Not sure where in nursing I belong

[zombie nurse, BSN, RN]

I've been an RN for 2 and a half years. I spent just under two years on a step down/tele unit/cardiac unit after having spent a year in a psych unit as an LPN while finishing nursing school. I left for a few reasons, including safety issues and a personal struggle with the fast pace and wanting to address emotional concerns of my patients which there simply wasn't time for. So I switched to LTC/SNF. I had been working PRN most of the time I was also at the hospital and found it less stressful. But going full time I found the glaringly obvious emotional needs of the residents painful to ignore again and have had complaints by other nurses about spoiling the residents making it harder for them. I am especially good at finding out what is causing difficult patients to be difficult and working with it until things calm down. Usually, however, these residents have a reputation and the other nurses continue to see them as the jerk that they have been historically and continue to treat them as such. This leads them not to get the same cooperation that I do. An example is one resident who came to my unit with a history of falling weekly, sometimes more than once in a day and also yelling, getting frustrated, demanding what she wanted immediately and stressing nursing out. I discovered that there were three problems, pain, trust, and frustration. Right off the bat I instituted the rule that this resident couldn't be left alone in the bathroom as a fall intervention because if she put her call light on she would try to walk if someone didn't come in a reasonable time and would fall. Having someone wait in her room built the trust that she wasn't going to be left waiting and she has only fallen 3 or 4 times since coming to our unit about 9 months ago, and only once in the bathroom because a new CNA didn't know the rule. She has had a stroke and her speech is difficult to interpret at times and I discovered her outbursts were because she became frustrated that she wasn't understood, or couldn't think of the words she wanted to say. I have worked hard to figure out what she is communicating and she has told me that I am the only one who understands her. I have figured out how to manage her pain which escalates as the tension cycle spirals, so when I apply her biofreeze I massage her muscles a little and she is calmer and her pain settles faster. All this to explain my methods and thought process. I am finding, however, that this type of care in an LTC is seen as excessive because it makes me take longer getting everything done. But I just can't ignore the needs. We have a new resident that has been in our unit for a month and I am already instinctively trying to figure out why he is so difficult.

My question is with this type of personality/bedside manner is there anywhere in the field of nursing for me? My experience so far is that nursing has been reduced to task focused rather than patient focused d/t staffing issues/increased workload. I don't think I can physically do a job where I have to ignore the human that is my patient.

[Been there,done that, ASN, RN]

Consider psych nursing.

Best wishes.

[Sour Lemon]

It sounds like you're still doing psych nursing, but in a SNF setting. You're doing great things, but there is always a cost.

Quiet and well behaved patients have as many needs as the "squeaky wheels" do. I've found that a single demanding patient decreases the quality of every other patient's care if I don't set firm limits.

[zombie nurse, BSN, RN]

2 hours ago, Sour Lemon said:

It sounds like you're still doing psych nursing, but in a SNF setting. You're doing great things, but there is always a cost.

Thanks! I found that psych nursing involved very little of this type of intervention, though because most of the residents were in the facility for less than a week. There just wasn't enough time to figure out their issue and address it. But your point is well taken.

2 hours ago, Sour Lemon said:

Quiet and well behaved patients have as many needs as the "squeaky wheels" do. I've found that a single demanding patient decreases the quality of every other patient's care if I don't set firm limits.

You bring up a valid point. It is important to balance time and not help one resident at the expense of another. I do find that once I figure out what is needed to create balance with a troublesome resident I spend less time with them than I did putting out fires. One example is filling out fewer fall reports and all the frequent vitals and assessments that follow a fall leaves more time for other residents. I will admit, though that there are days that it can interfere with other residents if they are more needy than other days. It is definitely a balancing act.

[Hondagirl88]

Hello,

I can 100% relate with you. As the RN in the LTC facility, what exactly is your role?

[Sour Lemon]

3 hours ago, zombie nurse said:

Thanks! I found that psych nursing involved very little of this type of intervention, though because most of the residents were in the facility for less than a week. There just wasn't enough time to figure out their issue and address it. But your point is well taken.

You bring up a valid point. It is important to balance time and not help one resident at the expense of another. I do find that once I figure out what is needed to create balance with a troublesome resident I spend less time with them than I did putting out fires. One example is filling out fewer fall reports and all the frequent vitals and assessments that follow a fall leaves more time for other residents. I will admit, though that there are days that it can interfere with other residents if they are more needy than other days. It is definitely a balancing act.

Maybe you'd enjoy a longer stay unit? I did clinicals at a state hospital when I was in school, and there were patients who had been there for years- one that I worked with was there for thirty years if I remember correctly.

I get what you're saying about balance. I do try to get on everyone's good side and hope for a smooth night, no matter what their reputation.