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.

I once overheard another nurse say, "I don't have to answer my call lights, I have a NA to do that for me." - please note, the NA's are assigned to specific patients and NOT to specific nurses. I happened to know that the NA to whom he was referring was on the edge of a meltdown because she had been running so hard to get her other duties done, and that the nurse was doing Facebook (or something similar). He was told with as much tact as I possess (approximately a thimble-full, less when I hear such idiocy) to get up off his orifice and take care of his call lights. The NA has since moved on to greener pastures. The nurse is still with us, though I can't imagine how he skates through his evals. I somehow think that the floor ended up rather poorer in that deal...

There are good and bad things about it. Ever since my hospital instituted bedside rounding, I've gotten out later than my "official quitting time," which then becomes donated time, because there's no way I'm logging back into the computer to change my timecard for five or ten (or fifteen, sometimes) minutes. Finding three nurses (or five, or six), walking to each room, sometimes split down several hallways, and then giving report in front of the patient all takes time, and doesn't cover those frequent times when the patient thinks, oh, there's two of you now, you can help me to the bathroom... no matter how many times they were asked if they need to go before shift change, or asked to please respect shift change as a time when the nurses may not be able to immediately fulfill their requests. It gets even more fun when surgicals hit at or around shift change, so that you're trying to get the initial vitals, share what the PACU told you, get them settled in the room, and hash out who gets to chart the first assessment. And answer questions from visitors. And the patient. And the hovering other nurse that the next shift is getting report from because she has a bus she needs to catch... On the other hand, there has been more than one occasion that something critical has been caught by doing the bedside report; an IV not turned on, or a nerve block set to the wrong drip rate, or a wound that has started to bleed through the dressing. Or a behaviour that I find odd, but that has crept up on the previous shift so gradually that she didn't notice it until it was pointed out. All in all, the pros much outweigh the cons (and please forgive my complaints; I've just had to become resigned to never catching the "early" bus). Like all new changes, the bugs have to be ironed out first. Everything is hard before it becomes easy.... if it ever does! (dark humor there, ignore me...)

Mine comes from a story I wrote when I was in nursing school, about a gathering of dragons in a kingdom where magic was in danger of disappearing. One of the key main characters who I got REALLY interested in was a young golden-colored dragon who got separated from her parents and was raised by a band of True Elves...then by a band of Iron Elves...then by the kingdoms of men and one special prince who turned out to be rather important later.... Tamara grew up oddly, with a taste for adventure, the acquisition of wisdom, and a skill for seeing the hurts in others and (eventually) the ability to heal them. About that time, her tribe wants her back, because she's their leader, thanks to her Golden color. She became the Golden Roya, and her skills keep the realm stitched and healed together. Yeah, it's such a high school name, but at this point, it's me, and I wouldn't be able to remember another one.

The nurse (not me!) goes into this one patient's room to give the Magic Silver Bullet (suppository). She'd just had a hip done and doesn't want to roll too far, so my coworker does the best she can by feel.... which turns out to be a mistake, since she misjudges the distance and tucks it up, not the rectum, but the other one, just an inch or so further forward. She goes to retrieve the suppository, but can't catch the slippery little sucker, apologizing to the patient all the while, while the patient is getting more and more uncomfortable until she finally says, "Honey, honey, stop... I'm not used to people digging down there!" We found out later that the patient was a nun... You'd think that people would learn to look before they stick, right? Wrong. Someone else (me) thinks she's hot stuff and can hit the right hole every time, no matter what... Yeah. I did the poke-and-hope method, and missed. Had to go excavating in order to get it back. The patient looked down at me, digging around for the slippery bugger, and says, "You know, [susan], my partner, could have had that thing out in no time..." My face turned so red I looked like a sunburn, and the patient had the good grace to laugh. As did the rest of my coworkers, after she shared the story with the next shift!

I work on a post op floor, and you wouldn't believe the number of people who lie about their pain. Sure, you get the occasional tough old bird who says, "Oh, my pain's about a 2 (out of 10)," but they're clearly pale and shaking. "I'll get you some pain medication," I say, and inevitably the reply is, "Oh, no, honey, don't trouble yourself for me. But, well, if you're going that way anyway..." But those are the exceptions, and a rare pleasure when you get them. Mostly, I get "OMG my pain is through the roof I can't stand it OMG OMG get me some pain meds NOW!" And some of them are legitimate. Surgery is very painful. However, there are those people whose pain tends to come on at strategic times... like as soon as someone asks, "How is your pain?" Patient, relaxing in bed: "Oh, about a ten, I'd say." Nurse: "A ten." Statement, not question. Patient, yawning: "Yup. A ten." Bald. Faced. Lie. Nurse: "A ten means you couldn't possibly imagine your pain feeling any worse." Patient: "Oh. Well, I'm at a nine then. Say, could you grab me the menu? I'm a little hungry." Nurse suppresses the urge to tear hair. But my absolute favorite happened at the end of a very long, very harrowing night shift. This patient had had a terrible night with pain, and I'd been calling the on-call MD so often we were on a first name basis. I'd done everything I could think of for her, including a fifteen-minute back-and-butt rub to try and calm her sciatica... this while caring for five other patients. I'd thought we had developed something of a rapport over the night... until the resident rounded in the morning and she completely lambasted me to the doctor: "This has been the worst night of my life! Nobody did anything for my pain, I felt like I was alone, what sort of hospital are you running and were you trying to kill me or just ignore me to death?" This while I was standing right at the door with the fourth IV push fentanyl of the night. She looked right in my eyes and lied. Then, after he'd left to write new orders, she smiled sweetly at me and asked for help repositioning. My jaw hit the ground so hard it left a bruise. Oi, some people...

Ohh! My heart just melted. What a cutie!

Why is it that lab never calls to tell you that your patient came up VRE positive before you spend an entire shift going in and out of their room? (And why is there no "crawly skin" emoticon?)

"You really enjoy quitting time, don't you?"

A day to myself? No dogs or kids or family? Ooh... Wake up naturally (no alarms!) before sunrise, go for a long walk with my camera and catch a few gorgeous shots above the bluffs... coffee and pastries to warm up, and a good book by the fireplace. Phone turned off, of course, and the computer off, too, so that there are no distractions. Prepare a leisurely lunch and eat it on the patio (if it's warm) or couch (if it's cold), watching the weather go by. Go to a movie in the afternoon, with friends if I can get anyone interested in the flick, then out to dinner for a melt-in-your-mouth steak and to the pub later for drinks with the guys (because it always seems more interesting to talk and drink with guys than women) where we compete to see who has the most interesting stories (I can't win with the folks I hang out with) or the wittiest reparte (I occasionally win, particularly hilarious if anyone happens to be taking a drink at the moment of the punchline). Then home to clean sheets (I have no idea how they got clean, because laundry is something that wouldn't happen on my _ideal_ day off...) and interesting dreams that have nothing whatsoever to do with work...

You know you're a nurse when the one feature you're really proud of on your wedding dress is the pockets.