Thanks for all you do. The last five years of my in-laws lives we made more trips to the ER than I could count (numerous strokes, heart problems, etc). The staff was always 100% professional. The ones that really got me were the Sunday evening "patients" who obviously did not want to go to work on Monday. Even those of us waiting could tell they were faking, only exhibiting their symptoms when an Er staff member was looking their way. Guess I am way too cynical for ER work.
What you describe here is not "cynicism" but rather "moral outrage." Allow me to explain.
The capstone of practice as an RN is what I call "nursing ethos." This is best described as that moral and ethical compass which guides a nurse throughout his or her career to seek the right thing to do and to do the right thing. Nursing ethos is shaped, among other things, by the moral absolutes of fidelity, honesty, and justice.
I propose that this sense of justice is what gives you the sense of disgust that you seem to be describing when you spot a malingerer. But that is not cynicism. The nurse experiencing a sense of moral outrage will say, "This person is wasting the ER staff's time and resources and making things harder for the patients who need us most. That's wrong, and I will not play that game." On the other hand, the cynic would just say, "Hell, they just want drugs. We aren't going to change them. Stop wasting time and money running tests. Shoot them up and get them out of my ER."
Cynicism is what perpetuates the cycle and allows malingerers to get away with what they do. And that robs the genuinely sick patients of the time and effort they deserve from those of us who went to school for a helluva long time to learn how to do what we do in order to do great good for other human beings. Malingerers anger me for that very reason. They are the hyenas of the healthcare system.
But getting mad at malingerers isn't going to change them, because they simply don't make the connection between their behavior and the underlying problems in their lives that drive them to seek sympathy, validation, attention and medication, the true purpose of which is to alter, however briefly, their personal reality. And at the heart of it, that is all the malingerer wants.
Then again, calling a malingerer out on his or her fakery is not cynicism; in fact, it is simply patient advocacy. By confronting the malingerer we do two things: we present the truth of the problem to the malingerer, and we defend the patient who is genuinely ill from having to suffer for the predatory selfishness of the malingerer.
Cynicism is a compassion-killer, and has no place in any nurse's heart. When I hear cynicism from a nurse, I simply tell him/her that perhaps it is time for them to find another career.