On The Attitude Of Nurses Who Have Given Up On Wiping Bums

A bit of a moan this one – I know, I know, I almost never moan…

Our job was to a middle aged man with sudden severe back pain. We arrived and soon determined that it was simple sciatic back pain. Our patient didn't speak much English but his wife was fluent (and given her East end accent she was probably born in England).

The thing about sciatic back pain is that gentle movement often helps it – so what we, as an ambulance service, do is fill the patient up with painkillers and walk them gently out to the ambulance. Then we transport them to hospital.

The thing about sciatic back pain is that we tend to see only the people with the severe version of it. They are often lying on the floor clutching their back, unable to move. Part of our treatment is explaining what is happening to the patient and building up a relationship so that they can trust us. It also helps with the pain.

We spent an hour on scene with the patient – giving him blasts of nitrous oxide (laughing gas) and slowly persuading him to get to his feet, and then, with more analgesia, getting him to walk out to the ambulance. Luckily he was pretty good with just the gas – it's not unheard of for us to give morphine in order to get the patient moving.

By the time we reached the ambulance we were all having a joke about it, with his wife explaining to him that this is what it is like to squeeze out a baby…

Then, as carefully as possible, we drove to the hospital.

Once at the hospital we put our patient in a wheelchair, the reasoning behind this is that sometimes you'll get trollies, or patients, that need to be moved around at speed and it's not good to have a slow moving patient blocking the corridor.

We think ahead like that. For us ambulance people are not dumb, we is smart!

The problem that I had was that of the attitude of two of the senior nurses (the type of nurse who, half the time, doesn't wear a nurse's uniform). There was a general rolling of the eyes that we were giving the patient pain relief.

“Why are you giving him nitrous oxide?”, one said.

(Here is a clue – if I write on my report form that a patient is in severe pain, but don't do anything about it then one of my managers has a damn good reason for calling me into the office for a chat. Plus it's also the human thing to do).

“Why did you bring him here? All we can do is give him pain relief”, one asked.

Well – I generally thought that this is the point of hospitals.

Patient in pain = patient needing painkillers.

The patient had already been taking regular painkillers for a grumbling back pain – so it wasn't as if he hadn't tried self treating.

Out of earshot of the patient these two nurses tutted and grumbled about him. They actually treated him well, but it was the attitude that I found incredibly annoying.

I'm more than happy to have nurses unhappy when I bring them the umpteenth drunk of the shift – heaven knows I used to get fed up with that when I was an A&E nurse. Also nurses, like the rest of us, can have 'bad days', but two of them? At the same time? In this case the patient had a genuine medical need, primarily for pain relief and secondly so that a doctor could assess him properly to determine the cause of the pain.

What annoys me, a few days later, is that I didn't challenge the nurses. I was feeling really rather grotty with (yet another) bout of man-flu, so I just let it slide. Nothing happened that would warrant a formal complaint as the patient was treated as he should have been and the nurse (in a proper nurses uniform) who actually looked after him was her usual excellent self – but the attitude of the senior nurses just rubbed me up the wrong way. If I'd been feeling more myself I might have asked when the NMC/RCN guidelines on pain management had changed, or why they thought that he deserved to be in excruciating pain.

I don't know, maybe I'm getting soft in my old age. Or maybe it's because I'd spent an hour getting to know him and his wife, and didn't see them as 'just another face blocking up the department, causing a breach'.

16 thoughts on “On The Attitude Of Nurses Who Have Given Up On Wiping Bums”

  1. Some “nurses” forget that the A&E departments in which they work are there to serve the patients' best interests.My nurse manager yesterday was rolling her eyes, tutting and complaining because I brought back a patient I'd just discharged after he'd fainted again in the waiting room on his way out. He was already at 3 3/4 hours, so me bringing him back to observe him a bit longer meant that he breached.

    In her eyes, I should have left him lying on the floor.

  2. I must admit that having spent more time in hospital than is healthy (over 3 years as a surguical inpatient in 40 years), I have seen pain relief over used to keep distressed patients quiet and withheld to ensure compliance (“Just let me do procedure x on you Mr Jones and then you can have your painkillers”). Whilst everyone is allowed bad days, to do this smacks of unprofessionalism to me. Pain, whilst subjective, is very real and often more crippling both physically and mentally than more functional injuries.I have had difficulty when presenting with injuries that don't cause me much pain due to reduces sensation. This will often lead to me being triaged further down the scale than someone with the same injury and 'normal' sensation. Despite not being able to feel it, the damage is just as bad, if not worse. For example the injury that led to me losing my leg didn't hurt at all when I did it.

  3. Having spent a large chunk of my weekend in A+E with my mum, I say hip hooray for the lovely folk who looked after her, we had the people seeing caring sort all along, although I now realise why she was moved along at 3 hours fifty! It was a stark contrast to the last visit where we got the nurse who treated little old ladies as though they are invisible

  4. I can't make an educated comment on treatment.What I can say is, with (ouch!) 14 years experience, sciatic backpain KILLS – not physically, mentally.

    I cannot function when my back goes out, I would eat babies (my own, if I have one) I would drown continents to make it stop.

    And then of course regret it (this is how torture works – also, vivisection).

    “All we can do is give him pain relief” – on a massively painful part of his nervous system that is trapped, and screaming?

    Oh honey, let me take you home with a Black & Decker drill, and your own sweet kneecaps, and you might learn a thing or two about treatment priorities.

    Sorry to be so brutal, but I only woke up to a lot of issues when I realised what real pain was, and it isn't funny or kinky or brave, it is beyond those defensive definitions.

  5. Maybe she used to be a midwife – they definitely don't approve of pain relief!PS I shouted at the tele on your behalf this morning – BBC saying about FRU's being quicker & cheaper somewhere in SW.

  6. A friend of the family suffered increasingly bad back pain which was misdiagnosed as sciatica and others by GPs and hospital staff on many occasions. When talking about this seemingly mysterious pain to another retired GP friend and about her history of breast cancer he suggested she get tested for bone cancer. The tests were positive but too late and she died a few months later.We were amazed that her GP and also A&E staff that she had seen before did not suspect this when they knew the same history – your post goes a little way to explaining why that might be…

  7. I too have been suffering from this for the last 10 years, some tiems you can go weeks without any pain (even months!!) then you knwo when you going to get a bout of it, mine is numbness is my knee cap and pins and needles in my footI had this happen once when i lived briefly in spain (company paid medical expense are such a blessing)

    After spending ages trying to lie down and not wake my girlfriend with my constant movements, i tried lieing on a hard flor, bending everything i could and nothing worked, the slightest movement woke me in pure agony, the movement of my ankle to bending my knee

    But my cure was a short taxi ride away, popped to a 24 hour clinic (at 4am) and apologised for waking the doctor up, he lay me down and asked me to lift my leg (i manaed about an inch if that), he looked at me grabbed my foot and lifted, and i have to say i damn near passed out from the pain, he then gave me the sweetest feeling needle into my back and within 60 seconds the pain was gone, went home to sleep and awoke the following morning and was pain free for following six months

    Sadly i am now suffering from it again and currently awaiting my physio Orthapedic triage (my second in 2 years) so i can have physio again, Pain relief works (pharmacy strength co-codamol) but leaves me too stoned to even work these days!

  8. Having both suffered through some serious back pains and working emergency rooms on weekends I have to get into the breach for the nurses … since — in the end — the patient was taken care of.I just remembered all the talks we had during our “hey there's only walking wounded left in the overcrowded waiting area [1] lets get squeeze in this first smoke and coffee for six hours”-breaks. Most of the patients we talked about seriously could have sued us for the comments we made about them.

    Now — eight years later — I know I should feel sorry about this really inapropriate behaviour but alas I can't. Most patients we mouthed of about were suffering from serious priority problems [2] and/or boredom [3] — which might be really unenjoyable for the patient but not within our jobdescription.

    So it might also have happened to me — had I been on the receiving end of your patient — that he would have gotten a GOMER [4]-sticker and the connecting comments.

    And concerning the administration of pain-relief by pre-hospital staff (of which I approve from the patient's point of view) I've seen patients with “severe pain of unclear source” so drugged up in my ER they couldn't even remember where they hurt — clogging up one of our scarce spaces for hours on end just to sober up so we could start tratment.

    [1] During “normal” days we would have to handle twice as many patients as our staff plan was made up for — weekends saw twice as many patients coming in.

    [2] Legendary: The guy who walked in one sunday-afternoon to get his hand fixed. It had been broken three weeks earlier.

    [3] After getting drunk yesterday I have this really bad feeling in my chest. It must be an heart-attack.

    [4] Get Out of My Emergency Room

  9. Going a bit OT, “natural birth” advocates never seem to be fans of natural (ie anaesthetic-free) dentistry, do they? Yet what could be more natural than a tooth coming out….

  10. “So it might also have happened to me — had I been on the receiving end of your patient — that he would have gotten a GOMER [4]-sticker and the connecting comments.”I'm just curious: what if the ambulance staff were also having a bad day, or the person dealing with this wasn't very assertive, you could have a patient in clear need of treatment, left to suffer….

    Most of us like to have a gripe about our jobs, but it's been my experience that in some places that attitude becomes toxic and instead of being a steam-vent to help deal with bad situations, actually starts to create them instead.

    At what point does the repeated consensus opinion that “some of our patients/clients/customers are tossers” start to cause serious failures, which affect the ones who are genuine and need help?

    (None of that is meant as a personal comment at/about you, just a general question.)

  11. My jaw is on the floor. What kind of training did these nurses have? Back in the 80's we were taught that “Pain is whatever the Patient says it is, and it is our job to make them comfortable.” This idea got me into trouble when I started working in an American clinic. A woman had been refused pain medication by her doctor. She was in a wheelchair, in the radiology department where I worked, wailing and telling me her woes. I flipped at the doctor. The next day I was reprimanded. (It was calmly but icily explained to me that some patients are drug-seeking, and that I should never EVER question or criticize the doctor in front of his patients. Ooops.)

  12. Different thing entirely. Giving birth is painful but not pathological. Many perfectly sensible, normal women give birth without epidurals etc and it has nothing to do with being 'weird' or 'against drugs'. It has to do with trusting in the process and having effective coping strategies. And midwives aren't against pain relief, but that's all very well saying that to someone who we know is too late for an epidural- but they won't believe you till it's over!

  13. Hmmn, not sure I agree – women (even in the UK) still die delivering babies, which sounds pathological to me. The less medical help available the higher the death rate (in general) which indicates that it's not such an easy, natural process.Theoretically, recovering from most kinds of infection is a natural process most people should be able to do, but many wouldn't make it without intervention.

    Also, I've known women traumatised by a bad birth experience who either went on to choose elective C-sections, or refused flat out to have more children, not to mention women left incontinent or needing fistulas repaired after childbirth, and again, I would call that pathological.

    And nothing is more natural than death, but a lot of people like painkillers for the last stages of that, I've met very few proponents of “natural death by cancer”….

  14. Unfortunately the story of this man with his back pain doesn't surprise me at all. I recently had a long running bout of neck and shoulder pain which came on suddenly (having never suffered with this before) It went on for well over 6 months before I managed to get a scan to find out what was wrong, in the meantime survivng on pain killers that had no effect, and being unable to sleep for more than about 3 hours a night. I couldn't move my arm properly, carry anything and had numbness and pins and needles in my hand. The pain got increasingly worse, to the point that I was so exhausted, and beside myself with pain that my husband took me to a+e. When I saw the doctor after pacing and crying for a few hours (which I understand completely) I was offered weaker painkillers than the ones I was taking and told to go home, this pain may never ease up I may well just be stuck with it forever (!!!!) I'm sure you can imagine how this made me feel!Eventually I got a scan, which showed I had a slipped disc in my neck which was pressing on a nerve which runs down my arm (by this point i already knew this as I had been seeing a chiropracter, and had x-rays done) Eventually I was told I could be referred to see a specialist, but this was also going to take an awfully long time. In the end I saw the surgeon privately and had the disc removed, and was completely pain free after a week! It took 10 and half months from beginning to end… there were times when I literally would have taken ANYTHING to ease the pain… in the end I was on gabapentin, morphine, and a hotch-potch of other things (32 tablets a day) and was still in agony!

    I don't think back and neck problems are taken anywhere near seriously enough, and the amount of pain someone is in should really be taken into account! I understand the NHS struggles a great deal financially, it just felt inhumane!

  15. PS On reading (and empathising with) Chilipepper's post below, I want to clarify that my beef is not with people who choose painkiller-free childbirth for themselves, I don't take pills for headaches or most period pain, it's with ANY attitude that says severe pain is part of a natural process and therefore, should be tolerated.”In sorrow shalt thou bring forth children.”


    Any severe and prolonged pain can and usually DOES cause trauma that lasts, that is my gripe, not choices made by people who are willing to put up with pain for whatever benefits they (me, occasionally) feel they gain by refusing medication.

    But it should be the patient's choice – and re timing of epidurals, my mate got repeatedly turned away from hospital until the baby was coming out of her cervix, so late epidurals could be down to misdiagnosis as much as anything?

    And as Tom mentioned, and my repeated experience shows, painkillers don't just offer pallaitive care for sciatica, they actually are part of the treatment by relieving inflammation, and more importantly perhaps by allowing the patient to move a bit more, and so undo the muscular tension trapping the nerve.


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