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.

[Tenebrae, BSN, RN]

Honestly look at the firing as a postive thing. I've had patients refuse meds on me, assuming I'm sure that I will go home and cry myself to sleep and be terribly distraught. As long as I know I have done my very best I do not allow myself to take it home. It's essential for your mental health to be able to go "yip. I did everything I could do" or "if this happened again this is what I will do differently. 

When you have a patient like this again, explain to the patient "I'm concerned about X happening (in this case 02 dropping), I'm wondering how we can meet your need but at the same time keep you safe" The O2 may drop, as long as shes able to transfer safely and it should come up again. 

People end up feeling powerless in hospital. When you can involve the patient in their care, they tend to be much less of an jerk. 

[Patricia Ordnung]

I know that right now, four years in nursing seems like a long time, but it really isn't.  You'll keep growing and learning, and the patients and families who thanked you for the excellent care they received will far outnumber the few (and most of us have had them) difficult ones who complained. 

[Maltmom0402RN]

I just wanted to share that you will grow that skin.  If I can anyone can!  I worked in homeless health and it would be a light day if I didn't get people demanding trivial things.  They would get mad and threaten to kill or assault me.  I had zero support from my supervisor.  One day you will tell that difficult patient "No" and turn around to leave.  Then realize you did it.  I had a demanding patient bang on my door and when I opened tell me why I was a horrible person for not forcing the doctor to get him Vyvanse.  I closed the door in his face and walked back to my desk.  When I started, I would try to negotiate and worry if they were upset.  I learned you cannot control demanding patients feelings or behavior.  If everyone is safe and you did your job within your scope, that is all that matters.

[gigi_rn]

Wait until she's intubated. Then purewick or Foley will be the least of her problems. I will never understand pts playing games with BiPAP, AIRVO, etc. Russian roulette. One time too many >>> vent!

[CalicoKitty, BSN, MSN, RN]

I would not stress about getting "fired" from a patient. Usually saves a ton of struggle. (Sorry for typos using my phone).

I started nursing before the purewick, and found the fracture bedpans to be great for pee. Just lift the hips a little and slide it in from the front. The legs stay a bit flexed and the urine stays well in the "cup" when I remove it.

On the other hand, as a wound nurse I hate purwicks. They rarely work (most patients are wet when I check), staff pretend they work and don't check/change the patient. If a person is incontinent of stool, that is what I find between thr purewick and urethra.

People do not usually want to pee on themselves (even with a catheter). People will hold their urine until they must pee on themselves (holding urine ia a UTI risk). Then they pee, likely way too fast for the simple suction to work (400 mls in 10 secs) so it overflows and leaks. Patients skin is still next to urine, sometimes whole shifts. The catheter is a warm wet sponge next to the urethra. And I have seen several women who end up with pressure injuries and skin tears to their labia and thighs, which can leave scars (especially on darker skinned people).

I want to see a real study where they check a urine sample after 1 week of the catheter. They all say "reduces CAUTI" because they do not consider it a catheter. I think they only test if UTI is suspected.

[Leader25, ASN, BSN, RN]

brandy1017 said:

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

I agree with this,yes goood riddance,we would get this scenario all the time with Parents,they behaved worse than a rude demanding child, and..........once    had a patient demand I speak in another language even though she was very obiously fluent in English,  then wanted her demands met first regardless of the other patients needs,then complained linen was too tight ........ sigh ........this too shall pass...

[RN_fr, BSN]

"Hurt people; hurt people”’

Understanding that phrase helped me get over those difficult nursing "punching bag" moments. 
Doesn't excuse or make it okay, but wat else are we going to do?

Most likely if it wasn't you, it would have been the next nurse that got it.  So thank yourself for taking one for the team. 👊

[brandy1017, ASN, RN]

CalicoKitty said:

I started nursing before the purewick, and found the fracture bedpans to be great for pee. Just lift the hips a little and slide it in from the front. The legs stay a bit flexed and the urine stays well in the "cup" when I remove it.

On the other hand, as a wound nurse I hate purwicks. They rarely work (most patients are wet when I check), staff pretend they work and don't check/change the patient. If a person is incontinent of stool, that is what I find between thr purewick and urethra.

People do not usually want to pee on themselves (even with a catheter). People will hold their urine until they must pee on themselves (holding urine ia a UTI risk). Then they pee, likely way too fast for the simple suction to work (400 mls in 10 secs) so it overflows and leaks. Patients skin is still next to urine, sometimes whole shifts. The catheter is a warm wet sponge next to the urethra. And I have seen several women who end up with pressure injuries and skin tears to their labia and thighs, which can leave scars (especially on darker skinned people).

I want to see a real study where they check a urine sample after 1 week of the catheter. They all say "reduces CAUTI" because they do not consider it a catheter. I think they only test if UTI is suspected.

Where I worked, they had female urinals that worked wonderful especially for someone with a hip fracture.  If your place doesn't stock them, I would advocate for them to be added.  They also helped for men that were swollen from CHF, for instance.

I agree I think the purewiks are a stupid gimmick and suspect patients still get UTI's for all the reason you mentioned.  Having the sponge against your skin is going to harbor bacteria and with women's short urethra's it doesn't take much for it to travel to the bladder and start a UTI.  A true silver foley would be much preferred for an incontinent patient to keep them clean, dry and infection free!

[mmc51264, BSN, MSN, RN]

So sorry you feel the way you do, but you really need to try and not let this kind of stuff get to you. People lash out at us all the time!  It's hard not to take it personally and I find it hard to not lash back at times. 

Don't be so hard on yourself. 

[Frito lay]

I just got fired from a patient too after being really nice and courteous . It baffled me and I was almost in tears . The patient was very manipulative and sort of drug seeking . The nurse before my shift changed the IV dressing but it infiltrated by the time I got there. It's not the first time I follow this nurse and patients IVs are infiltrated or leaking . Very annoying . 
anyways I ended up calling in sick the next day too and prayed I didn't get this patient back as her nurse , being fired from a patient for no reason or when the patient lies, is so wrong !!  

[nurse1285]

Sounds like this patient did you a favor. It's not terrible that the patient requested another nurse. You don't need to worry about it.  I would of thought....thank goodness I don't have to deal with this person anymore and move on.  Patients can be very demanding but they are there for medical attention and we need as nurses to do what is best for them medically.  In my day they didn't have pure wick.  It was bedpan or nothing.  You'll be OK,

[QueenB.RN]

Move on. It happens. Sounds like this patient has a lot of issues.