How to Avoid Becoming Cynical

Susie2310 · Dec 15, 2015

I think the key to avoiding cynicism is to keep thinking of patients as individuals, not lab values or diagnostic test results (please don't misunderstand; I'm not suggesting that you are doing that). I think just keeping in mind that even though abnormal assessment data, abnormal lab test results, and abnormal diagnostic test results may range from mildly abnormal to severely/critically abnormal; patients are individuals, and patients abilities to cope with various abnormalities are influenced by a number of factors, eg. their age and/or other co-morbidities. An 80 year old patient will have much less physical reserves than a younger person who is in generally good health, as bodily systems are wearing out, and the patient will likely have a number of co-morbidities, so will find it much harder to deal with, and avoid complications from, for example, a severe UTI even if it doesn't result in sepsis, or hypoglycemia even if the actual numbers only indicate mild hypoglycemia, or the hyperglycemia that you mentioned, and will take a lot longer to recover from these problems than a younger person in generally good health would.

Susie2310 · Dec 15, 2015

I think the key to avoiding cynicism is to keep thinking of patients as individuals, not lab values or diagnostic test results (please don't misunderstand; I'm not suggesting that you are doing that). I think just keeping in mind that even though abnormal assessment data, abnormal lab test results, and abnormal diagnostic test results may range from mildly abnormal to severely/critically abnormal; patients are individuals, and patients abilities to cope with various abnormalities are influenced by a number of factors, eg. their age and/or other co-morbidities. An 80 year old patient will have much less physical reserves than a younger person who is in generally good health, as bodily systems are wearing out, and the patient will likely have a number of co-morbidities, so will find it much harder to deal with, and avoid complications from, for example, a severe UTI even if it doesn't result in sepsis, or hypoglycemia even if the actual numbers only indicate mild hypoglycemia, or the hyperglycemia that you mentioned, and will take a lot longer to recover from these problems than a younger person in generally good health would.

I want to add that in regard to your mention of frequent flyers, and possibly becoming cynical in regard to their less than severely abnormal lab values, that I think it is important again to remember that people are individuals, whose lives we are only seeing snapshots of. It is easy to let our own prejudices, values, and ideas about people, e.g., their lifestyle and socio-economic status, influence our care, but in order to provide good care we need to be mindful of whether these things are affecting the quality of care we deliver, and to take steps to rectify the situation if necessary.

offlabel · Dec 19, 2015

Been doing this for a very long time.... and I do not want to sound snarky... you used the word "I" by far more than any other word in your post... By and large, cynical and burned out people have the idea that it's all about them. I and me are their favorite words and it perpetuates a vicious cycle.

That isn't to say that looking after your well being isn't very important, but there is a distinction that is important to make.

allnurses Guide · Dec 21, 2015

Why were you not more upset over the high BGL for that person? because with experience comes the knowledge that this is not all that unusual for that individual..... who has likely a higher tolerence for such numbers. Some of our chronic diabetics would be in trouble if we got them to "normal ranges", especially if done quickly. BGLs need to come down from that level over a matter of hours, which is why we admit them. Yes you had to call for protocol, but did you really expect a different plan? Slow but sure is what is needed.

So that isn't really cynicism, it is experience talking. You're doing fine, don't beat yourself up.

Anna Flaxis, BSN, RN · Dec 30, 2015

I'm having a hard time understanding your post, so I'm going to break it up into chunks and address each chunk.

I'm a New Grad RN working in ER, have been here for about 6 months. Tonight I had 3 patient's that are frequent flyers who already know me and recognize me; One has been in several several several times and I've treated her. I mention this because I'm becoming cynical and I want to avoid it.

Can you elaborate on what "cynical" means to you?

Tonight my patient's BG was overrange (492); I treated with prescribed insulin (regular and Lantus) and notified admitting MD who was basically like: "she was admitted for uncontrolled diabetes, it was going to be high" and he asked why he was being called. I explained it was the protocol and he basically hung up.

The admitting MD has a legitimate point. The protocol that states to notify the physician if glucose > than ______ is for the floor nurses. In the ED, he already knows the glucose is high- your job is to initiate any stat orders and get the patient to the floor.

I got busy and started treating my other, more emergent patients and working with this pt. on getting her BP under control. Last time she was admitted for uncontrolled hypertension and had to be put on a drip in ICU. I forgot to recheck her bg after administering the insulin, which is a mistake which I know I made. When I checked it this AM it was still overrange, which I expected

I'm confused. Was the patient hypertensive or hyperglycemic? When did you forget to recheck the CBG- last time she was admitted, or this time? Why were you checking it this AM- was she boarding in the ED, or did you start your shift in the AM, or ???? I'm really confused on the timeline here.

My question is this--before I started in ER I would have been shocked at a BG that high and been more aware of checking it and trying to bring it down. Now I feel I'm becoming cynical and, I'll admit it, my first though with that BG was that it wasn't super high at all. When I've had patients with glucose in the 900, 1000s, 492 doesn't seem like such a big deal.

It's relative. What else was going on with this patient? What was the anion gap? Was there an ABG drawn? Any LOC changes? Tachycardia? Electrolyte imbalances? The CBG is only one piece of the puzzle.

How do I avoid this? I want to provide the best care possible for my patients and being cynical and not questioning cynical doctors on their orders seems like a recipe for disaster! I want to be a good, safe RN and while I know I'm still learning, I don't want to learn the wrong habits!
Most of our ER doctors won't even treat BG that's below 300 if that isn't their chief complaint/reason for being in the ER.

This is an example of an instance where I think some experience under your belt on general medicine or med/surg would be helpful. I won't go so far as to say that new grads shouldn't be in the ED at all, because people are different and I think some new grads can do well in the ED right out of the gate. But I do think that for many new grads, that experience of caring for a patient through the progression of their illness from admission through discharge can be invaluable in being able to apply that knowledge to the ED setting.