Pros....How do you do it?

Silverdragon102, BSN · Dec 7, 2007

I would not say after 20 years I get used to it, have been known at times to cry with patients or relatives especially if I have nursed then for a while or over a period of years. Sometimes depends on your coping mechanism I cry easy but have also when really upset laugh and then feel guilty but overall feel better. Talking also helps but again differs depending if you have colleagues or relatives you can talk to

Medic/Nurse, BSN, RN · Dec 7, 2007

The TOUGH STUFF.

Not too sure if I ever want to be a "pro", but I do deal with it often and (generally) remain professional, so...

I think that you do have to put a bit of space around yourself in this profession. Compassion and empathy are essential at times, but so is taking care of what has to "done". Often, we have very difficult jobs.

We all will have to deal with stresses of the job and that is what these are - perhaps magnified at times, but still stresses of the profession. What works for me? Quiet time. Remaining spiritual. Exercise. Sleep. Good food. Physical connection (yeah, that!). A joyful connection with those I care about. Having trusted peers that you can discuss "certain matters" with in complete safety (essential).

For me, I have had situations that tested everything in me. I think I got it wrong (the self care thing) early in my career and was very unkind to myself at times. I fretted, obsessed and felt guilty often. I have had mild episodes of PTSD (yikes!) from certain calls (that is tough to admit). I think I had compassion fatigue at times. The tough stuff still happens - it is not easier, just different now. Experience. I guess I had to do things wrong to get 'em right (I'm always working on it).

For me, I can assure all that NOTHING fully prepared me for the difficulties of the profession that involve the TOUGH STUFF. The tough stuff? --- delivering life altering news, tragic outcomes or confirming a death.

I think it becomes a moment. A moment that will change everyone (even me and you!) in some way. I will have to control this moment to the extent that I can - allow for privacy, manage my emotions, having support available if needed or just answering any questions. Remain respectful of these moments.

I always try and remain aware that when I am delivering "bad news" the folks that receive the "bad news" will forever be changed. It is important to be truthful (not to the exclusion of kindness - I may not always know everything that is true...but, I can always find what is kind), deliberate, empathetic and fully present in the moment.

There is no one "way" that works for everyone. Just being aware of the issues will allow you to work through them, in your time.

Take care.

Practice SAFE!

scattycarrot, BSN, RN · Dec 7, 2007

I wouldn't describe myself as a pro but I will give my 2c!

We are all nurses but everyone of us has a different personality and we all cope with things in different ways. We also don't all get upset over the same things and I have no idea why that is. Some nurses are dynamite as Hospice care but I would find that too depressing and I have been told on many occasions by other nurses that they couldn't work in the ER as I do due to the upsetting things we see on a regular basis. Some nurses can't do pediatrics and on the unit I worked on, certain nurses would never get involved in a ped code due to being unable to handle it and/or due to a bad experience. Yet these same nurses could be involved in other horrifying patient scenerios without being upset at all. So, what one nurse finds heartbreaking, another may take in their stride without being affected by it at all. I don't think thats the nurse being callous, just emtionally detached perhaps. For example, i have been invovled in many codes, of whom the majority have not made it. The clinical side of this rarely bothers me and its not until I have to look through their belongings for example, that they become a person with an identity. Its not that I don't care and I don't treat that patient as an individual or with the respect they deserve, as I do but its just that in order to operate I have to distance myself emotionally. Thats how I give the patient the best care. Over the years, I guess it has become second nature. However, thats not to say that a stuation won;t get the better of me as it will and I hope always will(to remind myself that I DO care!) and in that case, a good cry and a talk with other co-workers/friends usually helps.

TonyFl · Dec 7, 2007

Thank you guys....

Its hard for me to imagine doing a job like nursing (or Dr.)...and not having a spiritual outlook. So many things are out of our control....and it would seem to me...that keeping your kewl (not easy) and having a belief system in God....would go a long way in this profession.

EricJRN, MSN, RN · Dec 7, 2007

I think that religious faith does go a long way in helping many nurses, but I wouldn't discourage a person from entering nursing simply because of the absence of that faith. I have a pretty pessimistic view when it comes to spiritual matters, but I'm still able to maintain my sanity (or as much of it as you'd expect for a guy with a cookie as his avatar).

For me, a big part of it is the knowledge that there will be some patients that we're simply unable to physically heal. With many of those patients and their families, good nursing becomes even more important so that they can have peace and comfort in the end. While many believe that God decides which patients cannot be cured, I simply believe that there is no divine decision-making behind it. I think that the psychological effect is the same: sometimes it's out of our hands, regardless of whose hands it's actually in.

swee2000 · Dec 7, 2007

Thank you guys....
Its hard for me to imagine doing a job like nursing (or Dr.)...and not having a spiritual outlook. So many things are out of our control....and it would seem to me...that keeping your kewl (not easy) and having a belief system in God....would go a long way in this profession.

Personally, when I started nursing school and work as a CNA, I struggled with not getting "attached" to patients, their families, and the situation they were dealing with. In fact, one of my instructors had a pep-talk with me about this during clinicals one night. At the time, I honestly thought she was very "cold". But several years later, I see she's right.

It's not that nurses don't care or lack compassion for patients, their families, or what they're dealing with. We are human. We cry and shed tears over what we see, hear, and do. We take it home every day, via our minds and shoulders, even though we can't talk about it with our spouses or families(because of HIPAA). We think about our patients on our days off. We know that the patient in room 5101 could be us or our loved one one day and in the same or worse scenario. But as I've also learned through experience, especially when assisting with or just witnessing codes, you HAVE TO remain seperated from the situation and your roles in life(nurse vs mother/daughter/wife/etc) in order to stay focused on the task at hand, getting through the day, &/or surviving in the stressful world of nursing. Yes, you want to cry as your doing chest compressions on a patient that you've cared for the past week(maybe longer) and gotten to know pretty well. But you have to wait until the time, place, and situation is right.

FlyingScot, RN · Dec 8, 2007

There are many different responses to the tough situations that we see and not all of them are healthy. As a seasoned nurse who has worked for over 20 years in what I think might be the "worst of the worst" (ER,PICU,NICU and Peds/Neo CCT...although I'm sure every unit is hard in it's own way so not devaluing anybody elses feelings) I have noticed that my peers often drink in excess, smoke like chimneys and have developed a certain "graveyard humor" in order to protect themselves. Believe me nobody parties like ER/CCT nurses. We develop extremely tough shells for many reasons. First off we are expected to handle extreme situations calmly and professionally so we internalize constantly (this is especially true of CCT nurses) which allows us to function but can spill over into our personal lives and even professionally when we are not in one of those situations (often mistaken by other staff members as arrogance). Secondly we work so hard at internalizing that we are terrified if we let our guard down even one little bit EVERYTHING will just explode out and we will lose that control that is so precious to us. Try to get one of us to a CISD I dare you. Do we cry sometimes...sure but most often we don't have time for it because we are off on another mission or the equipment needs turned around or the floor is clamoring for the paperwork. So we stuff it and move on. Does that make us callous? Externally it may seem so but that doesn't mean we don't feel anymore. So we have insomnia, migraines, IBS, divorces, depression and a whole host of other stress related issues. But it doesn't have to be this way for you. The first thing is to make sure that you are not defined by your profession or you will never be able to separate yourself from it. A patient that dies is not a failure on your part even if it was unexpected. I try to look at it as a priviledge to be a part of this person's life at what I think is really a sacred moment and I treat it as such. This rite of passage can have spiritual undertones if that is your belief or simply be a part of the circle of life.

Now from the sublime to the mundane. Develop good personal habits. If you smoke...stop. Exercise is a wonderful way to relieve stress, especially if it involves punching... like Tae Bo. I find that I get too introspective on a treadmill but beating the crap out of the situation figuratively makes me feel great. Monitor your alcohol and never use a bad day at work as an excuse to drink. It's an easy trap to fall into and a hell of a hole to crawl out of. Same with overeating or illicit drug use (not to mention those pesky urine tests). Talk with your peers. Often our families are ill-equipped to understand or help us deal with our work issues. Ask for CISDs when you think you need it. If your family starts saying "you've changed" you probably have and maybe a session or two with your EAP is in order. Be proactive rather than reactive. And last of all... hug your kids often because they have an amazing amount of healing in them. If you don't have kids borrow some like I do...it still works.

Namaste

swee2000 · Dec 8, 2007

The first thing is to make sure that you are not defined by your profession or you will never be able to separate yourself from it. A patient that dies is not a failure on your part even if it was unexpected. I try to look at it as a priviledge to be a part of this person's life at what I think is really a sacred moment and I treat it as such. This rite of passage can have spiritual undertones if that is your belief or simply be a part of the circle of life.
Talk with your peers. Often our families are ill-equipped to understand or help us deal with our work issues......And last of all... hug your kids often because they have an amazing amount of healing in them. If you don't have kids borrow some like I do...it still works. Namaste

These comments speak volumes!! Thank you for including them in your post.

snowfreeze, BSN, RN · Dec 8, 2007

Nursing has been for me a woman riding the hormonal rollercoaster and dealing with emotional issues as a nurse at the same time. I started out pregnant during my first year of nursing school and working part time as a new paramedic. The best thing I took from the paramedic experience was learning how to use my adrenaline rush in an acute situation without burning out or becoming aggressive. Many nurses I work with tell me I don't get upset over anything, I stay calm and cool but also repect others emotions.

I also had some training and experience in critical incident debriefing and that helped in more ways than I realized at the time. Stop, step back and look at the whole event from many perspectives. Right now the facility I recently worked for is doing simulation codes for training then we look at a video of the code and evaluate our skills and reponse. There are 9 people working a code, lead MD, MD assistant, bedside nurse, respiratory, respiratory assistant, anesthesia, ICU nurse/crash cart, documenter, supervisor Then you do it again working as a different caregiver in 4 more simulated codes. Everyone becomes quite adept at looking at the whole picture by the end.

I still cry at deaths, I can be cool and calm during the medical part of a code then talk with the family and give hugs and cry with them after that same patient is pronounced. Recently I had a daughter who was also a nurse who wanted to help in the post-mortum care of her mother. That was really emotional for me but I felt good afterwards.