We have recently been fully immersed in the next wave in my ICU. Since August we've been hovering at 25-50% COVID patients in our small unit. When I left yesterday morning we had 10/12 beds with intubated COVID patients. Two coded and died yesterday (one was 38 years old) and then another not yet intubated, was admitted into one room and a NON-COVID! was admitted to the other. So we're 9/12, 8 intubated and we think one might survive, one probably died while I was home today. I'll find out when I get there for my shift tonight.
I was talking with my husband about whether if this had happened say 10-15 years ago, would we still have this seemingly political divide between vaccinated/not vaccinated. He was pointing out to me that the mortality rate is something like 0.016% and trying to rationalize something and I feel badly but I just sort of snapped at him. I told him I don't care what the mortality rate is. My pandemic is made up of those 0.016% and their deaths have been awful and frustrating and now that they largely seem preventable they're just worse. We put 10 people on ventilators in the past week knowing full well that almost all of them will die. I admit that four of the patients that have died since August were vaccinated. However, they all had significant comorbidities. The rest of them weren't vaccinated and many of them were angry at us right up until they went on the vent. And even if it is only 0.016%, it's going to end up being more than a million people in the US. A MILLION PEOPLE that were someone's mother, father, wife, husband, child, etc.
I believe in science, so I guess it's hypocritical of me to say that I don't care about math. But I don't. Because a number doesn't capture people. And doesn't capture what it feels like to go into work knowing you can't do what you trained for. We can't save these people. They're dying ugly deaths and we can't do anything.
think it can be part of a defense mechanism to ask if the patient really needs to be on a ventilator or really needs an ICU level of care. It's very frightening to have a loved one seriously ill.
Yep. And that is completely different than already having some conspiracy theory idea about why the medical team is suggesting something as soon as the words come out of their mouth.
On 12/12/2021 at 5:01 PM, Susie2310 said:
I think another fly in the ointment is that some health care workers refused to be vaccinated without true medical contraindications and continued to take care of patients, while patients' family members, who may have been fully vaccinated and fully compliant with mask wearing/social distancing, were prevented from being with their loved one, advocating for them, and providing them with support.
Those are some very generous "may haves." Significant visitor restrictions + nurses refusing vaccines + but random angry Joe Blow has probably been wearing his mask and social distancing and was first in line to be vaccinated + but his close family member whose bedside he needs to attend has covid and is going on a vent? And all of that probably explains why some family members can be jerks who spout conspiracy theories?
That's quite an unlikely combination of circumstances.
On 12/12/2021 at 5:01 PM, Susie2310 said:
I've read some nurses say that they are glad/were glad that patients family members were not allowed to be with the patient/visit the patient when they were hospitalized during Covid; I'm sure some members of the public are aware that some health care professionals hold this sentiment.
You say that as if nurses were glad because of people's extra measure of suffering.
Working nurses, especially those who have been actively caring for covid patients, are very well aware of the trauma on everyone, including ourselves, related to the fact that people suffered and died while loved ones were helpless and kept away. Hopefully you are also capable of imagining WHY, the main reasons why, people who were being told we might have to wear bandanas while also not knowing if we would soon all be dropping dead took some small bit of relief from having our own exposure to SARS-CoV-2 DIRECTLY REDUCED by visitor restrictions and yes--relieved at having some portion of our focus narrowed to the significantly new and chaotic medical situation at hand. You seem to have the capacity to afford the general public all kinds of best-case-scenario credibility. It's a shame that your published opinions don't very often include much compassion or understanding for those trying to provide care.
On 12/12/2021 at 5:01 PM, Susie2310 said:
I also think that many members of the public are simply fatigued with the whole Covid situation, which has upended peoples lives.
Well, statistically-speaking, most of the people going on vents now decided they were "fatigued with the whole Covid situation" way too early in the game.
Everyone I work with has been vaccinated, and by now, boosted. No strokes.
Everyone in my family has been vaccinated, including the kids. Some of are high risk: DM, heart disease, obesity, lung disease. No strokes, no COVID, no ventilators, no long-haul COVID.
Specializes in New Critical care NP, Critical care, Med-surg, LTC.
20 hours ago, Susie2310 said:
I also think that many members of the public are simply fatigued with the whole Covid situation, which has upended peoples lives.
The only reason that I do not think that your arguments are "understandable", is that the behaviors we are seeing are not really new to COVID. I've been in critical care for years and by the nature of my place of work I deal with people having stress and in crisis. Yes, every now and then we would get a rude family member or someone that cause a problem, but not on the same consistent basis as with the recent COVID patients. Two weeks ago we had a family threaten to come and shoot us if their mother died. That's ridiculous.
And as far as the restrictions, we're back to nearly regular ICU restrictions- two people at a time. All we've done is add the mask/PPE part. And people are acting like now that's an unreasonable thing.
We're all tired. Physically and emotionally everyone, everywhere, is tired of COVID. If any of these family members want to compare notes, in the ICU we've been majorly impacted for almost two years. That doesn't give me the right to treat anyone badly. It shouldn't give them a pass, either.
We have a family member who cannot because of health issues and there are those that are immunocompromised that cannot. Understood.
The ONLY contraindications to the vaccine are allergy related, particularly anaphylaxis or a known allergy to one of the ingredients.
Other serious medical conditions do not preclude getting vaccinated. Not only that, but such patients are high priority for vaccination because if they get covid they are at very high risk of severe disease or death.
This is not about being argumentative, or being right. At this late stage any misperceptions must be confronted. This is no longer the time to be doubling down on one’s beliefs with information that may very well save your loved one’s life.
The only reason that I do not think that your arguments are "understandable", is that the behaviors we are seeing are not really new to COVID. I've been in critical care for years and by the nature of my place of work I deal with people having stress and in crisis. Yes, every now and then we would get a rude family member or someone that cause a problem, but not on the same consistent basis as with the recent COVID patients. Two weeks ago we had a family threaten to come and shoot us if their mother died. That's ridiculous.
Saying that the behaviors you are seeing are not really new to Covid, and that every now and then you would get a rude family member or someone who caused a problem, but not on the same consistent basis as with recent Covid patients, with your example of the Covid patient's family member who threatened to come to shoot you if their mother died - as I read this you're saying that rude, aggressive behaviors by family members have increased since Covid. My understanding is that you are surprised by this; please correct me if I have misunderstood you. The visitor restrictions due to Covid for patients/family members have been an enormous stressor for patients and family members; that is a fact. In my earlier post I stated some of the frustrations patients and their family members have been experiencing: the main one being patients being prevented from having their family members with them when they are sick or dying because the family member who may be fully vaccinated could either transmit Covid to someone in the facility or become infected by someone in the facility. The Covid Crisis Standards of Care is another huge stressor for those affected by this when they go to the hospital. The very real possibility of one's loved one dying from Covid (or something else) in a hospital without their family with them is another huge stressor.
You seem not to be distinguishing between normal times and these extreme Covid times. Of course patients and their family members are more stressed during Covid times and are in crisis more. What would anyone expect? I'm not saying that aggressive behavior, or threats to staff, is acceptable behavior; I'm saying that I understand the huge frustrations that lead to these kinds of behavior.
On 12/13/2021 at 1:48 PM, JBMmom said:
And as far as the restrictions, we're back to nearly regular ICU restrictions- two people at a time. All we've done is add the mask/PPE part. And people are acting like now that's an unreasonable thing.
I think people are completely fatigued with the whole Covid situation.
On 12/13/2021 at 1:48 PM, JBMmom said:
We're all tired. Physically and emotionally everyone, everywhere, is tired of COVID. If any of these family members want to compare notes, in the ICU we've been majorly impacted for almost two years. That doesn't give me the right to treat anyone badly. It shouldn't give them a pass, either.
No-one has said that family members have the right to treat anyone badly. But how can family members behave "normally" if they are under the huge stressors that I have already stated? People have been losing their jobs, losing income, may have lost their home or be at risk of doing so; their loved one may be very sick in the hospital but they aren't allowed to be with them to care for them and support them; their loved one may die alone in the hospital without family if the visitor restrictions don't allow the family member to be present.
It sounds as though you are close to breaking point, and I'm very sorry for what you and others have been going through. Health care workers' struggles during Covid are well documented. It seems to me, looking in from the outside, that unless you believe that things are going to change for the better in the near future, the choice you have is to either continue in your current job/hours, or not; I obviously don't know what your personal circumstances are.
I'm saying that I understand the huge frustrations that lead to these kinds of behavior.
No, you're pretending that people who are more pissed off than usual because they have chosen to believe that WE are the boogeyman who is out to get them are just frustrated due to the normal reasons that all the rest of us are frustrated. That's simply not true. They're acting like this because they think science and healthcare professionals are on the wrong side of everything to do with covid.
Can you understand that? I will make it simple:
Healthcare worker: Stressed due to people dying despite everyone's back-breaking efforts and the advantage of all the technology we have available, long hours, understaffing.
Random Joe Blow who threatens to shoot people: Thinks ^^ these are the enemy.
14 hours ago, Susie2310 said:
But how can family members behave "normally" if they are under the huge stressors that I have already stated?
I will tell you how. They can cry, they can even raise their voice or speak in slightly more frustrated or stressed tones, they can spend more time seeking support than usual. They can look tired. They can complain more. Etc., etc., etc.
What they can't do, is things like threaten to shoot people. SHOOT PEOPLE.
Your continued theme of making excuses for the inexcusable is noted.
The idea that people can have a pass for (various forms of) harm to others because of their own health stressor is ridiculous and always was. Nursing should be ashamed of having entertained this for so long.
14 hours ago, Susie2310 said:
It seems to me, looking in from the outside, that unless you believe that things are going to change for the better in the near future, the choice you have is to either continue in your current job/hours, or not; I obviously don't know what your personal circumstances are.
Then maybe it's a good idea if you stop commenting. As a self-proclaimed outsider who doesn't know the OP's circumstances, you haven't come up with a single helpful thing. You've made excuses for some of the most ridiculous human behavior that nurses have had to tolerate and now have capped off this episode of Susie's Airing-of-Grievances by advising a competent and compassionate adult professional of their choice to leave if they don't like abuse from patients and their family members.
Edit: It turns out I have one more comment:
With your perpetual dissatisfaction with nurses, have you ever stopped to think what the landscape is going to look like when a significant portion of compassionate and knowledgeable people do leave? What do you think your chances of having your loved one receive appropriate care will be then? It's already happened and still happening. Does that seem like a good solution to you?
You seem not to be distinguishing between normal times and these extreme Covid times. Of course patients and their family members are more stressed during Covid times and are in crisis more. What would anyone expect? I'm not saying that aggressive behavior, or threats to staff, is acceptable behavior; I'm saying that I understand the huge frustrations that lead to these kinds of behavior.
15 hours ago, Susie2310 said:
No-one has said that family members have the right to treat anyone badly. But how can family members behave "normally" if they are under the huge stressors that I have already stated?
Interesting. Honestly, that is the type of logic used to justify domestic violence. That man is under incredible stress at work, and then he comes home to to a dirty house? I am not saying that slapping his wife is OK, but we need to understand the triggers that led the man to this violence. While you aren't wrong, your focus is entirely misplaced. The focus here is on the victim, and while the man needs help, and we should understand the causative factors of violence, the priority, by a long measure, is to stop the violence.
Apparently pandemics are stressful. When people express their frustration, I empathize with them. If people's behavior is altered by stress, I give them a bit of latitude. You know who the decent people are by their response- they apologize. The ones who don't were jerks before they showed up, and will be jerks after they leave.
You asked two questions. Ill be happy to answer.
"What would anyone expect?"
I expect decent people to act decently. I expect jerks to act like jerks.
There are also societal expectations. We expect people to be law abiding. We expect people to not be abusive. While we aren't surprised when people violate these norms, we take action. When they don't meet these expectations, they need to be removed from the hospital, charges pressed if appropriate.
"But how can family members behave "normally" if they are under the huge stressors that I have already stated? "
They are behaving normally for them. Covid created a lot of problems, but did not turn anybody into an abusive *** any more than dirty dishes in a sink turns a good man into an abuser. Covid just gave them an excuse to act like an abusive *** in the hospital.
And no. These are not vaccinated people who are frustrated by not visiting their family when they are being cared for by unvaccinated staff. That's a stretch.
Interesting. Honestly, that is the type of logic used to justify domestic violence. That man is under incredible stress at work, and then he comes home to to a dirty house? I am not saying that slapping his wife is OK, but we need to understand the triggers that led the man to this violence. While you aren't wrong, your focus is entirely misplaced. The focus here is on the victim, and while the man needs help, and we should understand the causative factors of violence, the priority, by a long measure, is to stop the violence.
No, I'm not justifying violence/aggression. Of course violent/aggressive behavior needs to be stopped. Health care facilities have measures in place to do this, but it appears that you and others are complaining that these measures are not sufficient and that you want more severe/punitive measures. Have I understood you correctly? It seems you are saying that de-escalation measures are often ineffective: this then brings forth the questions of what methods are being used and how well the user is employing these methods - I recently read a study that showed that correctly using de-escalation measures is associated with increased effectiveness.
My point in mentioning the stressors that I referred to in my earlier posts is that by better understanding what many members of the public are experiencing, one can incorporate this understanding into how one interacts with them. If I understand the challenges someone is experiencing, I am more able to respond to them appropriately and to build a relationship with them.
On 12/14/2021 at 9:34 AM, hherrn said:
If people's behavior is altered by stress, I give them a bit of latitude. You know who the decent people are by their response- they apologize. The ones who don't were jerks before they showed up, and will be jerks after they leave.
There's no doubt that some people have bad attitudes or are sociopaths. Some people experience homicidal inclinations. Of course the people who are a danger to themselves or others need to be prevented from acting in a way that could cause harm. But beyond the measures already in place in facilities to deal with patients/visitors who present a threat of harm to themselves or others, what do you actually want? Do you want a security presence at every door to the facility, with an increased security presence in vulnerable areas such as the ER? Scanning devices at entrances to the buildings so people entering the building can be screened for potential/actual weapons? What are the exact measures that you would like? Would you like patients/family members to face criminal charges? How do you think the public would respond to a Court House level of security? My own thought is that while aggression/violence obviously needs to be deterred, health care facilities are seen by the public as being havens of safety, and I think there is a real risk that by utilizing more security guards, scanners at entrances to the buildings, etc., that some members of the public may not continue to use the health care facility's services in the way that they do now. It's possible that greatly enhanced security measures could discourage people seeking services from the facility to the point that facility income would be reduced; thus the ability to remunerate health care staff could decrease. Why don't you and others state exactly what measures you would like to see in place in facilities to deter aggression/violence, and then we can discuss the pros and cons of your suggestions. You mention that people who exhibit these behaviors should be removed from the hospital and charges pressed if appropriate: that would translate into arresting people in the hospital who are ill or in crisis, who may or may not happen to be "jerks" - do you think that would result in positive community relationships?
It seems to me that this entire discussion is actually about nurses' desire for enhanced security/police measures and nurses' desire for patients/family members to face criminal charges if they exhibit aggressive/violent behaviors (and then the question arises of what the definition of aggressive/violent behavior that incurs these measures should be). Perhaps it would be better to just be straightforward about that and call it that.
When people express their frustration, I empathize with them. If people's behavior is altered by stress, I give them a bit of latitude. You know who the decent people are by their response- they apologize. The ones who don't were jerks before they showed up, and will be jerks after they leave.
Unreasonable before covid and unreasonable during covid.
I have said this for years. This promulgated idea, historically supported by nursing, that decent people become what we are talking about even temporarily, due to a period of stress--that is false. They don't. They do a lot things that may be varying degrees out of their usual character, but they don't spew hate. They don't threaten, they don't frighten people. And, as you note, they do very often apologize. Their baseline is obvious.
I often think, as one example of many, of a family member at my patient's/his spouse's bedside. I was sitting in a chair at the beside (next to him) as they were told their child didn't survive the MVC the family had been involved in. At that moment, he brought his forearm down forcefully on the raised stretcher rail...then...he just slumped back into the chair and put his head in his hands and sobbed. His behavior was likely out of his realm of normal daily behavior upon hearing what many would consider the worst news anyone could ever hear. Yet he didn't scare anyone, he didn't put anyone in danger, he didn't even insult anyone, and despite his initial reaction of striking the stretcher rail, no property was harmed or destroyed.
He didn't find some hot coffee to throw, he didn't rip out his spouse's IV and start whipping the tubing around the room flinging blood at people, he didn't say he would be back to kill us all, he didn't throw a full urinal. He didn't even call us liars or demand to know how this happened. He didn't demand to speak to the manager in hopes of just wreaking havoc. Hearing such distressing news, he surely could have ripped the monitor off the wall or picked up his own chair and bashed it right over my head or someone else's. But, again, people who aren't practiced at scaring, threatening and hurting others don't just flow naturally into doing so--even when they themselves are experiencing immense pain and despair.
The patterns of who does what are not difficult to observe.
There are also societal expectations. We expect people to be law abiding. We expect people to not be abusive. While we aren't surprised when people violate these norms, we take action. When they don't meet these expectations, they need to be removed from the hospital, charges pressed if appropriate.
4 hours ago, Susie2310 said:
You mention that people who exhibit these behaviors should be removed from the hospital and charges pressed if appropriate: that would translate into arresting people in the hospital who are ill or in crisis, who may or may not happen to be ”jerks” - do you think that would result in positive community relationships?
Susie first of all, could you please quote people’s posts and write your replies separately? It would be helpful as it makes it a lot easier for other posters to quote you and reply to you.
I realize that the post I just quoted wasn’t for me but in response to hhern’s post, but I don’t think anyone here was discussing nurses’ desire for enhanced security and police measures. I think that you are the one steering the conversation onto that particular path.
I read the posts you’ve made in this thread and this is what I see. OP who is someone who has worked many shifts for well over a year, caring for Covid patients requiring ICU care. You showed up and felt the need to explain to OP how hard the pandemic has been for patients and patients’ loved ones. What made you think that OP even needed to be told about that?
The pandemic has been hard for e.v.e.r.y.o.n.e. Probably especially hard for ICU nurses.
Susie, I don’t know if you are aware or if this is just me, but I often get the feeling that you are attempting to educate us as if we’re a bunch of not overly astute five-year-olds. Most of us have either been patients, have loved ones who have been patients and whom we’ve worried about, or both. Most of us have cared for hundreds or likely thousands of patients and as many desperately worried loved ones. We k.n.o.w. what kind of stress people in these situations face. We know it’s scary.
I wish you could show even a tenth of the compassion and understanding for your fellow nurses as you do for patients and family members.
Now to the part of your post that I quoted. Yes, you can get arrested even if you are ill or in crisis. Being in crisis does not mean you are handed carte blanche to commit violent offenses. Family members threatening medical staff with violence or actually assaulting medical staff (or anyone else), is simply not okay.
I know that you said that you’re not excusing violent behavior, but it really does sound like you are. You are offering a number of explanations for the violent behavior. While those explanations can sometimes make a difference in a court of law when mitigating circumstances and specific aspects of an incident can sometimes have an effect on the verdict and/or punishment, they don’t affect whether something is a crime or not. What actually constitutes the criminal act/crime itself, is normally more simple and clear-cut.
Former career.. the numberoftimes I’ve said… Oh, you just stabbed x or whacked y over the head with a two-by-four.. but I’ll let you off this one time… because I can tell that you are in crisis…
=
You guessed it…
0
You cannot not arrest someone (or have someone arrested) because you are concerned about ”community relationships”. I am honestly not sure what you were even thinking when you posted that. Are you suggesting that nurses and other medical professionals will lose the public’s trust if we send the signal that it’s not acceptable to physically assault us or threaten us? Even if that were the case, and I don’t think it is, should we all just become some self-sacrificing punching bag/doormat in order to preserve the ”relationship”?
Have I understood you correctly? It seems you are saying that de-escalation measures are often ineffective: this then brings forth the questions of what methods are being used and how well the user is employing these methods - I recently read a study that showed that correctly using de-escalation measures is associated with increased effectiveness.
Nope. I am one of the folks often assigned the likely confrontational situations because of my ability to de-escalate. I am used as a role model in this regard. I also do not tolerate abuse, or abuse of other staff. And I didn't even read the study. Figured it out with years of conflict resolution experience prior to 17 years in ER/ICU.
5 hours ago, Susie2310 said:
But beyond the measures already in place in facilities to deal with patients/visitors who present a threat of harm to themselves or others, what do you actually want?
Hospitals to stand behind the claims of zero tolerance.
5 hours ago, Susie2310 said:
Do you want a security presence at every door to the facility, with an increased security presence in vulnerable areas such as the ER?
Sure. In areas that warrant this- sound great.
5 hours ago, Susie2310 said:
Scanning devices at entrances to the buildings so people entering the building can be screened for potential/actual weapons?
No doubt a good idea in some hospitals. Mine doesn't need it. Yet.
5 hours ago, Susie2310 said:
What are the exact measures that you would like?
You proposed a few good ones. Mainly for the hospital to stand behind staff. We lose a ton more good nurses to feeling unsupported than we do from vaccine mandates.
5 hours ago, Susie2310 said:
Would you like patients/family members to face criminal charges?
100% of the time they commit criminal acts. Misdemeanor charges when appropriate. Escorted off property when inappropriate but not illegal.
5 hours ago, Susie2310 said:
It's possible that greatly enhanced security measures could discourage people seeking services from the facility to the point that facility income would be reduced; thus the ability to remunerate health care staff could decrease
Poppycock. Actually, poppycock squared.
1- Enhanced security won't stop people from using hospitals. If it keeps out the kind of folks who don't like a secure environment, that is great, and well on the right side of the risk/benefit analysis.
2. This will not effect my pay. The fallacy that my pay is linked to hospital income is often perpetuated by admin. I am a commodity. The hospital pays market rates. They even used that term on the last pay adjustment. The market is based on supply and demand, not how much profit a hospital makes. They don't write the electric company a little bonus check when things are going well.
The very fact that a nurse would imply that somehow creating a safe working environment would negatively effect pay is really kind of nuts. What environment do you work in?
I know a lot of nurses, and can't think of one who would not be perfectly happy to see an aggressive, threatening visitor taken out in handcuffs. Wouldn't bother me if they were tased, except the ER is already too busy, and invariably they need jail clearance.
Thank you to the original poster and all of those nurses working so hard at the front lines I am so sorry you all are going through. That you stay shoes so much about you all. I care a lot as many of us do and praying so hard for this to end.
JKL33
7,038 Posts
Yep. And that is completely different than already having some conspiracy theory idea about why the medical team is suggesting something as soon as the words come out of their mouth.
Those are some very generous "may haves." Significant visitor restrictions + nurses refusing vaccines + but random angry Joe Blow has probably been wearing his mask and social distancing and was first in line to be vaccinated + but his close family member whose bedside he needs to attend has covid and is going on a vent? And all of that probably explains why some family members can be jerks who spout conspiracy theories?
That's quite an unlikely combination of circumstances.
You say that as if nurses were glad because of people's extra measure of suffering.
Working nurses, especially those who have been actively caring for covid patients, are very well aware of the trauma on everyone, including ourselves, related to the fact that people suffered and died while loved ones were helpless and kept away. Hopefully you are also capable of imagining WHY, the main reasons why, people who were being told we might have to wear bandanas while also not knowing if we would soon all be dropping dead took some small bit of relief from having our own exposure to SARS-CoV-2 DIRECTLY REDUCED by visitor restrictions and yes--relieved at having some portion of our focus narrowed to the significantly new and chaotic medical situation at hand. You seem to have the capacity to afford the general public all kinds of best-case-scenario credibility. It's a shame that your published opinions don't very often include much compassion or understanding for those trying to provide care.
Well, statistically-speaking, most of the people going on vents now decided they were "fatigued with the whole Covid situation" way too early in the game.