JOURNAL OF EMERGENCY NURSING

jec t s and followed the r andomiza t i on p roce s s pro- v ided wi th the s t u d y guide l ines .

In r e s p o n s e to q u e s t i o n four, unfor tunately , the s t u d y has no t ye t b e e n r ep l i ca t ed in the NICU wi th smal ler g a u g e ca the te rs . There is cer ta in ly a n e e d for further i nves t i ga t i on wi th #24 g a u g e ca the te rs , as

well as for longer pe r iods of t ime. I con t inue to a t t e m p t to s t u d y t h e s e a reas in our ins t i tu t ion . Thank you for your i n t e re s t in the study.--Karen LeDuc, RN, MSN, The Chfldien's Hospital, Denver, Colorado

Men also have circadian rhythms

Dear Editor: I wou ld like to b e g i n b y s a y i n g tha t I a m a p roud

m e m b e r of ENA a n d t ha t t he Journal is def in i te ly on the top of m y "to r ead list" w h e n e v e r a n e w i s sue is pub l i shed . Keep up the g rea t work.

I w a s thri l led to r ead the ar t ic le r e g a r d i n g the u n i q u e cha l l enges of the n igh t shift. I have worked n igh t s s ince 1992 and would not have i t any o ther way.

It t ruly is difficult to expla in to a non -n igh t s per- son exac t ly w h a t h a p p e n s b e t w e e n the hours of 7 PM and 7 AM. M a n y of m y fellow nur ses and I have to s top and consc ious ly f igure out the correc t d a t e before w e b e g i n d o i n g a p a t i e n t men ta l s t a tus examina t ion .

I m u s t a d d r e s s one po in t m a d e in t he article: t ha t t he d e t r i m e n t a l effects of n igh t - sh i f t work affect w o m e n more t han men .

I have w i t n e s s e d the equa l i za t ion of s taff ing be - t w e e n the s exes and da re to s ay t ha t t he rat io of m e n to w o m e n in nu r s ing pos i t ions nea r s 1:1, espec ia l ly at night , e spec ia l ly in the e m e r g e n c y d e p a r t m e n t .

M e n m a y not have a "nur tur ing impera t ive" pe r se, bu t w e also feel t he ob l iga t ion to s p e n d t ime w i th our loved ones w h e n our b o d i e s are c ry ing "SLEEP!" I have of ten s lep t a m e r e 3 to 4 hours only to a w a k e and a t t e m p t "normal" i n t e rac t ions wi th m y family a n d fr iends.

I wou ld b e i n t e r e s t ed in s e e i n g the conc lus ion and /o r s u m m a r y of cumula t i ve effects of work ing the n igh t shift on ED nurses as a whole, r ega rd le s s of gen- der.--Brad Cohen, RN, BSN, CEN, Atlanta, Georgia

Customer service still running amok

Dear Editor." "Cus tomer Service Assoc ia t e " or "Emergenc y

Nurse": r ecen t ly I 've h a d t rouble d e c i d i n g w h i c h to p u t on m y n a m e tag. Our e m e r g e n c y d e p a r t m e n t ' s n e w corpora te a t t i t ude d e n i g r a t e s m y prac t ice . Granted , a c u s t o m e r sa t i s fac t ion pol icy is helpful w h e n p r o m o t i n g efficiency, b u t I re fuse to cons ide r the p a t i e n t s u n d e r m y care m e r e "cus tomers ." W h e n w a s the las t t i m e tha t you he ld a customer's h a n d whi le he

or she w a s e x p e r i e n c i n g an a c u t e myoca rd i a l infarc- t ion? A c u s t o m e r p u r c h a s e s services; a p a t i e n t n e e d s m y care.--Jonathan Nelson, RN, Emergency Depart- ment, Swedish Covenant Hospital, Chicago, Illinois

Dear Editor." Though I a m a phys ic ian , I a m also a m e m b e r of

ENA, and I a lways look forward to r e a d i n g Journal of Emergency Nursing. Please a c c e p t m y a p p r e c i a -

t ion for a very well wr i t t en and carefully t h o u g h t out g u e s t editorial , "Cus tomer Service Run Amok" (1997; 23:514-5).--Thorn A. Mayer, MD, FACEp FAAP, Chairman, Department of Emergency Medicine, Fairfax Hospital; Medical Director, Flight Services-- Inova Medical AirCare

Dear Editor." I a m wr i t i ng to t hank you for t he g u e s t edi tor ia l

you p u b l i s h e d in the D e c e m b e r 1997 i s sue of the Journal . I a p p r e c i a t e so m u c h tha t s o m e o n e finally w a s able to s ay th is out loud, in wri t ing, and actual ly have i t pub l i shed .

I have b e e n an ED nurse for 12 years . Before that , s ince 1977, I worked as an ED Aide /Tech . I have worked in Missouri , Oregon, and n o w Florida, so I have h a d a s a m p l i n g of the publ ic in severa l a reas of the country. Throughou t the years , I have no ted a s t e a d y dec l ine in the abi l i ty of pa t i en t s and vis i tors to let oth- ers who are more ill b e the priori ty r ec ip i en t of care. The a t t i t ude of ME NOW is b e c o m i n g more p reva len t r ega rd les s of the s t a tus of the pa t i en t a i lment .

The wors t even t I ever w i t n e s s e d w a s w h e n a co- RN w e n t into t he w a i t i n g room after t he re h a d b e e n a de lay of severa l hours to expla in tha t w e h a d severa l c o d e s in a row, one of t h e m b e i n g a baby. The r e s p o n s e of t hose w a i t i n g was , "So what , let the kid die. I w a s here first." Recent ly whi le in t r i age I w a s s u b j e c t e d to a m a n who c a m e in t he door s c r eaming , "I w a n t a doc tor here r ight now. My wife is hav ing a hea r t a t tack." His wife w a s e x p e r i e n c i n g a r ap id hea r t rate. I have b e e n conf ron ted wi th th is behav io r m a n y t i m e s before, b u t not a t the de c ibe l level p ro j ec t ed b y th is man. He wou ld not let m e talk. He w a s so loud t ha t two d e p u t y sheriffs, a secur i ty officer, a n d the cha rge nurse all h e a r d h im th rough a solid wall and a sol id w o o d door. They c a m e out to t r i age and the d e p u t y told the m a n he w a s in a hospi ta l , no t a spor t s s t ad ium, and to ge t h imsel f unde r control. It t u rned out t he wife w a s not hav ing a hea r t a t tack; she w a s t r e a t e d and re leased .

As Ms. Z i m m e r m a n n sa id in the g u e s t editorial , peop le fail to a c k n o w l e d g e tha t e m e r g e n c y ca re is not the s a m e as " ins tant care." I once s i g n e d in a pe r son wi th a b roken f i n g e r n a i l - - t h e t ype r i p p e d d o w n in

208 Volume 24, Number 3