"Bad Patients" - A Labor of Love

Do you remember receiving your last "bad patient"? The kind where you walk onto your unit, see the haggard exhaustion in the previous shift's eyes, and ask in a whisper, at the beginning of report, "Is it bad"? We have all had our "bad patients", the ones that make a shift feel like eons instead of hours, test our patience to the limit, and make us feel like glorified babysitters instead of the professionals we are. But it is in these patients, these who are task-heavy and draining, we see what sets nursing apart from every other job on the planet, and - if we allow it - transform us. Nurses Announcements Archive Article

"Bad Patients" - A Labor of Love

Who was your last "bad" patient? Mine was ThreeTimes an Hour.

At least,that was the average timing of my patient ringing the call bell that night. Often times he rang more (rarely less), leading to a night remembered as one of the longest shifts of my nursing career. All thanks to a pesky prostate and an elderly gentleman who required assistance to stand.

Its funny to look back and think about how much time I spent in that room, helping this man onto thin, frail legs as he attempted to hold on to the plastic urinal with equally frail hands (always with my hand underneath it - never trust shaking fingers to hold a urinal, as I have learned the hard way!). As soon as he produced more liquid gold, I would help him back into bed, ensure his pillow was fluffed and the call button was in reach, and then run out of the room to check on my other patients, get tasks done, and chart as much as possible before the inevitable ring of the call bell returned, marking another twenty minutes as passing.

By the time morning rolled around, I was exhausted. The addition of the straight forward task of helping Three Times an Hour to my other workload meant I was one tired lady. When the next shift finally came in, they saw the haggard look in my eyes and assumed the worst - was this a "bad" patient?

We have all been there. You walk in at the start of a shift, and see the look in your colleagues' eyes. "Is this a bad patient?" we wonder (or perhaps say brazenly aloud). Is this one who demands much but needs very little - Rude and Condescending, perhaps? Bed-Ridden While On Lactulose, maybe? Needs a Linen Change As Soon as the Bed is Clean (also known as the Back Slayer, the Blanket Hog, or the Leaky Rowboat)? The list goes on for what constitutes, in a broad term, a "bad patient".

For myself, however, I have learned much and can appreciate much from these less than savory folks, these who are eagerly dumped onto the next shift as quickly as possible. Don't get me wrong - I get exhausted and frustrated as well, telling myself vehemently that "this isn't what I went to school for!". This particular night was no different - I found myself cursing under my breath each time the call bell went off, each time I found myself already running behind on a myriad of tasks ("why do old guys have to pee standing up? Why?!"). Every twenty minutes, I was expected at the bedside, not to help perform life-saving care or even contribute to the overall diagnostic standing of this man, but to help him with something he genuinely needed assistance with. But isn't this the heart of nursing, all jokes aside?

No, we are not merely bedpan cleaners, butt-wipers, or order-followers - we are much more than that. But at times, in these more humbling moments of humanity, I would see in myself what is terrifying to comprehend - my own vulnerability. I see the future: I am not sick, my parents are not sick, my siblings are not sick, we are not weak or fragile - but we will be. Even more frightening? The knowledge that such frailty is not limited to the old; physical demise cannot be compartmentalized to worry about later.

And that, I believe, is what makes nurses so special. We see in others, on a regular basis, that which the rest of society gets to conveniently forget about - that is, at least, until they or a loved one are the ones clasping the bedrails with trembling hands. We act as caregivers and healers, but also asa barrier - the very sick can present an ugly truth to those who retain their health. They are, in the very seconds we are cleaning them up, helping them stand, or turning them over, facing the very thing humans like to forget about- demons that we as nurses can stand between, and, for the moment, at least,form a wall of caring that can make even the smaller things feel like uplifting victories.

Often, when I drive by hospitals, I look up at the windows and wonder what illness lies behind them, what battles are being waged, but more often than not, I also think about who is performing the exhaustive, thankless work of the Three Timesan Hour patient, my brother or sister aiding in the quest to maintain dignity. I wonder, as I steal a glance up at what must be windows to inpatient units of all kinds, if others do the same - do other caregivers feel moments of solidarity with the souls working that day? Do others feel the pain and fatigue of their cohorts, valiantly working inside?

It can be hard to explain to others why nursing is so special, how we not only make a difference for others, but how those we care for can give to us more than weever expect. It can be frustrating to be reduced to a doctor's handmaiden or a glorified pill-pusher. People wrinkle their noses at our stories,and tell us they don't know how we do it. I am grateful for the chance to do it. It isn those moments of looking into someone's eyes as they are frightened, alone, depressed, or embarrassed that I find my work the most humbling. While it may be easy to say,as a new nurse, that you never want a shift like that, you never want to givethe immobile patient a Kayexalate enema or have the patient who needs so many little things that they amount to an enormous mountain, I believe they are necessary for building stronger nurses - if we allow it, those patients can teach us more than we ever imagined. I don't remember my other patients from that night - their acuity, their needs,their care escapes me - but I remember very strongly this man and the care I provided him.

Although he was my most recent, Three Times an Hour won't be my last "bad" patient. Next time, in the midst of perspiring profusely onto my scrubs as I perform whatever draining task awaits, my hope is that I remember how I feel when I am outside looking up at the hospital, oddly thankful for the opportunity to humble myself and be called a nurse, holding the beasts at bay.

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sbush86

About sbush86

sbush is a US Navy nurse with 5 years of experience in Hematology/Oncology and Critical Care Nursing.

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Thank you for this beautifully written reminder of the many "labors of love" that we do as part of our jobs. Sometimes caring for our patients means doing the "less glamorous" but much needed tasks. Our patients are dependent on us to provide assistance and care in a time when they are very vulnerable. It is at times like this that we can imagine that we are caring for a beloved family member.........or even envision how we would like to be treated if in a similar situation.

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I hope the patient was not experiencing urinary frequency every twenty minutes for very long, because urinary frequency along with a known history of BPH, suggests obstruction, retention and overflow voiding. A bladder scan to assess for retention and intermittent catheterization might have have given him relief and allowed him to sleep.

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Specializes in Hematology/Oncology, Critical Care.

Good point- This gentleman refused an indwelling catheter, and a condom cath only added more equipment to an existing problem of needing to stand. He seemed to take it all in stride that night and was extremely good natured- although, if he had further issues I would not find out as I did not work the following days and he was long gone when I came back in.

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I love your article, and I love doing the things for these patients that they need help with. I have spent time talking to worried parents, sitting while a constipated patient tries his best on the toilet and cannot be left alone, helped a child who dropped the back of her gown into the toilet water, and lots of bed-wetters who needed total linen changes and improptu baths in the middle of the night. I love being of service and helping these people and giving them dignity in the process. I'm being paid by the hour, and that's part of how I am paid to spend those hours.

On the other hand . . . I feel frustrated that nurses are stretched so thin they cannot spend that time with the patients. They have a set of busy, busy patients with lots of meds due, or someone who is unstable and needs constant support at the bedside for an hour before going to ICU, or all the hours of charting that need to be done. This is where I feel the conflict arise. As I'm helping the patient in the room or listening to a parent tell me their worries, in the back of my head I'm being pulled by the knowledge that I have an IV med about to finish next door, or that I'd better finish that huge pile of admission paperwork before the new patient goes to sleep. I would like to not feel rushed when I do those time-consuming things that can often make a real difference in the long run.

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Specializes in PDN; Burn; Phone triage.

Haha. I feel like every nurse eventually gets broken in with the sort of patient that the little old man embodies. Mine was a little old lady with a chronic rectal prolapse. Up and down to the commode, literally, every half hour or so because she was so convinced that she had to poop. Her terror of stooling herself was so great that she just could not be rationalized with that what she was feeling was not the urge to poop. It's definitely a quick lesson in patience and learning how to push through anything for 12 hours, although I just wanted to rip my hair out by the end of the shift.

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Specializes in OR.

I enjoyed your beautifully written article, and have indeed felt those same emotions driving by the hospital and looking up wondering about the patients and their caregivers behind those blinds. I am so reassured that there are still young new nurses who have the same dedication to providing the gentle dignified care that we all wish for ourselves and our families. After forty years as a nurse, I still find nursing a rewarding and satisfying career. You keep up the good work S.Bush!

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Specializes in Geriatrics, Dialysis.

We have a gentleman like this now. Up to pee several times a shift. He is old and frail and has dementia and he is going to pee the way he's peed since he was a kid...standing up. There is no changing this so why even try, there's no reasoning with a dementia resident. So we run for the alarm when it sounds. Fortunately he's steady enough to get to the bathroom, then we can stand behind him and wait...and wait...and wait some more until the final "shake" when he inevitably loses his balance a little. The we correct his balance, follow him back to bed and tuck him in until the next time.

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This is a great reminder for me. The constant need for your attention wears you thin sometimes. While I can handle one demanding patient, have 2+ of those "difficult" patients is what pushes me over the edge. I only wish I could have the ability to provide the care I want to. Sadly with the ever increasing task lists and patient loads, this is simply impossible most days.

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Since going through my dad's death and dying a few years ago, I was in the position of being the family member of the very frail and ill. Like with every personal health experience, I have learned something more of what it's like from the other perspective.

My dad was never as needy as the one described here, but I remember wanting somehow to convey to the staff that this was a good man that had loved his family so much and worked so hard all of his life, a strong kind man that was reduced to helplessness due to this disease. He was so much more than a weak incontinent patient sucking their time and energy.*

I've carried that with me into my own work and it has affected how I view the needy patient, not that I'm immune to exhaustion but it helps.

*(I was also there helping meet his needs as I surely know the staff's perspective a well)

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Well written, thank you. Some of us will indeed be in his position one day, and I hope if it's me or my family, our caretaker will be patient and kind to us.

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When you finally lay your nursing cap aside, you can write a book..what a great story, but, what a great nurse more!

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