I Cried At Work

[Guest 360983]

I had a super miserable shift yesterday. I'm a new grad, barely off orientation, in a crazy busy ER with a difficult population. I have 6 patients, who ought to range in severity from "You came to the ER for THAT?!?" to IMU. I should never have an ICU patient.

In a 2 hour period, I got 3 new patients. No problem, that's busy but I can do that. The problem is that these were the patients:

1) Came in for knee pain. Hx of liver disease that the patient said he saw an outside doctor for, but he had enough ascites to look pregnant, his legs looked like CHF and he had crackles. Oh, and he had an episode of angina last night, but "I'm here for my knee. My chest pain got better when I sat down for awhile and took some Tums. Why yes, it was in the middle of my chest and now that you ask, it did feel like pressure instead of pain." Ok, the monitor looks ok so I'll keep you and just run an EKG, enzymes & a chem 8. Oh, the EKG says possible current ischemia? Wait, the troponin is elevated? And his hematocrit is 6???? Let's talk to the patient again--oh, a history of melena, awesome. Hey, residents, this guy needs someone to look at him now. Can I move him to a resus room? No, not until the ICU consult is done? But he's got ischemia and a GI bleed and terrible liver issues and he's threatening to AMA because I won't let him eat!Sure, I'll just hang the blood and the protonix and octerotide, which means multiple calls to the pharmacy since we don't have that on the floor. Oh, hi ICU consult. No, those 2 20s are the best you'll get without an EJ or a central line, and you'd better be happy we got those in. I know you want larger bores, but I can't make veins magically appear. No, I will not take your 20 verbal orders, we don't do that and do you not see me pushing this guy to the resus rooms now that you've agreed to take him? I literally told the doctor "I think we should bring this guy over to the resus rooms. I am not the nurse you want taking care of this patient right now."

2) Dialysis patient sent to me from the resus rooms because she was "stable." Her K was OMG HIGH even for a dialysis patient. She was Spanish only, but why isn't she responding to most of my questions? My Spanish sucks but I can at least assess a dialysis patient. And why is she saying she had dialysis 1 week ago at this hospital when our records show it's been more than 2 wks. Hey, Spanish speaking coworker, can you ask this patient if she'll take her Kayexalate? Why is the patient just staring at me instead of taking it or protesting? Hi renal fellow! Wait, why are you calling the ICU right now? Usually our resident does that. Oh, we're trying to get her a bed RIGHTNOW and not 5 minutes ago? Hi, charge nurse? Come pick up the dialysis patient. Report? She refused the PO Kayexalate and she's unchanged from when you dropped her on me 2 hours ago despite me protesting an insane K and AMS together indicated she wasn't an IMU patient.

3) Guy comes in with vague chest pain x forever. Oh, and I fell at home a few weeks ago and it's been hard to breath since then. Fine, let's do some enzymes and a chest xray per protocol. Look, negative enzymes but the chem 8 indicates new onset renal failure. His potassium is WHAT? Awesome, let's push the cocktail. Oh, you need to take him to the resus rooms for a chest tube because his entire R lung is white on the xray? Here's the lab on the line with critical values for half his chem 8.

My other 3 patients were pretty low key and very stable, which was good because they were all getting ignored for HOURS. Like, one guy came in with a family member and I just glanced at him every so often to make sure he was still breathing. I figured the family member would tell me if he started doing something weird. Safe? Not by a long shot, though I didn't realize how unsafe it was until I was talking to my old preceptor this morning.

My charge nurse came by when she realized how bad my patients were and sent me to lunch. I was so frustrated and exhausted I started crying in the middle of the floor! I gave report to a few of my coworkers and they had almost everything done by the time I came back. The charge nurse put holds on some of my beds so I wouldn't get new patients. The other new grad took lunch with me (at 4 pm) and we ******* about life and I came back and charted like mad until the end of the shift.

I just needed to vent to some people who would understand. Thanks for listening.

[Patti_RN]

The only person who has a right to determine if a new grad (or anyone) is capable of handling a job is the person who hires them and supervises them. Period. Apparently, your supervisor has faith in you and your abilities. She is also allowing you to transition from new grad to experienced ED nurse--she's limiting the number of patients you're responsible for and she's giving you less acute patients.... or that is the plan. Sometimes things don't go exactly as planned and you've overwhelmed. It's OK... just communicate that to her--she seems very supportive and responsive.

Different individuals and different cultures have differing opinions on how much emotion is tolerable to display. Opinions on this issue are also much divided by gender. As those with psych backgrounds know, people can feel the same emotions but one person will show their anger, sadness, or frustration, another won't. It doesn't mean that the nurse who isn't crying is not overwhelmed and stressed. Might be that he or she is even more overwhelmed and stressed--bottling it up only hurts the individual in the long term. I'm not suggesting that you cry in front of a patient or a doc or other nurses you don't trust; hold it together until you're in the bathroom and go ahead and cry, then gather yourself, splash some water on your face and go back out there!

Don't let others assign their personal rules of workplace behavior on you. That's your supervisor's role and her decision. I would much rather have a nurse come in my office and cry or head to the bathroom and cry than have a nurse with other 'issues' (bullying, dishonesty, disrespect, unreliability, etc.)

You seem to have great instincts, good clinical skills, and with experience and an opportunity to transition to more patients of higher acuity, you'll be an even better ED nurse!

[fathertod]

I disagree with you assertions that a supervisor will be accommidating to weakness showed while on work time. In most nursing facilities, weak employees are weeded out, especially those who have breakdowns while under alot of pressure. Obviously, there is a learning curve, and part of the learning curve is not breaking down in the bathroom. Also, there must be a difference between "he" and "she" supervisors, because you reference the notion that "she" supervisors will be very accommidating to a crying employee. I am not sure where you work, nor of your level of experience, but individuals who breakdown like this would become the pariah of most workplaces and peers and co-workers would not regard "her" or "him" as highly as the person that is capable of performing tasks efficiently and those who advocate for their patients rather than suffer from momentary emotional breakdowns. It is likely that these individuals would become the fodder for inter-workplace gossip and ridicule in my opinion. Additionally, you cannot guess that "she" has great instincts, good clinical skills, etc. from a posting, for all we know you could be the bestest most skilled nurse in the world.

[Patti_RN]

I've been a supervisor, I've been a charge nurse, I've worked on a floor, and I've been a psych nurse (and supervised there, as well.) I'm now also responsible for hiring nurses and techs for two large units. I have years of experience, two graduate degrees, and I'm working on a third. I also own a business and am responsible for my own employees.

The OP referred to her charge nurse reassigning patients and allowing her to leave for a break/ lunch. Whether this was done because the charge nurse felt it was appropriate, or if this is policy set forth by the DON or others, it is clearly someone's decision to nurture new nurses; I addressed this as the charge nurse's prerogative--hence the OP's supervisor. My reference to her 'supervisor' was discussing the charge nurse's willingness to accommodate the OP's relative lack of experience with multiple, acute patients. There was no gender implication; the OP referred to the charge nurse a 'she', I was consistant.

I've dealt with crying employees. As a supervisor it is MY choice if I deem that person capable, not the person's colleagues.

[redhead_NURSE98!, ADN, BSN]

This thread is scaring the daylights out of me. As a new pre-nursing student, I'm really wondering what I've gotten myself into. Being well aware of the fact that I'm going into a female dominated profession, I've read an awful lot of threads here lately referencing nursing staff breaking down and crying due to frustration, anger etc. Is there no expectation in this field that adults will have developed adult mechanisms for coping with their emotions? Is there no expectation that professionals will conduct themselves professionally?

Perhaps I'm over sensitive to the issue for some reason but c'mon! Crying in response to frustration, anger, stress etc., I expect out of a toddler but not from a professional adult...in any field.

I wonder if some folks don't need to get to a counselor and try to develop some more adult mechanisms for dealing with their emotions.

Well, maybe when you're no longer a "pre nursing student," you'll understand.

[midlife101]

If I read that correctly, and I may not, the implication is that I don't understand stress or frustration because I'm not a nurse yet.

As it turns out, I have over 30 years of work experience in a variety of different fields and have seen at least my fair share of stress and frustration. In that time, I've never cried in reaction to those conditions.

Why? Because I'm a professional and I didn't want to lose the respect of my peers and supervisors by displaying a professionally inappropriate response to adverse conditions.

I'm no longer buying into the line that women are more emotional than men. Sorry, I just don't buy it. If I got angry and punched the wall, that response to the emotion of anger would be immediately labeled inappropriate and I would be disciplined. Nobody would do my work and send me in to the boss' office to punch that wall till I felt better.

Short version; you don't get to act any way your emotions push you and if you do, there are consequences that come with that.

[redhead_NURSE98!, ADN, BSN]

Well whoopedy doo. Come back when you've worked in a hospital.

[jeckrn, BSN, RN]

Sorry I have worked in a hospital and I agree with midlife, I have worked in hospitals for 14 years. RN's keep saying they want to be treated as a professional but in the same sentence say its ok not to act like one.

[dirtyhippiegirl, BSN, RN]

Sorry I have worked in a hospital and I agree with midlife, I have worked in hospitals for 14 years. RN's keep saying they want to be treated as a professional but in the same sentence say its ok not to act like one.

I don't understand why so many people insist that nursing can't be considered a profession unless held up to some arbitrarily, impossibly high standard.

I've seen doctors cry both out of frustration and sadness. On the flip side, I've also seen them throw pretty epic temper tantrums, certainly without further disciplinary action. (Also don't think that I'd compare crying with punching a hole in a wall. One causes property damage. The other is just embarrassing.)

*Professionalism* stems from letting out your emotions in the proper environment, with the right people. Not from bottling them up.

[sapphire18]

I don't understand why so many people insist that nursing can't be considered a profession unless held up to some arbitrarily, impossibly high standard.

I've seen doctors cry both out of frustration and sadness. On the flip side, I've also seen them throw pretty epic temper tantrums, certainly without further disciplinary action. (Also don't think that I'd compare crying with punching a hole in a wall. One causes property damage. The other is just embarrassing.)

*Professionalism* stems from letting out your emotions in the proper environment, with the right people. Not from bottling them up.

I wish I could "love" this!!

[anotherone, BSN, RN]

While I was crying, my patient died.

Don't worry, while that happened the bed filled up .

[anotherone, BSN, RN]

Crying and professionalism and nursing. so what. we are not , rarely , seen as professionals and it is not because a few nurses have been seen crying. I have seen nurses cry and other staff from drs, to rt, pharamcists, flip out and really show in other ways they are stressed/overwhelmed. so what you have worked in other jobs .it is NOT NURSING so you do not know. And if it is nursing and you can't understand how some people can have shifts/situations in which they are so overwhelmed and stressed that they cry well than that is too bad and some skills are lacking on your part. I try to never cry in front of others esp not in work , can imagine that being very humiliating, but I can understand how it happens. The crying is often from extreme frustration and feelings of being overwhelmed/hopeless etc . and it really is hopeless sometimes. That is why in another thread I said apathy is a GREAT attitude to have as a nurse, might not serve your patients or co -workers well but it will help you. Nursing is not a mission or selfless or any other thing IT IS A JOB . one that requires a certain skill and safe ratio to do. Guess what the ratio part is rarely adhered to and even when it is not YOU ARE STILL accountable for everything. On your floor the safe ratio is 4 pts to 1 nurse and 10 pts to 1 aide. well today you have 6pts NO AIDES on the floor. and these pts are all tons of work, meaning no breaks, charting will not be on time, things will not get done, and if you are a good worker, you will feel guilt over that, it will affect pt care, and some pts will think you are slow/incompetent but you are not allowed to tell them staff is down 30% or so. and the icing on the cake is you will be mandated for a total of 16.5 hours when you were scheduled for 8 hours. . I can see someone going into the breakroom and crying over that. esp if it is a constant thing. I doubt most nurses who have cried at work are going into pt's rooms and breaking down during med pass.

[Merlyn]

I don't know who you are..where you've been...

but your opinion of the "lowly med-surg " nurse 'the idiot med surg nurse' will surely bite you in the AZZ and I hope sooner than later.

She's an adrenalin junkie. Most ED nurses are. I worked ED I was one. and I worked med/surge and was an idiot. Some nurses think that they are the only ones that work, In ED the focus is stabilization or taking the patient out of Charon's Boat, on another unit the focus is keeping the patient out or even booking passage. One unit can not exist without the other and both units can and do work like dogs. Now we can all join hands and sing,

'We Are The World' (But please wash your hands because I know where you have been)