1 Emergency Medicine

Emergency Medicine: A Letter to Rhonda

Alyssa Folse
Louisiana State University

Authors Note:
The following Rogerian letter was written for English 2001, taught by Jean Coco, and

addresses issues raised in the case study The patient in 4: Framing and Sense

Making in Emergency Medicine, published in Health Communication in Practice: A

Case Study Approach.

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Dear Rhonda,

As the resident physician working in the emergency room I understand that there is

a lot of responsibility. We, as nurses, have peoples lives in our hands from the

moment we clock in to the moment we clock out. This means you must be

responsible for assessment, medication, care coordination and even goal setting. As

a nurse in charge you often need to be assertive and organized. It is up to you to

follow protocol and when not to for the sake of the patient and efficiency. We nurses

must make split second decisions and sometimes you dont know what is best until

after the outcome.

Emergency medicine becomes even more stressful because of overcrowding

and nurse shortages. the emergency room attracts Americans with all types of

ailments and all types of health plans so a nurse must be a diverse character when

switching from patient to patient. (Clark) When the patient in room four arrived with

a head injury you were right when you noticed it was a serious condition. Ordering

him the tests was the right way to go. When Nicki returned from her break she was

not informed about your order to not move the patient until the head CT. She was

never told that you put in a bed slip before the CT results returned. I, Sonya, who

took Nickis place while she was on break never informed Nicki about this order

either but she also did not know that was her job.

While patient care and safety is the most crucial factor in the ER, a nurse

must also think about error elimination. Keeping errors to a minimum can be done

by communicating verbally and written. When mistakes happen, they fall back on

the person in charge. In this case, thats you. This can be overwhelming especially

when dealing with a crowded Emergency room. In Nickis perspective, she was
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following written directions and was never informed on your verbal orders about the

patient. When thinking about all sides of this situation there is no true side. This

mistake was series of events that happened in just the right way at the right time to

cause a failure in the Emergency room.

When working in emergency medicine, a nurse holds many responsibilities,

some being: assessment, goal-setting, medication management, and care

coordination (Sokol). The issue with the patient in room 4 deals with the assessment

and care coordination. The patient was assessed, but his chart was not updated

with the status of his orders. The team of nurses that came on during shift change

were not informed about verbal orders which is why he was sent to a room early.

When leading an Emergency room a person should be focused on the patient,

collaborative with team members, structured, and flexible. (Sokol)

If there was a white board in the original room the patient was put into and it

had the orders from you written then maybe nurse Nicki would have known to hold

off on the transfer. In a study done by the University of California, San Francisco all

providers found their [the whiteboard] potential as a tool to improve teamwork,

communication, and patient care. (Seghal et al.) As a nurse in charge, I understand

you needed to be assertive when you corrected the situation, but I do believe you

should be appropriate also. As a leader, you should talk to your coworkers with the

proper tone and effectiveness. Yelling at Nicki in the hallway for the entire staff and

patients to hear was in effected and lowered the moral of the work place and

patients uneasy. You should practice talking to your coworkers that make mistakes

effectively and calmly. When you are in charge, it is easy to expect people to

accomplish the job the same way as you, but that is often not the case. You need to

be mindful and accepting of all peoples skills and resources.

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Not all failures can be avoided, but they are best handled when the team of

workers openly communicate orders and carry out a routine. Emergency medicine is

overwhelming and stressful but I believe it helps when communication is frequent.

Having something as simple as a whiteboard could prevent some of these mistakes

that are commonly made. Speaking in a respectful manner to all staff on an even

playing field keeps the work environment positive and efficient. I think Nicki would

agree that if you spoke to her in a respectful way she would have learned from this

situation. I also believe that if she would have later explained to you the issue from

her view, you would have been understanding. I appreciate you taking the time to

hear me out on this issue and I hope you consider my advice as a fellow nurse.

Best of luck,

Sonya
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References

Murphy, A.G (2005). The patient in 4; Framing and Sense-Making in Emergency

Medicine. Ln Ray, E.B. (Ed.), Health Communication in Practice: A Case Study
(pp.285-295). Mahwah, NJ: Lawrence Elbaum Associates.
Clark, C. S. (1996, January 5). Emergency medicine. CQ Researcher, 6, 1-24.
Retrieved from http://library.cqpress.com.libezp.lib.lsu.edu/
Sehgal NL, Green A, Vidyarthi AR, Blegen MA, Wachter RM, Patient Whiteboards in
the Hospital Setting. J. Hosp. Med 2010;4;234-239. doi:10.1002/jhm.638
Sokol PE and Wynia MK, writing for the AMA Expert Panel on Care Transitions. There
and Home Again, Safely: Five Responsibilities of Ambulatory Practices in High
Quality Care Transitions. American Medical Association, Chicago IL 2012.
Available at: www.ama-assn.org/go/patientsafety