It's long, dangerous, but worth typing, to me! - page 5
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... Read More
Oct 15, '07Occupation: RN Specialty: ER ; Joined: Aug '06; Posts: 515; Likes: 352Am 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.
Oct 15, '07Occupation: travel nurse - ob Specialty: OB ; Joined: Jul '01; Posts: 3,171; Likes: 4,505Quote from jojotooWhat 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.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.
To the OP - enjoy your time off and forget that work even exists for a few days!
Oct 15, '07Joined: Dec '04; Posts: 11,695; Likes: 14,916Quote from BabarnurseThe 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.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.
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.
Oct 15, '07Occupation: RN Specialty: ER ; Joined: Aug '06; Posts: 515; Likes: 352Miranda, 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.
Oct 15, '07Occupation: Patient Care Tech Joined: Feb '05; Posts: 44; Likes: 25It 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?Last edit by VivaLasViejas on Oct 15, '07 : Reason: personal attack
Oct 15, '07Occupation: R.N. Joined: May '07; Posts: 3,228; Likes: 3,680This 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.
Oct 15, '07Occupation: LPN- Behavioral Medicine Specialty: Behavioral Medicine ; Joined: Jun '06; Posts: 48; Likes: 25I 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.
Oct 15, '07Joined: Feb '05; Posts: 552; Likes: 229I 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!
Oct 15, '07Specialty: Psych, Psych and more Psych ; Joined: Apr '04; Posts: 70; Likes: 26Quote from missroseYou may believe they belong there, but unless the morbidly obese patient has a gun to head, knife to throat or pills in mouth an acute psychiatric hospitalization is not going to be covered by most insurances. Being morbidly obese for whatever (psychological) reason, unfortunately, is not going to be addressed in an acute psychiatric setting....(snip)... 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....(snip)...
But I hear what you are saying.
Oct 15, '07Occupation: Licensed Practical Nurse Specialty: Community Health, Med-Surg, Home Health ; From: US ; Joined: Sep '05; Posts: 9,297; Likes: 8,221One thing I thought of is that while the OP may have mentioned two particular situations that sincerely irritated her, there may also be others, but these were the two that either stood out the most often, or that happened recently. I don't think she was stating that these people did not need or deserve care...she said that these behaviors burn her out. I think that most people know that we, as nurses are responsible for whatever patients come our way as effectively as possible, but not one person can actually say that they do this daily with a smile, a halo and the Nightingale lamp at our midst each and every day. Sometimes, it is not all about willing, really, but ethical to care for them all. However, most people will occasionally mumble under their breath at least ONCE in their career.
Oct 15, '07Occupation: RN, Assistant Nurse Manager Specialty: 5 year(s) of experience in ICU, ER, Hemodialysis ; From: US ; Joined: Apr '05; Posts: 2,257; Likes: 499Well, if I may....I am a new grad; and so, I do not have that much experience in nursing; however, I am a reader. I believe many posters have only read the top part of the OP's post.
First, the OP has stated that she spends so much time CARING for the addict and obese pt that she can not give proper care to her pt with a brain tumor. This is to say that she DOES care for and does NOT neglect her addicted pts. She is expressing anger over caring so much for one that she does not care adequately for the other. This is a valid concern, and one that shows she is a great nurse!
Second, she stated correctly that she deals with an ever increasing problem with addiction and obesity. Again, this only shows what a great nurse she is. A great nurse will recognize trends in healthcare and work towards a solution. Which, if you read her WHOLE post, is exactly what she is seeking. She cares so much that she does not want to turn her back on nursing, but instead, is seeking a solution.
We must all, in a way, be judgemental as nurses. What do I mean? Well, if my pt is a smoker, I need to judge that to be unhealthy and something that he should quit. If I see a 300 lb. pt come in, I should judge that that is too much weight and that she needs to lose that weight. If I have a diabetic pt that states, "I keep my sugar in check", but his HA1C is in the clouds, I have to judge that he is not telling the truth and needs to adhere to his Dr's orders!! All of these are judgements that a good nurse will make. The solution, as I see it, is in nursing involvement. We must judge who needs to stay away from McDonald's and who needs to seek rehab. We must go into the room with smiles on our faces and a caring hand, but we should not just "give into the pt's unhealthy desires." Instead, we should initiate a conversation about weight management, diabetes management, addiction, etc. You or I could be the one that makes the right judgement about a pt that sets him/her along the path to health. We can not treat all pts the same. The obese pt NEEDS a reduce calorie diet. While we take care of the addicts plea for a pain med, we should also deal with his/her NEED for the pain med! I welcome these pts. I may be the one, a NURSE, that helps deal with this ever increasing addiction and obesity. And, if I don't get through to these pts, I will go home knowing that I did my best. Maybe next time will be THE time I get through. If not, at least I did my best and that is good enough for me!!! I have a great life, wife, kids, great profession, I get to work for this great website; however, some people's lives really do stink; and so, they turn to food or crack. Of course this only makes it worse, but that is what makes my position so much better for the pt. I can see what he or she can not. That life can be better for them....IF only they would let ME help because I CARE!!! I am not some delusional new grad. I know I will not make the difference 99.9% of the time, but I am looking for that 0.1, but I will only find him if I care for all 100% of them.
missrose, I hope tomorrow's shift brings a new perspective for you. And, I hope you find your 0.1%!!! I will leave with your own words....
Quote from missroseYet 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] I'd like to find a solution!![/I]
Oct 15, '07Occupation: R.N. Joined: May '07; Posts: 3,228; Likes: 3,680Quote from jb2uI think you forgot to highlight this in your above quote:<snip>
We need new parameters for caring for diseases that originate in the mind (choices) versus diseases that originate in the body (no choice)
Oct 15, '07Specialty: 12 year(s) of experience in rodeo nursing (neuro) ; From: US ; Joined: Apr '04; Posts: 2,618; Likes: 2,838Quote from BabarnurseBoth my PCP and the nurse who ran a smoking cessation program I tried made a very good point about obesity: you can't give up a food addiction "cold turkey." I can live without tobacco. I can't live (long) without food.2shihtzus,
I believe that addiction is addiction is addiction. It doesn't matter if it is to food, sex, alcohol or drugs. The person is still self medicating, just with different things.