Nurses cannot perform miracles

JKL33 · Apr 5, 2018

1. Don't even consider posting jack about work or patients on FB. Better yet, ditch FB altogether.

2.

She said "I thought I came here so you guys could help me."

This statement is meant to be provocative. Sometimes the hope is to open up a conversation when the person doesn't know a better way to do so, and sometimes it is to just try to hurt someone because of personal frustration or disappointment. I have seen both; in the ED I would have to say it is more of the latter. I wrote out the obvious examples, but thought better of it. Anyway, I decided quite awhile ago not to take offense.

When you choose to very deliberately not take offense, it can be a chance to try to get to the bottom of why they're feeling that way, and usually an opportunity for education, reassurance, or even just therapeutic listening. And, for those special scenarios where these proclamations are actually more like hissy fits, not taking offense is how you survive without absorbing others' misery.

EaglesWings21, ASN, RN · Apr 5, 2018

Definitely agree with the Facebook thing.

I am the type of person that likes to form relationships and wants to make sure my patients know I will do my best to take care of them for the 12 hours I was there. I guess it just had me so frustrated that I couldn't even begin to do that because she wouldn't let me get a word in edgewise. It is true like you said to let it roll of your back, which normally I can but she just got under my skin for some reason. I think she was a well-to-do person and had an unfortunate diagnosis, and it was almost like she felt entitled to be disease, pain, and nausea free immediately after her surgery.

Davey Do · Apr 5, 2018

Two of my work mantras that never disappoint me are:

"Expect the unexpected"

and

"All patients are victims".

KatieMI, BSN, MSN, RN · Apr 5, 2018

Two of my work mantras that never disappoint me are:
"Expect the unexpected"
and
"All patients are victims".

and

"To enter a patient's room with plans of any kind is like expect every person you meet to become your best friend"

Just do not do it. Know what you need to do there, and have your plans A, B and C re. that. Nothing more, and then every time you actually can do something above it you'll be pleasantly surprised.

JKL33 · Apr 5, 2018

I think she was a well-to-do person and had an unfortunate diagnosis, and it was almost like she felt entitled to be disease, pain, and nausea free immediately after her surgery.

That and, in our heart of hearts, we all know that as humans we have varying ways of dealing with disappointment and fear. Not taking things out on others can be difficult for people in our every day lives, not just patients. When there's an overlay of "This shouldn't be happening to *me* and you need to do something about it! [Humph!]" - yes, compassion doesn't come as easily because our brains tend to "register" the personal affront first, and then have to get past that.

Thursday confessional: I've had to get over this hump in my career. It feels good when you do. I started by working diligently on behalf of the "offending" patient, choosing every word carefully, and displaying compassion in ways not natural to me. I admit that initially I did this hoping they might feel bad that they were so mean to me. And they did. I started noticing the number of times people would apologize for "the way I was earlier." And then I realized they never really meant it in the first place....and that I shouldn't have been taking personal offense all along. I also found that when people find they can't push or scare you away, there is an immense opportunity for trust-building.

This is not to say that people get a pass for being jerks just because they also happen to be patients when we encounter them. But I'm here to tell you that coming up with a way to rechannel patients' negativity rather than absorbing it is crucial for nurses.

:happy:

allnurses Guide · Apr 5, 2018

I noticed a long time ago, particularly for those patients facing a lot of pain or a patient/family facing a life-altering diagnosis or outcome, that if you cannot cure them, in their mind you become part of the cause. That is just part of the mental process they are having to go through and I have determined that I just plain cannot take those sentiments to heart. I can empathize. I can stand at the ready to use all my skills to assist them any way I can. But I don't have the power to cure. Neither do physicians. Neither do pharmaceuticals. We cannot take it personally that a patient reacts badly to finally learning that their entire belief system about healthcare in our country is false. The magical thinking carried them a long way and the grieving that begins with our perceived failures comes across as bitterness, frustration and anger. It is still their journey to make. Not ours. We do what we can, but any nurse knows that so much of healing comes down to timing, overall health, luck of the draw and other intangibles that seldom make sense. But for most American patients, this is a new and novel concept and one that leaves them facing their own mortality. Just keep doing you and start learning how to let go.

LovingLife123 · Apr 5, 2018

Maybe I'm misunderstanding, but I don't think the patient stated they expected you to cure them, they just wanted some relief or help with their condition,

It can be very frustrating for a patient to be in pain for a long period of time and go down the long road of getting a diagnosis then to get treatment for that said diagnosis and it not go as planned.

I spend much of my days talking with patients and their families about their frustrations. And, at one point and time, I was that frustrated patient.

It's hard on us as nurses to come in and get blindsided by complaints. I know I'm like, wait, I just got here!!! I have no idea!! But then, if I take just 10 minutes to sit down and really listen, I can usually get to the bottom of the issue.

It's not our job to take abuse and attitude from our patients and family members. But, it is our job to listen. I willusually set the boundaries early. Let me get your assessment done and look at your orders first. Then, I will sit down and let them talk. Go over their concerns. Some things, we just cannot fix and I'm upfront about that. I can fix that your loved one is dying, I can't take away your disease. I can work on helping your pain and anxiety, I can help with communication, I can get the doctor to come and talk with you, I can try to make you more comfortable, or try to get you up today. I explain what is in my control to try and fix.

psu_213, BSN, RN · Apr 5, 2018

Two random thoughts:

1. Don't take it personally. She is frustrated about her illness, her post op course, etc.--every patient is going to react differently to those stressors, and some will have a quite negative reaction. You just happened to be lucky enough to be there for a her little outburst. Do your best to treat her; if she is going to insist on being miserable, that is her problem.

2. People have unreasonable expectations, and the "system" feeds into them. For example, people expect to have no pain (0/10, none). This is reinforced by post stay surveys that ask about how well the hospital managed your pain. Physicians may feed into it to. As an example, I had a patient who was POD 0 from a Nissen fundoplication. Not long after arriving from the PACU to my unit, I went back in. She was tearful and said, "it didn't work. Why is this hospital pushing this sham surgery on people." My guess (?) is that the surgeon told her that this would help her GERD, but did no warn her about the negatives of almost any post op experience (pain, nausea, etc.)--or maybe he did, and the patient just heard that it would help. Again, can't take that personally.

EaglesWings21, ASN, RN · Apr 5, 2018

LovingLife123, that's the thing is that I came in her room to assess her and see how I could help with her pain and nausea but wasnt even able to get to that point because she was going off on me about anything and everything.

Thank you all for the words of wisdom. Something to consider for next time. I think I was just caught off guard because I wasn't expecting to be talked to like that so early in my shift!

I have had a patient many years ago tell me that it was her right as a patient to have no pain and the doctors better give her some more pain medicine. I just don't know how people can be so misinformed. This is a country of I want what I want right now so I'm going to demand it now. Maybe it's a much larger social problem than this one incident, maybe my post-op patient was just having a hard time like previously stated and she did eventually apologize. I would just never dream of yelling at someone unwarranted, especially someone who made it known they were trying to help me.

nursej22, MSN, RN · Apr 5, 2018

Several years ago I had a hysterectomy and thought I was well prepared for the post-op pain after having had 3 c-sections. Boy was I wrong!

My PCA of Demerol didn't seem to do much, and I had a great deal of nausea and dry heaves on the day of surgery. I was hurting and angry that I wasn't getting any relief and I am sure that I was a real witch. I remember sending the poor RT scrambling when she came in to teach about the incentive spirometer. In the middle of the night my IV infiltrated yet the night nurse said it was okay, and I broke into sobs from lack of sleep and pain control.

I can only imagine what they said about me in report. Yeah, I was pretty unpleasant, but none of it was meant to be personal, except maybe that nurse that said my IV wasn't infiltrated.

T-ROD, LPN · Apr 6, 2018

I think too that previous encounters with health care workers in general can really change the way they perceive what they believe the outcome should be.

I have had patients that were horrid right off the get go. 95% of the time the previous shift had said or done something that angered them.Not intentionally either but now here you are and you better make it right.

Others are in horrible pain and understand that you have done all you can and except that. People are people and when put in a medical situation sometimes let their emotions over run.

I once looked an ER doctor and told him after the 5th CT scan my mom had done that they better find something soon or we would be going to the next hospital over. After a lovely exchange of words between us and the oncoming doctor they sent her results back to radiology and after a little deeper search noted she had a twisted intestine and was taken into emergency surgery within the hour.

My point, I work in this field and yet I still let my emotions overtake me.