As nurses we walk a fine line between professionalism, providing excellent patient and family care, and our ever-present imperative to maintain "customer satisfaction". While our patients are always our primary priority, we now find ourselves in a culture where the whims of the family are deemed more important by our superiors than the outcomes of our "clients". This dynamic causes a great deal of stress on the nurse's self esteem, and damage to our professional satisfaction. It is part of the reason for the ever-present march of nurses away from the bedside and toward less patient-contact positions.
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First let me say that the events in this story are true; however, the particulars have been changed so as to disguise the event and to eliminate any HIPPA violations. As of 3 PM today I am on vacation. I'm trying to concentrate on all things that are non-work related, but my head is still in the ICU. I spent the last four 12 hour shifts working with an elderly lady who is very ill. All three of her daughters are nurses at other facilities, and they all stayed attentively at her bedside. The first day they handed me a list of things they "didn't want me to forget to do for Mom." These included repositioning, incentive spirometry, feeding her meals, and the like. Well, I've been a nurse for a long time now, but I thought, okay, they are stressed. It's alright. They need to maintain some control in a situation that they have no control.
I made a point to pull up Mom's lab results and scan reports for them to read so they would feel well-informed and able to participate in her care. At the end of the first day, Mom coded. By the time they returned to her room, she had recovered enough to be awake and talking with us. I thought to myself how glad I was this family still had their beloved matriarch. Mom slept poorly that night and was quite lethargic the next day; however, she was appropriate when awake. By 6 PM the ladies had worked themselves into a state of near-hysteria because Mom was "not herself", and had not been strong enough to get up and walk. It had been less than 24 hours since she nearly died, and less than 24 hours since she had major orthopedic surgery. In the midst of their melt-down, they stated we (that would be me) were withholding information about Mom's condition and "not taking them seriously enough".
Okay, it was 6 PM, but I called the surgeon at home and got him to talk with them on the phone to answer their questions. I reminded them they had access (with Mom's approval, of course) to all lab results and scan reports. Their anger only escalated. The next day, part way through the shift I was told the new medication Mom had been given should not have been given without their express approval. Now Mom is alert and oriented and able to make her own decisions. As a matter of fact, Mom is a retired nurse herself. It never occurred to me to call the kids for permission to give her medication. They took this complaint to my manager. Now, I had spent four 12 hour days caring for this precious lady, washing her, feeding her, changing her dressings, and, yes, doing CPR on her. Successfully. I had worked hard...really hard...to care for this patient. Most days I didn't take lunch. I don't regret it for a second, and I certainly don't expect gratitude, but I didn't expect to be kicked in the gut either.
No, I don't do this job for money or for anyone's approval. I am so glad this sweet woman is going to live to go home and resume her gardening and canning and care for her cats. But I am also crushed. I am so frustrated, so depressed, so hurt. I feel hopeless, and just now I don't feel like going back to work at all. Ever. I'm sure I will eventually convince myself to carry on, but this has taken a toll on my spirit. Thank you for letting me vent. No one actually understands what we do but other nurses.
