Discharge Apology

We had the unlucky privilege of going to the Emergency Department last week and were surprised by some of the developments in local emergency care:

First, there was a total absence of support staff.

We had to change beds to accommodate for higher acuity patients, and we were briefly “lost” because no one was available to make the change in the electronic health record. One patient sat slumped in a chair, looking like a weary family member, with no caregiver assigned for more than an hour. When the caregiver was assigned, they had to holler down the hallway to find the patient.

In total, we moved to three different rooms during our brief stay, due to staffing loads.

We were surprised to find that there were no trash bins in the rooms. Our nurse had to keep carrying pieces of trash out of the room to some distant location. Despite this hassle, the nurse kept the rooms and workspaces clean.

There were no call lights in any of the three rooms we moved through. Is this normal now? Elderly couples wandered the halls, asking anyone that looked like they worked there if their labs results were available yet and whether someone could tell them where the bathroom was. Parents tortured us all playing Baby Shark on repeat in a desperate attempt to strong arm a doctor into coming and seeing about their children’s bone fractures.

When our nurse was assigned, things got better fast. He asked open-ended questions, allowing us to share the history clearly and in our own words. He assessed risk and took action to prevent falls and medical errors by following evidence-based protocols and explaining what he was doing and why. His care delivery skills in drawing labs and placing an IV were excellent, and he was able to answer questions when he provided education.

That was when the real shock came: At discharge, the nurse who had delivered such excellent care began a discharge apology.

You know those sad stories where a relative feels they need to apologize for another family member’s outburst at a wedding?

That’s how it felt to listen to this nurse apologize for the system issues in the ER.

After doing good work, he took personal responsibility for administrative decisions that have led to some risky and inefficient realities.

Why is the bedside nurse apologizing for system issues?