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Discussion

Horrible 14 1/2 hr shift.

So, I am completely frustrated still from my shift yesterday. Not really looking for advice, I don't guess, I just have found in the past posting these types of things can help me "recover".

I was bummed to start with to discover I had been assigned one of our "frequent fliers". 5 years ago when I started as a nurse's aide, I loved my job. I loved my patients: all of them, even the difficult ones. This woman, and her antics, was the first time in my career I remember dreading entering a patient's room. She enjoys being in the hospital, and the center of attention. She monopolizes your time, taking it from other patients. At one time, I was called to her room so she could report to me that her index finger was having a "stroke", so I should call the doctor to tell him she cannot be discharged.

In recent years, she has started "falling" within minutes of being notified of discharge orders. Flat on her face, "unresponsive"...but somehow manages to hit the call bell before she "loses her consciousness". Never a mark on her (and she's a big woman, if she fell there would have to be a sign). When she "wakes up", she remarks that she guess she will have to stay. And her doctor, who I love but is far too easy going, always cancels the discharge-so she can be monitored.

Well, MD told me yesterday she was going home, but no ride was available until 8pm (12 hours away). I knew what was coming, but before I could get to the room the call light was going off. I enter the room to find her butt up, face down on the floor-IV poll conveiently moved to corner, away from her landing zone where I left it. Refuses to respond. Call the supervisor, and us with a tech get her on her back. Still "out", but we can't help but notice her eyes are having a bit of trouble staying closed. And she's learned a new trick. She has a 2 inch scratch (not big enough to be considered a laceration) to her forehead, with some dry and fresh blood. Blood noted under her fingernails as well. We get her back to bed, doc comes in and looks at it. Steri-strip and dress it for good measures. Ordered to proceed with discharge.

For the next 5 hours, I had the pleasure of redressing her head "wound" 12 times, as she continues to take off her dressing and dig in the wound to restart bleeding, because we "can't send her home bleeding". She even took the steri-strips off. In spent my entire day with this woman, and I am ****** about it because I had 5 other sick patients that received crappy care due to her antics. Not eating and only peeing once in a 12 hour shift also kinda stinks when you are 36 weeks preggo. But really, the part that bothers me is that I am ashamed of the care that my other patients received. I really feel like I let them down.

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    Perhaps the lady needs some limit setting...

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    What about a psych consult?

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    Hey jess...you are not alone.

    I sometimes go home feeling the exact same way. Honestly ashamed and embarrassed that some of the patients that really needed and deserved my attention didn't get it...beacause some crazy (ya I said it) pt takes up all my time.

    Dont really know the answer on how to fix it...sounds like this lady needs a psych consult.

    And document the heck out of everything I guess..Although who has time to document well anymore with all the staffing cuts, increased workload, higher acuity pt's, and (ya I will say it again) crazy patients? But I guess that's a topic for another thread. Just keep swimming......(I love Nemo)

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    Wow, I work in psych, and this sounds very similar to the females I take care of. It kinda reminds me of my "borderline personality" patients. They are very difficult to deal with. Maybe your patient needs a psych consult. Sorry you had a such a horrible shift.

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    Next time she comes in ask her doctor about a psych referral...and look up "Borderline Personality Disorder" to see if it describes you patient. Good luck.

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    Break open an ammonia amp and bring her around a time or two, lol. Some people really enjoy their illnesses ( my mother is one example ) and it's frustrating. I guess, difficult as it is to accept, there is a need being expressed in that behavior. It's my responsibility to attend to that while she is in my care.

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    I knew I would never be a good psych nurse.

    I seriously would consider just putting a blanket on top of her and telling her to enjoy her nap on the floor until her ride came there.

    Yep.

    I suck.

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    Leave her a wet washcloth, and a pile of Bandaids, and tell her you certainly WILL discharge her if she's still bleeding. Self induced wounds are not a reason to hang around.

    I also like Jo's idea, give her a pillow and blanket, and possibly tie the call bell to the bed, just out of reach.

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    Take a deep breath and tell yourself that you will have a few weeks off with your beautiful little baby, away from all the drama in just a few weeks. That's what I used to do.

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    a psych consult

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    Ammonia ampule - that sounds very appropriate. Setting limits - 'Ms X, we are very sorry that you don't really want to go home, but you will be going today, so please stay safe this time.'

    Is her home life miserable? Call social services next time she comes in to investigate her home life.

    And stock up on those smelling salts!!!

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    Too bad the doctor doesn't have any cojones to set limits. Unfortunately, as nurses, we are required to provide "customer service", or we get reamed when the patient complains.

    Hey, next time she's "out" on the floor, bring in the body bag and start to unzip it, while having a spirited discussion with the techs on calling next of kin, getting her into the body bag, post-mortem clean-up, etc. THAT might open her eyes!

    Hang in there!

    Oldiebutgoodie

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