Meth induced abuse? =(

[LibraNurse27]

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!!

[hppygr8ful, ASN, RN, EMT-I]

You do need to learn to face your fear of difficult patients. Detox patients especiall Benzoholis and alcoholics can be very draining. I don't mind meth patients so much. I work in a small free standing psych unit that serves a fairl large suburban comunity just outside of Los Angeles area and we get lots of people high on meth straight off the street.  We usually get medication orders immediately and settle them down for a nice nap. Once they go down to sleep we don't bother them except to do vitals and offer food and water. At about day three they come up and are albe to act like human beings again. Uncomplicated methamphetamine detox is not usually dangerous for the patient so we focus on patient comfort and hydration and don't poke the bear unless it becomes necessary. 

Still I gree with 77Mercy that you must always act with the best interests of your patient at heart. Addicts/alcoholics aren't bad people,  they are sick (often very sick) people who need to get well. any genuine kindness can go along way towards getting them to be receptive to rehab. 

Does you hospital offer MAB or CPI training? I prefer MAB as it cover psycical detainment methods to use when legally necessary but even CPI will teach you how to deal with these patints confidently and safely. I have worked with some of the most dangerous psych patient's outthere and while I am always appropriatley cautious, I am very rarely afriad.

Again I concur with 77Mercy in that you have to becareful how you and your staff address such patients. You need to be therapeutic and professional at all times. I have sent staff off the unit because they referred to patients as allies, meth heads or meth crashers. They patents are here for our help and no matter how far they have fallen they still deserve to be treated with dignity and respect. 

By building your own conflict resolution skills you will become a better stronger nurse and be successful wherever you end up. 

Hppy

[LibraNurse27, BSN, RN]

I never refer to my patients as meth heads, alcoholics, "crazy", etc. I don't judge anyone for having a mental illness or addiction. I have bipolar disorder and I know there is a lack of mental health education and access to care, and many self treat mental health symptoms with substance abuse. I don't blame anyone for behaviors out of their control, as in psychosis, mania, altered mental status due to intoxication/withdrawal. 

What bothers me the most are people who are alert and oriented and still treat us abusively. Even with these patients I treat them with respect. I don't argue back. I try to show compassion, letting them know I understand they are not feeling well and asking if anything I can do to make them more comfortable. I have successfully de-escalated some patients, and this is rewarding. 

I understand I don't have to do this job. I'm still balancing the pros and cons, because my team is a huge pro. I get the mindset of "you chose to do this so don't complain", and I am working on it. But I think it's OK to express frustration when someone is verbally or physically abusing you. I hope I don't sound defensive, I do appreciate the reminder to try to see the whole picture and not take things personally. I love all the other aspects of my current job, and I would hate to quit over these situations, but it is coming close to that. I guess I am not able to overcome my personal history of assault and mental illness to be able to do all parts of this job. My mental health is getting so bad I am thinking of taking unpaid leave. I just feel guilty leaving my team when our unit is slammed with covid. Almost all of our covid patients speak only Spanish (whole other topic on the demographics of covid by region), and I am the only Spanish speaking staff. I'm not saying I'm amazing or anything, but right now my language skills are helpful, and even one fewer nurse makes our already short staffing worse =( We will see! Thanks all for your suggestions.

[77Mercy, RN]

You need to take care of yourself first. A job is a job. You have absolutely no reason to feel guilty. Coworkers come and go and everyone understands this. It may be a good idea to speak with a counselor or psychologist. I can give you some advice but only you can decide what is right for you. 
 

 

The mindset of you “chose to do It so don’t complain” was not what I was trying to communicate. What I was trying to say and what my coworker was presenting to me was”you don’t have to work as a nurse just because you went to nursing school. You are free to do what you choose. You are not trapped. You do not have to feel guilty for leaving. There is a whole big world out there and there are lots of different things you can do. When she said you can be a waitress or a maid it was not in any way a sarcastic statement. Some housekeepers and waitress make more than nurses around here and she used those jobs because I wouldn’t need any further training. Housekeepers can make up to 200 dollars a day and some waitresses make more money than nurses with their tips. In your situation it may not be about leaving nursing but you may want to think about a different nursing job such as working as an office nurse or telehealth or something. I am not sure but that is something you might was to explore. Whatever you do- make sure to take care of you! 

[LibraNurse27, BSN, RN]

2 hours ago, 77Mercy said:

You need to take care of yourself first. A job is a job. You have absolutely no reason to feel guilty. Coworkers come and go and everyone understands this. It may be a good idea to speak with a counselor or psychologist. I can give you some advice but only you can decide what is right for you. 
 

 

The mindset of you “chose to do It so don’t complain” was not what I was trying to communicate. What I was trying to say and what my coworker was presenting to me was”you don’t have to work as a nurse just because you went to nursing school. You are free to do what you choose. You are not trapped. You do not have to feel guilty for leaving. There is a whole big world out there and there are lots of different things you can do. When she said you can be a waitress or a maid it was not in any way a sarcastic statement. Some housekeepers and waitress make more than nurses around here and she used those jobs because I wouldn’t need any further training. Housekeepers can make up to 200 dollars a day and some waitresses make more money than nurses with their tips. In your situation it may not be about leaving nursing but you may want to think about a different nursing job such as working as an office nurse or telehealth or something. I am not sure but that is something you might was to explore. Whatever you do- make sure to take care of you! 

Thanks! I have talked to some counselors and they are not allowed to tell people what to do but they pretty much hint that I should get a new job, haha =( I think some people aren't a good fit for bedside nursing due to fragile mental and/or physical health, and that's OK. At least we can try it and gain skills and knowledge. Trying another area of nursing is a good idea, and you are correct in saying just because you went to nursing school you don't have to be a nurse forever! There have been a few threads about people who quit nursing and what they did instead, and most seem happy with their decision. We'll see! thank you for the compassion and advice!

[JKL33]

8 hours ago, LibraNurse27 said:

I never refer to my patients as meth heads, alcoholics, "crazy", etc. I don't judge anyone for having a mental illness or addiction.

Nothing about any of your comments has suggested you have that attitude; I'm not really sure why you have received so much instruction about it here.

You have to make the best decisions for yourself and it is wise that you are consulting with professionals in addition to taking in everyone's thoughts about difficult patient care situations. I did say in my original reply that I would take difficult patients over a difficult workplace; understand that I meant that would be my personal preference in a situation where I could just as well handle either--I.e. if given a choice I'd take difficult patient situations and supportive coworkers rather than the other way around. But if this patient care situation isn't working for you, don't be afraid to see what your other options are, even though you have wonderful coworkers. ?

 

[LibraNurse27, BSN, RN]

2 hours ago, JKL33 said:

Nothing about any of your comments has suggested you have that attitude; I'm not really sure why you have received so much instruction about it here.

You have to make the best decisions for yourself and it is wise that you are consulting with professionals in addition to taking in everyone's thoughts about difficult patient care situations. I did say in my original reply that I would take difficult patients over a difficult workplace; understand that I meant that would be my personal preference in a situation where I could just as well handle either--I.e. if given a choice I'd take difficult patient situations and supportive coworkers rather than the other way around. But if this patient care situation isn't working for you, don't be afraid to see what your other options are, even though you have wonderful coworkers. ?

 

Thank you for saying that, I was worried I gave the impression that I judge patients with psych or substance issues. I don't see myself as any better than them. I come across many with the same diagnosis I have and see how the illness has destroyed their lives, led to substance abuse, homelessness, becoming victims and/or perpetrators of violence. Then hearing coworkers talk about how they hate working with bipolar patients, sometimes ascribing that title to patients who are difficult but do not actually have the disorder.

I think it hits too close to home. Seeing people similar to me at their worst and hearing others' disparaging remarks about them is quite painful sometimes. It causes shame and fear about the future. Those are the true reasons it's a difficult population for me to work with. Anyway, sorry everyone, not trying to turn this into a pity party! I hope all of us nurses can find a specialty that fits us and a great team of coworkers.