Triggered ER Memories…

I got a canned e-mail from my dad’s medical provider, asking for one of those Press-Ganey surveys to be filled out.   I don’t do those.   They’re a colossal waste of time, and the results are used ‘against’ nurses in ways that are demeaning of the job. They’re a popularity contest for healthcare. Nurses aren’t concierge staff… they’re there primarily to give medical care.  Not have to be subjected to some very fortunate person complaining about not getting coffee ‘sooner’, totally oblivious to the reason it was ‘late’ was that the nurse was doing CPR on someone two doors down.   Anyway, it got me all stirred up, and I wrote the following before seeing that it was a ‘no-reply’ e-mail.  Sneaky them :p

–I’m xxxxx’s DPOAH, and deal with all of his e-mail (I’m his daughter- and a disabled RN). He is pleased with his care w/Dr. Kxxx- no issues whatsoever. I go to some appointments with dad, and also have Dr. Kxxx as an oncologist- great folks in the office area, lab draw folks, and Dr. Kxxx himself. Couldn’t get much better.

As an RN (I still keep my license), I have a general loathing for Press-Ganey, since it doesn’t consider all factors in someone’s care (especially inpatient- like if someone complains about their coffee request being slow to be delivered, while the nurse is tending to someone who is either trying to die, or has coded somewhere down the hall). Totally bogus complaint in the GRAND SCHEME of things… our society is too much about “me”, and not about the entire picture.

IF there are issues, I have no problem contacting the hospital directly. It’s really none of Press-Ganey’s business in my opinion. If you can tell me why their butting in is so important, I’m teachable !

I do have some compliments regarding a couple of tests I had a week or two ago. I had a abdominal and pelvic CT w/contrast and a CXR. The nurse and techs in both departments were outstanding. Lisa and Shannon were in the CT department- both very personable, friendly, and gave great instructions. They had the perfect balance between respecting my knowledge as an RN since 1985, as well as informing me of what was going on (and what needed to happen since I’m on metformin- and getting a follow-up creatinine done 2 days later). Lynette was in x-ray, and came SO quickly to get me for the CXR- very professional as well, and also kind. They made the inconvenience of having to drag my ratty body away from home much less unpleasant. My overall experiences in the outpatient/testing departments have always been good- every last person has been pleasant and professional. I didn’t feel like they were trying to suck up, so that Press-Ganey would be happy… they were genuinely doing a nice job.

I have had my share of nightmares in the ER there…

I haven’t been to that ER in a several years- so this might be outdated (wanna be fair). My experiences there in the early to mid-2000s were horrific. I was considered a ‘frequent flyer’, though many times, someone else called 911 because I’d lost consciousness (I have dysautonomia and documented epilepsy among other things). I could give you a laundry list of abuses and negligence in that place. Maybe it’s better now- I hope so. When I got there because I had actually been awake enough to call for help, I was following my MD’s instructions for when to get help (my blood pressure would drop into the 50s systolically- and it wasn’t safe to NOT get help when just lying down wouldn’t do anything). I still was verbally demeaned- for following my doctor’s instructions.  It’s so important for those in the ER to know that just because THEY aren’t familiar with a diagnosis doesn’t mean that it’s automatically some psych disorder, and they don’t know everything about the person, just because they have some vague medical info on them.  I never asked for pain meds, never had a squadron of unruly family around (never had ANYONE around), never even asked for help to the bathroom- which was partly because the call-light was nowhere to be seen, etc. I was told I was a “wasted bed”, and that “seizure patients never follow up”; (I actually had monthly appointments with my doctor at that time because things were so unstable). It got so bad that I learned to put in my own small gauge NG tube and put in 1/2 strength Gatorade by gravity, to increase my fluids- and take my chances at home. My doc  wasn’t thrilled with that (but I know how to manage an NG safely)- yet she knew what had gone on in the ER from what another doc had told her (he was one of the few nice docs). It’s amazing what medical equipment was available on eBay back then.

On April 1, 2007, I was brought in (BP dropped again), and by the time I got there, with the jostling around, it was better, but I still didn’t feel right… I had had a few weeks of weird symptoms that weren’t quite my ‘normal’ weird. The doc on that night actually refused to examine me. He wouldn’t repeat the BP (meant pushing a button- and he didn’t even have to do that; a nurse was near the monitor). I continued to have odd symptoms after being sent home, and eventually had substernal chest pain radiating into my neck. On April 11, I called my doc’s office and was told to go to a different hospital,  and tell them about the chest pain; THEY would take care of me. Tests showed that  I had multiple chronic, sub-acute, and acute PEs in all three lobes of my right lung and R PA (pulmonary artery). I spent 17 days in the hospital getting regulated on warfarin. The chest pain was from my lung pushing into the apex of my heart. That ER doc’s personal ASSUMPTIONS  at St. Xxxx’s could have cost me my life. As it turned out, it was ‘just’ another blow to my feelings as a sub-human. I didn’t have the typical PE symptoms until the 11th (actually the night before- but I wanted to talk to my doc about what to do since going to St. Xxxx’s ER was just a set-up to be blown off and humiliated).  And the doc didn’t bother to see WHY I’d been there “too much” (his words) in the prior couple of weeks.

Being considered a psych case, I was sent home unable to walk one time- crawled into the cab, then crawled to my front door. Another time, I was put in a wheelchair van, and sent home- if I needed a wheelchair to go home, how was I supposed to manage at home. Alone. ?  One doc began to intubate me without checking to see if I was even awake (I was- I’d just regained consciousness, and saw him walk in the room- alone, no help for suctioning, no meds for a genuine intubation, no indication of what he was going to do)…. he knicked a tonsil going in, cutting it, and setting off my gag reflex- so then I was vomiting blood. A nurse came in, and he eventually pulled the laryngoscope out. He asked me if I’d OD’d (a common assumption- though no drug tests were ever positive), and I said no. He told me that’s all I had to say… he never asked me anything!  I didn’t know what he was going to do (he was behind my head- my eyes back there don’t work well). Then left the room. I was so embarrassed to have vomited- but I guess they call it a gag reflex for a reason.  That nurse was very kind as she helped me get cleaned up… she must have been new.

A nurse put a Foley in one time (I’d lost consciousness at a neighbor’s home, and she’d called 911… I’d had no presyncopal feeling -which I generally did- just awake one minute, and about 3 hours later waking up in the ER). The nurse blew up the catheter balloon up ON my internal sphincter. I said it hurt, and was trying to tell her it hurt WAY more than it should- and she turned around and walked out of the room. She just left.  Absolutely no acknowledgment of what I was saying, yet she was looking at me; she heard me, and saw me trying to move the catheter.  I managed to push it in far enough to actually be in my bladder.  It took 4 liters of fluid to get my systolic BP to hit 80…. I was sent to ICU, and just managed to avoid dopamine (which could have been a disaster for someone with dysautonomia).  I was admitted as an OD– yet NO drug screens  EVER showed any type of drugs.  Really?  Even with evidence, I was still some loathed OD patient?  My doc came to see me the next morning, and told me she’d see if she could enter a note to negate the OD diagnosis.

These are a few things that I will probably never forget… and the ER at St. Xxxx’s still scares me. I sent a few letters to the customer service person (whatever they’re called) at the time, and got the canned letter of ‘we strive for excellence in patient care’, blah, blah, blah. Nothing ever changed, because I was seen as a nut job. NO psych history, no drug abuse, no ODs, nothing psych related at all. Just judgmental nurses and docs who saw me too often for their liking. I (me, myself- no doctor) eventually figured out a medication interaction that was contributing to some of the BP issues (the dysautonomia won’t ever go away- but it helps to not have interactions messing with it). I also started going to another ER if I had stuff going on that required an ER (after the PEs, there were some other incidents of chest discomfort/SOB, as well as hematuria one time, requiring some IM vitamin K, and an overnight stay for a couple of tests and IV antibiotics for a UTI). I’m lucky I went there when I was having symptoms that were eventually diagnosed as AML- subtype M3 (APL). I was there for 6 weeks in isolation, induction chemo, and started 19 months of daily chemo of some type (except for ‘scheduled breaks’ and when I had shingles on my butt). I don’t have confidence that St. Xxxx ER docs would have bothered to check things out. And, I could have ended up like Jeannie Hayes- the WREX anchor who died 2 days after officially being diagnosed, after a brain bleed.

As an RN, I know that some patients are annoying, but that doesn’t mean that there isn’t some genuine medical issue going on as well. I did my best to not bother the ER staff. I did anything they asked of me while I was there. Most of the time, I didn’t make the call to be sent there, and when I did, it was because of my personal doc’s parameters. Nobody deserves to be treated like they’re a crazy HUMAN being, and waste of time. I think some of it is the age of many of the newer nurses, and the overall mentality that ‘work’ is a destination, not a verb. I don’t remember a single nasty tech, lab person, etc… it was always the docs and nurses…. very sad.  And even if I HAD been someone with some psychiatric issues, does that mean that subhuman care is justified?   People ask why those who do have mental health issues don’t get help… I can guess part of the reason.  The humiliation isn’t worth it. 

Anyway, I’m sure this is more than you wanted to hear. I don’t do Press-Ganey, since they don’t address issues I’ve had. They run a popularity contest, and I’m not interested in those.

Have an enjoyable week, and maybe remind the ER staff that they know nothing of the patients’ entire lives… they see a snapshot of a bad time. And regardless, they still don’t deserve to be belittled, or even physically injured because of their prejudice and assumptions.—-  (end of ‘note’)

ER staff gets very little information about a patient’s entire life- or even enough to make a true assessment (or judgement) about the person.  They see symptoms and test results, and whether or not they like the ‘diagnosis’ of patient who is before them.  It’s unprofessional and abusive to not treat someone with compassion.  If it was their family member being talked to in the same manner, they’d be outraged- yet they feel it’s OK to do it to strangers.   I realize that there are some amazing, compassionate emergency rooms out there, with incredibly kind and patient staff nurses and doctors.  I commend them.  They have to deal with whatever walks in the door- and that has to be difficult.

IF it becomes so easy to judge an entire person on a diagnosis (and be less than humane), it’s time to find a new job, or another area of medicine to work in… maybe the morgue.   😉

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Nurses Aren’t Very Nice People

That was the search engine term on my blog site stats.

That’s the perception of nurses by more than a few people (including myself at times when I’ve been a patient).  I have some definite opinions about this, and most of it relates to the move towards a more ‘concierge’ industry with those blasted ‘customer satisfaction’ surveys that emphasize the trivial things (hot coffee, visitors happy, everybody cheerful and fit for a ‘Leave It To Beaver’ episode) and not whether or not the person got out of the hospital in better shape than he/she entered it. If people want customer service, they need to go to a spa. If they want professional healthcare, that sometimes isn’t all warm and fuzzy, they want nurses who know their jobs and do them in spite of the nastiness of some of the patients and inadequate training of the newer nurses from SOME schools (definitely not all of them, but I’ve heard many newbies talk about things they didn’t do in school… ‘old school nurses either did it or didn’t graduate).

I haven’t met many nurses who don’t genuinely want to give good care.  Now, there are those who go into it for the relative job security and decent base pay.  Nursing isn’t for those who have no compassion, and compassion isn’t teachable.  I apologize for those nurses. They don’t belong in the field.  But for most of the nurses I worked with over 20 years of being an RN, and for the additional 8 years that I’ve been in and out of hospitals as a patient (and seen a lot of good young nurses, and a lot of ‘do-nothing’ nursing students….not their fault- it’s how things are done in some schools), most really do want to do a good job.  That also may mean that having perfect coffee, enough chairs for visitors, and other ‘maid’ duties aren’t on their list of priorities.  If someone is going south in the next room, YOU may not be at the top of the list of people to please at that moment.  So sorry.

You may not realize the pressure put on nurses to make those satisfaction surveys glow, which demeans the professional aspect of BEING a nurse.  Raises and yearly evaluations include those stupid satisfaction surveys, so your coffee not being hot enough (which the nurse has nothing to do with- or may not know how you like your coffee as some inborn knowledge) becomes more important than whether or not you lived through your illness or injury.  Throw in some unprepared new nurses, a cranky doctor or ten, and your nurse may struggle to get through the day doing her JOB- not being your waitress.  Does she want you to be happy? Of course she does !  But someone down the hall who is trying to die twenty ways to Sunday comes first…and is stressful to care for.  Your nurse became a human long before she became a nurse, so cut her some slack.  Chances are she hasn’t peed once in the six times she’s hauled your butt to the bathroom.  She probably hasn’t eaten during an 8 hour shift while bringing you at least 2 meals, and maybe grabbed something in the breakroom during a 12-hour shift.  Yeah, you’re the patient, but the nurse can’t run on fumes with urine backing up into her brain.

What you don’t see are the nurses who have to wipe away tears when they leave your room because they know the diagnosis your doctor is going to tell you in the morning and it breaks her heart knowing that you’re going to leave a young widow with three kids under 10 years old, within the next year to year and a half.  You don’t see the nurse make six phone calls to find one person who will talk to her about getting some discharge planning help that social services, who is usually very good, can’t seem to get anywhere with because you don’t have the right insurance, and you need some specialized care (like alcohol rehab)…but the nurse knows some people in the business.  You don’t see the nurse who has spent the last three holidays at work without her kids or family because another  slacker called in. Again.  You don’t know that your nurse is being bullied by her boss because one time she said she couldn’t cover a second extra shift that week, and she’s just trying to keep it together long enough to find another job and keep a paycheck coming in.   Basically, your nurse is human, and has her own stuff to deal with- and you.  And five more along with you.  She knows that you are the center of your universe when you’re sick… but she has to watch out for all six of you.  And generally ignore herself. Yep- it’s the job.  But sometimes it gets old when there are just more people complaining.

SO before wondering if nurses are nice people, ask why they should be when they get crap from both ends of patients’ bodies, peed on, slapped, yelled at, belittled and demeaned, and complained to non-stop, and then search engine phrases sounding if all nurses are like Nurse Rachett from ‘One Flew Over The Cuckoo’s Nest’- when all she wants to do is sit down and talk to you about how the hospitalization is affecting you.  She WANTS to spend more time with you.  She wants your coffee perfect and all of your visitors there after visiting hours to be comfortable.  She wants you to get well and have a wonderful rest of your life- but unlike you, she has to deal with the reality of however many patients she has assigned to her, and the responsibility to keep you all in viable condition until  the next nurse shows up.   Even if you have an IV and multiple IV antibiotics going, and tubes in more than one orifice, fresh surgical wounds, and oxygen, YOU may be her easiest patient.

Make sure your needs are met, and hope for the ‘wants’- but understand that you aren’t the only one that your nurse is looking after.  She does care. She wants you happy. But she’s only human. ❤

Nurse 101: How to Understand Your Nurse

In these days of patient satisfaction surveys, the actual quality of the nursing care has become a sideline in hospitals, clinics, and medical offices.  These surveys focus on things that have absolutely nothing to do with the quality of care or knowledge of the professional staff; they refer to the pleasantness of the hotel experience that happens to have nurses instead of concierge staff.  SO, it’s only fair that the patients know what the nurse actually does.  When I slip into the feminine pronoun, I’m really including all nurses- male and female.  It’s just that most of my former co-workers were female before I ended up on disability (c’mon guys- go to nursing school, we need you, too !).

1) Your nurse protects you from stupid people.  That may be a less experienced nurse, a very experienced physician (somebody had to graduate bottom of the class),  your family and friends, or even yourself.  While you have every right to undermine your medical care, your nurse is required to follow orders and standards of practice. Those are designed to keep you in the best shape possible…so you go HOME.  He/she cannot participate in your non-compliance, so don’t get mad at him/her for not responding to your temper tantrums when you don’t get what you want.  Get well, go home, and self-destruct there.

2) Your nurse uses his/her experience to know if you are starting to tank. Go down the tubes. Circle the drain.  He/she then notifies your physician- or in the case of a massive meltdown of your respiratory and/or circulatory system, calls many people around the hospital to come and try to keep you from dying.  That is called a ‘code’.  That is a very serious thing- and it could be happening to someone else your nurse is responsible for, so that request for another box of tissues may be delayed.  Dying person trumps runny nose. So sorry.

3) Your nurse is not paid to babysit your unruly family, or chase your nieces and nephews (or kids) up and down the halls.  Either rein them in, or don’t be surprised when they are asked to leave. If you need help with that, security loves to escort people to the parking lot!

4) Your nurse actually wants the best for you.  She wants you to get well, and she hopes that you also want to be a partner in your own care to achieve the best possible outcome.  She didn’t go to nursing school to watch people make lousy choices and then do all they can to stay sick.

5) Your nurse wants you to be happy with your care !  Sometimes it might seem like she is distracted….well, here’s a secret: she has more patients than just YOU !   Most nurses I’ve worked with want to spend more time with patients, but there are medications to pass, doctors to call, orders to process, calls to pharmacy and consulting doctors, CHARTING (documenting down every fart, pee, poo, problems with pain, complications, and what not- on EVERY patient she has), etc.  There is a LOT going on behind the scenes that also goes into your care, and the care of all of her patients.  Let her know what you want and need- but give her a break if it takes a little while to see her again…she may have 4-5 other patients (on the day shift in well-staffed hospitals) that also are asking for things.  When you are sick, it’s hard to think about the other folks, but she has to worry about them as well 🙂  It’s not that she doesn’t like you…you’re just doing better than the next guy, so she has to keep that person from bottoming out before she can come back and see how you are doing.  If you have something going on that really can’t wait (chest pain, can’t breathe, blood shooting out of your nose, or some other medical change that is making angels sing in your head), then tell the person that answers your call light.  While the nurse who comes in to check you won’t know you as well as your ‘real’ nurse, at least you’ll have someone check you out.  But if you use that for everything, you will have a very cranky nurse with a fake smile.  Not really all that great to piss off the nurse. She wants to like you, but it’s not a requirement.

6) This is a big secret: Nurses have bodily functions and get sick!… and most of the time they don’t have 3 minutes to address them.  Lunch may be a granola bar in the bathroom, since there’s not time for both (don’t worry, she’ll wash her hands).  She might be at work with a horrible cold, because the nursing office won’t allow nurses to take sick days unless they are dying and have a certificate from 6 doctors saying that being at work will kill her sooner. OK, it’s not quite that bad, but nurses are not encouraged to take care of themselves.  Taking days off is considered ‘inexcusable’ and if she has too many of those, she gets fired.  If she has kids, taking time off for a sick kid counts against her.  Your healthcare professional is encouraged to ignore her own health, to take care of YOU !

So here’s the bottom line.  Your nurses want you happy and on the road to recovery. They want to provide the best care they can to support you in your physical recovery.  They are not waitresses, entertainment for your kids, or even your personal, private nurse. You are one of many, and she is literally running her butt off to get everything done in a day for all of her patients.  Make your needs known, but understand that ‘wants’ aren’t the same thing.  And don’t ding her on the satisfaction survey unless there is a serious, health-altering snafu that she does... lukewarm coffee won’t affect your longevity.  Look at the bigger picture.  And know that’s what she does every time she comes to work- for several patients.  You are a part of her overall picture, and she’s generally doing the very best she can to take care of you.