I'll probably find out soon enough, but I'm curious...

roser13, ASN, RN · Apr 30, 2010

"Are they expected to duck out the back or keep quiet when things get hairy?"

Quite the opposite. Think of it this way....your job will be not only to care for your patient's physical needs, but also emotional needs and to be a strong patient advocate. Far from "ducking out" when things get hairy, the nurse has an essential place in dealing with family members, helping them understand the big picture, and how best to care for their loved one.

You will learn as you go in nursing school. Yes, there will likely be a few classes or class discussions that will touch on the volatile emotional issues, but more than that, you will start to form your own opinion as to how you will best help your patients and their families when "those" times happen. Starting with clinicals, you will get a feel as to the role of nursing in times of patient crisis.

Recent personal example: a relative of my husband's was in ICU with an extremely poor prognosis. She was also a full code. However, the family members were distinctly non-medical and I was certain that they didn't recognize what they were seeing. I wanted to stay in the background, since it wasn't really my relative, but I did have a word with the primary nurse, asking her if she had spoken with any family members regarding a potential DNR. Her response was immediate - she was just waiting for one of us to initiate the conversation and since I did, she immediately started educating the family on the realities of the situation.

That was her choice - to wait until asked. Other nurses might have initiated the conversation on their own. Either way works and it is up to the individual nurse to find his/her own way to deal with these situations.

But don't worry - after your education and experiences in nursing school, you will likely feel much less anxiety about these issues.

rachelicuflorida · Apr 30, 2010

That's actually a great question, and as mentioned before, tactful, direct, assertive communication will become an important element in your success as an RN. Remember that patients and their families need you to support them while keeping it real. While I was in nursing school, questions regarding caring and ethical practice were part of each test. I was taught how to approach physicians when I had patient concerns. I was taught what to say and what not to say to patients and families. It gave me a good foundation.

Eventually you will feel confident in the role of being the person the patients and families turn to when things get hairy. Also, never hesitate to consult chaplain services with the patient/families' permission. Even if people aren't particularly religious, it is nice to have some support from a person who isn't throwing medical terminology at them!

melsman1904 · Apr 30, 2010

You will be taught therapeutic communication in nursing school. This will help you understand how to speak to people during terrible times in their lives. Also remember that saying something to people during difficult times isn't always necessary. Sometime the best practice is just to let them talk. Like others have mentioned, you primary job will be to support the pt/family during this time and help them understand what is going on.

squirt2008 · Apr 30, 2010

i agree with previous posts. being a bedside rn during end of life or other tough times is such a big responsibility. you are not only supporting the patient and being their advocate, but you are supporting the family, friends and loved ones of the patient. just the act of "being there" is so critical, listening more than talking, and of course being respectful of their views and wishes. somehow you will find the right words to say during those times. never be afraid to call a md if you feel the patient is in pain or discomfort. it is important to stay strong and not "fall apart" but i know from experience that patients and their families also appreciate it when you are "human" and show emotions when appropriate.

classicdame, MSN, EdD · Apr 30, 2010

therapeutic communication is generally part of the nursing curriculum. Most of us were taught that once the patient expires your new "patient" is the family, in some sense. So you advocate for them to get whatever help they need (phone, tissues, chaplain---).

As for bad news, therapeutic communication helps here as well. You will learn there are many ways to express caring. Words are not the only way.

Will-B · Apr 30, 2010

Thank you for asking this. I have appreciated reading what the experienced nurses have replied. As I am just starting too, this "was" a concern of mine too.