Politeness Costs Nothing

“Come!”, she said to me.

She didn't even glance over her shoulder as she repeated, “Come”.

“Oi!”, I said back to her, more than a little miffed, “Don't talk to me like I'm one of your clients”.

—–

We'd been working on the edge of our area so it was a pleasant surprise to find ourselves sent back to our own patch.

Top priority call – a transfer from the Mental Health Unit to the A&E department. All of 400 yards.

But no matter, the patient apparently had a swollen foot, and the mental health unit can't treat that – given the nurses I meet there I doubt that they could treat a shaving cut. We do this all the time, transferring patients this short distance.

I wasn't sure why this was a high priority call, apparently the nurse wanted it to be so. As they are on the scene and are apparently a trained professional our Control follow their lead.

So, at risk to me, my crewmate and any members of the public dumb enough to get in my way we blue-lighted it to the unit.

At the unit we were met by the the nurse who said nothing to me except, “Come”.

This is not the best way to get into the good books of the nice ambulance man.

She mumbled an apology as I followed her to the patient. There was another nurse in the patient's room and the patient was laying on the bed. I asked the nurses what the problem was; they looked at one another and umm-ed and aah-ed before telling me that she had a painful foot.

I looked at the patient's foot, it was a bit swollen and the blood test results in her notes showed an infection. She'd had the problem for at least four days.

“Who called the ambulance?”, I asked.

One of the nurses admitted to being the guilty party.

“You see, by asking for a blue-light response I have had to drive to this call with the same speed and risk as if I was going to someone who is having a heart attack”.

“She isn't having a heart attack”, said the nurse.

“I know, that's why it is inappropriate to ask for a blue-light response for a case like this”.

The nurse made no indication of understanding.

We spoke to the patient, she was refusing to go to the hospital, I tried persuading her but she was adamant that she wouldn't be leaving the bed.

I asked the nurses about the patients mental health issues.

“We don't know”, one nurse said, “she's only been here four days, so we don't know much about her.”

Ok – fair enough, maybe she has a long and complicated mental health history.

My crewmate flicked through her notes, “Says here that she is delusional and hasn't left her bed in two years”.

Yeah, that'll do for a history – seems that my crewmate suddenly knew the patient better than the nurses who'd been looking after her for the last few days.

The patient was refusing to leave the bed, she told me that one reason for this was that her foot hurt.

I turned to the nurses, “You've been giving her painkillers?”

“Yes”, they replied, “Paracetamol”.

“O.K. Paracetamol is a painkiller, that's good. When did she last have a dose?”

“Yesterday”.

“Errr, you know it only lasts about four hours”.

The nurses looked sheepishly at each other.

I continued, “what you are saying is that this patient has been in pain, yet she hasn't been getting any painkillers. Is there any reason for this?”

The nurses said nothing.

We finally managed to get the patient to the hospital, accompanied by the traditional nurse escort that doesn't know the patient at all.

It was a stroke of luck that my complex manager was on station as we pulled up. I let her know what was going on, I let her know that we'd been run on blue lights across town so that we could quickly get to someone who'd been unwell for a few days, I let her know about the nurse being rude to me and I let her know that the patient hadn't been given painkillers.

She took our paperwork from us and promised to bring it up in the meeting that she has with them later this week.

It's nice to have a manager who supports you – but without having a complete turn-over of staff at the unit I can't see there being much of change. This isn't the first time I've had a problem with this unit.

15 thoughts on “Politeness Costs Nothing”

  1. I agree with your management point. I currently am in a situation of too many cooks, some of which are fantastic and can see how the problems have arisen and others who immediately point the finger at moi for being the one to mention it, let alone repot it.Good for you for telling the nurses though – there are too many out there giving us hardworking (not always perfect) nurses a bad name!

  2. I don't know what to say, Tom. Obviously this is not your first bad experience with that unit. But I am afraid you wouldn't get a better impression if you came to my unit and handed over to one of the two stupid cows we have there. The rest of the people working there are marvellous, but those two let down the whole ward. Everyone knows about them (including the managers) but there is nothing else we can really do. After all you can always learn things like techniques and stuff, but things like politeness you either have them or not.

  3. Unfortunately Tom, this seems to be a national and international trend with regard to politeness, now I could bang on about moral fibre etc etc but it would do no good I am afraid. There are sections of society who just do not have the “polite gene” and unfortunately it is an increasing segment. I am not going to try and solve the problem as there is little or no point, I am just going to continue in the way that I was taught by my parents, treat others as you wish to be treated yourself. It works for me, and if I come across a rude patient, health care practitioner or anyone for that matter, I continue to be as polite as I possibly can, if not more so. I then add at the end of anything that I say that it is possible to be polite, I have proven that by what I have just said/done. It usually makes them a little embarrassed, sometimes it works other times it flies right over their heads.As for the way in which homes and units continue to use and abuse the ambulance service, I am very sorry to add that that won't change much either, I echo earlier sentiments that its not always a true picture of the unit/home, but unfortunately its the picture that the incompetents are painting. We have several in our area that we attend to, most of the calls are non-urgent but they want to get them out of the unit so they don't have to bother with them. No matter how many times I explain to them that it would be advantageous to all concerned if someone where to greet the FRVs/crews at the front door, so that we didn't have to stand outside for 10 minutes, it just seems to go in one ear, out the other side and settle down nicely in the wall paper on the other side of the room…….

    Hey ho

  4. Having worked for most of my career in A&E, and having to deal with obviously unwell psychiatric patients and the reluctance of the same-site mental health unit to take responsibility for them I can empathise with you.I'm particluarly ashamed that these 'nurses' seem to have no idea of how to provide basic care for a patient in their charge. I spend time replying to the the scattergun approaches of folk like Dr Crippen who lambasts other HCPs who extend their roles. Actions like these make our position difficult to defend.

  5. I asked the nurses about the patients mental health issues.”We don't know”, one nurse said, “she's only been here four days, so we don't know much about her.”

    Ok – fair enough, maybe she has a long and complicated mental health history.

    I think you're probably being a bit over-generous in your opinion there. Okay, they may not have much info about her previous history, but she's been on the ward 4 days and they can't tell you about her mood levels (depressed? elated?), if she's describing any delusional ideas, responding to hallucinations, if she's attempted to harm herself or others…? All things that would be pertinent for you to know and they should be able to tell you. If they can't, they're not doing their job.

    There's really no excuse for it. I know us RMNs are notoriously rubbish at dealing with physical health issues (just as RGNs are equally rubbish at dealing with mental health) but there is such a thing as common sense, and they clearly weren't displaying any of it.

    A foot infection? If they were worried, why didn't they just bleep the psychiatric SHO to take a peek at it? It's what I would have done

  6. Sadly, this is exactly the sort of 'dumbth' I have seen in my last 3 jobs. It's not just impoliteness, it's total apathy and lack of caring a damn about people. Each place has its good staff but, of course, when nothing is done about oafs like these, the good ones leave….often. I don't know where they go but I fear some of them leave the profession altogether through lack of support and respect for the good work they do. Whilst behaviour like you descibe is allowed to go unchallenged, the hard workers get despondent.

  7. I am lucky that I haven't had an encounter with any nurse as rude or seemingly inept as this. There are a couple of nurses at the hospital I frequent who I know are abrupt and seemingly impolite but I have come to accept that it is the way they are.I have also come across some nurses at other hospitals who look at you like you've just be removed from the bottom of their shoe and don't even bat an eyelid when you hand over never mind listen. This is the reaction that really annoys me, at the end of the day we all have a job to do.

    What ever happen to manners and common politeness?! (slow realisation: I'm starting to sound slightly older than my 24 years!)

    http://ambulancenut-learningtheropes.blogspot.com

  8. I *am* being overgenerous.To be fair the Psychiatric SpR had looked at the foot and somehow managed to persuade the orthopods to accept her. She'd been in A&E the day before, so I think it was a bit of a failing all round.

    I don't expect RMNs to be great at physical things, but I'd expect them to be able to arrange analgesia.

    Here is my problem – for thirteen years or so, as an A&E nurse and as an ambulance worker, I can count on the fingers of one hand after a tragic accident with farm machinery the number of psychiatric referrals that I've made where I haven't felt that the RMN or Psych Dr. have been trying to shift the work onto someone else.

    Actually, that's a lie – the psychiatric liasion team at the Whittington hospital were superb.

    But you know, I do *try* not to tar everyone with the same brush, and if the internet has taught me one thing it's that there *are* good RMNs, ASW, etc. out there.

  9. Bloody hell.And that's hardly the way to speak to anybody (until they lose your respect / right to dignified treatment through certain behaviours), especially people that are in a mental health unit, and are depersonalised enough as it is.

    GRRRAH

    Pardon me, also. Two of my closest friends are regular mental health unit patients, and their “treatment” disgusts me (and them).

    The word “nurse” does not describe those people you were having to work alongside.

  10. More slagging off of acute nurses. More pontificating by fellow healthcare professionals about a situation theyve just walked into without really knowing anything about it.Firstly – transporting patients to A&E via ambulance was policy in my previous clinical area, even though A&E was about the same distance away as in this story.

    Secondly – delusional, hasnt left bed for two years may well be enough of a history for an ambulanceman, but onbe would hope mental health nurses required a bit more information about a person.

    Thirdly – acute units across the country, but particularly in London, are plagued by poor staffing levels, the overuse of bank and agency staff, poor continuity of care as a result and enormous pressures in terms of bed occupancy, acuity of patients and complexity of presentations.

    Lastly – yes, calling a blue light ambulance was inappropriate, yes the under-use of analgesics was poor practice (but may have something to do with the staffing/continuity of care issues I mentioned earlier) but what purpose is served by this kind of sneering snidery between people who should be, lets face it, all in this together? Raising a complaint with the unit manager might have been more helpful than just raising it with your boss in what sounds like a kind of “yar boo sucks look what those rubbishy nurses have been doing NOW” kind of a way.

  11. The issue of analgesia is an interesting one.I wonder if the patient had declined analgesia, rather than not having been offered it ?

    It is always worth remembering that mental illness does not automatically equate with lack of capacity so medication cannot be forced onto a patient if they prefer not to take anything – this has always been a potential minefield in mental health especially when patients suffer intercurrent psychiatric and physical problems.

    An inflammed foot (gout, cellulitis, septic arthritis, etc) is almost always best dealt with by an NSAIDs rather than paracetamol (assuming there are no contraindications) so perhaps there are issues about the initial management by the psychiatrist, or A&E doctor who had both examined the patient before referral ?

    Many people have strange ideas about analgesics – they stagger into A&E virtually crying because of back pain, headache, joint problems, etc, but look in horror at the triage nurse when asked if they have taken anything for it (before answering no, they haven't – even though they've had symptoms for 3 days).

    Mind you it's hard to give the nurse the benefit of the doubt when they exhibit such poor communication skills, notwithstanding beakies robust defence, of course ;o)

  12. I'm not moaning about the transporting of patients, while I think that there are better ways to do so than the use of frontline ambulances I'm utterly at the bottom of *that* food chain.The psychiatric history that I am looking for is what is relevant for me to (a) transport the patient, and (b) handover the patient to the nurse at the other end. It doesn't need to be some nicely DSM IV diagnosis, but knowing that the patient refuses to get out of bed meant that trying to get her into a chair wasn't going to work, but that a stretcher would work fine.

    The nurses in this case just looked at each other and shrugged – their sole response to any question about the patient was to say 'the doctor knows/says so'.

    I'm well aware of staffing pressures – I do also work for the NHS… But that doesn't excuse things like not giving a patient who is in pain and is asking for painkillers a paracetamol. If it *does* mean this then we may as well all pack up and go home.

    Now, imagine that you are a unit manager – who would you pay more attention to? an 'ambulanceman', or the ambulance head of Complex who has spoken to your boss?

    It's not snidey sneering – it's me highlighting that there are some crap nurses out there, and if you don't believe that then you have had a very different experience to me – and you are lucky for it.

    Or should I let what I consider bad practice slide? Or should I raise the issue with someone who should know if what I experienced was bad practice or me just getting the wrong end of the stick.

    And if I get called to you should I assess you by grunting a “wot?” at you?

  13. Oh agreed – it was the patient that asked me for a painkiller before we tried moving her because her inflamed foot was hurting so much. While I can't be sure that she wasn't refusing analgesia earlier it would seem unlikely.I'm very much aware of capacity – the patient didn't initially want to go to A&E, and she appeared to have capacity to refuse. I had to tell the nursing staff that there was no way I was going to wrestle an elderly lady out of her bed against her will.

    Agreed also about the NSAIDS, but life is sometimes too short for a jumped up truck driver to be questioning such things, and the patient was going to be admitted under the orthopods, so I'd assumed that they'd sort something more appropriate out.

    And yes – I've taken to not bothering asking if my patient who is in the worst pain of their life has tried taking anything for it. In fact if a patient says 'yes' to that question we feel like throwing them a party, it's that unusual.

  14. Regarding the use of ambulances – as I said before, that was policy where I used to work. Something to do with health and safety and the inability of the general hospital's porters to do the job. I suspect the nurse who booked the ambulance was not aware what a blue light ambulance actually meant and just said yes when asked if she wanted one. Yes, she could have asked.And it might have been helpful for you to ask specific questions relevant to your business there rather than just ask for some vague “history”, which means many things to many people.

    I have been a unit manager and I would listen to complaints regardless of the source. I might be a little pissed off that you didn't come to me first, to be honest.

    I'm not saying that these nurses were shining beacons of good practice, far from it. But as an old acute nurse, I do get somewhat tired of people slagging them off when they've just bobbed in for a couple of minutes and have no idea of context or even of what goes on on your average acute ward on a day to day basis. Sometimes, one or two particularly difficult patients can take up an entire shift, which means that other, quieter patients such as this woman don't get the care they need. Blame understaffing.

  15. I was only recently introduced to this blog, so sorry for necro'ing the storyline here by a year and a half. I've been reading like a madwoman the last two days – ever since the first post I stumbled upon… and this has lead to a bleary eyed first thing in the morning peek and more of your writing.As a side effect, I mis-read a bit on this one….

    This: 'But no matter, the patient apparently had a swollen foot, and the mental health unit can't treat that …'

    Was read as: But no matter, the patient apparently had swallowed a foot, and the mental health unit can't treat that…'

    Thought I'd she are the giggle with you 🙂

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