February 12, 2008, 10:29 am

Attitude Adjustment Required


What the hell is going on here?

The one on the left has to be a nurse because she is wearing a cap (that looks like a two-gallon Stetson, definitely a -1/10 on the Emergiblog Cap Rating Scale!)…

…and holding a Darth Vader mask in front of her face.

Given the hair, it might be Gene Wilder behind that mask.

(I swear we have “hats” for measuring urine in a commode that look exactly like that cap.)

Looks like something you might don for a “code brown”, lord knows I’ve had patients with what I swear was flammable excrement.

I don’t remember ever having to orient to a welding unit, and metal shop wasn’t a required class in my nursing education. Maybe it’s a graduate course…


I need an attitude adjustment.

Frankly, I think the entire world of emergency medicine needs an attitude adjustment.

But, since I only have the ability to work on my own attitude, I’ll start there.


Work has just sucked lately. Major league suckage.

I’m not sure what phase of the moon or what evolutionary phase humanity is undergoing at the moment, but for some reason we have a new paradigm on the night shift.

It’s called the “0400 Rush Hour”.

Somewhere between 0330 when the “third nurse” leaves the department and 0400, they start pouring in. All ages, all sexes.

And they are sick. Really sick. As in drop-the-blood pressure, rupture-the-viscous, call-the-cath-lab-stat, vag-hemorrhage-from-hell sick.

As in what do you mean there are no beds and we have to keep this patient for four hours? sick.

As in what-the-hell-are-you-thinking-this-patient-is critical and why-don’t-you-give-a-damn? sick.


Yeah, I’m tired.

I snapped at a co-worker this week. It wasn’t the straw that broke the camel’s back, either. Just came out of the blue – BAM! Not exactly the epitome of professionalism.

ER nurses are not supposed to do that. We are supposed to see the whole picture, function efficiently and if we are hungry, have to pee, have a headache or are just plain pissed off we keep it to ourselves and don’t not take it out on each other.

It’s not about me.


But it is about the patients. And I’m finding it harder and harder to give what I consider good nursing care in an emergency department.

We know what needs to be done for our patients. But from the patient’s perspective, it’s the less critical aspects that make all the difference.

And I’m not talking patient satisfaction scores here. I’m talking about making sure our patients are comfortable because we care how they feel, no matter what their chief complaint or how demanding they may be.

Caring. As a nurse I am supposed to be “caring” for the entire patient. That’s hard to do when you work in a department that by definition is a “medical-model”, as the ER is (and should be!). After all people don’t come to the ER to have their chakras realigned. They come in because they believe they have, and often do have a medical emergency.

So what’s my issue?


Well, this week I had someone tell me how to do a fingerstick glucose. A family member of a patient. I responded cordially, agreeing with exactly what they were saying and even adding a little theory as to why we do it the way they described.


You see the disconnect? There’s no harmony between how I feel and what I actually do. I’m acting. I’m acting professional.

The person who felt the need to give me an inservice in finger-stick blood sugars was scared. Didn’t look it, but they were. And the only way they could deal with a frightening situation was to feel as though they had some control over what was happening to their relative.

I know that. And I responded appropriately to them.

Then I went and snapped at my co-worker for absolutely nothing.


And while I’m ventilating, let me state for the record that patients are not stupid, jerks, little-old-ladies, asses, gomers, druggies, “alkies”, twits, hysterical, wimps, whiners or babies.

(Unless you are under 1 year of age and then you are a baby…)

And if I feel something is necessary to report, I am really tired of hearing “I couldn’t care less” or “we aren’t dealing with that now” or “I don’t want to hear it.”

Because it will be mentioned and it will be heard, whether or not action is required. And if I feel it’s germain to the care of the patient, I’ll document that I mentioned it.


They may not know how or why to appropriately access an emergency department. They may or may not have the means to pay for their medical care. They may be talking on a cell phone and listening to their iPods while decrying their inability to pay for the two-hundred dollar antibiotic they just got the prescription for.

Some may knowingly abuse the system.

Most don’t realize they are doing it.

But if we can’t at least try keep a non-judgmental attitude, we are going to eat ourselves up inside with anger, disgust and tension.

It’s happening to me – I’m the only one I can speak for, really.

And I’m going to work on stopping it from going any farther.

Anybody wanna join me?


  • Nurse K

    February 12, 2008 at 10:35 am

    Anybody feel the need to join me?


  • Laurie

    February 12, 2008 at 2:57 pm

    being a professional requires ‘acting’ at times – that’s what makes you a true professional! We are all entitled to our “moments”, they key is to keep them as moments, and not months, years, or eons. Good luck!

  • Beach Bum

    February 12, 2008 at 4:13 pm

    As a former actor, I can tell you that one way an actor can come up with the required emotion is to pretend to experience it.

    The pretense can often be a way into feeling the real emotion. Pretend emotions are just one side of the emotional coin; the other side the true ones.

    Don’t judge yourself for having to “manufacture” the appropriate response, just think of it as an acting exercise to help you find your true feelings.

    I enjoy your blog.


  • ednurseasauras

    February 12, 2008 at 5:16 pm

    Think of the acting as yet another component of the job for which you aren’t compensated nearly enough. Like transporting, drawing blood, EKG’s, stocking, and moving around 1/2 forest worth of documentation, much of it meaningless and repetitive.

  • Jacob

    February 12, 2008 at 6:40 pm

    What you’ve described is what scares me most as I’m nearly beginning my nursing career. I know how easily I get frustrated with “stupid people” – I know I’ll need to work on being gracious and kind.

    I’ll join you. Be gracious.

  • beastarzmom

    February 12, 2008 at 10:03 pm

    Happens in all walks of life. I did my fair share of it working in the PICUs, NICUs, MICUs and CCUs way back when and I still do it in the medical IT world today.
    You pick your battles, and on the front lines, it’s not with patients or their families. Fortunately, most of our coworkers can empathize and understand where it came from.
    yes, I said *most*.

  • AlisonH

    February 13, 2008 at 12:03 am

    Your attitude actually did quite well. You understood why the person was hovering and commenting, you validated them by teaching them a bit (and if they already knew that stuff, well, yeah, likewise), and you did a good job. The only thing missing was a gentle smile with a bit of a chuckle to acknowledge that yes, you did know how, to diffuse the tension you were both feeling in the moment, while showing solidarity with them in what they were going through. And actually, from what I’ve seen of you here, you probably did that for them, too.

  • Rita Schwab

    February 13, 2008 at 4:41 am

    Years ago I worked in ED registration, an often facinating job. However, I eventually left because the emotional drain was too great. There are patients and families I think about to this day.

    Take a deep breath and give yourself some well-deserved praise because you haven’t given up on this challenging career.

    If I need an ED one of these days, I hope there’s a Nurse Kim there waiting for me.

  • Mon

    February 13, 2008 at 5:06 am

    I can feel you Kim. YES I CAN FEEL YOU KIM!

    I rarely have any problems with my patients, it is usually the relatives who are irksome.

    “Oh can you please slow down the IV, my sister might get cold.” Then I would answerr, “Maam, each drop of the IV is properly computed. Unless it’s in the doctor’s oreder, we cannot do much about it.” THen smilessss… yeah smmmiiiilllllllllllessssssss!!!


    Curse those relatives!!!

  • Nurse on Wheels

    February 14, 2008 at 8:59 am

    I find “acting” just in itself, tiring. The entire job is draining and then you have to smile throughout everything you do. It’s really tough.
    I can’t count the amount of times I have been complained to about the “long wait” for results, something I have really no influence on. I just think, You have had blood work, xrays, scans, and consults, 4 hours is not a long time! That stuff would normally take a weeks to come back if done on a outpatient basis.
    I do my best to update patients on delays, procedures–that whole thing, but it just frustrates me when it’s not enough. That’s when I find it hard to “act”.
    You did a great job recognizing that family member’s want for some control. You can go home and put your head down knowing you are a good nurse and tomorrow will be another day (or night).

  • Candy

    February 14, 2008 at 12:48 pm

    Him, if you weren’t a good nurse you wouldn’t care, because GOOD nurses do care. But this isn’t about caring, it much more.

    My dear, you are suffering from burnout. Not just job burnout, but, even more dangerous, life burnout. Look at what you’ve dealt with the past year and what’s on your plate now.

    Snapping at a colleague is not the problem, but a symptom. When everything irritates you, it’s a sign that you’re on the bottom of the pile. You know what dumps down on the bottom of the pile.

    The American Idol higher power covers lots of other things, too. Paradoxically, it seems to me my HP is harder to access when I really need him — I’ve been mad at mine for a year and have struggled as a result. A good place to start might be to forgive yourself for shortcomings, real or imagined, and your HP and anyone else, too, that has disappointed, hurt or been mean to you.

    Then, take a deep breath and drive to your nearest Starbucks. Get a delightful coffee beverage, go sit in a corner and DO NOTHING. Put on your sunglasses and just sit.

    Then consider this. The system is broken and does need fixing, but you can’t affectively do anything about it when you’re overhwlemed yourself. You need a break — and need to give yourself a break.

    Get a massage. Take the Coast Starlight (Amtrak) to Portland. Drive up to Stinson Beach or visit someplace quiet in Napa or even Fort Bragg. Go walk on the beach and see how the water teases the sand away.

    Then let out that deep breath and shed a few tears for what was, what won’t be and what’s to come. Reinventing, like debridement, is laborious, painful work. Just do a little bit at a time.

  • Mother Jones RN

    February 14, 2008 at 7:41 pm

    I start repeating, “I love my job, I love my job,” when I’m stressed out at work. The theory of “fake it till you make it” isn’t working for me. I don’t know that it ever will.


  • sonya

    February 18, 2008 at 6:24 pm

    Oh how I relate! I work in nursing, and if more people assessed the situation instead of freaking out, there wouldnt be so many trips to the E/R.. I bought responselink medical alarms for my parents, its too bad that everyone didnt have one,,,lol,, since the live operator will assess the situation and then call for help, it might slow our nursing duties down just a tad for non existant emergencies… JMO.,. lol

  • Lorettajo Kapinos

    February 19, 2008 at 9:58 pm

    How very well spoken!!!! Every day, at least at some point, I feel that way at work. I have phrases that I keep silently in my head to review for my own personal entertainment. The only one I will actually think about saying out loud is: “If you can effectively yell at me, then it may be safe to assume that you can breath effectively as well.”

  • Alisha RN

    February 20, 2008 at 1:48 pm

    OMG, had almost the same incident happen to me this week! Trying to teach re meds, reaction, allergies and the son went almost balistic on me. More than anything I have experienced in ANY career in my life. He asked if I wanted him to go to my ‘manager’ and in an unrestrained moment I said “Yes, yes I do, and tell her I was trying to teach the pt’s family about medications and reactions and that’s what pissed you off, just go ahead, tell her.”
    I don’t care if he did, I hope he did. I will defend my practice ’til the end.
    Maybe the same madness that is occuring out on the west coast is the same madness that is occuring here in the midwest.
    Just had my first pt die of DIC, I caught it before the MD’s did. For >48 hrs before she coded I asked 4 MD’s “could this be DIC?” Answered by, “no, she’s got other issues and a systemic infection”. I’ve never seen a pt bleed like this. A 56 yr old, bleeding from everywhere. She was a sick lady, but that was rediculous. I documented EVERYTHING.
    But that doesn’t change the fact that she isn’t here any longer.
    I always enjoy your blog, thank you.

  • Firedog

    February 21, 2008 at 5:19 am

    Kim, you are an excellent example of what we try to instill in nursing students and our new grads. You were being human and humane.

  • Carol

    February 21, 2008 at 3:26 pm

    Oh boy do I understand. The same thing happened to my just this week. I felt so bad that I snapped at my charge nurse, I kept apologizing and she finally told me that if I apologized once more she would get upset with me. Luckily she understood where I was coming from, even if I didn’t initially. As for my patients, I love every one even those that are exceptionally difficult. The family however can be rough, I had one wife yelling at me that I was incompetent, lackadaisacal because I did not jump up and start taking care of her husband the minute they walked in the door, after going home that night I realized that she was afraid for her husband and I was the closest thing that she could take it out on. Either way I don’t think I handled the whole situation very well and am trying very hard to improve on my responses to there type of situations.

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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