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Meth induced abuse? =(

Posted

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 8 years experience.

Hi all, I work on an ICU Stepdown unit with wonderful coworkers. After reading about nightmare orientations/preceptors/units, I feel even more grateful. My team is wonderful, we help each other and don't let anyone drown. No gossip. My orientation was excellent.

The downside is, it's a county hospital and we deal with many behavior issues. I love caring for most of our patients, working for a vulnerable population, etc, but the abuse is getting to me after 4 years. A huge percentage of pts come in high on meth or withdrawing from it, causing labile behaviors. They don't want to be bothered, scream at us, make verbal threats, sometimes get physical. Also deal w/ etoh withdrawal. My anxiety is so high when I have to go into these pts' rooms, even when they're just irritable but nonviolent.

I am worried if I get a new job I will never find these team dynamics again. Maybe it would be worse to have a less stressful jobs but a bad work culture. Maybe it's worth dealing with the anxiety/fear? I'm looking for honest answers about how rare people think it is to find a good work culture, and any recommendations on what I should do. Thanks so much!!

If wonderful coworkers and a supportive environment and evidence of investment in nurses (good orientation)...I would first focus my energies on developing the ability to maintain inner calm and peace when dealing with difficult patients. There is much to be learned and it makes a world of difference. It is one of those hurdles that, in working to clear it, completely has the ability to make someone into a stronger and happier person in the end. It is such a useful quality to finally understand how not to be provoked and completely tapped out by difficult patients and their problems. It is a skill that is also easily extended into other areas of life once learned.

We're all different, but I would take easy coworkers and a supportive atmosphere over easy patients almost every time. Difficult patients in a supportive atmosphere is doable. Lovely patients in a toxic backstabbing atmosphere where nurses are constantly disparaged is not doable. Also, difficult patients = working hard at doing the work you were hired to do. But a difficult workplace = having to work at something other than what you are primarily there to do; it is the necessary work plus more work that should be unnecessary. No thank you. (Personal opinions, obviously. 😬)

LibraNurse27, BSN, RN

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 8 years experience.

2 hours ago, JKL33 said:

If wonderful coworkers and a supportive environment and evidence of investment in nurses (good orientation)...I would first focus my energies on developing the ability to maintain inner calm and peace when dealing with difficult patients. There is much to be learned and it makes a world of difference. It is one of those hurdles that, in working to clear it, completely has the ability to make someone into a stronger and happier person in the end. It is such a useful quality to finally understand how not to be provoked and completely tapped out by difficult patients and their problems. It is a skill that is also easily extended into other areas of life once learned.

We're all different, but I would take easy coworkers and a supportive atmosphere over easy patients almost every time. Difficult patients in a supportive atmosphere is doable. Lovely patients in a toxic backstabbing atmosphere where nurses are constantly disparaged is not doable. Also, difficult patients = working hard at doing the work you were hired to do. But a difficult workplace = having to work at something other than what you are primarily there to do; it is the necessary work plus more work that should be unnecessary. No thank you. (Personal opinions, obviously. 😬)

Excellent advice! Thank you. Difficult coworkers can make an easy job hard... didn't think of it that way...

Hello and thanks for your post. It resonated with me because I was fortunate to have a fantastic team on my first nursing job, too. After 2 years I left for the ED which had a very different and oftentimes difficult culture. Eventually, I settled in but it took time and I learned that, despite the many opportunities for learning, I really didn’t like the ED. Think of it: nobody is happy to be there. So, I moved on to other things, some were good, others not so much.

The truth is I’ll always miss my first team and I wish I could’ve figured out how to be happy there. The work was kinda boring but the people were great and, to this day, I’ve never found a team that compares. So my advice is, seriously try to figure out what you don’t like and come up with some strategies that may help lessen the blow. Share your concerns with a coworker or two because they may have some great advice. At the very least, it will help to talk about it. If it’s time to move on, then give yourself permission to do so. Good luck with whatever you decide!

CharleeFoxtrot, BSN, RN

Has 10 years experience.

5 hours ago, LibraNurse27 said:

Excellent advice! Thank you. Difficult coworkers can make an easy job hard... didn't think of it that way...

This should be printed on the back of every nurse's diploma. Absolutely true. I once worked an extremely difficult job at an LTAC, and always looked forward to certain days when the "dream team" worked-a group of wonderful coworkers who made the day lighter just by being there.

LibraNurse27, BSN, RN

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 8 years experience.

thank you @Sivraj and @CharleeFoxtrot ! It's nice to learn from others' experiences, and your comments confirm what I was suspecting, that "dream teams" are rare and should be appreciated, and will likely be missed. thanks!

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 10 years experience.

It sounds like time to get involved in your shared governance councils to start the ball rolling on policies to help nurses deal with these kinds of patients. I work at an inner city county hospital too. We have a team whose entire job is to answer calls for escalating behaviors and take care it, whether that be through medication or other means. If your hospital doesn't have this, it needs to.

If it is a matter of cranky patients there isn't much you can do. But threatening physical violence or actually being violent? Heck no. Start watching how your coworkers deal with it. You can learn from them. Also start letting whoever makes the assignments know that when you have had a certain difficult patient for a shift and you are coming back the next day/night, you want that patient assigned to someone else. You have the right to do that and most hospitals I have worked at understand. Everyone gets a turn with the hard ones rather than one person stuck with them shift after shift.

LibraNurse27, BSN, RN

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 8 years experience.

Thanks @Nurse SMS! I have mentioned that the cranky/threatening pts are especially hard for me to deal with, especially threatening male pts due to past experiences with assault. I think night shift charge tries to assign these to my wonderful male coworkers who say they don't mind having them (and, because they refuse everything so they aren't a busy assignment).

I let them know I am fine with sick/busy/hospice pts, whatever they want to give me other than the meanies, LOL. I rather drag pts to CT all day and give a thousand IV meds than deal with behaviors. Love pleasantly confused pts too! Some days it's unavoidable to have these pts, so I will ask and observe coworkers who seem to have it down, as suggested 😃 thanks all for the lovely advice!

twinmommy+2, ADN, BSN, MSN

Specializes in ED. Has 16 years experience.

Oh meth heads touch my crazy nerve almost every time. And I have a deep crazy nerve too but they make my mom voice come out.

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 10 years experience.

3 hours ago, twinmommy+2 said:

Oh meth heads touch my crazy nerve almost every time. And I have a deep crazy nerve too but they make my mom voice come out.

LOL!! My coworkers used to call me a "Mom Nurse", so I know exactly what you mean here. I was often chosen to get the challenging patients. Straightened them right out.

FolksBtrippin, BSN, RN

Specializes in Psychiatry, Pediatrics, Public Health.

On 8/17/2020 at 10:22 PM, LibraNurse27 said:

Hi all, I work on an ICU Stepdown unit with wonderful coworkers. After reading about nightmare orientations/preceptors/units, I feel even more grateful. My team is wonderful, we help each other and don't let anyone drown. No gossip. My orientation was excellent.

The downside is, it's a county hospital and we deal with many behavior issues. I love caring for most of our patients, working for a vulnerable population, etc, but the abuse is getting to me after 4 years. A huge percentage of pts come in high on meth or withdrawing from it, causing labile behaviors. They don't want to be bothered, scream at us, make verbal threats, sometimes get physical. Also deal w/ etoh withdrawal. My anxiety is so high when I have to go into these pts' rooms, even when they're just irritable but nonviolent.

I am worried if I get a new job I will never find these team dynamics again. Maybe it would be worse to have a less stressful jobs but a bad work culture. Maybe it's worth dealing with the anxiety/fear? I'm looking for honest answers about how rare people think it is to find a good work culture, and any recommendations on what I should do. Thanks so much!!

A good work culture is precious. Probably rare.

I don't know that you will actually find a place that you won't have to deal with drug addicts. They are everywhere. Rich people are also drug addicts sometimes and are often worse to deal with than poor people.

It's very hard to work with sick people, they are at their worst. But that's nursing.

LibraNurse27, BSN, RN

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 8 years experience.

Precious. I love that word! It is full of gratitude and a great reminder that support, friendship and teamwork are so important. Thanks!

cardiacfreak, ADN

Specializes in Hospice.

On 8/19/2020 at 5:18 AM, twinmommy+2 said:

Oh meth heads touch my crazy nerve almost every time. And I have a deep crazy nerve too but they make my mom voice come out.

On 8/19/2020 at 8:34 AM, Nurse SMS said:

LOL!! My coworkers used to call me a "Mom Nurse", so I know exactly what you mean here. I was often chosen to get the challenging patients. Straightened them right out.

I no longer work acute care, but it was also my job to "straighten them right out".

I remember one particular nasty mouthed fellow tell me, "And there's nothing you can do about how I talk to anybody, I'm the patient and you have to be nice to me.". I replied, "No sir, I don't have to be nice, I only have to take care of you to the best of my ability, my job description states nothing about nice"

LibraNurse27, BSN, RN

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 8 years experience.

1 hour ago, cardiacfreak said:

I no longer work acute care, but it was also my job to "straighten them right out".

I remember one particular nasty mouthed fellow tell me, "And there's nothing you can do about how I talk to anybody, I'm the patient and you have to be nice to me.". I replied, "No sir, I don't have to be nice, I only have to take care of you to the best of my ability, my job description states nothing about nice"

LOL! True! We only have to be polite and professional, it is not "illegal" for us to not be super friendly to someone who is hurling insults and objects at us!

77Mercy, ADN, ASN, BSN, RN

Specializes in Public health, recovery. Has 26 years experience.

When I was a young nurse I was complaining to my co worker how mean and nasty some of my patients were too me. I just didn’t like my job. My coworker reminded me that if I didn’t want to be here I could leave. I didn’t have to be a nurse. I could be a waitress, a dishwasher, a maid etc. Every  job has positive and negatives. Not everyone is always nice. That’s the world we live in. We no longer have to accept physical abuse from our patients like we used to. Security can be called and patients can be removed if they are violent. At least from where I worked. She told me As far as rude or mean patients go. Their bad behavior is on them- not you. You need to be professional at all times. You are their advocate and you are their nurse. They may be having the most stressful time of their lives. You need to put yourself in their place and realize they are not feeling well. Withdrawing from drugs is not an experience that I ever wish to have. Nurses need to be tough. Remember who you are and that you can handle this. Don’t ever take anything too personal. Don’t ever lower yourself to being nasty back. Don’t be judgmental. Question your own thoughts and beliefs. Do you refer to your patients as “meth heads“. Is that really fair? Is that all you see? I drink Diet Coke but if people only saw me as a Diet Coke head, how would I feel? Would they all treat me different? Would I be angry at the people who treated me like I was “just a Diet Coke head?” I am starting to ramble here but just be aware that you need to be questioning your thoughts, ideas and actions also. It may be that you just can’t handle working where you are. You don’t have to stay but if you are going to stay- you need to think about how your own ideas and attitudes may be getting in your way. 

2 hours ago, 77Mercy said:

When I was a young nurse I was complaining to my co worker how mean and nasty some of my patients were too me. I just didn’t like my job. My coworker reminded me that if I didn’t want to be here I could leave. I didn’t have to be a nurse. I could be a waitress, a dishwasher, a maid etc.

In general I would consider this an utterly terrible response to a coworker. Good for you if you were able to make something of it.

Some of your other points are more helpful, such as these two:

2 hours ago, 77Mercy said:

Their bad behavior is on them- not you. You need to be professional at all times. You are their advocate and you are their nurse.

 

2 hours ago, 77Mercy said:

Don’t ever take anything too personal. Don’t ever lower yourself to being nasty back. Don’t be judgmental.

 

I think it is a process to understand how we (as individual persons) fit in with our work. I think it often works well to afford our coworkers the acceptance (for their feelings) that few others will offer. I doubt I would ever tell a coworker "you don't have to do this, you could be a maid..." when they verbalize disappointment in being treated poorly by patients. That is neither affirming nor empowering.

I think nurses should strive to maintain professionalism. But it's one step too far to respond to our coworkers as if they aren't human beings who may experience emotions similar to other human beings 🤨🤷🏻‍♀️. Being a professional (or being ethical, or being duty-bound as a nurse) does not require one to "enjoy" poor treatment no matter where it comes from. *Reacting* poorly is something we should always strive to change/improve, but not enjoying poor treatment is not a moral failure.

 

Edited by JKL33

77Mercy, ADN, ASN, BSN, RN

Specializes in Public health, recovery. Has 26 years experience.

Quote

 

 In general I would consider this an utterly terrible response to a coworker. Good for you if you were able to make something ofit.

I would have to politely disagree. I needed to hear that. It was a simple but very true statement. It reminded me that I had choices. I wasn’t stuck. I didn’t have to be there. I was completely miserable at that job and I needed to hear that at that time. It sounds like you misinterpreted what she said in a negative way and I don’t believe that was her intention. 

Edited by 77Mercy
Did not include original quote

77Mercy, ADN, ASN, BSN, RN

Specializes in Public health, recovery. Has 26 years experience.

😧

Edited by 77Mercy
Incorrect post area