Nurses Have Feelings Too
How do you comfort a family during the imminent death of their loved one while you are being verbally abused
I am fortunate to work in Neuro ICU. I love my job. I love to be in a position to help patients and their families when they are most vulnerable. During my nursing career, which has spanned almost twenty years mainly in critical care, I have also had the good fortune to work as a Hospice nurse for exactly one year. That was eight years ago, but the experience I gained from that has helped me to give meaningful care to those entering into End of Life. The passing of a loved one is probably the most painful experience a family member will endure in their lifetime. I know this to be true because I have been that family member in the past, hence the decision to become a nurse in the first place.
The patient, a fifty-one year old woman vacationing with her husband on the beaches in Florida. They had been getting ready to go out for dinner on the second night of their stay when the patient started throwing up and became unresponsive. The husband called 911 and she was taken to the hospital nearer to the beaches. They did a CT scan and found there was a massive bleed in the brain. She was rushed to our ER where she was seen by our eminent Neuro surgeon and Neurologist.
Prognosis was grim. They were told there was nothing they could do. Many of the family members came yesterday from all over. Last one was to arrive around 1700. The family had decided to withdraw life sustaining measures after the last person, her daughter, got to spend time with the patient. All the paperwork was signed and on the chart. The daughter signed right away when she arrived.
While I was in change of shift report, the husband came out and said they were ready. I agreed, at his request, to stay after my shift and be the nurse at the bedside during the extubation. I called RT to extubate, the order was on the chart, and went to the Pyxis to pull the meds ordered by the physician. I gave 1mg of Ativan and 2mg of morphine as ordered. The RT pulled out the tube.
All was good until the patient started snoring, a loud neurological snore. The husband became upset and yelled at me. I went to ask for an increase in the dose and fortunately the night shift House Officer had just come on duty and told me to make it 4mg every hour instead of 2mg. I pulled another 2mg of morphine and when I got back to the room, the daughter who had just come, verbally abused me. I tried to explain to the family that the patient was in no distress and unaware that she was snoring. The husband yelled at me "Are you stupid! Look at her. This is murder!" He kept yelling as I left the room to ask the House Officer to go in there and talk to the family. The night shift RN went in. By this time it was getting later and I still had to chart the last couple of events.
Then the kicker, the night shift charge nurse came to me to tell me the family complained to her that they were very upset because they were told it would be a smooth transition with no distress, and she believed them!! This after I had comforted them all day and went out of my way to see to their every need. There was no distress to the patient. There is always distress when a young person dies. She was brain dead from the ER.Last edit by Joe V on Jun 16, '18
About wkndnrse, BSN, RN
Joined: Jan '13; Posts: 5; Likes: 37
Neuro Intensive Care Registered Nurse; from US
Specialty: 19 year(s) of experience in Neuro ICUDec 23, '15Joined: Apr '15; Posts: 211; Likes: 1,110That's a real bummer. It's so hard knowing you've done the best job you can do and people are still upset. At the same time, you have to know that it's not about you. These folks are horrified and upset that they've just lost their loved one and it's much easier to dump that horror on a physical human being in the room rather than "the universe" or "God" or whatever force out there allowed this to happen. I hope you were able to go home and vent in whatever way you needed (this article, maybe?) and find some peace.Dec 23, '15Occupation: Neuro Intensive Care Registered Nurse Specialty: 19 year(s) of experience in Neuro ICU ; From: US ; Joined: Jan '13; Posts: 5; Likes: 37Thank you for your comment. I felt like I had failed the family, the patient, as their nurse. Never felt that so deeply before. I prayed for them on the drive home. We are not invincible even though we might think we are at times.Dec 23, '15Occupation: RN Specialty: Mental health, Med/surg, telemetry, PCU ; From: US ; Joined: Apr '11; Posts: 176; Likes: 1,299You did not fail the patient or the family. To lose a loved one so suddenly and unexpectedly is a horrific situation and you did your best to help them. You getting yelled at was not about you, it was about their grief and sorrow.
In nursing we all have good days and bad days, on the bad days I feel like the two words that sum up our profession are "Never enough". We can put our heart and soul into the job, sacrifice our basic needs, work incredibly long shifts, give everything we have and yet it still isn't enough to somebody whether it's the patient, family, medical staff, or management.
Feel better soon, and be good to yourself.Dec 23, '15Occupation: PICU RN Specialty: 6 year(s) of experience in pediatrics, occupational health ; From: US ; Joined: Aug '08; Posts: 263; Likes: 1,552Quote from TheMoonisMyLanternThis.You did not fail the patient or the family. To lose a loved one so suddenly and unexpectedly is a horrific situation and you did your best to help them. You getting yelled at was not about you, it was about their grief and sorrow.
You hit the nail on the head. People who have never been around or experienced a death would find the death of anyone a horrific ordeal, but if it is a loved one, well, that would just magnify the situation.
It is sad they reacted that way, but I am hedging my bets they are now regretting their actions. When people panic they don't think clearly.
What is the most frustrating thing in this situation is the actions of the House Officer. I would have reported her the next day to her boss (or my unit director) in a heartbeat. Where is the backing for the nurses? That is what infuriates me in this situation!
I think my rant could go on and on. I will just leave it at that. We got your back!!!Dec 23, '15Occupation: RN Specialty: 3 year(s) of experience in PACU, Med-Surg ; Joined: Dec '15; Posts: 2; Likes: 3As other posters have already mentioned the key thing to keep in mind is that the patient's family acted this way as a result of the loss they were experiencing, NOT BECAUSE OF YOU! Remember the five stages of grief include anger and denial. Although they had agreed to pull the plug, it doesn't mean they were 100% prepared emotionally for the outcome. As their loved one began slipping way the reality of the situation probably hit them like a ton of bricks. You are not to blame in the least so please don't feel guilty. As nurses our job encompasses so many facets many times psychologist being one of them!Dec 23, '15Occupation: RN Specialty: 3 year(s) of experience ; From: US ; Joined: Sep '09; Posts: 1,557; Likes: 2,537I dislike when I have nursing colleagues who don't give other nurses the benefit of a doubt when families complain about nurses. I'm one of those who do give the benefit of a doubt, and don't report complaints, unless family has a real complaint.Dec 23, '15Joined: Feb '12; Posts: 479; Likes: 963She wasn't brain dead. If she was brain dead, there would have been no breathing whatsoever. Working in a neuro ICU, you should know that the standard confirmatory test for brain death is an apnea test...Dec 25, '15Specialty: 12 year(s) of experience in ER, ICU/CCU, Open Heart OR Recovery, Etc ; From: US ; Joined: Oct '15; Posts: 730; Likes: 1,638You did everything you could. The family was acting out because they lost a family member, suddenly. That doesn't excuse their actions, but it didn't have anything to do with you.
I'm so sorry this happened. Been there. *Hug*Dec 28, '15From: GA, US ; Joined: Sep '15; Posts: 656; Likes: 510I don't want to sound like a broke record but you did your job well. The family members were grieving still and felt like their loved one was suffering. I'm very sorry you were verbally abused. It is not ok and I hope it didn't affect you long term.Dec 29, '15Joined: Apr '14; Posts: 3,830; Likes: 11,458That had to feel awful to be the recipient of all of that expressed pain. (((((Wkndnrse)))))Dec 29, '15Occupation: Med Surg nurse From: US ; Joined: Jun '14; Posts: 36; Likes: 50Nurses are human beings too. We have feelings, families, problems and lives...and yes we get sick and injured and die. Why is it generally accepted (even by our own colleagues) that abusing a nurse because you are sick, grieving or just in a bad mood is OK?Jul 18, '16Joined: Jul '16; Posts: 1Quote from /usernameIt didn't say she was brain dead only that there was nothing more they could do.She wasn't brain dead. If she was brain dead, there would have been no breathing whatsoever. Working in a neuro ICU, you should know that the standard confirmatory test for brain death is an apnea test...
I'm sorry the charge nurse reacted that way. Nurses must have each other's backs.
I'm sure the family regrets their actions.
It was difficult for all of you.
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