"She's coming back next week", and my weird reaction...

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    So today my unit manager informs me that one of our residents, who has been gone now for about a month, is coming back this week. This lady has been at an acute care long term facility for a little while; last I'd heard she was on a vent. I honestly didn't expect this lady to ever make it off the vent, considering the shape she was in. I had built up a good rapport with this lady, I've taken care of her a lot, and I've been rather sad about the turn of events. She's also horribly difficult to care for. She's stubborn and non compliant. She has a trach and refuses to allow staff to care for it properly. There's just... a host of other things that make her horribly difficult to care for, and quite honestly I never wanted to do so again. Found out this morning that she is coming back this or next week. I had two very strong and mixed emotions at the very same time. One, I was very happy that she was doing so well; she even called the facility herself to ask for her old room back. Two, I was rather upset that I'm going to be caring for her again. Maybe this latest experience of being on a vent for so long, will wake her up and make her more compliant. If not, this is honestly going to make my possible upcoming decision to switch jobs, a much easier one.
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    It Seems reasonable to me that you rather dread the prospect of dealing with such a challenging person again. It also seems very reasonable that you are happy that she made it through this latest crisis. Feeling happy that someone lived doesn't preclude you wishing to not have that person be your responsibility again. If we are honest we have all had individuals or facilities that we simply didn't enjoy working with or in no matter what we do to cope or "adjust our attitude" about the situation.

    So if you wanted reassurance that your mixed bag of emotions is normal and, in my opinion, quite understandable then I am totally on the same page with you. Sometimes the best solution is to remove ourselves from the surroundings or persons who cause us such stress.
    NurseCard and VivaLasViejas like this.
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    You're singing my song too, NurseCard. I think we all have had the experience of working with a challenging patient/resident who has to go a higher level of care---at least temporarily---and it's GOOD to get a break from them. The lowered level of tension in a building is almost palpable! Not that we wish anything bad to happen to the person; in fact, sometimes they amaze us with their ability to come back from an illness that, quite frankly, should've taken them out. Doesn't mean we want to see them come back through the doors, though.

    I'm recalling a fellow who used to live at my ALF that had survived a massive stroke which left him flaccid on one side. It also made him a bitter, angry, bigoted old man with a sharp tongue and a way of going limp when the aides tried to transfer him with a gait belt. Several of our staff got hurt in this manner, and he did it on purpose, which really torqued me off and caused me to have many daydreams about finding a way to get his sorry butt into a nursing home.

    He should've been in a nursing home anyway---he was too heavy care for us---but he had money, and a daughter who made him seem like a purring kitten by comparison....she was pure evil and she had this air of entitlement that gave everyone notice that her concerns were more important than anyone else's. It didn't matter if you were responding to a medical emergency, she would just buttonhole you and then harangue you for an hour about some petty gripe. Altogether one of the most unpleasant people I've ever had the misfortune to know.

    HE actually had a dry wit that came out to play every now and again and made it hard to loathe him entirely; she, on the other hand, had no redeeming social qualities, and the day he went to the hospital with bronchitis, the stress level in the facility dropped so low you could practically hear it rolling on the floor. Of course, he was just ornery enough to make it through the illness, and went to a SNF for rehab. For the next several weeks, we waited on tenterhooks; we knew that with our luck, he'd come back and then we'd never be rid of him and his screaming shrew of a daughter. But the Fates were kind, and two months after he'd been sent to the hospital, we got word that his care really did exceed the limitations of an ALF (like, DUH, we didn't know that??) and that the daughter was moving him out.

    Now that he's gone for good, though, we sort of miss him, even though he was a PITA. He did have his good moments after all, and truth be told, we all felt sorry for him because he had a sharp mind in a body that no longer worked. We do not, however, miss the daughter one. tiny. bit. I STILL have nightmares about that woman!
    NurseCard likes this.
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    Well, thank you for the replies; as always it is much appreciated. =) Yeah, I'm REALLY dreading taking care of this woman again. I really tolerated her pretty well, until one night she got sent out to the hospital for, I believe, respiratory distress... and came rolling back into my facility at 1:30 am. No call from the hospital saying she was coming back.. no report... nothing. The rest of the night was a pure nightmare with her, and that night was when I said, "I just can't take it anymore". That was actually about a month or so before she went out the last time, and ended up in the ALTC facility. She's on my hall, of my unit, and so I can either take care of her the best that I know how, or I can ask to switch halls (which we all know does no good), or I can take this acute care psych position, if and when it is offered to me.
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    Quote from NurseCard
    She's on my hall, of my unit, and so I can either take care of her the best that I know how, or I can ask to switch halls (which we all know does no good), or I can take this acute care psych position, if and when it is offered to me.
    Acute care psych? EEk-I think you would be jumping from the frying pan to the fire with that move (that's how it would feel to me) It does seem like the most difficult residents have longevity,doesn't it? I have one right now that makes my skin crawl.We were quarantined twice this winter ,once for influenza and then the norovirus, staff were dropping like flies but she never had one day in bed,the little stinker.Viruses are afraid of her.Her daughter is just as bad as the one mentioned by VLV.I feel like a really horrible person sometimes but one can only stand so much! I feel so sorry for the other residents-they have to put up with her crap 24/7.I get to leave after 8....
    VivaLasViejas likes this.
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    NurseCard, I can certainly relate to not wanting to take care of a particular resident; we had one who would flat out tell you that she didn't care if others needed help, she wanted all of your attention for the shift. And if you didn't give it, she would throw herself on the floor (how? she was a hoyer lift and couldn't feed herself, but she always managed to find the strength to hurl herself to the floor). *Every* long term care facility has (at least) one of these challenging patients. And in an acute care psych facility, sadly the same folks will continue to rotate thru; they might get discharged, but they will come back. Just something to think about.
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    I've done acute psych and have actually enjoyed this; I've worked in the facility where I might be going and like it there. This lady... it's not her personality that gets to me, per se... what gets to me, and it got to me when I did Med/Surge too... is having to take care of someone with both severe medical issues AND psych issues. I find it horribly, horribly difficult to take care of a woman with severe COPD, a TRACH, AND the unwillingness to let us care for her properly. In psych, especially general adult psych... you're dealing with behavior issues, but generally not severe medical fragility. Now, medical problems of course creep up, and it's the job of a psych RN to recognize those problems... but in my experience, it just isn't the same as say, having to care for a lady with severe heart problems AND severe somatization disorder, and delusional disorder. As is the case with another dear lady on my unit. =)
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    Plus, in acute psych, the patients DO leave eventually. They may come back, but everytime they come back, there's the hope that the next time they leave, they won't be back.


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