GoldenRoya

Yep, I've called out patients for their bad behavior before. One memorable occasion was a middle-aged man who continually verbally abused the nursing staff, being very manipulative and rude, and rating his pain a consistent 10/10 - even though he was laughing, talking on the phone, and ordering pizza as he said it. I finally had enough and said, "Dude. I have your pain meds right here. I've been in here with your pain meds every three hours on the nose. You're getting your meds no matter what number you tell me, so just give me an honest number and life will be more pleasant for both of us." "I'm still getting my meds?" he asked. "No matter what?" I told him yes, I got it, he was post op and pain was a real thing, I just wanted him to be honest. "Fine. It's a three." "Thank you!" I said, just a little exasperated. He got his full dose every three hours, he stopped being a manipulative little $#!t, and miraculously, as soon as he was reassured that his needs would be met, his attitude improved and his angry demands for pain meds subsided. We got him down to q4hrs and provided him with a strategy for weaning off the narcs when he got home, and for dealing with the side effects. He was never the ideal patient, but he was far more pleasant after I got him to shut up and listen. Some people just need a firm hand to cut through the fog. (Note, I said "some people." It's a strategy that should ONLY be employed if you're very certain it will work.Using a firm hand on certain other personalities will get you reprimanded.)

Apparently I knew when I was five! At my graduation, my mom brought out a booklet that I'd made in kindergarten. It was one of those "This is my family:" prompts with room to draw pictures underneath. On the page that said "This is what I will be when I grow up:" I'd drawn a nurse. From the mouths of babes, eh? That said, I didn't truly know I wanted to be a nurse until I was about two years into my career. I didn't "like" it until I felt fully competent. There's still days when I feel like an imposter and wonder what the hell in doing. Then there's wonderful days when I leave work smiling. What can I say? It's a calling.

Best trick I ever learned? Keep quiet. If they're yelling, do not open your mouth, do not quirk your eyebrows, do not make a single expression beyond 'this is my paying-attention face.' Let them yell until they are finished - this usually takes 45 seconds to a minute. Key point here: if you interrupt or respond in any way prior to the end of that minute, the timer restarts to zero. The temptation is to step in too soon, especially once the personal attacks start. Resist. There will be a couple of pauses for breath; resist. You're waiting for them to respond to you, not you to respond to them. So let them yell and expend all their ire and only once they have stopped yelling and started to speak in a normal voice do you respond. Emotions are like a balloon leak - letting them fizzle out makes less noise than taking a pin to them.

Prioritization questions happen a lot, whether it be "your patient has this happening, what do you do first?" questions, or "you have these patients and these situations arise, who do you see to first?" Brush up on your critical-thinking-in-critical-and-noncritical-situations for those. Interpersonal questions also happen a lot. "You have a problem with a coworker, how do you handle it?" (Hint: You want to address it with the person first, and only after they've blown you off do you go up the chain. And you don't talk about them behind their back.) Google "behavioral interview questions" to give you a general idea of the type and scope of such questions. There's a LOT of potential ground that they could cover, but if you keep your head and stay calm, you should do fine. Excessive hesitancy or asking, 'um, is that right?' tend to be black marks. I think (or maybe this is just my manager talking!) that saying, 'At this point in my career, I'm not sure; I look forward to gaining experience so I know for certain how to respond' looks okay if you honestly don't know how to answer: it shows that you know your limitations and are open to learning, and aren't going to do something half-cocked because you don't want to look stupid. Use that response sparingly, though; like I said, it could be just the one manager who looks on that type of response with approval. Good luck with your interview!

Not among the nursing staff, but our central supply folks seem to have gotten into the habit of hoarding stuff, especially over the weekends. Little things, not so important... like saline flushes...and alligator clips...and gloves...and chux. Because if Central Supply gave it away, the floors would use them! And they wouldn't have any left in central supply! The horror!

Tumor juice. Large, weepy tumor that the little old fall-risk pivot-with-strong-assist-of-one lady can't stop messing with...and she grabs your arm to steady herself with a hand that's still damp with the tumor juice. Thank goodness for gigantic scrub sinks, that's all I can say.

And I think it's great that you had several good experiences. But, as you say, you're not the type to demand and complain. The exact OPPOSITE of the type of patient that most of us are referring to. I've been threatened because I wouldn't let someone eat before a procedure - because he might vomit, aspirate, and die. I've been told I'm a horrible person and a terrible nurse because I was "late" bringing in the "as-needed" pain medication. I've been told that I'm nothing but a "medical waitress" and I need to get my "Mediao-nurse butt" into gear and get the family everything they want because I'm their "servant" for the shift. -- Nearly a direct quote there. Heathermaizey, most of our patients are like you - wonderful people who we love to take care of and spend time doing the little things for. The people and attitudes we complain about are the ones that treat us like we're not worth anything at best, and are insulting and assaultive at worst. Those are, unfortunately, the ones that tend to stick in our minds, because words hurt, and attitudes hurt, and it's hard to keep coming back to work when the people who hurt us for no reason are given free reign to keep doing just that. It also hurts that the insulting person's review carries just as much weight as the happy person's review. More, in fact. Because it's not the pleased people telling the administration that 'you're doing everything right, keep up the good work, your nurses are awesome!' that they're going to pay attention to. It's the review that says, 'my pillows weren't fat enough, the noise level was atrocious, my elderly mother wasn't allowed to stay overnight, and I had to wait forever for my pain medication!' that's going to generate a response. Some of us don't exactly think that's fair.

This is hearsay...but I heard it from the person involved, so I call it probably pretty accurate hearsay. We had a patient - not confused, perfectly oriented, and completely capable of controlling his actions - break a CNA's arm. Deliberately, because he was annoyed and he got his hands on her and he could. Our nurse manager not only did nothing at the time, but when this patient was readmitted, she did not support the nursing staff who wanted to bar him from our floor. He was allowed *back*. The CNA in question transferred jobs a short time after. Which is a serious shame, because she was one of the best we had.

Actually, no, I lied. My favorite story was when she was walking a deaf man down the hallway. He was on a walker, and the video interpreter was being wheeled in front of him so that the things the PT was saying could be translated for him. The PT kept asking him questions ("what kind of home do you live in, how many stairs, do you have someone at home to help you," etc), and when he would stop and lift his hands up to reply, she would screech, "Don't let go of the walker! Don't let go of the walker!" He finally gave her a piece of sign language that needed no interpretation and proceded to ignore her. The nursing staff chuckled over that for days.

Mostly the folks I work with are wonderful people who go the extra mile to make sure our patients are well taken care of and don't leave a huge mess for someone else. However. There are always those fewe rotten fish that stink up the barrel. The particular individual I'm thinking of is a PT, who has no business being a PT at all. Alongside expecting help to get a 'Up with assist of one' patient up, she would expect the nursing staff to have the patient ready and sitting on the side of the bed for her when she was ready to show up. She would turn the call light on and wait until someone came to answer it (sometimes, unfortunately, a very long time later since, you know, busy floor and lots of other patients AND being chronically short staffed) and ask for a blanket. Or a pillow ('It's on the windowsill behind you; what, too hard to turn around?'). Or say, "The nurse will change your bed while we go for our walk, won't you?" *sickly sweet smile, knowing that she's just trapped me even though the patient's not even mine and I have stuff to do* My favorite PT story, though, was the one where I was in an isolation room holding a basin for a patient who was actively heaving with some of the worst nausea I'd dealt with thus far in my career. This PT pushed back the curtain and said to me, "Well? I'm waiting. I need your help with Mr. X." "Fine," I replied, knowing that Mr X had just had joint surgery and might, legitimately, be an assist of 2, "get him ready and I'll be there when I'm done here." Helped Ms Nauseous get cleaned up, gave her some mouth rinse, made sure she wasn't going to explode again, asked a coworker to grab some anti-nausea meds for me - about ten minutes of TLC. I come out and before I even wash my hands, the PT is on me demanding to know what took so long. I say nothing, and we go to Mr X... who is still in bed, hasn't been shifted, no immobilizers or even a gait belt or walker in the room. The PT said, 'well, go on, get him ready!' I gave her a look that could have peeled paint, turned my back, and left. I refused to be in the same room as her after that; if she was assigned to my patients, when she called to tell me she was going to be coming at a certain time, I told her to be sure to bring a PT assistant with her, because there was no one on the nursing staff who had time. She was reported several times for her laziness; to my knowledge, nothing has been done. I told my NM straight up (when the PT reported ME for my refusal to be a team player) that I didn't have time to be a nurse AND a PT, it wasn't my job, and she could bring her own assistants since she knew very well that these heavy patients she kept signing up for were beyond her capability. I didn't hear a word about it after that.

A few weeks ago, I took care of a patient who was dying. In fact, I was surprised when he made it through my shift. I thought, 'He won't be here when I come back tomorrow, he's going to go overnight.' Imagine my surprise when he was still there the next morning. About mid-shift, I had some unexpected free time, and decided to give this man a bed bath. I figured it would take maybe 15 minutes. By the time I was done, 45 minutes had elapsed. I found some of his personal care items in the bathroom and applied deodorant, combed his hair, did some really good oral care to freshen his breath. I washed and lotioned his feet. I gave his hands a light massage. He was unresponsive throughout, but it didn't matter, because this was my gift to him. Four hours later, he died. His daughter came and thanked me. She told me that he had always been a fastidious man, and she was sure that he'd been holding on because he wanted to be clean before he met Jesus.

"Did I forget to mention the rectal tube is a bit tricky?"

I left a position I loved because I was feeling overwhelmed by the insane demands placed on the nursing staff. PT doesn't want to take the patient on a walk? Nursing can do it. Doctor doesn't want to make sure the dismissal paperwork has the correct medications on it? Nursing can do it. Nursing aides don't want to cut their breaks short even though the floor is going crazy? Nursing can pick up the slack. Patient would prefer to be unconscious in a drug-induced haze? Why won't nursing give them more medications? Why aren't there enough sodas in the fridge for all the visitors to have a six pack? I pay your salary! Oh, and my favorite: "we've had an increase in falls lately, so whenever your total knee patients are out of bed, you have to be within arms' reach of them. No, you can't be charting or straightening the room, you have to be able to put your hands on them at a moments notice. I don't care if it takes twenty minutes or if it repeats four times a day. No, the patient can't refuse to have you in there. What do you mean, not everyone wants to have you watching them poop? Oh, and why are you behind on your work? Your other patients are being neglected. No, we're not paying overtime so you can chart."

If the day was made stressful just by the multitude of small annoyances/inconveniences (and not a major bad event), I usually just take a walk with my dog (I have to do that anyway, because she needs to pee bad by the time I get home) and let the day go while she takes in the sniffs and antagonizes the neighborhood pooches whose owners aren't courteous enough to take them for a walk at one o'clock in the morning (I usually try to steer away from those houses, but sometimes, if it's been a bad enough day or I'm just plain exhausted, I forget. Oops). The exercise and exhaustion are usually enough to shake me loose from any lingering bad feelings. I avoid alcohol just because it's a downer and usually makes a person feel worse, ultimately. A glass of milk, on the other hand, goes over well to easing one off to sleep.

The only one I follow is Face Off (making movie monsters and movie magic! With the bonus of being a really positive show with contestants who genuinely want to help one another so that they win based off of the quality of their creations rather than some fluke of fate, or, worse, backroom deals and knives in the back). I refuse to watch anything that makes me feel worse about humanity in general. People are better than the lowest common denominator that makes for "successful television" (I REFUSE to call it good!!!) these days.