Terrible clinical day, nurses don't seem to care. - page 6

I may get a lot of flack for this from the more experienced nurses, but I would like some help in understanding this situation. Today, I walked by a patient's room in the hallway. Keep in mind... Read More

  1. by   nursemike
    Quote from ooottafvgvah

    I think my true problem was not so much the restraints itself (although it was extremely emotional to see it), but rather the lady being called, by multiple staff, a crazy old lady. She used to be someone's mother, sister, daughter, etc. I guess I just think it wouldn't be too stressful or take too much time out of the day to refer to someone as an actual human being.




    I definitely understand this now better today than I did yesterday. Thank you everyone for explaining this. I looked up some more information and i'm a little surprised we weren't taught that in school. We were pretty much only told that there were 'physical restraints, and then chemical restraints'.



    I know what you mean. I guess I've just seen some nurses attempt it more than others, and that's the type of nurse I would like to be, at least to try for. Even just this semester alone I've gotten some good perspective on why things are the way they are.



    I hope to continue learning like this (if maybe a little less emotionally ), and despite how terrible I felt yesterday, I think it was a good experience, because I definitely learned a lot about restraints and why they are used, and how people react to them. Thank you everyone for your help and encouragement.

    I've quoted several of your remarks out of context, not to address them in particular, but because I see in them a trend I would like to both commend and expand upon. I don't have much to add to the topic of restraints: I hate them, and I use them. They suck. They save lives. 'Bout sums it up. Also, a couple of recent posts stoled what I was about to say about compassion fatigue. It sometimes seems like the nurse who'll ask me, "Hey, when you get a minute, would you go see Mr. XXX and slap him around for me?" is the nurse who is least likely to crack up and actually slap him around. We all have negative emotions, from time to time, and those of us who aren't angels, or even saints, are at least spared the stress of pretending we are, for whatever that may be worth.

    But the point I really want to make, to the OP and anyone else willing to hear it, is that we all want to be treated like the caring, competent professionals we are, but if we can't extend that respect to each other, who on earth will? Now, clearly, not all nurses are equal, and a handful are downright bad, but I am arguing that when another nurse does something, our presumption should be that it was the right thing to do. I know some of my instructors taught that I should expect to see more experienced nurses using out-dated and/or sloppy practice, and not to fall into that, myself. A valid lesson, to be sure, but no more valid than what I've learned for myself, that pretty much every nurse I work with is a good nurse who cares as much as I do, is at least as smart as I am, and is probably a lot more experienced than I am. Now, it's always possible that if we disagree on some solution to a given issue, I could be right and they could be wrong. It's even more possible that we could both be right--that there are multiple right answers and the one we choose is a matter of style or personnal preference. But I find I've learned a lot just by recognizing that what I think, or even what I was taught, could be wrong.

    I think the OP has been shown, and grasps, that restraints are not an absolute evil. Clearly, they aren't an absolute good, either. They should never be used to punish a patient, or even for a nurse's convenience. But I would encourage us all to think that if a nurse and a doctor believe tying a patient's hands is in the patient's best interest, they probably have a good reason for thinking so. A facility with a No Restraints policy is saying, in effect, that the suits and bean-counters are better judges of patient care than the people in scrubs are, and if we work from the presumption that the other nurse is wrong, we're buying right into that. Again, I don't mean to bust the OP's chops, or anyone else's, but in the light of this experience and the comments in this thread, does it seem like a reasonable idea that when you see something you don't understand, or even don't agree with, you start by thinking, "A nurse did this, so it's probably right." Then try to figure out why it's right. Then, if you still have questions, ask them.

    "A nurse did this, so it's probably right." It's a huge leap of faith, and there will be situations where the evidence doesn't bear it out. Sometimes even good nurses are wrong, and some nurses are wrong a lot. But think about the converse: "A nurse did that, so it's probably wrong." Because every working nurse will eventually encounter that from someone. It's discouraging, degrading, and dangerous, but if you get through a shift without getting it from someone--a patient, a doctor, a patient's family--you're lucky. The smartest, most compassionate, best nurses I know have to put up with it. But how great would it be to at least know that you won't have to put up with it from a fellow nurse? So I'm asking the OP, and anyone else who'll listen, to take that leap--not blindly, to be sure, but not hesitantly, either. If we can do that, who knows? Maybe someday, others will, too.
  2. by   Tweety
    Quote from ooottafvgvah
    Why is it either/or though? Is it actually impossible to both care for yourself, and for others for a length of time? I've known people who can do both, so I'm not yet convinced that it one or the other only.
    Most of us are both. I don't think the poster was saying that it's impossible to have compassion wile being self-nurturing. We just have to be self-aware enough to be able to step back sometimes.

    Calling a patient a "crazy lady" isn't exactly self-nurturing, it's demeaning and dehumanizing. It's probably someone's way of coping with the harsh reality of aging in America where elders are tossed aside.

    Also, it's very easy to judge a person we see in the hallway talking about the crazy old lady. It's not really fair to judge a person's insides by their outsides. Their one-on-one interaction with this patient could be filled with compassionate care and unless you read minds or are a fly on the wall, you shouldn't judge. You don't know what they've gone through with this patient. She could be a sundowner who screams all night, pulls out all her tubes, falls out of bed, completely off the chain, that sucks the life out of staff with confusion.
  3. by   heron
    Quote from ooottafvgvah
    Why is it either/or though? Is it actually impossible to both care for yourself, and for others for a length of time? I've known people who can do both, so I'm not yet convinced that it one or the other only.
    Of course, it's not one or the other! If it was, there wouldn't be any caring nurses in the world. The balance is what's critical.

    Sometimes compassion fatigue is transient ... occurring when you've been rushed off your feet for the 4th or 5th shift in a row and patients/families/nursing students look at you like you're the devil incarnate because you can't muster up one more "you poor thing, here ... let me help" if your soul depended on it. Usually cured by a good night's sleep or a vacation. Regrettable, sometimes avoidable ... but it happens.

    Sometimes it's bone deep ... too many shifts dealing with too much misery, mickey-mouse managers and patients/families who never heard of the word "thankyou". It's like pushing a rope, sometimes, to do your best and be met with the b------t you've seen described on this site. Harder to deal with because then it becomes part of a general burn-out syndrome ... sometimes it takes a complete break from nursing or a particular specialty area to get a grip on it.

    Sometimes it manifests as a coldness ... a seeming inability to get worked up over the particular tragedy that's in front of you. Sometimes it manifests as a kind of bleak, black, cynical humor. It looks different in different people, just like any other emotional or physical phenomenon.

    Compassion fatigue is NOT a sign of weakness, stupidity or failure. It is a normal emotional response to intense emotional demands over a period of time. Some of us learn to deal with it better than others.

    You will find that self-care, though simple in concept, is often easier said than done. Especially those of us with families that also need care, educations to further, etc., etc. In this country, we don't even acknowledge the critical role of sleep in maintaining physical or mental health ... if you refuse a shift, or to do the laundry/make dinner/take the kids to soccer practice because you're tired ... just watch the eyes roll!!!
  4. by   LesMonsterRN
    Quote from Tweety
    Most of us are both. I don't think the poster was saying that it's impossible to have compassion wile being self-nurturing. We just have to be self-aware enough to be able to step back sometimes.
    This is what I meant to convey in my last post. I've been trying to think of a way to restate it, but you said it just fine, Tweety.
  5. by   wooh
    Quote from nursemike
    ...But the point I really want to make, to the OP and anyone else willing to hear it, is that we all want to be treated like the caring, competent professionals we are, but if we can't extend that respect to each other, who on earth will? ...
    ..."A nurse did this, so it's probably right."...
    ...So I'm asking the OP, and anyone else who'll listen, to take that leap--not blindly, to be sure, but not hesitantly, either. If we can do that, who knows? Maybe someday, others will, too.
    What a FABULOUS post. Would love to see it posted as an article on the site.
    I'm so tired of us beating each other up. The whole "eating our young" thing is crap, we're beating each other up, whether younger or older. I have to totally agree with your post. It would be so wonderful if we could assume other nurses are doing things right rather than assuming things are being done wrong. It may hurt our need to feel superior to others. But don't we want others to assume we're right until finding out differently rather than assuming we're wrong until we prove to them we're right? And don't we deserve that respect from other nurses, and especially nursing students?

    Also agree with the above about compassion fatigue. There are so many days I want to strangle someone. Because I DO care so much and it's ridiculously frustrating to deal with conditions we have to work in. Isn't it better that I make an off color joke about it to my coworker than well, actually strangle someone? Because I agree, the people that express their compassion fatigue are dealing with it, the people that make Mary Poppins look like Hitler are the ones that tend to finally snap and leave the profession, or become REALLY lazy.

    I also have to say, I've often called someone a "crazy old lady." I've called my grandma that. With the history of Alzheimer's in my family, I'll someday probably be one myself. Sorry if it offends people. But I have always ADORED my crazy old ladies. I've been requested to take care of my coworkers' families that fall into the crazy old lady category because I'm great with them. I flip them, fluff them, and will play in THEIR world as long as I can when I have them. I'm a master of redirecting them. I've talked them down from attacking other staff members. I've made them stop crying when they were frustrating. If you'd rather have someone refer to your grandma as a "demented elderly female" but have them crying and upset the whole time and breaking their hip when they fall out of bed, that's mixed up priorities in my mind.

    Could I use more flowery language? Yep, but I'd rather reserve my limited emotional resources to actually care and respect my patients, rather than prove to someone that I do with my flowery language.
  6. by   sicushells
    To the OP... the problem that you seem to be coming back to over and over that we (exp. nurses) might not be addressing is how the nurse talked to you.
    From your post you didn't see the nurse interact with the patient at all, right? So you didn't see the nurse go up to the patient and say, "You're just a crazy old lady, stop asking for help." (which would be atrocious).
    What you seem to be upset about still is that the nurse told You the patient is just a crazy old lady. Maybe she really doesn't care and is extremely burned out, or maybe she's spent most of her day in the room caring for a patient who can't remember what year it is, let alone why she needs to stay in bed. Yes, it would have been NICE if the nurse you talked to (the tech or whoever you talked to first seems to not have been taking care of the patient, or really known what was going on, so i'm disregarding them.) had said, "Oh that sweet dear... she just doesn't know what she's doing." Instead of saying "yeah, she's crazy, ignore her." It's easy to get frustrated. So... sorry the nurse wasn't super sweet and patient with you. Sorry she let some of her frustration over caring for a patient who is very out of it, out on you... but the nurse has a responsibility to her patient, not towards you. (You weren't shadowing her, she wasn't working with you, she wasn't your preceptor, right?) Suck it up, try to remember to be calm and patient and explain what's going on with your patients to every attending, resident, med student, extended family member, and nursing student that wanders by. And when you slip up and snap at one of the above, or say something less than angelic about your patients to another clinician.... forgive yourself. It happens.
  7. by   Tweety
    Quote from LesMonsterNS
    This is what I meant to convey in my last post. I've been trying to think of a way to restate it, but you said it just fine, Tweety.

    You made a most excellent posts that explains it well. Thanks!
  8. by   LesMonsterRN
    Quote from Tweety
    You made a most excellent posts that explains it well. Thanks!
    <tangent>I guess I feel like being self-deprecating today. It only happens on days I manage to drop my car keys down an elevator shaft. </tangent>
  9. by   Pepper The Cat
    I completely understand this situation, and I would hope I wouldn't be one of the upset students. However, from a student's perspective, can I just make one plea? You are completely right about what should have been done with this patient, but did someone explain to the students calmly why things were the way they were? I can't tell from your post, other than that they were told politely not to hold meds, but where they also politely and rationally told WHY? I think so many issues (including the one I brought up here) could be taken care of much better if just a few minutes are set aside to answer questions. Everyone was a student once, and remembers how frustrating it was to not be explained some very important things. It helps you become a better nurse, and the nurse herself can feel better about truly helping someone.
    Yes - they were told. But because they had not seen this side of him, they did not believe us. And tried to hold the med again. This time, the nurse was watching and she gave it. And we never gave him to the batch of students again. Our unit had a good reputation for nursing students - we have been told several times that our nurses are very supportive of students and teach them alot. This batch just wasn't open to feedback - the instructors fault, not theirs. We requested that this instructor not be permitted back and we haven't seen her since.
  10. by   Koyaanisqatsi-RN
    Quote from Pepper The Cat
    Yes - they were told. But because they had not seen this side of him, they did not believe us. And tried to hold the med again. This time, the nurse was watching and she gave it. And we never gave him to the batch of students again. Our unit had a good reputation for nursing students - we have been told several times that our nurses are very supportive of students and teach them alot. This batch just wasn't open to feedback - the instructors fault, not theirs. We requested that this instructor not be permitted back and we haven't seen her since.
    Well I think in this situation the problem is pretty clearly with the students. If they were explained why this patient needed that medication, and didn't listen, it reflects on their likely future behaviour as nurses. Too bad.

    Quote from sicushells
    Yes, it would have been NICE if the nurse you talked to (the tech or whoever you talked to first seems to not have been taking care of the patient, or really known what was going on, so i'm disregarding them.) had said, "Oh that sweet dear... she just doesn't know what she's doing." Instead of saying "yeah, she's crazy, ignore her." It's easy to get frustrated. So... sorry the nurse wasn't super sweet and patient with you.
    I've got to be honest, it's a little offensive to be talked down to this way. I have been very respectful here, and I was very respectful to the nurses in question. I am not, and have never asked for someone to be "super sweet" to me. I am simply asking for the professional courtesy and respect and compassion that is the industry standard in nearly every job in existence. I have been in experienced roles before, tutoring new people and I have been able to take the small amount of time required to treat other people with a basic amount of respect.

    I'm just going to say that I find a little irony in consistently being told to stop making assumptions about the nurses behaviour, when some of you are making assumptions about me and what my problem with this situation has been.

    Again, I'm very much grateful for the advice on restraints and what to do in the future, but the assumptions that I was a brat towards these "obviously overworked" nurses is simply that: an assumption.
  11. by   firstyearstudent
    Nursing education is crappy because it relies too much on overworked bedside nurses who aren't compensated (or who aren't compensated enough) for teaching students and orienting. They have too much to do already without worrying about what the students are getting into (or telling their instructors!). How much happier everyone would be if nurses who wanted to teach were given decreased pt. loads in order to do so safely and effectively. I'd love it!

    Up until very recently I was super nice to the nursing students and their clinical instructor (because I graduated recently and said I'd never be one of those "nasty" floor nurses.) Then I realized I was getting all the students! The students were asking for me and the instructor was funneling them my way because I was doing my best to do some actual teaching and didn't complain. Unfortunately, I started becoming not so nice and friendly because I was burning out and finding I wasn't effectively managing my time. Patients are my priority...

    I complained to the instructor recently because she have me three students to pass morning meds with. She looked at me and said, "Well, more hands to help, right." I felt like slapping her and just walked away. I was a wreck that day, morning med pass took me three times as long and I was late with two patients. I couldn't find my MARs all morning. And a med error occurred (wrong route, given PO, not IV as ordered), which I guess was my fault but I didn't report... It was just too much.
  12. by   heron
    This looks like it's fixin' to deteriorate into one of those endless threads about eating our young.

    Me, I'm gonna have a lemonade and finish my vacation ... nbch:
  13. by   LesMonsterRN
    :lol:

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