I am still a baby nurse and just recently began working in a Neuro ICU. I previously worked in an Intermediate care unit for 7 months at a comprehensive stroke hospital and had confused patients often.
I am am having a hard time adjusting to the neuro icu. I have been off orientation for 2 weeks and am struggling because I don't think I like it. When I accepted the position, I was expecting strokes, tumors, etc. Patients that were truly sick and needed care. This is not what I am seeing. The majority of our patients are minor strokes and most of them should be on the floor. I hardly see vents or drips.
The patient I am having the hardest time dealing with is a confused frontal lobe glioma patient. She does not meet icu criteria and is actually a med surg patient but has been placed in the icu because her son works for our cooperate headquarters and she gets "VIP" treatment.
Well, for me that was the first trigger. I believe all patients should be treated equally regardless of the "status". I feel as though this is abusing the system and occupying an icu bed that should be held for a truly sick person. She will not stay in bed and is extremely confused. Her husband gets aggressive with staff and threatens to "call the supervisor and president" because he is listening to what his confused wife is telling him. The doctors have doped her up so much that she is hard to handle. She does not sleep through the night, abuses the call light, pulls at her lines, crawls out of bed and will not comply to nursing staff.
I am really trying not get frustrated but I am seriously at the end of my rope with patience for her.
Are there any suggestions that anyone may have to help me not get so frustrated and handle the situation in a professional manor? Even for in the future?
I don't want to be that jerk nurse that refuses a patient but I also don't think i will be able to provide the best care because of all the circumstances.
Those types of confused patients with anal sphincter family members are in ICUs everywhere -- not just Neuro ICUs. I've had my share of "frontal" patients in CTICU when they stroke peri-operatively. A truly "special" patient like yours pops up approximately every six months in every ICU in the nation (or at least the ones where I've worked or had friends working) and harries some new grad (or new hire) into regretting their career choice, their job choice or both.
You are new in the job; you're currently working on showing your new colleagues how to view you. You don't want to make the mistake of refusing the patient at this stage of the game. It takes only one decision like that one to make a bad reputation for yourself, and it takes YEARS to overcome the reputation. The best path is to suck it up and make the best of your time with this patient and her "VIP" family. The good news is that your colleagues will have some sympathy for you and you're well on your way to having a good reputation with your peers.
I don't have any magical advice for making the best of the situation. What has helped me is to take none of it personally. It isn't personal. You got stuck with a sucky patient in your first two weeks off orientation. Sooner or later it was bound to happen. The good news is that this patient will make some very good stories for you to tell in a year or two when everyone is kicking back on a slow night and regaling the new kids with horror stories from the past. In fact, one of the things that helps me deal with the horrible patients is knowing that with time, this will be a Really Good Story. (I'm not kidding -- it helps!) If you can see the ridiculousness of the situation while you're IN the situation, it helps to deal with the ridiculousness. That family member spouting off about how special he is and how Very Important that makes is relative is acting like a fool. So go ahead and laugh to yourself about it. If you keep a journal -- and I recommend it -- you can ventilate all of your negative feelings safely in your journal and go back to work calmly the next day. Others will tell you that the family member is under stress and this is how he deals with it . . . which, while true, doesn't make him any less of an anal orifice. They'll tell you that the patient can't help her behavior and while this is also true, it doesn't make the 17th or 71st episode any easier to deal with.
Come to think of it, I DO have magical advice. Humor. There are times -- and this may be one of them -- when you have to laugh because if you don't, you'll cry. Laughing is better for your blood pressure and ever so much more fun. You don't have to laugh out loud (probably better if you don't), but try seeing the humor in every new episode and you'll be so much happier in the long run.
And again -- think of the fun you'll have in the next "My Worst Patient EVER!" thread!
If you were a veteran on the unit your coworkers would take turns answering her bell. You won't have to do this on your own the next time. Yes, it is a test, but now that you know that, its an easy test to ace. Just slog through. Give the same directions, be empathetic, offer food and drink, offer the number of your supervisor, repeat hospital policies over and over again, then do the opposite of the policy when your boss treats this jerk as a special snowflake. It will happen- and you need to be prepared for the frustration. Like Ruby said, it has nothing to do with you, its a dysfunctional system.
Maybe ask your preceptor if she would check on your patient when she hits the call bell, and you finally have a chance to chart. Give yourself a little break, then back at it!
You have to find a sense of humor with neuro patients. TPA guidelines in a stroke center say they have to go to a Neuro ICU for that 24 hour period. So no, many of them don't qualify for maybe what you think an ICU patient should be, but we have to monitor for bleeding which is a huge side effect of TPA. Plus, the constant NIHSS assessments cannot be done on the floor. They have 5-6 patients compared to our 2, we can do them, while the floor cannot.
You will learn. Neuro patients can be the most frustrating at times. You do have to walk away and breathe. Hopefully you work on a team where they can take a couple of call lights for you. And sometimes I just say, I cannot properly do your nursing care if you are constantly calling in me in here. I never mind helping you and making you comfortable, but now I am late on your required medications to help get you out of here. Or, if it's something I totally cannot control and they are pulling at lines and constantly becoming a danger to themselves, restraints are in order. You don't always have to do wrist restraints, there are tons of othe types as well.
Most of all, have a sense of humor.
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