It's long, dangerous, but worth typing, to me!

[missrose]

I am posting this because I feel we need to get real!

I just realized today why I am suffering from nursing burnout. It's because the patient population has change so much in the past ten years. Ten years ago, I didn't have to deal with meth addicts EVERY DAY! Ten years ago, the meth patient was the rarity. Ten years ago, I didn't have to deal with morbidly obese patients EVERY DAY! It's not news... the data is out there: Americans are getting fatter and fatter every year! Why? What do these two types of patients have in common that frustrates me? BAD CHOICES! Morbidly obese patients are very difficult to take care of..... they can't move themselves in bed. (my back is killin' me!) They have infected wounds caused by their obesity. They suffer from diabetes which adds a whole 'nother list of complications (and time providing care). Meth addicts are just plain impossible to take care of! They want (and get) more morphine... because the LAW says if they say they're "in pain" we have to treat their pain..... even if they have no wounds or other obvious cause.... yet 10 minutes after they get their IV morphine, they want to go outside, dragging their IV pole on wheels, so they can have a cigarette. And I have to let them, because they have "rights"!! Yet their safety is my responsibility!! ?? I just don't get it. What about my rights as a professional and a responsible nurse?!

The guy down the hall with the brain tumor or colon cancer? He didn't CHOOSE to be sick! And yet I don't have adequate time to take care of him as I'd like or as he deserves because I'm too busy taking care of the whiney meth addict or the morbidly obese patient! I apologize for my brutal honesty.... but these patients belong on a psych unit because their diseases are psychologically base. I am not a psych nurse. I don't want to be a psych nurse. The patient with the brain tumor or cancer or Alzheimers? He/she is most always very appreciative, humble, pleasant even! Depressed, yes of course! But cooperative! But the addicts? Always demanding, whining, and often downright insatiable! No wonder there's a national nursing shortage!

Will I feel bad after posting this and re-reading what I've posted? NO I WILL NOT, because I have re-read it three times before clicking "post".... my back hurts and I am stressed out from another 12 hour shift of worrying if my patients are safe, comfortable, and well taken care of. That's the most important part of my job.... making sure my patients are safe and comfortable. Yet lately, I leave work feeling inadequate. I feel my SICK patients are being shorted by the overwhelming needs of my addicted patients... whether they are addicted to food or drugs. But how can I help them if they refuse to help themselves?? We need new parameters for caring for diseases that originate in the mind (choices) versus diseases that originate in the body (no choice).... even if those choices have deep roots such as background, lifestyle, lack of knowledge or awareness.... they must be addressed and repaired. And soon! (sigh! Just typing as fast as I'm thinking here, folks!) At least I still possess the compassion to care about finding a solution!! I haven't walked away from my chosen profession yet. I'd like to find a solution!!

[luvmy3kids]

It was a venting post, as she said in the beginning. She has since had a vacation and posted back saying she's feeling much better.

:yeahthat:

I think some people may have missed her post stating she's feeling much better. Of course the thread will/can continue... but it's nice to know that she is feeling a bit "re-charged"... so to speak.

[jojotoo, RN]

It was a venting post, as she said in the beginning. She has since had a vacation and posted back saying she's feeling much better.

God save me from the mutual admiration society that arrives after every single allnurses' venting post. We get a lecture about how they would never do or feel such a thing, and anyone who lets a judgemental thought cross their mind must be burnt out. Sometime people just need to blow off steam.

IMO an honest nurse who vents is better than a judgemental nurse who never has a negative thought. I know who I'd rather trust MY life to.:angryfire

How's THAT for harsh and judgemental?

Sorry Canoehead, I'm confused about your post. Who was on vacation and now feels better since being back?

[Diary/Dairy, RN]

[iMO an honest nurse who vents is better than a judgemental nurse who never has a negative thought. I know who I'd rather trust MY life to.:angryfire

How's THAT for harsh and judgemental?

THANK YOU!!!!!!!!!!!!!!!!!!!!!!! I get that way too - and if I discusted someone on here - I would be even more hurt.

[canoehead, BSN, RN]

Sorry Canoehead, I'm confused about your post. Who was on vacation and now feels better since being back?

The OP.

[jojotoo, RN]

Am I missing something here. The original post was written on 10-13-07 at 10:58 PM. So that was a pretty short vacation. But I'm glad that she's feeling better.

[bagladyrn, RN]

Am I missing something here. The original post was written on 10-13-07 at 10:58 PM. So that was a pretty short vacation. But I'm glad that she's feeling better.

What I think the OP was saying is that she was going on vacation and would have a better outlook when she goes back to work.

To the OP - enjoy your time off and forget that work even exists for a few days!

[rn/writer, RN]

I am disgusted by the OP. I hope like heck she never has to battle the demons of addiction. If she does, I hope her nurse is not as judgemental as she is.

The OP said that she has times when she is frustrated with her patients. You said that you were disgusted with her. Seems like a similar judgmental attitude--except that the OP wasn't happy with feeling that way.

In situations like these, the only approach that makes any sense to me is to try to separate the person from the behavior. Simple, but far from easy in many cases. It allows some breathing room and some opportunity for limit setting. You can try to connect with the person while still being honest about the behaviors. Too often we reject both (person and behavior) or just give up in order to keep the peace.

It can be quite interesting (as well as de-escalating) to ask the patient what they are thinking. They've usually been inundated with information, but they are not often asked for anything other than factual data about their meds and such. It's rare for a patient to be asked if they are willing to follow a treatment regimen. We just assume they are, and that can be very far off the mark. We also don't inquire about what the disease and the treatment mean to them in their lives. For some, health is not a concept that they can get their heads around. They don't see it as being a reachable goal. And the healthcare industry is not very good at meeting them where they are and giving them bite-sized pieces to swallow. It is highly probable that they have been presented with an all-or-nothing picture, and, since they can't see themselves doing all, they opt by default to do nothing. We see the nothing and assume they are willful and selfish and just don't give a hoot when that may not be the case at all.

We also don't spend a lot of time asking about what is important to such individuals. Maybe food or drink or some other "problem" is the focal point of their lives. We aren't going to get very far trying to "take" something of importance away without helping the person to replace it with another source of pleasure. If we don't take that into consideration, we turn into the anti-pleasure police and the entire relationship becomes adversarial. This can be the root of much antagonistic behavior in an in-patient setting.

Connection with the person behind the problem whenever possible is what helps me keep from wanting to strangle some patients. If I can see the person as a person, it helps me. Knowing they have a grandchild or a beagle or a guitar or a tankful of angel fish helps me get past some of the labels, and then I have a greater desire to help them. Seems silly that such little things can turn the tide, but they work so I grab onto them.

Of course, there are those who defy explanation and leave me foaming at the mouth. With that very small percentage, I vent at the nurses' station and work to set reasonable limits. I tell them to list everything they need because I will not be available for a length of time and I don't want them to have to wait. Put in such terms, it sounds like I am going the extra mile for their sake, and I am, but I'm also doing it so I don't commit bodily harm and jeopardize my own mental health and well being. Some still try to push my buttons, but so far I have been able to calmly say, "I'm sorry, but I can't help you with that."

Getting disgusted with nurses who are frustrated doesn't help any more than getting disgusted with patients who have "self-inflicted" problems does. Connecting with a person is more likely to lay the groundwork for some kind of improvement in the situation, even if it's only temporary. Sometimes all you can accomplish are baby steps, but that's okay as long as they still move forward. And venting might be necessary before that can happen.

[jojotoo, RN]

Miranda, It's calm, well-reasoned posts like yours that keep me coming back. Many times I have incorporated your suggestions in to my practice. Thanks.

[Babarnurse]

It was a venting post, as she said in the beginning. She has since had a vacation and posted back saying she's feeling much better.

God save me from the mutual admiration society that arrives after every single allnurses' venting post. We get a lecture about how they would never do or feel such a thing, and anyone who lets a judgemental thought cross their mind must be burnt out. Sometime people just need to blow off steam.

IMO an honest nurse who vents is better than a judgemental nurse who never has a negative thought. I know who I'd rather trust MY life to.

How's THAT for harsh and judgemental?

[EmmaG, RN]

This thread has angered me beyond words. I've been reading it since it was posted, and have so far avoided getting into the fray.

Jojo said "I guess I could understand (and agree with) your frustration a little bit more if your complaints were directed at specific patient behaviors than at specific patients." and I have to agree with this; beyond that, I think the original post is simply ignorant. But I'm not going to point out its obvious fallacies.

When I first read it, I thought of my aunt--- who was really a second Mom to me (more so after my own mother died). My aunt was "morbidly obese". 5'10" and I'd estimate at least 300 pounds. And she was the kindest, most compassionate person you'd ever want to meet. And YES, she was "appreciative, humble and pleasant even" (God, I'm getting furious here just quoting those words...) even though she was "morbidly obese".

Did she like to eat? Of course she did. I don't recall her appetite being that much greater than anyone else's, however. She was always on the go--- worked hard, volunteered her time with disabled children. Yeah, she "chose to eat" and she enjoyed it. But I thought that was normal; as I recall from my days as a student, NOT wanting or liking to eat is pathological. Ah well, I guess I must have misunderstood.

But no worries. Her cancer cured her of her "addiction". Why, when she died, she was positively svelte.

I watched as her nurses cared for her in her final days; I'm so damned glad it was they who were there for her.

If you know what I mean.

[SW_07]

I can completely understand the aggravations of dealing with patients. And even more so I can understand the need to vent about stressful days but after reading the OP, I feel that it was less of a vent and more of an attack on certain types of patients. It had a feeling of a vendetta. The truth is we can not pick and choose what patients we get. As a nurse you should be willing to assess and care for all types of patients whether you are a psych nurse or not.

What about the neuro patient that feels sorry for themself and is angry and takes it out on the nurse? Is that a job for a psych nurse? That patient as you put it is "choosing" to be angry.

Or what about the terminal patient who has lost hope and is refusing to bath or eat? Is that a job for the psych nurse.

We need to be willing to care for patients regardless of what they have going on or the reason's why.

[HealthyRN]

I respect the OPs right to vent and I don't believe she has a "vendetta" against certain types of patients. We all have certain types of patients that we don't enjoy caring for, but we do because we have to provide compassionate care to all people. As long as we don't treat that patient any differently, I think it is healthy to be able to vent about it.

The problem is that it is very difficult to separate disease of the mind and body. Research has shown that there is a genetic link in addiction. People make choices that provide the right environment for those genetic alterations to become apparent. I do believe that it is still, in part, a societal problem. We cannot entirely blame it on "genetics", because it is true one wouldn't become an alcoholic if they never drank alcohol. Perhaps they would never drink alcohol if it wasn't so widely acceptable by society. And on the other hand, the largest part of the responsibility must lie with the individual.

I have a brother that is addicted to drugs and alcohol. It has destroyed his life and our family and he will be dealing with the consequences of his actions for many years to come. It does upset me that he made the choices that he did. For awhile, I felt very sorry for him because it is very easy for me to sympathize with others. After all, he is addicted and couldn't help it. However, after several years of this going on, where family member after family member has tried to offer assistance and help him find a way out of the downward spiral, we have given up and put it into God's hands. The ultimate responsibility is my brother's. I am sure that there is a genetic component to my brother's addiction, but that does not take away his responsibility. Just because he has an addiction does not mean that he should be held to a different standard from anyone else.

I would hope that any nurse caring for my brother would treat him with respect and compassion, but I would definitely understand any irritation experienced in the process. Addiction is very frustrating!