Is it me???

5 This post is if anything a bit of a light hearted poke at myself having spent 13 hours in a very busy ED today (and for that matter yesterday and the day before yesterday!!!). I have spent the day assessing in triage and cannot help but wonder what I am doing wrong. I clearly need to sharpen my communication skills which I had always thought passed as average but clearly not. Let me elaborate.....

I need to find a new clearer way to establish past medical history. I tend to simply ask whether they are generally well and if they have any current or previous medical problems. I have had so many patients today firmly tell me that they are fit, well and healthy. No problem with that except when I have double checked by asking about medication they have gone on to give me a list as long as the waiting time. Perplexed I will ask why they are on BP, angina and diabetic meds if they are fit and well only to be told that they are........ apart from the hypertension, IHD and diabetes!!

Then we stumble on to allergies. Try as I might, I can no longer raise a smile when I ask about allergies to be told for the 45th time that the only allergies they have are "the wife", "hard work" and the age old favourite "hospitals"!! I know I am a grumpy old nurse but I really really have heard every variation.

Undeterred I continue and bring on who is your next of kin. How can this one be so difficult!!! So many times today patients have said on being asked, "well I would like so and so to be my next of kin!!!" Whilst I am sure that Ethel, or Maud or next door neighbour Nigel are all lovely people they are not legally officially or in any other way that matters your next of kin.

With growing trepidation I explore symptoms. What brings you here today??? "Well nurse I can't swallow" said by patient happily munching a packets of sweets. "I've hurt my ankle and can't walk on it" says the next who carefully hopped into the room not realising that I previously watched them walking to reception without a limp in sight. The man with the sore neck showing me that he could not turn his neck by turning it and saying look I can't do this flummoxed me as did the patient complaining of nausea and abdo pain who very carefully carried in their large bag of half eaten take out food.

From this point I almost dare not ask if they have taken any analgesia and am invariably met with a look of incredulation and the comment "no of course not I wanted you to see how bad I am"!!!!

Then we get into the waiting barter game. it goes something like this:
Them: That board says its a three hour wait so how long will I really be waiting.
Me: 3 hours (I will also tend to apologise and explain why)
Them: Yes but I am young/old/due at an important meeting/or know your boss!!! so how long for me
Me: 3 hours
Them: This is a disgrace. I can't wait that long I will go and see my own doctor in the morning!!!

In the midst of this there are moment of much welcomed relief. Todays was a very sweet two year old firmly wedged by the bottom in a bucket who I managed to free with a loud pop to roars of approval from her parents, aunties and grand-parents.

So please do share your "is it me" moments ......
Quote from snoopy29 Then we get into the waiting barter game. it goes something like this:Them: That board says its a three hour wait so how long will I really be waiting.Me: 3 hours (I will also tend to apologise and explain why)Them: Yes but I am young/old/due at an important meeting/or know your boss!!! so how long for meMe: 3 hoursThem: This is a disgrace. I can't wait that long I will go and see my own doctor in the morning!!!

It's definitely not you! I'm just a new grad, but I had my preceptorship in the ED and the examples that you detailed happened to me very frequently. I thought that it was maybe my fault since I was just a nursing student at the time and hadn't really had much experience yet, but my very experienced preceptors shared the same frustrations- just like happy2learn said, the majority of people don't treat the ED like it should be treated..many hope that they can just go there to have quick care..it's frustrating, but keep your head up!

Quote from happy2learnI never understood why people go to the EMERGENCY department for something that they must not really feel is an emergency if they are going to go see their doc in the morning.

Apparently it is you. Every last one of our patients is always legitimately experiencing an emergency, is well versed in their medical history and medications, and never ever give us sarcastic answers. Furthermore, they are all extrememly understanding and accomodating while waiting to see the physician. Isn't it like that in every ER?(This is the part where we laugh hysterically and say..."I wish.")

Cookienay - -

Been an ER nurse for 22 years. Sounds like you're adjusting quite well. Look at it as entertainment, or excitement on a busy day. If you let it be stressful you're on the short road to burn out. Be assured it's no differant elsewhere, except in inner city ER's waiting times can be > 24 hours. And ER's generally let people in without the wallet biopsy private doctors do in their "telephone triage."

As far as communication skills...a good friend of mine once asked, during an H&P-have you had any difficulty breathing? Are you breathing now?.........I was in the cubicle next to her and had to run out of the ER into the hall...she followed!fortunately the pt was breathing...

Well, it wasn't JUST me, it was the surgeon and the anesthesiologist too....Emergent abd surgery, prepping in the ED, asked "ever had any surgeries?" "no, never, none". I asked, ED doc asked, surgeon asked, anesthesia asked. Same answer.I joked with him as he was being wheeled out that we'd be careful "down there", and he replied, "Don't, I've already had that done." I said "you told me no surgeries! ever!", he and his wife both said "oh, we just forgot about it". How does any male ever forget that!!

i'm sure that's a problem unique to the er. all of my icu patients and their families understand me just fine. or maybe it's my superior communication skills. i never ever have to remind a patient with a midsternal incision that they cannot use their arms to life more than 5 pounds -- and that includes pulling or pushing themselves around in the bed -- because they all heard me and understood the first time and they never forget.i never have to remind my male patients that they have a foley -- they all understand and no one tries to climb out of bed so he can "stand up and pee." (it always seems to be the male patients.)everyone understands that they can't have anything by mouth until after extubation -- i only have to tell them once. and once they're extubated and i tell them all about the swallow evaluation they never ever bug me for something to drink until they've passed the swallow evaluation. no one ever asks me for more ice or fluid than they can have, and no one is surprised that they're having pain after surgery because no one actually believed the surgeon when he told them they wouldn't have any pain. everyone is always ready and willing to do their incentive spirometer and walk in the hall because i've told them how important it is and they not only believe me, but they remember and take it to heart.gee, i don't have any problems communicating with my patients. what's with yours?

Oh dear there is nothing for it then........ I have to accept it is me, not heaven forbid them!!!

Quote from snoopy29oh dear there is nothing for it then........ i have to accept it is me, not heaven forbid them!!!