Help me with compassion fatigue

lmccrn62, MSN, RN · Mar 15, 2015

What type of unit do you work in? It is very frustrating when patients ring on the dot for pain meds. Better pain management would decrease those behaviors. Adding a long acting and using the q4h as break through. If the long acting is sufficient they will call less. Also patients that are chronic pain patients require their baseline medications and then they need for the acute pain they have. Take a course on pain it would be helpful to help you be better at your job.

HouTx, BSN, MSN, EdD · Mar 16, 2015

It's OKI to vent. You're among friends here. Hey, we all have things that get on our last nerve. Asking for coffee to be re-heated was my 'hot button'..... arrrrgggghhhh.

lmccrn62 has offered some great advice. I would also recommend discussing this with the patient's physician - as part of the development of a more effective pain management regimen in anticipation of the patient's eventual discharge.

heron, ASN, RN · Mar 16, 2015

I agree that some education on the subject of pain is in order ... the oversimplified version from nursing school is totally inadequate. Consider this: a "clock-watcher" may be an addict trying to stay stoned ... or a long-term pain sufferer who knows how to manage his/her pain effectively. We teach them to stay ahead of it, taking medication before pain becomes intense and if that means q4h dosing then that's what they do. Or s/he might well be an addict trying to ward off withdrawal or deal with the stress of hospitalization with the only coping mechanism s/he has. Since I don't know what kind of unit you work on, it's hard to say what might be going on.

I also suggest finding - or starting - a support group like Al Anon ... most of your patients are probably not addicts trying to game the system, but a small proportion are and their antics can wear you out. A support group can become a place to vent/work through the frustrations outside the workplace. Professional care-givers are human ... no one likes to be manipulated or bullied. Don't flog yourself for having a normal emotional response. Those thoughts/feelings you don't like are probably pretty valid. There are steps you can take to work through them and find a way to function more comfortably.

I found it helpful to remember that none of the games were about me ... they were about the drugs. I was the one with the narc keys, so I was the one they had to control to get what they want. That idea helped me to avoid taking it personally. If you're lucky, you'll have support from the MD and nursing supervisors to set limits on the more egregious behaviors (ie calls to the doc at 1am on a Sunday to change doses/intervals or get a different med). If you're not so lucky, then you're kind of stuck with trying to cope on your own. That's when it might be the better part of valor to just give 'em what they want within the limits of medical safety and the md orders.

In dealing with active addiction behaviors, it's important to accept a few things. First, don't get sucked into a power struggle. You won't win. It will just intensify the manipulation/bullying and you still won't "fix" the problem. It's like teaching a pig to sing: it wastes your time and annoys the pig ... who still won't be able to sing.

Second, get clear on exactly what you're treating. Unless you work on a detox or drug rehab unit, it's unlikely that the patient is on your unit to treat his/her drug problem. Spend your energy on the chf or endocarditis or broken leg or whatever put the patient under your care. Think of the drug issues as a comorbidity that just has to be kept stable while s/he's there.

Third, accept that you're not going to feel warm fuzzies for every patient you meet, regardless of whether drugs are involved. Compassion is the ability to recognize that "there, but for the grace of (whatever), go I". It has nothing to do with how you feel. It's about how you perceive the patient and his/her problems. It's a rational process and perceptions can be rationally re-framed, by education, meditation, even prayer if that's a meaningful thing for you. You can be compassionate and still feel angry, frustrated, exhausted, even indifferent at times. Sometimes our expectations of ourselves are totally unrealistic.

Finally, figure out how to give yourself a break. Do whatever it is that you do to play. Recreation is just that: re-creation of your heart, head and soul. Take a vacation or just establish some kind of cleansing/relaxing/energizing activity that has nothing to do with nursing so you can leave work at work.

Emergent, RN · Mar 16, 2015

I need help. I have lost all sympathy for drug seeking clock watchers who want their prn meds q4h on the dot. I know intellectually that these people may very well be in pain. I know that pain is whatever the patient says it is. I have just seen so much drug abuse. I am starting to feel like an opiod delivery service, and that is just bad. How do I get myself past this little judgmental funk I'm in? I don't want these thoughts in my head.

Try having a bad accident, severing tendons, nerves, arteries, then face a long, painful rehab. That might help! :up:

babybums · Mar 16, 2015

I feel the same way. I'm an RN in NICU and I have very little compassion for drug addicted parents. They rarely visit and when they do they wake the baby (who has not slept all day) and when they hear the high pitched crying they leave. In fairness though some parents do try to stay straight and are interested in caring for their infant. Very difficult situation to handle with compassion.

Raviepoo · Mar 18, 2015

Try having a bad accident, severing tendons, nerves, arteries, then face a long, painful rehab. That might help!

Um, actually, that happened to me a few years ago. I still have pain, but I have a high tolerance and take nothing for it.

I'm not talking about those patients.

Raviepoo · Mar 18, 2015

I wrote my original post after a pretty bad shift. The next day I made a point of planning those requests for prns into my shift. It went much better. I think I will survive.

Thanks to everyone who responded with constructive advice.

Cleake · Mar 19, 2015

I have the same issues on rehab floor where I work. These patients are there post surgery but I think some just like to abuse the narcs and it does get aggravating and makes for an unpleasant day when caring for many of the same patients.

Gooselady, BSN, RN · Mar 20, 2015

Good for you :) I worked in psych and chemical dependency most of my career, and 'coping' with the drug seeking patients was an ongoing thing. It wasn't like I suddenly had a revelation one day and never had another resentful thought . . . it was more like over the years, I'd get FED UP! and then I'd get a little more insight and peace with what I was doing, what the whole point was in the first place, and so on. All that back-n-forth up-n-down helped me a lot when I worked in acute care, and when other nurses were naturally goin' 'round the bend, I told them what helped me, which was to make it as impersonal as I could make it.

Just give the darn PRNs as ordered unless in your nursing judgment the patient is gorked or close to it. It's none of my personal business if they nodded out like heroin addicts when I left the room. I was following orders. And in my heart, I most certainly didn't want to make a contribution to their addiction. I let it go, at that.

Over and over again .

toomuchbaloney · Mar 20, 2015

In my view, part of battling compassion fatigue is to establish and maintain very good professional boundaries. Those very good professional boundaries include NOT perserverating upon issues or details which are NOT a portion of your professional duties or responsibilities and are outside of your scope of practice or ability to remedy.

KatieMI, BSN, MSN, RN · Mar 21, 2015

In my view, part of battling compassion fatigue is to establish and maintain very good professional boundaries. Those very good professional boundaries include NOT perserverating upon issues or details which are NOT a portion of your professional duties or responsibilities and are outside of your scope of practice or ability to remedy.

That's the truth itself... the problem is where these boundaries actually are.

I actually love to work with chronic pain patients, at least with those who seem to be at least minimally concerned about their forming (or already well-established addictions) and want to do something about it. I teach them and their families gate theory of pain, the "warm-cool" techniques, guided imaginary, localized stretching and basic relaxing massage depending on the pain's cause. I go through every pain med they are taking, explain things like time of the action start and maximal action and, if they are willing, speak with provider(s) to re-adjust schedule, especially when PT/OT involved. I also teach sleep hygiene and a few other things, among them pain perception ("the pain is what patient says" is what is in the book but it is just not always so in reality, and especially in cases of chronic opioid-attenuated pain). I see at least partial effect (i.e. stopping being "on the clock" callers and no dose escalation) maybe 50% of the time and think that it is at least somewhat positive because otherwise these people would be just given one prescription after another.

I learned all that in the process of beating fibromyalgia without a single pain pill, only by "alternative medicine" means (it cost $$$$ out of pocket, though). I wish I would be able to use other techniques I know such as deep massage, or acupuncture but I definitely can't do anything like it as "just" RN. I do not think, though, that educating and teaching how to use basic pain-relieving techniques can cross any professional boundaries right now except the one I put in my brain myself as "it's just another addict, give'm that shot and get on with everything else". If I can at least attempt to do something I have the right to do and patient wants to try, I'll do it.

And, yes, I know people who hate me with passion for thinking like it and doing it. They know about the hell of fibromyalgia only in theory, though.