[RocknRN]

I've been working as an ICU nurse for about six months now on an S/TICU where most of are pt's are neuro either from Trauma or bleeds. I love my job, but I find that by the end of my third 12 hour shift in a room with 2 out of control confused pt's I begin to loose my patience and feel frustrated. I don't like feeling this way because I do truely care for my patients, but sometimes I feel like I'm going to go crazy and just wish they were intubated and sedated! Is it normal for me to feel this way? Any coping advice?

[kc ccurn]

Your feelings are normal. There are some days where you want only to take care of the intubated orphan. When I start to get frustrated, I try to take a step outside or just to another area and take a deep breath and try to come back with a different attitude. If they are truly agitated and restless, maybe they do need some sedation to help them calm down, but don't medicate so you feel better. Pt's that are left agitated, restless can escalate to becoming combative and are prone to hurting themselves or someone else.

[gwenith]

I spent two years in a neuro ICU and I know xactly what you are talking about - worse they would often give me the combatative/disorientated ones as I was considered "patient" - used to drive me up the wall. Neuro ICU is THE most demanding and difficult of all the disciplines especially in relation to your emothions. Hang in there.

[Elenaster]

I actually have alot more patience with patients that are neurologically compromised than the ones that aren't and are just being extremely difficult (pulling off leads, removing themselves from the vent, etc.). I know it sounds strange, but if I know that the patient can't help it, I'm so much more tolerant of his/her behavior.

Are you allowed to use soft wrist restraints at your facility? We frequently use them in confused/combative neuro patients, mainly because we don't want them pulling out their EVDs or bolts or harming themselves in other ways. It can be tricky sedating them too, because on one hand you want them to calm down because it's better for their ICP and overall recovery, however you don't want to drop their GCS because then you'll buy yourself a new set of problems (head CT, etc).

[NeuroICURN]

As a Neuro ICU nurse, who deals with this very kind of thing day in and day out, I can truly sympathize!!

I find it helps to remember that, a lot of the time, these people are not normally like this. While you will see bits of their basic personality come out in them, for the most part, they are NOT themselves. Also, blood is very irritating to the brain and this contributes to why the "bleeds" are not themselves!

Now, does that mean that none of the patient's get to me? Not hardly! But for the most part, I take it with a grain of salt! I have to agree with whoever it was that posted that they'd rather deal with a neuro pt. anyday rather than someone who's completely with it and is just being difficult!!!

So, step back, take a deep breath and remember that they're not themselves! And after you do that, thank God for drugs like Propofol and Versed (when applicable) *****

Take care

[Berliner]

It also doesn't hurt to develop an off base/ sarcastic sense of humor. Helps to brush off those moments when you just can't keep up the mantra of "this is a human being, they aren't being themselves, how would I feel if this was my mother..." An then there's the good ole fashioned ***** session- usually turns frustrated nurses on break into ones that can finally get a good chuckle.

[kc ccurn]

It also doesn't hurt to develop an off base/ sarcastic sense of humor.

So true, you need a great sense of humor for anything in live, ESPECIALLY working in ICU....helps take the edge off all the tension and stress.