How to Break a Nurse’s Heart

A few nights ago I was working in Fast Track, where the walking wounded go. It was insanely busy. Volumes were high, many of the patients were unexpectedly complex, and since the rest of the department was stuffed with then more acute ill (as usual), admitted patients began to fill Fast Track beds. In Fast Track, this has two consequences. First, there is physically fewer places to see people, and second, one of the Fast Track nurses is essentially seconded to assume care of these patients. The effect is to significantly disrupt patient flow. Delays, as they say, were significant, though we were working furiously hard to get patients in and out of the department.

After about five hours of wading though patients, I was flushing an IV line just outside from the Fast Track waiting room when I heard part of a conversation within.

“. . .I have never seen such slow and stupid staff as here,” a woman was saying. Someone else said something inaudible, and there was general laughter.

Nurses in the ED are generally very conscious of the public overhearing conversations, especially if the subject is sensitive or confidential. The walls have ears. On the other hand, patients don’t generally realize there is no sound bubble that prevents their conversations from being overheard elsewhere in the department. And I get that patients are in pain, are frustrated, are angry. But to say this woman’s comment was bone-breakingly demoralizing would be an understatement.

I wanted to take this woman around the department, to show her the challenges of running an Emergency Department when it’s full of admitted patients.

I wanted to give her the private Blackberry number of the hospital CEO so she could complain to him, directly.

I wanted to explain to her that I had been nearly continuously on my feet for those five hours, without a break, and my only sustenance had been two stale chocolate-glazed Timbits from God-knows-when.

I wanted to toss in my stethoscope and leave.

I wanted to tell her to shut the fuck up.

I didn’t do any of these. Instead I went to start the IV: a chronic anaemia patient who needed a top-up of a couple of units of packed red cells. Not complicated, but time-consuming. She would be taking a geri-chair for four or five hours, and when the transfusion was running, she would need frequent nursing assessment and documentation. She was sweet, patient and even grateful and marvelled I had the time to find a warm blanket and a tuna sandwich for her. There wasn’t any Hallmark moment in this, if you’re wondering. There was no object lesson, no redemption, no new courage to carry on, et cetera. She brightened my sour mood, but only a little. Being human, the comment lingered like a bad odour — C. diff, maybe — for the rest of my shift.

I mentioned the comment to my colleague of the day. He thought about it for a minute. “Maybe,” he said, “we should fulfil public expectations.” We didn’t, of course. But the thought was enough to bring the merest smile to my lips.

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  1. #1 by Beth Boynton, RN, MS on Thursday 17 March 2011 - 0954

    I feel the same way with my work on an Alzheimer’s unit. I find it extraordinarily frustrating to be working so hard and be so disrespected. Sometimes, it is family, sometimes patients, sometimes colleagues and sometimes leaders fail to recognize the skill, knowledge, emotional intelligence, and physical endurance it takes.

    I respect you and your expertise.

    Beth

  2. #2 by Raquel on Thursday 17 March 2011 - 1029

    It is very hard when you start getting really sick people in fast track. You don’t have the space, the equipment or the staff to care for them efficiently. People have no idea. Your other nurses have respect for you and know how hard you work.

  3. #3 by onlinenursing on Thursday 17 March 2011 - 1037

    Nurses – we keep doing what we were trained to do despite. Education is no different, administrators, family, parents, students… all feel very entitled and underestimate/undervalue the work of educators to make better nurses and as I have found, I never have a day/time off despite the alleged 10 month contract :)… besides falling on my sword I am darn good at teaching and inspiring nurses to do and be more!

    As Phil Baumann says Nurses are the last Jedi Knights of the Republic… he is quite right.
    Some days just plain suck and there is no solution for them… yet some of us keep coming back and giving it our all.
    The only way we make it better is to keep working but also keep problem solving, encouraging, and pulling people along to shadow us/follow us/ hear from us about how hard and important this work is. (Sounds Pollyanna-ish but so far it is the best way I have found to speak to what we do.)
    Your blog does this!!! Simply by highlighting your day and this conversation so eloquently you speak volumes to many about nursing. Keep up the great work and try not to eat unnamed unidentified food in the break room!

  4. #4 by Maha on Thursday 17 March 2011 - 1159

    During my first couple of shifts in fast track I was completely drowning because I got stuck with Dr. Let’s Order a Rheumatology Consult On a 20 Year Old Guy with Tennis Elbow. Needless to say it got really busy when I overheard some guy say something along the same lines. Lucky for me, my knight in shinning armor float nurse overheard his comment and called out the patient on his idiocy in front of all of his dude-bro friends and other patients. The guy kept his yap shut for the remainder of the visit and I had a huge grin on my face for the rest of my shift.

  5. #5 by Jenn Jilks on Thursday 17 March 2011 - 1203

    This civilian apologizes for the stupid people out there. There will always be stupid people. Ignorant, selfish, the Me generation. My deepest apologies, on behalf of all of us who may be patients.
    What I learned, caring for a parent with cancer and one with dementia, is that they lose perspective, and are not always in their right minds. This doesn’t sound like the case here. I love how the ED treats people as equals, except for their medical issues. In a waiting room, in a gown, no one knows who is rich, poor; powerless, powerful!

    I found, as a teacher, you sure heard when things weren’t going right. Seldom did someone celebrate your wins.
    That said, I believe that focusing on the people who are positive is the only way to go.
    I would have enjoyed it a great deal if you’d poked your head in the room and said, ‘Stupid, here! I’ve come to …[whatever she needed doing]. Since you are a far better person than that, I prefer imagining you did so!

  6. #6 by The Nerdy Nurse on Saturday 19 March 2011 - 1641

    I think it is always wise to do your very best to step back from a situation that is frustrating to you and attempt to see if from the other persons perspective. However, when you’re sick or hurting, or your family members are sick or hurting, sometimes your passion just gets the best of you and you may blurt out insensitive things.
    The ER is high stress for those involved in the care as well as those who are being cared for.

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