Terrible clinical day, nurses don't seem to care. - page 5

I may get a lot of flack for this from the more experienced nurses, but I would like some help in understanding this situation. Today, I walked by a patient's room in the hallway. Keep in mind... Read More

  1. by   Koyaanisqatsi-RN
    Quote from morte
    actually erik touched on this but, you really had no right to an answer....she was not your patient, and perhaps when the nurse answered you that way it was her way of deflecting the question, since you werent that patients student nurse?
    What would have been wrong with simply telling me that? No one did. I agree that I didn't have the right to know her full history or anything, but someone telling me, "she's fine, that's all I can say" would have helped a lot.

    Quote from wooh
    Well, if you'd asked me about it with the accusing attitude that I didn't care, I'd have not bothered to waste "the literally 3 minutes it takes" to explain it to you either. Someone DID tell you she kept pulling out her IVs, but that wasn't good enough for you. How were they supposed to know how long it would take to explain that facts of real nursing life to you? Especially if you're coming in with the attitude that they just don't care?
    I'm not sure why you assume that I came in with the attitude that they don't care. When did I say that? I'm saying that it was the perception I had aftertalking to them. I can promise each and every one of you that I didn't give any nurses attitude. I don't work that way, never have. I was just worried about the patient. Someone saying, "yes it's a shame, but she isn't safe unrestrained and, being elderly, chemicals would be a bad idea" would have more or less completely allayed my concerns. I wasn't trying to ask for a dissertation of restraints and nursing behaviour.

    I think my true problem was not so much the restraints itself (although it was extremely emotional to see it), but rather the lady being called, by multiple staff, a crazy old lady. She used to be someone's mother, sister, daughter, etc. I guess I just think it wouldn't be too stressful or take too much time out of the day to refer to someone as an actual human being.


    Quote from kanzi monkey
    Another thing--chemical restraints are psych meds. They are not recommended unless absolutely needed in elderly patients, and even then you can't give them if the patient can't clear them or have certain cardiac conditions.
    I definitely understand this now better today than I did yesterday. Thank you everyone for explaining this. I looked up some more information and i'm a little surprised we weren't taught that in school. We were pretty much only told that there were 'physical restraints, and then chemical restraints'.

    Quote from RNperdiem
    I was 21 and had never set foot in a nursing home or hospital until my training.
    The world of the disabled and isolated elderly is a hidden world for many healthy young people.
    Altzheimers and dementia were things I had only read about.
    It took me a while to understand what it is like to have a patient unable to retain information due to a lack of short term memory.
    I tried to soothe anxiety and fears that were incomprehensible to me.
    This describes me exactly. Prior to this I had only ever been in a hospital as a patient or visitor. I had no idea.


    As sicushells has pointed out, we cannot always "use happy sunflower words" (as a burnt-out daycare worker once put it). We cannot mandate our emotional responses to always conform to the Mother Theresa paradigm of caring ... and it would be unhealthy to try. "Calling" or not, we are human and get tired, impatient, angry ... all the icky negative stuff that will come up when dealing with life/death situations with other all-too-human people.
    I know what you mean. I guess I've just seen some nurses attempt it more than others, and that's the type of nurse I would like to be, at least to try for. Even just this semester alone I've gotten some good perspective on why things are the way they are.

    Quote from pepper the cat
    We had a pt who was pleasantly confused during the day - but was a terrible sundowner - exit seeking, hitting, resisting care, etc. After several weeks of trial and error, we found the right med mix at the right time would keep him pleasantly confused even into the evening. This included a small dose at noon.
    Students came in, saw the med at noon and decided to hold it (without checking with the nurse0 because "he wasn't agitated, or aggressive". Well - evening came, students were gone and pt sundowned. The next day the students were polietly told NOT to hold any of his meds. They were all upset because they felt we were just sedating him to make our life easier - they didn't see that this type of behaviour was upsetting to the pt, his family and took staff away from other pts as everything 10 minutes we were either re-directly him or helping the nurse care for him not get hit.
    I completely understand this situation, and I would hope I wouldn't be one of the upset students. However, from a student's perspective, can I just make one plea? You are completely right about what should have been done with this patient, but did someone explain to the students calmly why things were the way they were? I can't tell from your post, other than that they were told politely not to hold meds, but where they also politely and rationally told WHY? I think so many issues (including the one I brought up here) could be taken care of much better if just a few minutes are set aside to answer questions. Everyone was a student once, and remembers how frustrating it was to not be explained some very important things. It helps you become a better nurse, and the nurse herself can feel better about truly helping someone.

    I hope to continue learning like this (if maybe a little less emotionally ), and despite how terrible I felt yesterday, I think it was a good experience, because I definitely learned a lot about restraints and why they are used, and how people react to them. Thank you everyone for your help and encouragement.
  2. by   pinksugar
    OP, you sound like a nice person, and I am sure you will be a terrific nurse. That being said, once you start nursing and have your own license, you will realize that sometimes nurses have to do things that are unpleasant in order to protect patients. I have chemically and physically restrained patients before. Why, you may ask - well, I didn't want them to pull out their femoral arterial line, or self-extubate, or do one of the many other ridiculous, very dangerous things that some patients seem to like to do to themselves. It doesn't mean that I didn't care - those patients were turned dutifully, restraints removed and ROM exercises done with regularity, were fed, watered, and toileted appropriately, etc.

    Don't judge a nurse until you have walked the walk, that is all I am saying. You don't know that that nurse doesn't care about that patient. When I was a student I had plenty of grandiose dreams about what things I would and wouldn't be doing for/to patients - once I was in the real world I had a much more realistic picture of what I had to work with.
  3. by   firstyearstudent
    Yeah, well, nursing definitely has its ugly side. But is just turning your back on the "system" and saying you don't want to be part of it the best solution? Who's going to take care of the crazy old ladies if you're not there? You think there is someone better than you (obviously not, because you care and have a good head on your shoulders -- good enough to ask all the right questions). But remember, hospitals, nurses and doctors can only help people as much as they can with the resources they have. It's not always pretty. Just like you will see festering, gangrenous wounds, you will see mental and spiritual distress (yes, some of it brought on by the "treatment"). You will learn to look it right in the eye and do your best to help however and whenever you can, while still preserving your own sanity (and your job heh heh). And, hopefully, when you learn more, you will try to make changes in the system if you're really as bright, ambitious and caring as you seem.

    Every time I think of the lobotomies that were performed, I remember that there was probably a nurse there who helped prep the patient and assured them that "everything was going to be all right." Don't ever stop asking, is this the best course of treatment for this patient, do I want to be a party to this? There may come a time when you need to say, "no."
    Last edit by firstyearstudent on Apr 22, '09
  4. by   FUTURE_RN_08
    After making sure the patient was safe, I would have ventured out to her nurse and let her know what you witnessed in the room. Then I would have ask her if she was possibly a falls risk? I would have thought if she was 80, frail and confused she surely could have been at a "high risk" for falls. The top priority is the safety and well being of that patient. If you hurt someones feelings about questioning what was going on, is just proof they were probably being lazy and neglectful. I know when it clinicals we try not to casue any problems, and I underdstand that. But, you should have notified your instructor so she could have seen what was going on and if there were any problems.
  5. by   heron
    Quote from FUTURE_RN_08
    After making sure the patient was safe, I would have ventured out to her nurse and let her know what you witnessed in the room. Then I would have ask her if she was possibly a falls risk? I would have thought if she was 80, frail and confused she surely could have been at a "high risk" for falls. The top priority is the safety and well being of that patient. If you hurt someones feelings about questioning what was going on, is just proof they were probably being lazy and neglectful. I know when it clinicals we try not to casue any problems, and I underdstand that. But, you should have notified your instructor so she could have seen what was going on and if there were any problems.


    Did you even read the thread???
  6. by   systoly
    Quote from FUTURE_RN_08
    After making sure the patient was safe, I would have ventured out to her nurse and let her know what you witnessed in the room. Then I would have ask her if she was possibly a falls risk? I would have thought if she was 80, frail and confused she surely could have been at a "high risk" for falls. The top priority is the safety and well being of that patient. If you hurt someones feelings about questioning what was going on, is just proof they were probably being lazy and neglectful. I know when it clinicals we try not to casue any problems, and I underdstand that. But, you should have notified your instructor so she could have seen what was going on and if there were any problems.
    I know you are concerned, but please do notify your instructor (before anything else) given such a situation, so your intsructor can explain the five errors you made.
  7. by   heron
    Quote from ooottafvgvah
    I know what you mean. I guess I've just seen some nurses attempt it more than others, and that's the type of nurse I would like to be, at least to try for. Even just this semester alone I've gotten some good perspective on why things are the way they are.
    And that's why I suggested you look up "compassion fatigue" ... some of us get all "tried out" after a while.
  8. by   LesMonsterRN
    It's the nurses who've never fallen prey to compassion fatigue that I worry about.
  9. by   Rascal1
    Quote from LesMonsterNS
    It's the nurses who've never fallen prey to compassion fatigue that I worry about.
    I'll ditto that. And the very thought of that scares me ! :smackingf
  10. by   Koyaanisqatsi-RN
    Quote from LesMonsterNS
    It's the nurses who've never fallen prey to compassion fatigue that I worry about.
    Why is that?
  11. by   firstyearstudent
    Quote from ooottafvgvah
    Why is that?

    Because they're psychos or martyrs? Not normal?
  12. by   LesMonsterRN
    Compassion is essential to what we do. Sometimes we can care too much for too long and therefore run the risk of having that caring "used up" if we don't take care of ourselves. Those who claim to have never been close to it and never worried about it (or maybe just gave up) might not have felt that compassion in the first place, IMO.
  13. by   Koyaanisqatsi-RN
    Quote from LesMonsterNS
    Compassion is essential to what we do. Sometimes we can care too much for too long and therefore run the risk of having that caring "used up" if we don't take care of ourselves. Those who claim to have never been close to it and never worried about it (or maybe just gave up) might not have felt that compassion in the first place, IMO.
    Why is it either/or though? Is it actually impossible to both care for yourself, and for others for a length of time? I've known people who can do both, so I'm not yet convinced that it one or the other only.

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