others' perception of us

[wanda06211]

Thurs night was a crazy night for me. I only had 6 patients and most of them were good except I had one with a hemoglobin of 4.0 (that is not a typo). The 4.0 hemoglobin guy was getting blood all night and had a previous MVA that left him with just enough brain damage to be ornary, combative, and just mean in general, but he was still "with it" enough that we couldn't really restrain him. Hemoglobin guy was scheduled for an EGD and colonoscopy in the am so he was NPO (and not one bit happy about it; nor was he happy about the blood). He proceeded to tell me that he felt we were using him as an experiment and that he would not be back to this hospital every time I went into his room. He wanted to go outside so he could smoke, but with blood hanging and his low hemoglobin, this was not an option. No worries, he just drug his IV pole to the bathroom and smoked there (3 times!). We had to stop in between each of 4 units to take him out in a w/c just to keep him from smoking in the bathroom. At 0600, I was standing at the med cart when I smelled smoke yet again. By this point I had had enough. I walked to his room, turned the corner and saw his IV (pole, catheter, blood and all), but not him. He had ripped out his IV (for the second time) and his bed was now covered in blood while he stood in the bathroom smoking. I managed to get him back to bed and hooked up again just in time to give report. I felt like I had been hit by a truck. I was completely frazzled. The funny part of this is that while I was coming apart at the seams, I never thought about how I looked to any one else. Well, I went in tonight for a couple of hours and I saw our RT. She stopped me and asked me how I managed to stay so calm that night. I told her I thought she had the wrong person. ;-) She said she had watched me all night chasing after this guy and I seemed to be so cool and calm. She said she even left it in her report that she wondered what it would take to "rattle" me. HA! I told her she had missed the part where I had a little break down. I guess I am just glad to know that I at least look like I have it all together and know what I am doing. I hope my patients see me the same way. ;-)

[trudlebug]

Way to go Wanda!

Keeping focused on the outside like that will keep 'em blissfully unaware that you are frazzled on the inside.

Just remember to ask for help when you need it!

[acgemt]

Wow, I am very impressed. I would have thought he would win himself restraints during the whole ripping out the IV thing. I don't know what I would have done in that situation...you seem to really have it together, and I commend you for that. What is it with patients smoking??? You would think they would have some sense to deal with not having one while they are SICK...go figure...Good job to you!!

[wanda06211]

you seem to really have it together, and I commend you for that

That's the thing, I SO did not have it all together, and I was about ready to pull my hair out. At one point I even asked my charge nurse if we could call the doctor and get an order for xanax---for me! LOL! But I just kept thinking that I was doing the best I could and that was all I had to offer. I was so glad to see 0700 come that morning so I could get out of there. I was to be off the next night (fri), but I came home that morning and got some rest and actually went back in for a couple of hours (off the clock) to "baby sit" this guy and help my co-workers out. (I just could not imagine knowingly leaving someone else in the shape I was in the night before.) I figured a couple of hours would give them time to get other assessments done and catch up on some charting. (I'm sure it sounds like I am a really generous person for that, but the nurses I was helping would have done the exact same thing for me. I would not have done it for just anyone. ;-)

[Daytonite, BSN, RN]

It sounds like you did everything right. It is important to stay professional and not let patients know what you "really" think about their behavior. This is sometimes very hard to do. Some patients will really put you to the test. This poor patient was only being himself and you mentioned that he was brain damaged. His behavior is very typical of some with brain damage. Over your career you will have other patients similar to him. This is not totally unusual. It sounds like you realized that.

I do not, however, agree with your decision to sit with him on your off-time. I understand that you felt for this patient and didn't want to see him injure himself. Did your manager know you were doing this? Please realize that even though you weren't "on the clock" you still, because of your status as a licensed RN and employee of the hospital had a duty to follow all the policies and procedures of the hospital just as if you were working. Most places I worked would not knowingly allow nurses to come in and sit with patients on their off time because of liability and labor law issues. Your days off are for you to rest and have a personal life.