I need your advice/opinion desperately

[throwaway1]

I'm truly begging for advice. I am sick to my stomach. I can hardly sleep. I was tossing and turning into the early morning and had to call off work today. I had just gotten on shift yesterday and there was a patient I had taken care of before. She was on BiPap (which she usually ends up on) and was in the ER overnight on hold for the ICU since we didn't have beds. She was tearful from the moment I walked in the room. The doctor requested that we remove her BiPap for a few minutes for her to talk to family about where she would like to be transferred. Another senior nurse and I went in and removed her BiPap. Her O2 sat began dropping rapidly so we placed on on NC @ 5L and she came back up. She asked for a phone charger but we told her we didn't have one. I gave her a few minutes to talk on her phone. I relayed to the doctor which hospital she would like to go to. Then the requests started. She can be kind of demanding. She said that she has a headache and wants toradol since that normally works. I said no problem I'll let the doctor know. She said she wants to eat which I knew the doctor probably wouldn't allow but I said I'd ask. I told her the doctor says you can't eat but I got you another glass of water and let her have a few sips. He ordered magnesium on her so I drew the lab for that and hung her magnesium drip. I told her once the doctor ordered her pain med I would come back to give it to her and told her that it was time to put the bipap back on. I secured it and made sure that I asked her it wasn't too tight. She then states that she needs to use the restroom. I came back with her pain med. I told her that we should do a purewick since she is short of breath. She says I'm not short of breath. I want to get on a bedside commode. I said but your O2 sat dropped to 65% within 30 seconds when we took you off the BiPap. She did not need to be trying to transfer to a commode with the Bipap on. (We are also in the emergency room. It is ridiculous to think that staff should come transfer you with a bipap on to a bedside commode every time you have to go. I did not say this out loud. Just what I was thinking.) I ask if she's ever had a purewick before. She says well yeah. She says the ICU staff puts her on the bedside commode and I need to go desperately because you just gave me lasix. I say I will check with the doctor and walk out a bit frustrated and in a huff. She has had a purewick many times before. I ask the doctor and she says she will check with the ICU staff for consistency. (I normally try not to argue with the patient and just say it is up the doctor but I have been told to work on being more assertive per management. I don't want to keep immediately running to the doctor for answers I know so I tried to talk to her first.) They say, no we do not get patients up with Bipap on. I walk back in and she is hysterically crying yelling at me "I heard what you said" "You said "I'm not doing that." as you walked out the door" I don't deserve this. I want a new nurse. Get out." I tried to talk to her but she wouldn't let me. I don't even recall saying that but I guess it's possible. (Plus I don't really understand why even that phrase would be upsetting) In my four years as a nurse I've never been fired once. I am known as the overly soft and nice nurse. I know that I was more frustrated and less friendly than I normally would have been but I was still courteous. Nobody could believe that I was fired from a patient. I couldn't stop crying. I don't understand what happened. I am sick over this. I know I could have been more patient with her like I normally am, but it feels like if I am anything less than perfect, this is what I get? And when the doctor tried to explain she says the nurse was rude to me before that happened. I don't understand. I can't function like this. Please give me your opinion because I am baffled.

[toomuchbaloney]

Illness, stress, and loss of dignity can make a person cranky. Just move on.  

[throwaway1]

toomuchbaloney said:

Illness, stress, and loss of dignity can make a person cranky. Just move on.  

Thank you for your reply. I know you are right.

I just feel like I don't know how to let it go because I could have handled it better. I think that if I was more patient like I normally am it wouldn't have happened. How do you accept that?

[blueskynurse9]

The patient was very uncomfortable for obvious reasons and needing to void. She asked to use a bedside commode and was refused one. What other options was she offered? 

 

[throwaway1]

blueskynurse9 said:

The patient was very uncomfortable for obvious reasons and needing to void. She asked to use a bedside commode and was refused one. What other options was she offered? 

 

Thank you for your reply. As I said, I offered her a purewick as she has used many times before (including the last time I took care of her). She insisted she wanted a bedside commode so I said I would ask the doctor. The doctor checked with ICU and they said they do not allow the patients up to a bedside commode while on Bipap. They also use a purewick or foley. I was back in her room in less than 5 minutes and that is when this happened. 

[FiremedicMike, BSN, RN, EMT-P]

blueskynurse9 said:

The patient was very uncomfortable for obvious reasons and needing to void. She asked to use a bedside commode and was refused one. What other options was she offered? 

 

Pt was offered a purewick, did you not even read the post?

To the OP, sounds like this patient sucked.  I've never personally been fired from a patient but I'm sure I had patients who didn't care for me.  At the end of the day, you're an ED nurse not a floor nurse and it's a whole different ball game.  We have a unique job in the hospital and unfortunately you can't please everyone.

Move on from this and (I say this emphatically and not condescendingly) toughen your skin a bit. 

[blueskynurse9]

I'm sorry, you did mention that. That's what I get for coming on here after getting stuck working a 16 hour shift. She was extremely frustrated and uncomfortable. If you didn't actually voice your own frustration to her, you have to let it go. 

[FolksBtrippin, BSN, RN]

I think you can improve on a few things.

1. Let a patient fire you without taking it personally. Sometimes patients do fire the nicest nurse. That's okay. You might even see it as a break from a difficult person. 

2. Understand that the patient was refusing a purewick, which is her right. Next time, get consent for the purewick before you give lasix so you don't have to find a solution for a person who has to pee really badly. If a patient doesn't want a purewick, offer a bedpan, and if a bedpan is also a no, then you have to let them use the toilet or commode. So think about this before it happens. 

3. You already know this, but I will second the idea that you should avoid passing the buck. Never pretend to ask the doctor and don't ask the doctor for things you know the answer to. Take responsibility. Both your patients and your coworkers will respect you more, even if they like you a little less. 

[Emergent, RN]

Goodbye and good riddance to a demanding patient. Count yourself fortunate.  You did your best, but this patient had unreasonable expectations. 

[brandy1017, ASN, RN]

I think bedside nursing has gotten more difficult ever since administration refused to allow foleys.  This was because Medicare refused to pay for adverse events like UTI's.  Never mind the added stress and workload on nurses who are more short-staffed than ever, combined with the increased obesity of majority of patients along with multiple chronic illnesses.  I'm sorry a purewick is a poor alternative for a foley as they tend to leak if the patient doesn't lay perfectly still or if it is a cheap brand which staff has no control over!  I really think the foley free movement is overkill as there are silver antimicrobial foley's available that could be used as well as maintaining good peri care.

As to the patient firing you well, I wouldn't take it personally, instead I would look at it as they did you a favor!  As others have suggested plan for bathroom needs before Lasix in the future so you aren't rushing to deal with trying to convince a disgruntled patient to use a purewick or trying to find a commode and adequate staff or lift equipment to move them.

Your symptoms sound like anxiety which is rife in nursing, especially ER and other high acuity fields.  I would consider if a job change to something less stressful would improve your quality of life!  You don't have to be a bedside nurse forever!  It is not a badge of honor, nor does it make you a better nurse.  I would consider finding a job that doesn't leave you feeling so stressed and anxious that you have to call out sick after a bad patient interaction because the truth is there will be plenty of difficult patients and situations in the future.

I say this as someone who spent her career as a bedside nurse for almost 30 years in a high stress environment dealing with anxiety and many times dreaded coming in to work.  I would take as many low censuses as possible to deal with the stress and take vacations even if staycations to try to have work life balance.  The only thing I have to show for it is a small church pension, but now most places don't even offer a pension.  I wish I had listened to my heart and quit and found a less stressful and more pleasant job years ago. 

I took early retirement rather than continue under the unsafe working conditions end of 2020.  If things had been decent, I would have stayed.  My back was wrecked so I can't stand without pain, so I didn't try to get a clinic job.  I've had PT several times since I retired, and a few facet injections and now I just had an ablation which might help with the back pain, but even if it does it is only temporary. 

Don't let this happen to you!  Don't stay where you are unhappy and where you will just end up injured and used up in the end.  Your health both physical and mental is precious and a healthy back is vital to work and enjoy life!  Don't make my mistake!   

[brandy1017, ASN, RN]

Emergent said:

Goodbye and good riddance to a demanding patient. Count yourself fortunate.  You did your best, but this patient had unreasonable expectations. 

Right!  The few times I was fired by a patient it was a relief!  One time I was perplexed as I didn't know anything was wrong and I thought we had a good interaction.  My supervisor understood these things sometimes happened so just put me on another wing the next day. 

 

[RatherBHiking, BSN, RN]

One day you're going to look back at this and think oh wow it really wasn't THAT big of a deal. You didn't harm her. Some people are difficult to work with and you can't please them no matter what you do. You sound like a very caring nurse trying to be patient and give the patient what they requested however, as you know, that's not always possible. You need to be firm and not waffle and say well maybe the Dr will allow it this time...people lie to get their way all the time. It doesn't matter if they allowed her in the ICU anyways because she is not there. You can be firm and nice at the same time. Say something like "oh wow I really wish we could let you get up but due your condition at this moment and our policy we aren't allowed and I agree it sucks…” If they argue back do not keep standing there and explaining or saying well let me check.... Say nope sorry and walk away to get what you need. You said you're known as the soft and nice nurse. That's the personality type patients think they can manipulate and get mad when they can't. It's not the best personality for the ER. If you love the ER you'll have to grow tougher and let this kind of stuff roll off your back. Think of the patients like your kids, you have to do what's best for them even if they don't understand or like it. If you just don't think you can deal with this all the time and/or find it too stressful look for a different job that fits your personality better. I know for me personally I would not enjoy the ER.