I should have said something... - page 2

Recently I admitted a patient in 5 point restraints going through ETOH withdrawal who needed Ativan IVP. A coworker and friend was helping to secure one of his wrists and when the patient wiggled,... Read More

  1. by   rnin02
    [quote=Jesskanurse;1979762][quote=canoehead;1979118]A little volume for a drunk and uncooperative patient- absolutely.


    Ok, I don't feel comfortable with this comment. To me this seems a little insensitive. A lot of people suffer from chemical dependencies and I dont feel comfortable calling someone who I am taking care of a "drunk." I try to use empathy, and to me that doesn't seem empathetic. He was going through a lot. I can't imagine how hard it must be for someone experiencing ETOH withdrawal, but I would assume it's not easy. I think too many people are quick to get angry at patients when they see ETOH on ther list rather than going that extra step to try to treat the patient fairly. It isn't our job to judge their habits, just take care of them. Right?
    Empathy for a patient willingly seeking treatment for chemical dependencies, absolutely. Being firm with a "drunk" who needs 4 point restraints and IVP ativan is also 100% necessary. I feel bad for these patients, but you need to be firm (and loud at times) because these patients are unpredictable, and can be dangerous. I have seen patients hit staff, destroy beds (while in 4 points), pull knives on staff members, etc. At this point in their treatment, they need our firm, forceful sides, and definetly their IVP ativan!
  2. by   PANurseRN1
    Quote from Jesskanurse
    I totally understand... I should have been more tough. I guess I was just wrapped up in the whole situation, there were at least 2 other nurses in the room, as well as security, a sitter, and I know the Nursing Supervisor, and Clinical Nurse Consultant was either right outside the room or just in the hallway. I dont know who did and who didn't see what I saw though. I think I was trying to prioritize in my head what I needed to do (since everyone had hyped me up for this patient) and since I'm fairly new, it's hard for me to balance everything at once. I will definitely work on that in the future though. Do you think it's too late to say something? This happened at least 2 weeks ago.
    I think you are going to have a difficult (at best) time trying to explain why you waited two weeks to speak up. You have to follow your conscience, but be prepared for some hard questions if you say something now.

    Also, no excuses. It doesn't matter who else was in the room or within earshot. That's just another way of trying to reassign blame. You are responsible for acting as a professional, period.

    FWIW, I had to report a nurse for abusing a peds. pt when I was a freshman nursing student, so yes, it can be done, no matter how new you are to nursing.
    Last edit by PANurseRN1 on Dec 20, '06
  3. by   Jesskanurse
    [QUOTE=rnin02;1980174][quote=Jesskanurse;1979762]
    Quote from canoehead
    A little volume for a drunk and uncooperative patient- absolutely.

    Empathy for a patient willingly seeking treatment for chemical dependencies, absolutely. Being firm with a "drunk" who needs 4 point restraints and IVP ativan is also 100% necessary. I feel bad for these patients, but you need to be firm (and loud at times) because these patients are unpredictable, and can be dangerous. I have seen patients hit staff, destroy beds (while in 4 points), pull knives on staff members, etc. At this point in their treatment, they need our firm, forceful sides, and definetly their IVP ativan!
    Maybe I didn't make my point very clear. I hhave no problem with the being firm part. I absolutely think it is important to be firm so as to protect safety of everyone. However,

    I did have a problem with referring to the patient as a "drunk."
  4. by   EMTSNA
    The reaction to throw the baby out with the bathwater in the case of a generally good nurse who screwed up is as shortsighted and judgemental as refering to "fat cows" and "crazies". This is a knee jerk reaction. With regard to the situation, what will be gained at what cost?
    I suppose you would have to look at the whole picture.
    Is this a nurse who regularly is rude to patients and oversteps physical boundries.
    Is this a nurse who is usually exellent and caring. Had they just been pushed too hard at one moment during a particularly stressfull shift.
    Was this action actually damaging to the patient, causing physical damage and/or emotional turmoil. The nurse responded poorly, but this could be utilized as a learning experience.
    If the nurse is receptive to an honest and open realization that they were stressed and made a mistake, it might be more therapeutic and effective to let the nurse reflect on what he/she was feeling that led them to act in that way.
    I feel that positive remediation could be more effectively accomplished through peer support as opposed to a punitive response from administration.
    Oh well, maybe I'm seeing this too optimistically.
    Probably would be better to hang the nurse out to dry. Most likely everyone would be better with this individual out of nursing.
    Last edit by EMTSNA on Dec 21, '06 : Reason: punctuation
  5. by   GardenDove
    [post edited to remove quotation containing personal attack]

    Good Lord, calm down. :trout:
    Last edit by Jay-Jay on Dec 22, '06 : Reason: Quoting edited post attacking OP
  6. by   sanctuary
    Thanks, GardenDove, I needed a chuckle.:chuckle
  7. by   zacarias
    I personally believe you are not AS guilty as the person who slapped the ETOH patient but that you still have duty to report it, there is a distinction between those too.
    Also, to minimize further anxiety for the patient, I would only reprimand (say "NO!") to the other nurse IF it seems to you that the slapping will imminently happen again in the room. Otherwise, I would wait until you both leave the room, and then address the issue with that staff member.
  8. by   Jesskanurse
    To elaborate on some questions from previous posters:

    This is a nurse who tends to get very dramatic very easily. If she asks for your help and you say yes but take a few more seconds to finish up what you're doing, she walks away in a huff saying forget it. This nurse has also had warnings for other things in the past (not for this specific type of action).

    Please... I really can't take more 'grow balls' comments. It's offensive. I feel like I'm getting yelled at by some posters... my goodness! Like I said before, it was almost like I didn't even have the chance to think of how to react with everything that was going on. Again, I am working on this and I know this skill will improve in time. Thank you all again.
  9. by   Jesskanurse
    Quote from sanctuary
    Yes, your instinct is correct, and your insecurity as a newbie got in the way. Well, it never gets easier. I've been called on the carpet, called names by my peers, and "reduced in rank" for criticising the wrongs I've seen around me. But I promised myself a loooong time ago that I would rather be fired for doing a job right than to keep a job and lose self respect. Repeated that a couple of times when I was being 'counseled' about my attitude. and it shut them up. That being said, look for another position and keep on speaking up. Our patients need you, and your heart.
    Oh, and thank you Sanctuary for your kind words. You made me feel better. I feel this way as well, but sometimes feeling something is much easier than proving it through your actions. (especially around much more experienced nurses)!
  10. by   mingez
    Quote from Jesskanurse
    Quote from canoehead
    A little volume for a drunk and uncooperative patient- absolutely.

    Ok, I don't feel comfortable with this comment. To me this seems a little insensitive. A lot of people suffer from chemical dependencies and I dont feel comfortable calling someone who I am taking care of a "drunk." I try to use empathy, and to me that doesn't seem empathetic. He was going through a lot. I can't imagine how hard it must be for someone experiencing ETOH withdrawal, but I would assume it's not easy. I think too many people are quick to get angry at patients when they see ETOH on ther list rather than going that extra step to try to treat the patient fairly. It isn't our job to judge their habits, just take care of them. Right?
    To be fair, I think you misunderstood canoehead's statement. He/she wasn't calling anyone a "drunk." Rather saying that they were drunk, as in the state of being drunk. Nothing inappropriate about that. If someone's intoxicated, they are infact drunk.
  11. by   nursejohio
    [QUOTE=Jesskanurse;1980233][QUOTE=rnin02;1980174]
    Quote from Jesskanurse

    Maybe I didn't make my point very clear. I hhave no problem with the being firm part. I absolutely think it is important to be firm so as to protect safety of everyone. However,

    I did have a problem with referring to the patient as a "drunk."

    She wasn't referring to the pt as a drunk aka skid row bum, wino, pick your alcohol related adjective. She said 'a drunk and uncooperative pt' which from the OP, was true. If I go out tomorrow night, get hammered on margaritas, pick a fight and wind up in the ER in 4-points, darn tooting I'm being drunk and uncooperative. That's completely different from the disrespectful reference to the homeless guy at the bus stop "oh him, he's just a drunk". There's definately a difference
  12. by   PANurseRN1
    Quote from mingez
    To be fair, I think you misunderstood canoehead's statement. He/she wasn't calling anyone a "drunk." Rather saying that they were drunk, as in the state of being drunk. Nothing inappropriate about that. If someone's intoxicated, they are infact drunk.
    Exactly.

    I'm not sure what the OP wanted by posting this, since posts that disagree with her POV are deemed offensive. If you post a question asking for opinions, you're going to get a variety of them. If you don't want to hear some potentially negative feedback regarding your actions, then the next time preface the post with "Only comments that support my opinion wanted."

    OP: some of the posters were trying to impress upon you that new or not, you need to speak up. I'm not sure I understand the "I didn't have time to think" rationale, since you seemed to take in a great deal of what was going on in such a short period of time, never mind give a detailed list of the other nurse's history of inappropriate reactions. That was certainly enough to have gone to management weeks ago, when this first happened.

    It's interesting that a few months ago, when the OP was still a student, she was lecturing nurses who used "therapeutic lying" in dealing with dementia pts. Now she's witnessed an inappropriate action by another nurse but said nothing and now wants support.
  13. by   Noryn
    The "you are just as guilty" always make me laugh a bit. That really isnt accurate. You arent actually abusing the pt and in the judicial system if you see a crime and dont report it, you usually dont get tried for that crime However the point is, you can be charged with a lesser crime and not reporting abuse/neglect is a serious charge in itself.

    So to the original poster, you arent guilty of abuse and you are going through what all new grads go through. Your nursing instructors are typically ideal role models and in school you are in a perfect world, that ends with graduation. There are just so many grey areas you have to deal with.

    You obviously have a conscience and know something is wrong, hence the post on the board. You just need to act on it. I would report it to my nurse manager. It is the right thing to do, and you have that duty to protect your patients. Also if it was ever reported and you did not speak up, then you can get into quite a bit of trouble as well.

    Being a new grad, is hard. There is so much to learn and again there are so many situations that dont have an easy answer. Just always treat your patients like you would want your family members treated. Also you need to forget the idea (that we are all born with) that you only get in trouble if you do something wrong. Sometimes you get in trouble for doing the right thing but in the end you can sleep at night and have respect for yourself! Good luck!

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