How do you cope when patients are not getting better

[GE90]

I'm a new grad who's been working for 5months in peds, somehow I recently started to feel very powerless when looking after some very sick kids or the kids who are in lots of pain, especially when I'm working night shift where the amount of support is not as great as day shift, eg. Not as many doctors around.

Other senior staff often told me patients tend to deteriorate at night so for lots of them its expected to see them worsen overnight. They also said we dont tend to do a lot of procedures at night and these procedures can always leave the them for the morning staff to perform. What they said make sense but I just hate leaving anything not done as it feels like I'm not competent enough, also I cat stand the fact that no matter what I do the kid is still suffering in pain or getting better and once I got home I'd spend hours lying on bed thinking about these patients, thinking about the stuff that I might have forgotten to handover to the next shift, thinking about whether i made the right call for my actons, thinking about what would happen to the patients while im gone( better? worse?) And thinking about what the outcome would be if the patient had been looked after by another more senior nurse.

I'm not a sensitive or emotional person and I hate talking about my feelings with others but i really wanna know how do you guys cope when things are not going the way you want or do you ever feel like you are not doing enough?

[toomuchbaloney]

Sure, everyone feels like that to varying degrees when working with those who will die.

It is hard when our patients are young.

It is important for you to begin, right now to develop some professional boundaries. Put limits on what you are going to personally assume responsibility for in your professional work. Put limits on your empathy when you are off the clock. Practice keeping some things in a nice tidy work locker in your brain to the best of your ability.

We cannot save all of the children. Sometimes we have to watch them die or let them go, even when we love them. We are mortal.

There are great swaths of time when the best thing we can do for any human is to care for them, let them know that we care, be with them, ease their pain, and let them know that they are not alone.

[jadelpn, LPN, EMT-B]

You can only do what you can do. Period. To take care of sick kids is hard for the most seasoned nurse.

First months in any nursing job is overwhelming. You need to visualize a giant stop sign in your head and switch off those thoughts when you get home. Every time. Otherwise you will make yourself ill.

Create your own filter. That you are usually not an "emotional" person could work to your advantage. You are part of a team, and not the sole provider to your patients. You can be compassionate without being emotionally invested in your patients. Looking at it from a clinical standpoint, if the pain control is not working, you need something else. If there's a change in condition, you need to advocate for some alternate care plan--and use your charge nurse "Patient such and so is not responding to the pain medication. She/he needs something else" "Patient such and so will not settle, could you assess the patient so we can come up with an alternate plan?" " I am concerned that patient so and so has a change in condition. Not an acute change, but one which will require education for the parents, and other resources. I am going to email the case manager regarding my findings and will document that I have done so. Can you think of anything else I could be doing?"

Best wishes and remember, you do you and take care of you when you are out of work. Metaphorically close the door when you walk out of the facility.

[GE90]

Th's for the advice toomuchbalconey, really appreciate it. I work in a general peds Ward where terminal illness is very uncommon, but its just so hard to not being able to do something more to relieve their physical pain or fix them before handing over to the next nurses....

[GE90]

Thx jadelpn for the advice. When I see a problem that I think I couldn't handle I do notify the charge nurse and the doctors, but some doctors are just horrible to work with, they don't seem to care or understand what my concerns are especially during night shift, other colleagues just told me to make sure I document everything the doctors said. However I feel like this is just the way to protect ourselves rather than actually doing something to help the patients. And when I left work I'd spend too much time thinking about what I could have done better, I can't sleep or eat or have the mood to do anything, once I return to work and discover that the patient has deteriorated while I'm home I'd feel extremely gulity and terrible....

[NightNerd, MSN, RN]

I will echo what others above have said, but I also think you should consider that maybe talking about your emotions could be a good skill to learn at this point. Yes, it is VITAL to turn it off at home, but you also don't want to develop an emotional backlog of things you have just ignored either. There's a valve l balance.

If your employer has an EAP, see if it can connect you with a counselor. You don't have to go alllllll the time, but just having that emotional and mental tune-up is, I think, a great thing every month or so. This is a time when you can reflect on what you dog week for patients, what you've learned for next time, etc., and will help you develop mechanisms to cope with some of the sad and heartwrenching things we see every day. (You can certainly also accomplish these things with a nursing mentor, either a current coworker or a past professor or something. Either way works.) We need to process this stuff the best we can, and then move on to the next challenge.

[NightNerd, MSN, RN]

Wow, add English to my post above. I think you get the idea, but holy smokes, those are some crazy autocorrects!

[TheCommuter, BSN, RN]

How do I cope when patients are not doing well? I compartmentalize. Patients go into one compartment, whereas those in my personal life go in another compartment.

I also realize that not everyone can be saved, and this fact allows me to sleep at night.