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.
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!
Been in similar situations (haven't we all?). My one consolation is that most of my patients usually prefer to be neglected--the less they see of me, the happier they are. Well, I work nights, so the occassional PITA lets everyone else get some sleep.
I agree about the psych consult. My first thought is, what's it going to accomplish, really? My second thought is, it might give her somewhere else to go for attention.
Ah, patients. Ya gotta love 'em. 'Cause ya ain't allowed to slap 'em.
I'm sorry you had such a bad shift! People are so crazy!
I had a patient once that was a addict. The MD was only giving him PO pain meds and had ordered aerosolized morphine just to shut the guy up. The guy was so upset b/c he wasn't getting IV drugs. He followed me up and down the hall my whole shift harrassing me. I also caught him licking the nebulizers to get those last drops of morphine. Finally at change of shift we found him on the floor and his arm was obviously broken. After a psych consult this guy admitted that he broke his own arm on the window seal in order to get IV pain meds....
Good thing I charted everything that crazy man did!!!
I'm sorry you had such a bad shift! People are so crazy!
I had a patient once that was a addict. The MD was only giving him PO pain meds and had ordered aerosolized morphine just to shut the guy up. The guy was so upset b/c he wasn't getting IV drugs. He followed me up and down the hall my whole shift harrassing me. I also caught him licking the nebulizers to get those last drops of morphine. Finally at change of shift we found him on the floor and his arm was obviously broken. After a psych consult this guy admitted that he broke his own arm on the window seal in order to get IV pain meds....
Good thing I charted everything that crazy man did!!!
Oh yes, I forgot about the frequent calls for the "stuff in her artery"--even after the IV was d/c'd. By the end of the shift, when I had time to sit down, I had 4 pages of notes on that one lady. I made a copy and sent to the DON and the hospital admin (not that it will do any good, but I wanted to make sure they were aware of the situtation if the family complianed)
BTW, I found out this morning from a friend that works in the ER that she went in a few hours after she left. They sent her right back home!
And thanks to all for the encouragement and support. It is appreciated, and I've already spoken to the MD about a mental health consult. He said it has been done, but he will consider another when she comes back (she will)
We had a frequent flier (younger pt w/ chronic illness) who had a VERY controlling (and complaining) mother, nothing was ever good enough, my son is being neglected, the nurse's don't answer his call light fast enough yada yada yada. Management stepped in after mom complained to the hospital administrator and set up a contract for his care IF he still wanted to be admitted to our hospital. Yep he had already made the rounds to the 5 other local hospitals and had gotten the boot from them. Pt was still a pain in the %^% but we had limits that we could remind him and mom of that they had agreed to. A psych consult is a nice thought but what good will it do, doesn't sound like she would be compliant with meds or counseling? Hope you and your co workers can find some much needed relief and enjoy your new little one!
oldiebutgoodie, RN
643 Posts
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