAT THE PATIENT, NOT THE NUMBERS.  So yes, I can understand the moment of alarm when I told you that the patient that I brought you had dropped her pressure into the 80s with the last measurement (despite all the previous measurements being in the 90s and low 100s), but perhaps if you had taken just a cursory glance at the patient before going all trippy on me, then you may have noticed that she was just fine.  Because, you see, perhaps the low blood pressure was a transient state due to the nitroglycerin patch that I took off of her chest before coming up.  I may have been concerned with this reading had I not looked at the patient.  But I did look at the patient, and I saw a pleasant, non-altered, ambulatory patient with no EKG changes, no pulse changes, good skin color and perfusion, and no diaphoresis or dizziness.

My dear floor nurse, I don't blame you for wanting to get a blood pressure machine and check for yourself.  That's fine.  But why did you feel it necessary to try to make a really big deal about it in front of the patient?  You could very easily have said, "okay, I'm going to go and get some vital signs now."  And then when you asked who the nurse was that took care of this patient and I answered that it was me, did you really have to say "well I'll have a talk with you when I'm done here!"  And if you were really so concerned about this patient, then why did you not try doing something so simple as, say, look at her, or check a pulse, and why, after scampering out of the room in a huff, did it take you more than 5 minutes to come back with a blood pressure machine?  When I asked you if you had obtained a tele unit, did you really need to be snarky when you answered that you "obviously have something more important to deal with right now because I need to find out if I have to bolus this patient"?

I know that life on the floor can get quite boring sometimes and it is really exciting to have something to worry about.  I sympathize with that.  But try to leave the patient out of it, would you?  Instead, you keep muttering about how bad this is and how closely you are going to have to watch her so that nothing goes wrong with this dangerous pressure.  Maybe this was all some great device of yours to help raise the pressure by making her get stressed out.  I don't think she even caught it, but her son clearly did.

But it's all good.  You got your vital sign machine and found that her pulse was great, her rhythm was sinus, her oxygen was dandy, and her blood pressure was 111/70.  Not one to be defeated, you checked the other arm and found 117/68.  Still not one to be defeated, you declared that this was just because she had just stood up to transfer to the bed and surely the pressure would go back down.  But at least now you were willing to go and get the tele unit.  It is a good thing that you were done with your "more important" tasks.  Or were you?  You came back in with the weight scale.  Okay, so it is really vital to you that you see what her weight is right this second while the ER nurse stands by waiting for you to get a tele unit - after all if her pressure keeps dropping she could sweat off several pounds and you would have no way of knowing her exact weight on arrival.  But it got a little bit ridiculous when you finally brought the tele unit into the room, set it on the bed, and then pulled out a paper and started to  interview the patient about her home medications.  Now we have gone past the option of you just being so disorganized that you don't understand priorities in patient hand-offs, to the point where you were obviously trying to "punish" me for daring to bring you a patient who was terribly unstable as evidenced by... well, nothing really.

You see, you have no way of knowing that I was at the end of my shift and had already reported off to the next nurse on my other patients, and so that makes it all the worse that with all your huffing and self-righteous puffing about how unstable this patient was, you could have been endangering my other truly unstable patients in the ER who were without their nurse while you ho-hummed through this unnecessary debacle.  Your childish and selfish reaction to this whole episode placed in jeopardy the confidence of this patient and her family in our hospital, and could easily have placed my other patients in the ER in jeopardy as I waited for almost 30 minutes for you to move your molasses.  And for what?  For some misguided sense of urgency and adventure.

Did you even notice that while you were neglecting to do your job I put the portable tele unit on the patient, wished her well, got handshakes and big thanks from her son and daughter, and left?  You see, she and her family liked me a lot.  Maybe that's because I was caring and friendly and watched out for her for 4 hours before she came up to you.  Perhaps it is because I took great care of her and watched her vital signs and all her needs very closely.  Maybe it is because I called her by her preferred name and respected her as a person and not just my "hon".  I don't think I'll ever know for certain all the reasons why they liked me, but I could certainly read the look on their faces as you scampered in and out of the room paying no attention to your "darling", and I think you have a bit of an uphill climb ahead of you.

You certainly didn't make a great impression on me.

It is too bad you kept me past my time to go home, because I would have very much liked to have that promised conversation with you so that I could have explained a thing or two to you about caring for patients.  Yeah, I'm still a fairly new RN, but it would appear that I could probably teach you a couple things, sweety.

Oh, and one more thing: if you had responded when I first faxed report to you instead of making me wait over an hour to bring the patient, then you wouldn't have had to worry about me telling you about the low blood pressure at all.




Anonymous said...

God.....I know the type well,unfortunately.

Anonymous said...

Oh how we all have had to deal with this before.
I don't even work in the ED and I know where you're coming from.
It took me a couple of years, but now I simply find an opportunity to pull the nurse aside to explain how they are acting in front of the patient.
It does however tend to make the 'air' much thicker and more tense.
You did the right thing.

Bianca Castafiore? said...

Salut, mon cher Braden! I have been en vacances, but am happily now de retours... mon amie The Retired Educator recently made the connaissance of a floor nurse akin to the one you address here, with one small major difference. She was obsessed with the "appearance" of *thing* -- distraught over accepting a special bed from ICU(that she did not know how to use), over the lack of clean sheets, the need for a new gown, footies, etc. -- she missed the more salient points about medications and condition (thereby insuring that she screwed up the first round of medications... but by golly, the Patient Belongings were all neatly folded in a drawer!) Retired Educator didn't merit a "hello" much less a "darling"! Floor nurse was occupied with setting up an emergency sponge bath -- those 2units of blood to be transfused would just have to wait their turn! Dieu merci -- Thank God for the good nurses (*wave*)who engage their brains before all else...
R.E. is extraordinairement grateful for all the care she received, but feels safest at home!

Tracey said...

I have always been a floor nurse and sometimes have been quite miffed at the ER's care in my hospital but like you said it is all about the patient and never the place to act that way in front of them. I've never understood this behavior from/between nurses.

Now in my new job I see both sides of the care and it just further reinforces for me that we are ALL here for the patient no matter where we work. I just wish everyone could get over the whole different nsg dept thing and work together. In my hosp it's ER v floors, ER vs ICUs, floors v ER, ICUs v ER, floors v ICUs, ICUs v get it!!

You sound like one of the GOOD ones Braden.........the ones I loved getting patients from. Oh and I love these letters you write to people!!!

Anonymous said...

You see, the problem is that a lot (not all...a lot) of floor nurses have a tendency to avoid thinking at all costs. Instead they will rigorously fill out paperwork while avoiding doing anything resembling actual work.

Glen said...

We live and I was raised in the south so "darling, hon, sweetie" have always been used. I do however cringe everytime I hear that come out of my mouth, especially at work because they can sound very condesending. It's just one of the MANY things that I have to work on.
It sounds like the floor nurse from your story may have an issue with prioritizing. Even working in the OR where we depend heavily on vital sign read outs I still try and remember to actually lift the drapes and look at/touch the patient to get a complete picture.

NewGradNurse said...

Ouch, a stab in the floor nurse territory.

While not saying I agree with her (because I don't), you took a few low blows.

Don't worry though-I recover well.

BTW-nice to see you put your girlfriend's picture on the blog.

Anonymous said...

Way to bring the heat. Some of us floor nurses need a little heat lit to their behinds. I've seen the type and they scare calling the doc for a cough when the reality is the patient is going into flash pulmonary edema.

I'm for sure with you though on the treat the patient, but guided by the numbers...

That's why some of us (there are some out there) have their stuff together and roll well with whatever comes up from y'all in the ED (in spite of my prior hissy was a particularly bad weekend.)

Keep on with the strong work!