Ok, first off let me say I know this topic will probably generate a lot of strong opinions. I will also state that I am not a perfect person and don't take care of my health 100% so please don't think I am trying to be an elitist or something in posting this.
Disclaimer aside, I want to know if other nurses sympathize with me.
I am going to try and be as brief as possible in my story. First of all we have 2 resident patients on my floor that have been there over a year. They are obese and have suffered strokes. They require total care. These particular patients are about 250lbs and 1 has hemiparesis and the other has use of 1 arm (not sure what to call that).
The patient that really has me over the edge is one that is over 300lbs, vent dependent, unstageable sacral (of course, no one wants to turn this patient which is a whole other issue), lower extremities contracted with knee replacements, on dialysis, PEG feeding, restrained because she pulls any tube in sight, and contact isolation for c diff and acenotibacter. This patient has been on the floor for 3 months so far because no LTC facility will take her (understandably).
Not to mention all the cellulitis patients and other comorbities we deal with on admissions.
I am a 25 year old male and starting to feel back pains. This really has me over the edge as a combination of lazy/uneducated coworkers and heavy (literally) care.
Please share how you deal with these kinds of patients and what I can do to reverse my growing animosity towards these patients.
Specializes in LTC, assisted living, med-surg, psych.
Again I say: let's work on the SOLUTIONS to managing heavy patients, rather than getting all high and mighty about how they got that way and how superior thin people are to the obese. Whining/kvetching/moaning/griping etc, about taking care of obese people (or COPDers, or psych patients, what have you) is nothing but a waste of time and energy; what's needed is to demand the staffing and equipment upgrades necessary to care for these patients properly.
Don't bother with the flunkies in the middle---take it to the top! Show them that you've done your homework by producing evidence-based studies on the money-saving properties of keeping nurses' backs healthy by providing lift equipment and sufficient staff. Be able to show them the benefits to the bottom line of reducing lost-time accidents due to back injuries; that's the only language they understand.
Nobody is telling anyone how to feel about caring for certain types of patients. It's when those feelings spill over into thw workplace---and they do---that emotions become an issue. And when you get down to where the rubber meets the road, it doesn't matter how you feel, you have a job to do and you owe that patient the best you can give.
Look, I understand. I've been a floor nurse, and I've also been the patient whose first words in the recovery room were an apology to my nurses for having to hoist my 300+ pound orifice off the operating table and into the bed. It's sad that any patient should feel they have to do that. But that's why I say that the judgementalism does affect patients, even when we try to conceal it.
I don't care how fat of thin they are.... Not high and mighty but don't think all thin people are that way by chance either. Once a pt is in a certain weight range, and unable to care for his/herself that pt requires more staff to care for him and her and more of a physical effort. I don't understand why people get so upset by this. Many to most people in our society are overweight and obese .. They will get cancer, neuro illnesses, traumas, elderly etc...... I think it is reasonable for hospitals to acknowledge this when looking at staffing and facilities. many older and even "newer" hospitals are not equipped right .
I work in LTAC and have had pts in excess of 500 lbs. Management is supportive and says absolutely do not turn/move without at least 4 people. Oh, and the patient is total care and on a vent. The practicalities are where the problem comes in... our patients are supposed to be turned every 2 hours - physician's order in the system. First, FINDING 2-3 more people to help with the turn, then getting everyone gowned and crammed in the little room... some shifts work well together and we don't have trouble getting help, other shifts we'll be waiting 45 minutes to get lift help in... really messes with the time management when you're waiting for other people for almost an hour, 6 times in a shift. Next time I'm going to ask management what they want documented in the patient record when I can't execute the physician's order for that 2 hour period because I can't get the appropriate help - I know they don't want "personnel not available" all over the chart, but I have to give a reason when I can't execute an order.
There has to be a better way.
And I don't hate on the patients - I'm a pretty big girl myself and I know how hard it is to get healthy when you reach a certain point - they wouldn't choose it if they could.
But it is a powerful motivator for me to haul my butt off the couch and start building muscles and trying to do what I can to be healthier.
Nope not your fault. And no one is complaining about cancer patients or wheelchair bound patients. Overweight patients are the issue here.[/quote']
The poster that you are responding to is illustrating that she is obese (or overweight) secondary to cancer.
I agree each pt deserves the best care possible. I agree each pt should be treated with respect. But it's ok to have private feelings. There are certain patients I like dealing with the most, and the least. Obesity isn't really a trigger for me, but I work Peds, so I digress... What I'm seeing here though are a lot of nurses that are telling people it's not ok to secretly, inwardly sigh when they have yet another 400 lb patient to do total cares on. All day. "It's not their fault," they cry, "what if they have a disease or are on steroids?" Nope, not everyone gets a pass. I've been on Synthroid for my basically non-existent thyroid since I was 8 years old. I've been on steroids for Addison's disease since I was a teenager. My BMI? 29. And I have to work SO D@MN hard to keep it there. I'm not bragging, that's pretty close to being obese. But it's not, because of choices I make. And I love food. OH how I LOVE eating.
No one is disputing having private feelings; the issues are when people are treated differ merlot because they are heavy and obese, delaying care and increasing mortality and morbidity.
I wonder why, as a profession, we feel bad and don't want to label the patient. Instead we tiptoe around and look for ways to excuse it.
There is no shame in telling someone that they are overweight because, in fact, they are taking in more calories than they are burning. Period. And if they have hypothyroidism or take steroids, well, it sucks, but they're going to have to eat even less and/or exercise more than regular people if they want to maintain a lower weight. This seems like a more useful thing to say, rather than just keep "not judging" them. I'm glad I have a healthcare team and a family that supports me and can be honest with me at the same time.
OK...
one of issues as nurse we do, in our business is MAXIMIZE individuals, not put them down, shame them, or discriminate against them; labeling of pts is UNETHICAL to our practice.
As far as eating less while on steroids; a DEFINITE NO NO; one of our BASIC responses when we take in less food is-BINGO-MAKE FAT...how would THAt be healthy for a person who body is SEVERELY COMPROMISED to not get their daily caloric intake to help their immune system??? REALLY, to tell someone who is on a medication that is a HUGE RISK to take to STARVE THEIR BODY...you would encourage and increasing of a pts mortality and morbidity??? I think...,NOT
As someone who has worked in Rehab SCI paralysis, TBI , etc and had MANY dead wt pts, including a pt who only could use one have and was 800+ lbs dead weight, I understand; I really do; but I agree with Viva in terms of going to management; making solutions to the issues of MAXIMIZING your pts and your back, hips, neck, shoulders-you get my point :)
One of the things we can do is vent; HOWEVER this should give us pause when dealing with pts; YOU (the collective YOU) can be that pt someday in the near future; one of the things I have experienced- as Esme has shared (and I thank YOU Esme-you STILL ROCK in a wheelchair!!! Remember THAT ) is our own colleagues that are in this business disregard and become disrespectful in treatment of people with illnesses; I don't care if a pt is 1,000 lbs, I will treat them how I want to be treated in my lowest LOW; and I will step up and coordinate care with my team to make sure this pt is MAXIMIZED-meaning in my practice: I provide care, discussion of diet, safety, comfort, support emotionally and give resources, IF needed; some co morbidities are such that the overweight and obesity WON'T go away; the most important part is meeting pts where they are; and going from there. ALWAYS.
And this is not a high horse standpoint; this is from a viewpoint of having a MAJOR medical incident in my late 20s and having to enlighten student nurses my age or younger AND management HOW to meet ps where they are, and not to be so IGNORANT in their delivery of care; it shouldn't matter whether a nurse or not, either. They GOT the message, THANKFULLY.
Every day, I care (not "deal with") pts is various situations and backgrounds....I brushed my pts hair who REFUSED care, laying in filth and called me a with and a black (female dog) and didn't trust me (SEVERE schizophrenia); however I was concrete in telling her she needed to wash her hair, and allow people to help her; I got it done with another person and with her help in her agitation phase. in her (brief) clarity, she thanked me. Reading these posts reminds me how I treat pts consistently; being an ICU pt with complex issues after the hospitalization and STILL having holistic after effects really helped me strengthen my practice; I am grateful that I can still practice as a nurse...and still manage heavy pts due to getting my teammates to help me, and having lifts helps as well.
I'm sure there may be a few posters here that would trade to have her than an obese pt; but my point is there are HUMANS we are dealing with; I am aware we are as well; HOWEVER in the nurse-pt relationship- we MUST be the leader; this is Nursing 101/Fundamentals of Nursing.
We can be on the same tail end one day; the BEST thing to do is be a part of the SOLUTION...OP, check your back, grab your EBP, your co workers and go to management; use your vent in this post to DO SOMETHING about it; and find successful was to provide EXCELLENT care to your bariatric pts; NONE of us know if we will need that back scratcher one day to scratch our unmentionables while the nurses are at the nurses station venting their disgust; it may be our ONLY comfort.
It is not exclusive to overweight people. It is just as difficult when one has a patient who is 80 pounds soaking wet--if they have no movement could be completely contracted,are literally dead weight--you can't hold and clean at the same time, no matter what the weight. Then there's the patients who are demented and fighting attempts tooth and nail, or peds that are out of control with fear. Weight has little to do with it. Equiptment and enough staff to successfully take care of people who need total care are essential.[/quote']
Twenty Five year olds complaining about their job? What else is new. The younger generation today feels that everything should be easy for them and they shouldn't have to work as hard as the older generations have. If you have a problem with obese patients and it's killing your back, get out of nursing and get another job. Obese patients aren't going away any time soon and the younger generation's hissy fits about how their poor backs are bothering them ain't going to change them.
I love the way the younger generation feels they have so much more knowledge than those who have been in the nursing field for decades. You just have "book knowledge". Those that have been in it longer actually have a clue as to what it's all about.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
Twenty Five year olds complaining about their job? What else is new. The younger generation today feels that everything should be easy for them and they shouldn't have to work as hard as the older generations have. If you have a problem with obese patients and it's killing your back, get out of nursing and get another job. Obese patients aren't going away any time soon and the younger generation's hissy fits about how their poor backs are bothering them ain't going to change them.
I love the way the younger generation feels they have so much more knowledge than those who have been in the nursing field for decades. You just have "book knowledge". Those that have been in it longer actually have a clue as to what it's all about.
I'm 25 & I don't want an easy job. I've had those & they bore me. I want something that challenges me, that makes me think. But I am not a big girl, I will not try to lift anything over 50 pounds without help.
But everyone, no matter their age, is going to complain about their job. No job is perfect. If you find that perfect job let me know!
I agree with you there on us, the younger generation, only having "book knowledge". I talked to an older coworker (she's 40-50, I'm 25) & we compared our nursing school experiences. Her clinicals were muuuuch more hands on as an LVN than mine were! I'd say now we are more "book educated" than before.
Twenty Five year olds complaining about their job? What else is new. The younger generation today feels that everything should be easy for them and they shouldn't have to work as hard as the older generations have. If you have a problem with obese patients and it's killing your back, get out of nursing and get another job. Obese patients aren't going away any time soon and the younger generation's hissy fits about how their poor backs are bothering them ain't going to change them.
I love the way the younger generation feels they have so much more knowledge than those who have been in the nursing field for decades. You just have "book knowledge". Those that have been in it longer actually have a clue as to what it's all about.
wow. back injuries are debilitating. one injury and one's nursing career or any! may be over! wow. some value their ability to provide for themselves and our back. Yeah, complaining won't solve obesity but it may make hospitals have more staff, more lifts, bariatric beds and rooms with bigger bathrooms etc.
I have had complete strangers make comments to me about getting out of my wheelchair to improve my health by losing weight!!!!!!! IF YOU THINK I COULD GET OUT OF THIS CHAIR DON'T YOU THINK I WOULD???? If only to chase you down and let you know that your behavior is inexcusable.
As someone who has gained weight due to no fault (or inaction) of their own as a result of a medical diagnosis and corresponding treatment, thank you Esme. The constant badgering and belittlement by healthcare providers is not going to change the fact that the 40 lbs. that I have gained in the last 5 years is due to a treatment of an underlying medical condition –- the treatment the very same nagging providers suggested!
My course of treatment is known to be an enabler of weight gain that is very well documented in multiple studies. Does that quell any of the questions, comments, and subtle (or not so subtle) hints that I am bombarded with every checkup? Of course not. It is due to my “inaction” or "laziness".
Never mind that I go to the gym three times a week, of which that time includes 45 minutes of aerobic activity each session. I also practice a strict nutrition monitored and calorie controlled diet assigned by a registered dietitian.
I'm 38 years old, 5'7, male, and 230 lbs -- am I proud of this fact? No. Do I enjoy it? No. But I do my best to handle the things that I have control over -- namely how active I am and what I put in my mouth.
Do I still gain weight? Yes.
If some nurses and providers could only hear the way they communicate to patients during thier course of treatment, I would like to think that it might change. Yet, I don't have too much hope due to the stigma and associated perceptions many have both inside (and outside) of the healthcare community about how 'lazy', 'unwilling to change', or 'non-compliant' they are.
Yes; there is some modicum of truth that some obese people will not change or don't care. But, I would be willing to bet for every one of those there are many others that want nothing more than to shed the weight they have. Sometimes its more difficult than just saying "no more Twinkies" (to borrow an '80s vernacular) -- there might just be an underlying diagnosis.
Twenty Five year olds complaining about their job? What else is new. The younger generation today feels that everything should be easy for them and they shouldn't have to work as hard as the older generations have. If you have a problem with obese patients and it's killing your back, get out of nursing and get another job. Obese patients aren't going away any time soon and the younger generation's hissy fits about how their poor backs are bothering them ain't going to change them.
I love the way the younger generation feels they have so much more knowledge than those who have been in the nursing field for decades. You just have "book knowledge". Those that have been in it longer actually have a clue as to what it's all about.
Every generation thinks the previous one is spoiled.
"The children now love luxury; they have bad manners, contempt for authority; they show disrespect for elders and love chatter in place of exercise. Children are now tyrants, not the servants of their households. They no longer rise when elders enter the room. They contradict their parents, chatter before company, gobble up dainties at the table, cross their legs, and tyrannize their teachers. " -Socrates
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Nope, not your fault. And no one is complaining about cancer patients or wheelchair bound patients.
Overweight patients are the issue here.
I agree each pt deserves the best care possible.
I agree each pt should be treated with respect.
But it's ok to have private feelings. There are certain patients I like dealing with the most, and the least. Obesity isn't really a trigger for me, but I work Peds, so I digress...
What I'm seeing here though are a lot of nurses that are telling people it's not ok to secretly, inwardly sigh when they have yet another 400 lb patient to do total cares on. All day. "It's not their fault," they cry, "what if they have a disease or are on steroids?"
Nope, not everyone gets a pass. I've been on Synthroid for my basically non-existent thyroid since I was 8 years old. I've been on steroids for Addison's disease since I was a teenager. My BMI? 29. And I have to work SO D@MN hard to keep it there. I'm not bragging, that's pretty close to being obese. But it's not, because of choices I make. And I love food. OH how I LOVE eating.
I wonder why, as a profession, we feel bad and don't want to label the patient. Instead we tiptoe around and look for ways to excuse it. There is no shame in telling someone that they are overweight because, in fact, they are taking in more calories than they are burning. Period. And if they have hypothyroidism or take steroids, well, it sucks, but they're going to have to eat even less and/or exercise more than regular people if they want to maintain a lower weight.
This seems like a more useful thing to say, rather than just keep "not judging" them.
I'm glad I have a healthcare team and a family that supports me and can be honest with me at the same time.
I am sorry you suffer with Addisons....
I have steroid induced Cushings. Moon face, buffalo hump and all. Which will probably never go away as I have "destroyed" my adrenal glands...time will tell.
I am sure we have all heard of it.
I take 80 to 100mgs of steroids A DAY....with periodic infusions that are measured by the GRAMS...yes I said grams. To shut down my immune system that is attacking my body. Along with approximately 15 different po meds that accumulate to about 30 pills....daily....and then there are the injectable and infuseables.
I don't sit around eating food all day long, my meds make me sick and I have trouble swallowing due to muscle weakness in my esophagus and trust me I would give my right arm to exercise and increase my physical activity...when even combing my hair if a physical accomplishment. Take a shower and have to brush my own hair? a miracle.
What I object to is the treatment of obese people as if they are deaf, lazy, and stupid and undeserving of compassionate medical care. Just because I look like Jabba the hut with a sunburn doesn't mean that gives anyone a right to treat me with any less respect and empathy.
If I could get out of my chair I would. I care for myself, I wipe my own behind....I live in terror that someday I won't be able to and know what is being said about me by the very profession where I spent a lifetime.
Nurses may think their feelings are internal,...but they are not. The chatter at the nurses station at 3am can be heard all the way down the hall...trust me you are heard loud and clear...the whispered...it's him again...is loud and clear. I can't stand that guy in 214 is crystal clear.
I just think ALL patients deserve respect and empathy...regardless of their diagnosis...be they smokers, alcoholic, obese, old, crazy, drug seeking or addicted.
So much as some nurses hate fat people....I abhor ignorance.
) is our own colleagues that are in this business disregard and become disrespectful in treatment of people with illnesses; I don't care if a pt is 1,000 lbs, I will treat them how I want to be treated in my lowest LOW; and I will step up and coordinate care with my team to make sure this pt is MAXIMIZED-meaning in my practice: I provide care, discussion of diet, safety, comfort, support emotionally and give resources, IF needed; some co morbidities are such that the overweight and obesity WON'T go away; the most important part is meeting pts where they are; and going from there. ALWAYS. 
VivaLasViejas, ASN, RN
22 Articles; 9,996 Posts
Again I say: let's work on the SOLUTIONS to managing heavy patients, rather than getting all high and mighty about how they got that way and how superior thin people are to the obese. Whining/kvetching/moaning/griping etc, about taking care of obese people (or COPDers, or psych patients, what have you) is nothing but a waste of time and energy; what's needed is to demand the staffing and equipment upgrades necessary to care for these patients properly.
Don't bother with the flunkies in the middle---take it to the top! Show them that you've done your homework by producing evidence-based studies on the money-saving properties of keeping nurses' backs healthy by providing lift equipment and sufficient staff. Be able to show them the benefits to the bottom line of reducing lost-time accidents due to back injuries; that's the only language they understand.
Nobody is telling anyone how to feel about caring for certain types of patients. It's when those feelings spill over into thw workplace---and they do---that emotions become an issue. And when you get down to where the rubber meets the road, it doesn't matter how you feel, you have a job to do and you owe that patient the best you can give.
Look, I understand. I've been a floor nurse, and I've also been the patient whose first words in the recovery room were an apology to my nurses for having to hoist my 300+ pound orifice off the operating table and into the bed. It's sad that any patient should feel they have to do that. But that's why I say that the judgementalism does affect patients, even when we try to conceal it.