It's long, dangerous, but worth typing, to me!

[missrose]

I am posting this because I feel we need to get real!

I just realized today why I am suffering from nursing burnout. It's because the patient population has change so much in the past ten years. Ten years ago, I didn't have to deal with meth addicts EVERY DAY! Ten years ago, the meth patient was the rarity. Ten years ago, I didn't have to deal with morbidly obese patients EVERY DAY! It's not news... the data is out there: Americans are getting fatter and fatter every year! Why? What do these two types of patients have in common that frustrates me? BAD CHOICES! Morbidly obese patients are very difficult to take care of..... they can't move themselves in bed. (my back is killin' me!) They have infected wounds caused by their obesity. They suffer from diabetes which adds a whole 'nother list of complications (and time providing care). Meth addicts are just plain impossible to take care of! They want (and get) more morphine... because the LAW says if they say they're "in pain" we have to treat their pain..... even if they have no wounds or other obvious cause.... yet 10 minutes after they get their IV morphine, they want to go outside, dragging their IV pole on wheels, so they can have a cigarette. And I have to let them, because they have "rights"!! Yet their safety is my responsibility!! ?? I just don't get it. What about my rights as a professional and a responsible nurse?!

The guy down the hall with the brain tumor or colon cancer? He didn't CHOOSE to be sick! And yet I don't have adequate time to take care of him as I'd like or as he deserves because I'm too busy taking care of the whiney meth addict or the morbidly obese patient! I apologize for my brutal honesty.... but these patients belong on a psych unit because their diseases are psychologically base. I am not a psych nurse. I don't want to be a psych nurse. The patient with the brain tumor or cancer or Alzheimers? He/she is most always very appreciative, humble, pleasant even! Depressed, yes of course! But cooperative! But the addicts? Always demanding, whining, and often downright insatiable! No wonder there's a national nursing shortage!

Will I feel bad after posting this and re-reading what I've posted? NO I WILL NOT, because I have re-read it three times before clicking "post".... my back hurts and I am stressed out from another 12 hour shift of worrying if my patients are safe, comfortable, and well taken care of. That's the most important part of my job.... making sure my patients are safe and comfortable. Yet lately, I leave work feeling inadequate. I feel my SICK patients are being shorted by the overwhelming needs of my addicted patients... whether they are addicted to food or drugs. But how can I help them if they refuse to help themselves?? We need new parameters for caring for diseases that originate in the mind (choices) versus diseases that originate in the body (no choice).... even if those choices have deep roots such as background, lifestyle, lack of knowledge or awareness.... they must be addressed and repaired. And soon! (sigh! Just typing as fast as I'm thinking here, folks!) At least I still possess the compassion to care about finding a solution!! I haven't walked away from my chosen profession yet. I'd like to find a solution!!

[twinmommaRN08]

Every minute of every day of our lives we make choices. Those choices affect us and others. These nurses who care for those who CHOOSE not to take care of themselves have every right to be frustrated. We could all make better choices on any given day, but it's the ones who are actively killing THEMSELVES that are so frustrating.

You forgot to mention that every nurse made the CHOICE to enter this profession and is obligated to give care to those in need. Not to judge their lifestyle and stereotype groups, but to assess needs and look for opportunities to teach and make a difference.

I don't believe the OP is wrong for feeling the way she does, but IMO it came off as judgemental.

[Katnip, RN]

i very much relate to your frustration of dealing w/demanding, needy pts.

so far though, i have not been able to stereotype any particular population.

i think the bigger issue is, how to deal w/the demands.

maybe it's not "nursey", but i don't have any problems telling these pts that i have others that are much more critically ill:

and i would appreciate tending to all their needs now, rather than running in and out at their beck and call.

it's definitely a form of limit-setting.

i let them see i am not happy.

i don't know anymore.

i'm really becoming convinced that i am THE nurse monster, because i just don't have these problems.

once i speak up, there's never another problem (unless they're confused).

but still, i continue to have awesome relationships with them.

maybe these pts really do need a kick in their butt? (ever so gently, of course)

leslie

Well said, as usual Leslie.

I guess my point was that any patient can be irresponsible and a pain in the tush to take care of. And I do set limits. But I don't cast blame on the patient for being there.

I've had my share of patients I've had to set limits on, like you so I guess you and I are monsters. And they can drive you nuts, but to me it's because of their behavior in that moment in time, not of what they've done or not done in the past, since I know nothing about their circumstances.

[leslie :-D]

I've had my share of patients I've had to set limits on, like you so I guess you and I are monsters. And they can drive you nuts, but to me it's because of their behavior in that moment in time, not of what they've done or not done in the past, since I know nothing about their circumstances.

exactly, kat. (i'm thrilled to see you again.)

i just don't want to downplay the op's frustrations...

that it doesn't matter who they are, but rather, what they're doing is problematic.

i've had problems with every type of pt imaginable.

all backgrounds, weights, ethnicities, etc.

it would be impossible for me to find any common grounds.

more important, it doesn't matter to me.

leslie

[Nightcrawler, BSN, RN]

Thank you for your understanding, advice, and kind words of support! After reading the replies (and after a much needed vacation with family and friends in Montana!) I will return to a new assignment with a better attitude. I have always and will always treat each patient with respect and kindness, regardless of their diagnosis. I do find that the patients who treat me with the least respect are the drug addicts and the morbidly obese. I can't change that, can't fix them, and will remind myself not to take it personally. I just want to continue doing what I've been doing for 12 years.... and that's enjoy being the best nurse I can be! Again, thank you!

I understand your frustration, but I would ask if you notice the unreasonable demands of the obese and addicts because they are more demanding as a group, or because the cause of their illness bothers you so much? Perhaps you are more understanding of demanding patients that did not "choose" to be sick? I know that I have my own biases when it comes to patient care and that I have a much shorter fuse when dealing with this type of patient.

I think that the problem lies more with workload and acuity than it does with individual patients. If you do not feel that you have enough time to spend with all of your patients, then you need to work within the system to create safer patient loads. If you are correct that the obese and the addicted are the most demanding of patients, then there are only going to be more of them hospitalized over time, not more. There are more obese, even morbidly obese people every day, and meth is a growing crisis. Rather than becoming burned out, we need to work on the system to recognize the complex social care that we are providing to these patients and to include this in acuity assignments. At one hospital that I worked, patients over 400 pounds were given extra acuity points because of the number of staff that it took to safely care for them.

If we do not work within the system to promote safe staffing, nurses will just continue to get burned out and seek new careers. As acuities continue to increase and patients come in with more and more complex problems, we need experience on the floor, and we need to do what it takes to care for the patients and not drive nurses away.

[nursingisworkRN]

Frustrations understood. I think that as nurses, we are encouraged to be supportive and understanding, and that we are frowned upon if we speak up about certain pts.

If you find that this situation has become a daily thing and it is starting to affect you adversely, I would probably suggest a change. Have you considered another area of nursing?

I have had similar experiences with "difficult" pts. I have found that the combination of being understaffed, overworked, scheduling problems, rotating back and forth between days and nights, no resources/preceptors available, lack of team work, and high level of acuity has started to affect me poorly. I stay late at work, don't sleep well or enough, have not been running/exercising, and cancel plans with my friends b/c I am so tired, and as you stated, my back HURTS! I have a change of venue next month, and am so excited for just something DIFFERENT.

Plus, I lack the patience and tolerance for the folks who feel it is okay to throw a tray at me because of???? never ok to throw things at me, unless the pt is demented/ can't help it and then anything goes.

And yes, having a pt back who was discharged the day before who fluid overloaded themselves AGAIN b/c they ate a bag of potato chips?? And has the nerve to tell you who completed their chf core measures with them that "I didn't know I couldn't eat that. You never told me." Zero accountability. ALWAYS FRUSTRATING.

LOL-I also think a gentle swift kick to the rear that is well meant and well placed is effective. Many pts push the limits b/c they can. Sometimes it is necessary to remind someone that they are in the hospital, not a hotel, and some of their freedoms are limited here because they have direct adverse effects on their health. CHF/DM/PE is not getting a donut and a smoke break. And no, I am not sorry it hurts when you breathe if you take your heparin gtt into the bathroom to smoke. GIMME A BREAK!

[pagandeva2000, LPN]

I have been an LPN for a bit over a year, and while I do still have a love and passion for nursing, I am burned out as well. I am more mentally, physically and spiritually exhausted than before when I was an aide with less responsibility. I developed plantar fasciitis, and many times, my feet are literally throbbing, in spite of the orthotics I use. When I get home, I escape by reading and looking at documentaries. I don't care to get together with family and friends as often, and I am always on the make for more money since LPNs don't get paid as well (yet, I don't wish to become an RN). Therefore, I have agency work on the side when I am off, which pays better, but makes me more tired.

We do deal with unappreciative families, patients, administration and policies that police the nurses for silly reasons. I do understand that we have more narc-seeking patients, obese and sicker patients than before (or it may be in my case, that I am more responsible for them). More time is taken into covering our butts than it is focused on the actual patient, making it worse. I do feel your pain. These days, I just cherish the ones that do say that I made a difference, may it be patient or co-workers. And, I make it my business to rest when I have time off, and do not deal with unnecessary drama when I am off of work.

[AlwaysTired]

I work in crisis stabalization drug/alcohol detox and deal with addicts daily. As a matter of fact I just got home from a very frustrating 12 hour shift and the patients were particularly rough today! And yes I get very tired of their demanding, manipulative, downright mean behaviors but am I one of the few who actually see these people as being very sick?? Addiction (drugs,alcohol,food,etc) IS an illness. Yes, they chose to partake in the behaviors initially but there is this invisible line they cross (or a black hole that they get sucked into) and experimentation or pleasure seeking or whatever the initial thrill is turns evil, ugly and dark and the behavior becomes uncontrollable by a sick, unhealthy body and mind. I wish I could explain it better; it's an abyss of some sort and no healthy, well person would choose to look like these people, smell like these people, and in most cases act like these people. I just have to take a step back and realize that. And yes, they deserve great nursing care too. If you can't have at least a little compassion and sympathy for the most nasty, hateful, smelly, overweight, abusive patients then I'd say nursing isn't the place for you. It didn't say in my nursing oath to only care about and tend to those who treat me (and themselves) kindly.

[Babarnurse]

I am disgusted by the OP. I hope like heck she never has to battle the demons of addiction. If she does, I hope her nurse is not as judgemental as she is.

[pagandeva2000, LPN]

I work in crisis stabalization drug/alcohol detox and deal with addicts daily. As a matter of fact I just got home from a very frustrating 12 hour shift and the patients were particularly rough today! And yes I get very tired of their demanding, manipulative, downright mean behaviors but am I one of the few who actually see these people as being very sick?? Addiction (drugs,alcohol,food,etc) IS an illness. Yes, they chose to partake in the behaviors initially but there is this invisible line they cross (or a black hole that they get sucked into) and experimentation or pleasure seeking or whatever the initial thrill is turns evil, ugly and dark and the behavior becomes uncontrollable by a sick, unhealthy body and mind. I wish I could explain it better; it's an abyss of some sort and no healthy, well person would choose to look like these people, smell like these people, and in most cases act like these people. I just have to take a step back and realize that. And yes, they deserve great nursing care too. If you can't have at least a little compassion and sympathy for the most nasty, hateful, smelly, overweight, abusive patients then I'd say nursing isn't the place for you. It didn't say in my nursing oath to only care about and tend to those who treat me (and themselves) kindly.

I understand your points, that all people deserve nursing care, but, I think it is healthy to voice concerns and to be honest with ourselves in the safety of a forum such as this as long as no harm has come to the client due to negligence because of our personal biases. I don't believe that a people who admit to themselves that they have private issues with a certain group of people that nursing is not for them. Maybe they need to transfer to another unit where the number of those certain patients are less, but, it doesn't mean that this person or others are not effective, compassionate nurses. It may come from frustration of not knowing how to reach them that is the problem.

I remember in nursing school where a professor stated that we have to come to terms on how we feel about certain issues before we walk into the patient's room quickly. This means saying to ourselves what and who we don't like so that we can be ready to interact. She used the example of a woman having an abortion. We may not agree personally, and may not participate in the actual termination process, but when we walk into that room, we have to first say to ourselves "Okay, I totally disagree with what she did" but then walk in there and do what we have to do for them NOW.

I KNOW that I am no saint or Florence Nightengale...I can easily admit to myself that many of my patients get on my LAST nerve. I will be as thorough as I can when caring for them, but, I can still walk out of that room and be glad that the session is over.

[leslie :-D]

I am disgusted by the OP. I hope like heck she never has to battle the demons of addiction. If she does, I hope her nurse is not as judgemental as she is.

sorry you feel that way.

i think it's very natural to vent about our very demanding pts.

anyone who says that it doesn't bother them-ever-is not being honest with themself.

i'd much rather hear someone vent, rather than keep it inside, and eventually explode.

we have a darned tough, tough job.

and to pretend that we're a bunch of Mother Superiors, is bunk and very unrealistic.

leslie

[bagladyrn, RN]

I can sympathize with the OP's sense of frustration. I also have days when I am frustrated by entire groups of pts. However, I usually do realize that I am being judgemental, even when I only hear myself making these statements in my head.

I think however that to begin to denigrate pts. because of their behavioral choices which you see as resulting in their disease, is a slippery slope. How is condemning the person who is obese or addicted different from those providers who rejected and condemned HIV positive pts. "because it was the result of their lifestyle choices"? Thank goodness we don't hear THAT one so much any more!

[pagandeva2000, LPN]

I am disgusted by the OP. I hope like heck she never has to battle the demons of addiction. If she does, I hope her nurse is not as judgemental as she is.

I don't think that the OP was being judgemental, I see her as venting. If she was being negligent or abusive that would be a different issue altogether. Of course, we don't know that, but, many nurses do feel this way. It may also be that she is furstrated because she feels ineffective on how to deal with these patients as well as her feelings about them.

sorry you feel that way.

i think it's very natural to vent about our very demanding pts.

anyone who says that it doesn't bother them-ever-is not being honest with themself.

i'd much rather hear someone vent, rather than keep it inside, and eventually explode.

we have a darned tough, tough job.

and to pretend that we're a bunch of Mother Superiors, is bunk and very unrealistic.

leslie

I agree with you, Leslie. No one is a saint. We each have our own issues because we are HUMAN. Nurses have opinions, emotions and frustrations the same as anyone else. And, we need a safe place to vent our frustrations. This is not to say that we may not face opposing opinions; we take the risk of being judged ourselves each time we open our mouths to people. However, I can safely bet that all of us have walked away from situations angry as heck.

And the issues are that with the mountains of paperwork, unsupportive administration and uncooperative co-workers, it is easy to burn out even if it was not our intent. Also, this nurse is speaking from her personal observations, experiences and interpetations drawn from them. I know I am no nun...