September 29, 2005, 5:15 pm


What a sourpuss! How’d you like your Anacin delivered by this angel of mercy! She looks like she’s ready to administer that entire box per rectum. How DARE you have a headache. How DARE you make her call the doctor
after hours. You. Will. Pay.

Her textbook for Essentials of Nursing 101 must have been “The Patient as Enemy: The Nasty Nurse Model”.

There are times in the Emergency department when even the most dedicated nurse can begin to feel that way. The department is full. You are holding three med/surg and two ICU patients until you can get orders/beds/nurses to move them up. You’re down a nurse because of a sick call and just try to get coverage on a Saturday evening. You have 8 people on the triage list and 14 sitting in the waiting room. Every other hospital in your county is on ambulance diversion, which means you must take the ambulance traffic. Dr. Surgeon wants everything STAT for the appy and Dr. Cardio is taking someone to the cath lab. Now. Ms. Scratchy Throat wants to know how much longer it will be and Mr. Groin Itch wants to leave without being seen. Thank god you are working with Dr. Efficient in the ER, but he’s yelling for the charts you haven’t had time to finish. You have been running for six hours, you haven’t eaten for ten and more than likely you’ll be overtime because someone just called in for the night shift.

In walks Mrs. Mom with her three children, all under the age of four, all of them with fever, all of them to be seen.

You want to scream. You want to pull out your hair. You want to laugh hysterically. You want to burst into tears. You want to yell at the top of your lungs, “NO FREAKIN’ WAY!”
That’s when you start to think of the patient as the enemy…….

Instead, you smile, ask “How can I help you?” while you do quick visual check of all three kids, take down their names and point them to the waiting room to await triage.


  • Because the patient is NOT the enemy.
  • Because the worst thing you can do to a patient is make them feel stupid, awkward or wrong for showing up.
  • Because it is not their fault that they happened to show up on your weekly “Day of Hell”.
  • Because they may not have the education/background/experience to know what they are dealing with.
  • Because your hospital has spent beaucoup bucks advertising and promoting your facility so that people WILL come in.
  • Because sighing and rolling your eyes is not professional behavior.

There are many opportunities during the patients’ stay in the ER to discuss the fact that they may have had other options. A call to their doctor. An Urgent Care clinic close to where they live. An appointment the next day. I mention this when I discuss the discharge instructions.
I tell patients that, while we are always available, there are ways of accessing health care that are cheaper, easier and often more timely than waiting in an ER.

The key to coming across in a caring way in the middle of “hell-shift” is to smile and focus. Smile at the patient. Focus on them when they are talking. Don’t have one foot out the door while you answer their questions. Be pleasant. Acknowledge that it is busy but that you are there for them.

It isn’t easy when you are tired and frazzled. But I find that just acting this way helps me to feel that way. It makes it a lot easier to get through the shift and your patients really appreciate it.

Because no patient wants to feel like they are the enemy.


  • kenju

    September 30, 2005 at 12:24 pm

    Right, no patient wants to be made to feel like an enemy – or look like a fool – even though many of them are.

    This philosophy would be good for all employees to adopt (with minor changes in application), especially department store clerks!

  • Third Degree Nurse

    September 30, 2005 at 1:50 pm

    My sentiments exactly. If everybody would follow the Golden Rule of treating each other the way they would like to be treated…

  • Heather

    September 30, 2005 at 4:59 pm

    Every nurse and student nurse should have to read this. I once heard an ER clerk tell a pt.’s wife that she was wrong about what her husband’s last name was. The wife was pointing out that they had gotten the last name wrong and the clerk said, “No, I didn’t.” I looked at her and wanted to shake her until some sense sunk in!

  • Anonymous

    September 30, 2005 at 7:11 pm

    I recently had an ablation to put a stop to afib episodes, but prior to that about every six months I was ending up in the ER with irregular, very fast heartbeat, lightheadedness, and panic attacks. Invariably the first thing I had to deal with arriving at the hospital was a skeptical nurse who assumed I’d drank too much coffee or something. I tried to put myself in their shoes… but when I feel like I might suddenly drop dead of a heart attack, should I really be the one doing that?

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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