Caring Under Pressure

LoveableJ · Nov 2, 2011

You cant view this article unless you are a member of medscape. Just to let you know.:)

dudette10, MSN, RN · Nov 2, 2011

membership for medscape is free, so I hope I'm not violating copyright or TOS by cutting and pasting from my log in.

Abstract
Your negative emotions can override your caring and compassion. Here's advice on how to avoid this trap.
Introduction
Compassion is an essential ingredient for great nursing. Without compassion, you might as well come up with another word for nurse.
Recently, I visited a local emergency department (ED) for management of a small-bowel obstruction, to which previous surgeries had made me susceptible. I've had several obstructions in the past few years; sometimes, I must go to the ED for assistance.
This time, I was told no beds were available. After being triaged, I waited with increasing pain and a distending abdomen. When I started vomiting, I pulled the cord in the bathroom for assistance. I was wheeled to the back, where I sat in an area with three other patients, each divided by curtains. I continued to vomit and retch, but no one came to assess me.
Time passed. I went in search of someone to assist me. Struggling to stand, I reached the nurses' station, where two nurses were typing on computers. Neither looked up.
After several long moments, I moved down to the doctors' area, where eight people were doing various things--looking at their phones, conversing, working on computers. Finally, one doctor asked, "May I help you?". I responded, "Will you? Will you help me?". She immediately ordered medications, including antiemetics, an analgesic, and I.V. fluids.
My time in the ED continued in this manner, with the nurse coming in to perform duties prescribed by the doctor but not speaking to me. I felt like a thing, not a person. Not once did she inquire about my pain or nausea or ask if I needed anything.
Obviously, it was a busy day and the nurses were short-staffed. A lot was being asked of them; I can empathize. But that's no excuse.
I left the ED angry at the nurses' behavior. Most likely, they didn't realize how disrespectful they were and what consequences their actions could have. That day, they'd treated patients without caring, reflecting poorly on the hospital and our profession.

The author is an RN. There are a couple more pages of the article to post.

Rob72, ASN, RN · Nov 2, 2011

From Medscape:

Abstract and Introduction
Abstract
Your negative emotions can override your caring and compassion. Here's advice on how to avoid this trap.
Introduction
Compassion is an essential ingredient for great nursing. Without compassion, you might as well come up with another word for nurse.
Recently, I visited a local emergency department (ED) for management of a small-bowel obstruction, to which previous surgeries had made me susceptible. I've had several obstructions in the past few years; sometimes, I must go to the ED for assistance.
This time, I was told no beds were available. After being triaged, I waited with increasing pain and a distending abdomen. When I started vomiting, I pulled the cord in the bathroom for assistance. I was wheeled to the back, where I sat in an area with three other patients, each divided by curtains. I continued to vomit and retch, but no one came to assess me.
Time passed. I went in search of someone to assist me. Struggling to stand, I reached the nurses' station, where two nurses were typing on computers. Neither looked up.
After several long moments, I moved down to the doctors' area, where eight people were doing various things--looking at their phones, conversing, working on computers. Finally, one doctor asked, "May I help you?". I responded, "Will you? Will you help me?". She immediately ordered medications, including antiemetics, an analgesic, and I.V. fluids.
My time in the ED continued in this manner, with the nurse coming in to perform duties prescribed by the doctor but not speaking to me. I felt like a thing, not a person. Not once did she inquire about my pain or nausea or ask if I needed anything.
Obviously, it was a busy day and the nurses were short-staffed. A lot was being asked of them; I can empathize. But that's no excuse.
I left the ED angry at the nurses' behavior. Most likely, they didn't realize how disrespectful they were and what consequences their actions could have. That day, they'd treated patients without caring, reflecting poorly on the hospital and our profession.
Impact of Negative Emotions
When you are angry, irritable, or unhappy and let your emotions drive your behavior, here's what happens:
Your emotions distract you. The conscious mind can focus on just one thing at a time, so if you're self-absorbed and have trouble focusing on patients, you can't empathize. You lack the mental "bandwidth" to do so; you're unable to provide the caring and respect required of nurses.
When you're emotional, you don't think clearly and are more likely to make mistakes. When your emotions take over, your mind gets left behind.
Both you and your patients lose your compassion. When you are so upset you can't focus or are busy thinking about everything you need to accomplish, you miss out on those moments you could be sharing when caring for patients. Suppose you want to spend 20 minutes with a patient but you know you have only 3; instead of being angry because you can't spend 20 minutes with him, use your 3 minutes wisely. It makes all the difference.
Negative emotions are stressful and drain your energy. At the end of the day, you leave work exhausted because your mind has been working overtime maintaining negative thoughts. It takes a lot of energy to stay angry! It's not a natural state. Something has to trigger it, and then you must "tend it" to maintain it over time. Whew! That's a lot of work!
Your patients become angry and depressed. Everyone has an innate need to feel valued. To respect means to value. To see the value in others, you must treat them with respect. Patients who don't feel valued or respected may become angry, depressed, lonely, or desperate--which can negatively affect their physical condition.
Empower Yourself
To avoid the trap of letting your feelings override your caring and compassion, follow the guidelines below.
Manage Your Emotions and Your Mood
They belong to you. Decide what kind of presentation you want to make to the world and what kind of experience you'd like to enjoy as you greet people along your journey. Choose to be your best.
Focus on What You Can Do and What You Can Control
Let go of what you have no control over. You'll find this a huge relief. Much stress arises when you focus on trying to control something you can't control; for instance, you can't control how many patients are admitted or how sick they are. You can only control your thoughts, emotions, and behavior.
Trade Each Moment for Something of Value
Stay present in the moment. Focus on what's right in front of you rather than holding onto anger over the past, what you don't have, or everything you need to do today. Be here now.
Let Go of Expectations
Know there may be a huge disconnect between the kind of nursing you want to deliver and the kind you can deliver in the current circumstances. You can only do your best, and on some days, you can just get by. But when you do your best and are respectful--when you care about your patients despite how busy you are--they will respect that and appreciate what you give them. People understand. On the other hand, when you're mean, people are less forgiving. It's disrespectful to treat another person as a problem or an annoyance, and there's no excuse for treating someone disrespectfully. When you disrespect others, you disrespect yourself. When you forget to care for others, you're not caring for yourself, either.
So care about yourself. Remember why you became a nurse and what keeps you in nursing. Be the best nurse you can be. Do the best you can. Make someone comfortable. Pay attention to what your patients might need. Don't ignore them simply because you can't give them everything you want to give. Instead, give them what you can give and they'll be forever grateful.

dudette10, MSN, RN · Nov 2, 2011

edited.

Thanks Rob. :)

Rob72, ASN, RN · Nov 2, 2011

dudette got a bit ahead of me.

In honesty, I can agree with the core points, but find much of it to be the "positive thinking" paradigm, which is grossly inadequate to high-intensity professions. I.e., yeah, fighter pilots do get pep talks, but more importantly, they receive light duty (when they aren't doing their duty), better food, longer rest periods, and generally some of the highest compensation rates in the service.

Contrast that with nursing. Longer shifts; high-performers will be given more shifts. Compensation generally low, in comparison to business and service fields with comparable degree levels. Health-maintenance ("better food') is non-existant.

In essence, don't foist a false model on us, and expect us to respond. Undervalued employees, without autonomy, consistently under-perform.

dudette10, MSN, RN · Nov 2, 2011

I think this is where her experience could have been different, and maybe she would have never written this article, even if all other care was delivered the same.

My time in the ED continued in this manner, with the nurse coming in to perform duties prescribed by the doctor but not speaking to me. I felt like a thing, not a person. Not once did she inquire about my pain or nausea or ask if I needed anything.

Altra, BSN, RN · Nov 2, 2011

I encourage www.medscape.com registration -- it's free, and is a valuable resource.

The RN author's column relating her recent ER visit is disappointing and full of great irony. She describes feeling devalued as a patient, and concludes that the problem is that the stress placed on the nurses has affected their care. She lectures, at length, on the narrowing of focus commonly seen in times of emotional stress but fails to see how that applies to her as a patient. She continues on for multiple paragraphs with a number of stress reduction suggestions for nurses, tips for "managing mood", etc.

I certainly was not present at her ER visit so I cannot possibly comment on the overall situation in the ER that day, or whether or not staffing was short, or whether or not the nurses were "stressed". I can make the observation that the author is a professional nurse with a chonic illness who has not used the resources available to her to avoid repeated visits to the emergency department, and that there are a number of observations in her column that simply deny the reality of nursing, e.g., describing nurses "typing on a computer" as though this were a frivolous activity, rather than the core nursing function of documentation.

I hope that the author's SBO has resolved, and that her mood has improved.

Munch · Nov 3, 2011

I had a crani a while ago and suffered a few complications(swelling of the brain, infection of the incision site) requiring a few ER visits and admissions. One time when I went to the ER where I had the surgery at which is in Manhattan. VERY busy ER. It took me no time to get through triage and into the main ER. Problem was they had no beds available that night like the author mentioned in the article so I too had to wait in a seat before getting into a bed all the while I was going down hill feeling extreme head and neck pain, was dizzy, lightheaded, etc. Now I knew going into this hospital that there was a chance it was going to be busy...it's Manhattan for crying out loud. But being a nurse and being a patient many times due to chronic illness I know how important it is to SPEAK UP. I knew the nurses weren't gallivanting or sitting around eating donuts...they were legitimately busy(which I am sure the nurses were in the article, but the author does indeed make them seem like they were playing solitaire on the computer instead of working). Anyway I finallygot a bed and the doctor saw me and ordered high doses of dilaudid, zofran, ativan, antibiotics, fluids, a CT scan and an LP. My nurses that night seemed to be loathe to bring me the medications/fluids. But it was a VERY busy night. I probably would have been in a bad mood too.

Everyone has a bad day/night even compassionate health care workers and sometimes they take it out on their patients. I learned to take bad moods of nurses/doctors when I happen to be a patient in the hospital with a grain of salt.

wooh, BSN, RN · Nov 3, 2011

The beatings will continue until morale improves!!!

elthia · Nov 3, 2011

After my recent health experiences. I truly am starting to feel that how you are treated by the majority of the employees of a hospital or healthcare system states a whole lot about their work environment.

I recently had surgery, and the everyone from the daysurgery nurse, the transporter, the CRNA, the PACU were wonderful...I felt like I was one of their own, and I don't even work there. I never met any of those people before, but the compassion was evident in the care.

A visit to a rival hospital ED was horrible...it was 2 months ago, and I felt like I was a treated like a drug seeker. I got the impression I was wasting valuable resources, and was told by the staff physician, "it's not like we are going to admit you, or do surgery, you just need to take some advil and get over it."

I said somewhere else, nursing is supposed to be a caring profession, but we don't care enough for each other. If the work environment is not a good one, it comes out in how we treat our patients.