A patient with chronic migraine headaches who happened to be visiting from out of town came in for “9.5 out of 10″ pain. Apparently she had been around enough to know that if she complained of the worst headache in her life, she’d be signing consent for a spinal tap.
I ordered an IV and some subcutaneous Imitrex.
The nurse came back after going in the patient’s room. “She can’t take Imitrex. It gives her palpitaions.”
“Fine. Giver her IV Toradol and IV Reglan.”
A few minutes later, the nurse returns. “Toradol doesn’t work for her headaches.”
“Give her IV Stadol instead.”
The nurse walked back out of the room. “She wants IV Demerol.”
“Tell her she’s not getting IV Demerol. She can have the Stadol or she can leave. This isn’t McDonalds – you don’t get things your way.”
The patient took the medications I prescribed, her symptoms resolved and she left.
I didn’t think much about the interaction until a week or two later when I overheard the following discussion between another staff member and a patient in the waiting room.
“This is bullsh**! I’ve been waiting here for three hours and I still haven’t seen the doctor.”
“He’s taking care of several very sick patients now. We’ll call you back as soon as possible.”
“Yeah? Well it’s still bulls**t! I have seen people get called back before me and I’ve been waiting longer.”
“You know what? This isn’t McDonalds. You don’t always get things your way.”
“You’re right about that! At McDonalds, they give you service … with a smile.”
“Yeah? Well at McDonalds, the customers pay for their food.”
[string of obscenities as the patient walked out the door]
After hearing that interaction, I never used the “McDonalds” comment again. The witty comebacks stuck in my head, but it also made me realize how my offhand comments could be taken to heart by others and used pejoratively.
More recently, one of our nurses did an excellent job managing a critically ill patient. As she wheeled the patient up to the ICU, I passed her in the hall, gave her a high five, and said “Strong work with Ms. Jones, here. You saved her life!” The patient looked up at her with a smile. The nurse blushed and smiled. The rest of her shift you could see that she was happier. Don’t know if it was my comment or not, but I like to think so.
So I started making a conscious effort to compliment people when they’re doing a good job.
I say “strong work” a lot more. Now I hear other people saying it to each other.
I go into the rooms and tell patients things like “It’s lucky you have this nurse taking care of you. See how much better she’s making you feel?” The patients seem happier.
When secretaries are getting frazzled from all the work, I go up to them and say “I’m sure glad you’re working today. Otherwise we’d never be able to keep up with all the chaos. I don’t know how you do it.”
The funny thing? Even when the morale is low in the rest of the hospital, everyone is pretty happy in the emergency department. Sure, we complain about things like everyone else. But everyone likes working together.
While the rest of the hospital has been trying desperately to hire nurses to work on the floors (with a 20+ percent vacancy rate), in the past 5-6 years we’ve only had a few nurses leave our emergency department – a couple because they moved, and one because she got a significantly higher paying job at a hospital closer to her home. And there’s a waiting list for nurses in the hospital who want to work in the emergency department.
Amazing what a little recognition and teamwork can do.