Burnout/ Compassion fatigue

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So.... I love critical care, but over the last year or so my Unit has experienced a huge influx of detoxing addicts and/or alcoholics. Many are rude or even combative, as are some of the families. We utilize the CIWA protocols and are trained in the detox process, yet I frequently find myself in near-combat situations, and it seems we are expected to submit to verbal and physical abuse, as patient and family "satisfaction" is more valued than nurses well-being (physical and emotional). I have family members in this patient group, and I do have compassion for these patient. I'm just really, really tired of being hurt. Today I was kicked in the head, intentionally, by a detoxing patient who had just had a spinal fusion, but (despite his Miami J collar) was able to pinch, kick, spit, head-butt his "caregivers" with impunity. Is anyone else experiencing this issue, and if so, do you have suggestions on how to better deal with this problem?

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I don't have any helpful tips or suggestions regarding your situation as I've never experienced this type of working environment, but I'm sorry you're having to deal with this. Hoping conditions on your unit improve for all involved.

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At my facility that patient would have bought himself five point restraints. A request for a PRN for agitation may be in order as well.

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Specializes in Medical-Surgical/Float Pool/Stepdown.

Restraints and a good old ETOH WD scoring protocol to give as much Ativan or haldol as it takes to safely WD (Pt and staff safety)!

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Specializes in Psych, Addictions, SOL (Student of Life).

Wow - I have literally detoxed hundreds of patients and never been physically asssaulted - Are these patients who came in for detox or just started to detox while recovering from some other illness or procedure? A good librium protocol to manage the detox symptoms usually keeps the patient calm. Always take a nice big orderly in with you.

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Specializes in Med/Surg, ICU.

Is the MD of the spinal fusion patient aware that he is thrashing around to the extent you describe? I can hardly believe that the physician would be ok with that as far as the patient's recovery is concerned, no less your own safety. I have cared for many detoxing patients with the CIWA protocol and have rarely encountered a situation you have described. Are restraints not an option? Are you applying the CIWA protocol appopriately? Do your coworkers not support one another when you have combative patients in order to keep each other safe?

My facility, coworkers and physicians I work with are not perfect, but I do feel like protocols have been put in place that keep both the patient and staff relatively safe. If a patient is being combatitive and violent, staff are expected to assist one another with cares that could leave the caregiver in a vulnerable position, physicians are expected to order any medications and restraints needed to keep everyone safe and management/corporate have used time and resources to train staff to how to protect themselves and avoid potentially dangerous situations. Also, security is always just a phone call away and we have used them as necessary when patients or family members get out of hand. I would not be ok with working in any kind of place that provided anything less.

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Specializes in Acute Care - Adult, Med Surg, Neuro.

Haldol and a few big security guards after calling a Code Restraint Personal Requested (RPR).

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I've always been a huge fan of a succinylcholine chaser after Milk of Amnesia.

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Specializes in Critical Care, Capacity/Bed Management.

A precedex gtt is always nice, doesn't knock out their respiratory drive and usually takes care of their tachycardia

We might do Ativan 1mg q 15 minutes PRN with something like Ativan 2mg q 2 hours/4 hours depends on what the residents are comfortable with but once a patient is near the point where we are calling a code white/grey (in some places) then they are more open to prescribing what is needed

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Specializes in Critical Care, Education.

You need to be your own advocate. There is no justifiable situation in which employee safety is deliberately ignored. Please use all of your internal resources & processes to address the safety issue. Fill out an incident report each time you are assaulted/struck by a patient & complete all of the follow-up requirements each time. If your organization does not have adequate procedures/protocols to address violent/combative patients, take action to initiate one. If all else fails, report the situation via your facility's compliance line. These complaints are normally handled by an 'outside' entity that reports directly to senior leaders... they cannot be squelched by anyone.

Take care of yourself.

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Specializes in Critical Care.

OP, I "liked" your post not because I enjoy what you're going through but because I can empathize. I thought I'd clarify so people don't think I'm sadistic ;)

I second the posters that suggest restraints & sedation, although the type of assault you describe (head butting, pinching...) can easily be done while restrained so perhaps you are already using them.

I do hope you have adequate support from your coworkers. When I worked ICU and Emerge and we were dealing with this sort of situation, we always ran to help out. Having a good doc on your side is always helpful too. I definitely recommend documenting (professional practice, patient safety reports etc) & being vocal about the danger you are facing with these patients.

No wonder you're getting compassion fatigue. One of the many reasons I left ICU. I get it. Good luck & stay safe!

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