Terrible clinical day, nurses don't seem to care.

[Koyaanisqatsi-RN]

I may get a lot of flack for this from the more experienced nurses, but I would like some help in understanding this situation.

Today, I walked by a patient's room in the hallway. Keep in mind she is not my particular patient today. She calls out to me in a frail voice for help, and sounds like she is in very bad shape. I go in to see her and she is crying, and very frail. She must have been in her 80s or even higher. She stated that she could not move her arms, and that she was desperate for some water. My first thought was that she might have been having acute MI or something similar because she couldn't move her arms, I really didn't know. I held her hands quickly and asked if she could feel my hands in hers. She said she could, but that she can't move her arms, and continued to cry and beg for water. She kept saying that she did not know where she was or why, and to please help her.

At this point, I noticed the restraints. She was strapped into her bed, this is why she couldn't move her arms. I was horrified. This is a med/surg floor, not a pysch ward. I asked one of the tele people what was going on and they stated 'it's just some crazy old woman, she's weird don't worry about her'. I asked her nurse and this was the same answer I got from her, again. She stated this woman had previously tried to pull out her IV and so they restrained her.

So...

Help me understand. They clearly had to get an order for these restraints. Why did they not choose a chemical restraint or sedative instead of strapping her into the bed? Why does no one care about this woman, writing her off as a crazy old lady; when she is, in reality, a frightened human being who was strapped into her bed in a strange place and scared to death. Not to mention thirsty, as she was apparently NPO and no one would explain to her why.

I went into the stairwell and cried for about 5 minutes. This is not why I wanted to go into nursing. I see things like this every day, but never this bad before. Restraints! They strapped this poor woman down and wouldn't explain anything to her. I spent some of the rest of the day talking to her and trying to help her relax even though all she wanted was to get out of bed and get some water.

It broke my heart. And if this is what nursing means, that eventually you become so burned out that a fellow human being suffering in one of the worst possible ways becomes just some 'crazy old lady', then I want no part of it.

[cherrybreeze, ADN, RN]

Wow that's news to me...

I'm confused on why that would be news to anyone. If you're not directly involved in a particular patient's care, you don't have the right to their info. That's one of the most fundamental rules OF HIPPA....

[cherrybreeze, ADN, RN]

This is a very good question. For starters, I think if you find yourself in a situation where you have to vent a lot, you're probably in the wrong situation. A little griping and grumbling may not be such a big deal--I call it an important part of the healthcare-worker bonding process. Some of my favorite coworkers, mostly very good nurses, have a rather sardonic sense of humor. But if you are seriously frustrated on anything near a daily basis, it's likely time to do something else. It could mean one is just not cut out for nursing, but I think it's more apt to be you're in the wrong unit, or facility.

I think it's prudent to be concerned that cussing and kicking the med cart may be reflected in how we treat our patients. Those who most believe they are as sweet as can be to the patient's face, no matter how badly they feel toward the patient, may not be quite the actors they suppose they are. I think most of us are pretty good at distinguishing someone who is seriously interested in our well being from someoone who pretends to care.

Even very confused patients aren't necessarily stupid, and a lot of times they don't have much else to do than observe their caregivers.

On the other hand, I once described a unit clerk as being like your mom: she'll drive you nuts, but you gotta love her. And I think that's typically true of our loved ones--we don't always get along, all the time, but we love each other even when we're annoyed. Personally, I find that to be true of patients, as well. I don't stop caring about them, even when they get on my nerves. And it might appall any nurse managers reading this, but I don't even think it's necessarily wrong to let a patient see that they're getting on your nerves, as long as they can still see that you genuinely care about them.

But on yet another hand, I think we need to be careful not to let our occassional gallows humor and/or venting condition us to become heartless. Call someone a "crazy old lady," often enough, and you could just start to really see them that way. And, as the OP demonstrates, it doesn't look very good to others who may not share the same jaded mentality.

One of my touchstones has been that nursing is a human endeavor. It was pretty clear to me before I ever got out of orientation that I was never going to be Supernurse. If I have to place a Foley in a female, especially one my age or younger, it makes me a little uncomfortable. I'm simply not able to carry off the impression of a consumate professional who has done this a thousand times, so I settle for looking like what I actually am, a decent guy trying to perform an awkward task with the least necessary fuss. Similarly, if a patient wants an extra blanket during my 2200 med pass, I get it. If they then ask for ice water, I get it. If they then say, "I hate to be a bother, but can I have some pain meds?" I don't tell them it isn't a bother, unless it truly isn't, but I probably will say something like, "That's okay, they pay me to do this," or possibly even "they pay me to put up with you." And sometimes I recognize that people who are on the call button a lot may just be lonely, so when I have a little time, I'll just pop in to hang out with them. I hope that isn't coming across as too saintly, because I probably will also report to the nurse that follows me that the patient is "needy," or "kind of a PITA."

To summarize, you don't necesarily have to be hypocritical to be a good nurse. Sometimes schizophrenia works just as well.

I was the one that mentioned the *gallow's humor* aspect, but much of what you described here also describes howI practice. Ironic, yes? A little actual humor in dealing with your patients goes a heck of a long way, I find (once you suss out which ones can deal with it, and how). I love to pop in and "hang out" for a few minutes, if time allows. If I have someone who frequently is asking for warm blankets, I'll try to offer the next one before they ask....same with pain meds, or whatever else the frequent request may happen to be. One of my favorite sayings to patients is, "if this is the worst thing that happens today, it's been a pretty good day" whether they've just dumped their lunch tray or didn't quite make it to the bathroom in time. The relief on their faces is priceless. So, I wouldn't say I've let it make me become heartless by any stretch of the imagination. :) I like to think the opposite.

[hikernurse]

I was the one that mentioned the *gallow's humor* aspect, but much of what you described here also describes howI practice. Ironic, yes? A little actual humor in dealing with your patients goes a heck of a long way, I find (once you suss out which ones can deal with it, and how). I love to pop in and "hang out" for a few minutes, if time allows. If I have someone who frequently is asking for warm blankets, I'll try to offer the next one before they ask....same with pain meds, or whatever else the frequent request may happen to be. One of my favorite sayings to patients is, "if this is the worst thing that happens today, it's been a pretty good day" whether they've just dumped their lunch tray or didn't quite make it to the bathroom in time. The relief on their faces is priceless. So, I wouldn't say I've let it make me become heartless by any stretch of the imagination. :) I like to think the opposite.

I agree, Cherry. Laughing at something in private sometimes gives us the only control we have over a situation that's too hard to face straight on. It sure doesn't make me less likely to care about my patient; in fact, it can give me enough distance to be a good caring nurse. I know it doesn't lessen my ability to cry with a mom after she's heard bad news about her baby. If we had to internalize everything we face at work on a daily basis, I don't think we could last more than a few shifts. Gallows humor is sure hard to explain to people who work out of our business, but it can be a very effective way to cope.

[Rascal1]

I'm confused on why that would be news to anyone. If you're not directly involved in . particular patient's care, you don't have the right to their info. That's one of the most fundamental rules OF HIPPA....

Many health professionals that do not take care of them directly, still may need access to the patients' charts. As a few examples... Utilization review,Discharge planners,MDS. coordinator,Unit manager,any other nurse who is aiding the primary nurse or the patient. Just to name a few..

[wooh, BSN, RN]

Many health professionals that do not take care of them directly, still may need access to the patients' charts. As a few examples... Utilization review,Discharge planners,MDS. coordinator,Unit manager,any other nurse who is aiding the primary nurse or the patient. Just to name a few..

Nursing students wouldn't fall on that list.

[Rascal1]

Nursing students wouldn't fall on that list.

Students could very well have reason to peruse a patient chart,but appararently not this particular student.:icon_roll

[Koyaanisqatsi-RN]

Students could very well have reason to peruse a patient chart,but appararently not this particular student.:icon_roll

I think the point is, my being curious about this patient's condition is not enough to warrant me digging around in the chart. Especially when an MD or other nurse might need it. That's in addition to it violating HIPAA.

[wooh, BSN, RN]

Students could very well have reason to peruse a patient chart,but appararently not this particular student.:icon_roll

Since this particular student wasn't caring for this particular patient, then there was no reason for this particular student to look at this particular patient's chart. Being in the building doesn't give anybody, even a nursing student, the right to look through any chart in the building. If I'm caring for the patient, then I can look through the chart. If my coworker asks me to give a med to one of their patients, I can look through the chart. If I'm a case manager or auditing charts or for whatever reason being paid to be in the chart, I can be in the chart. If I'm in a chart though, I better have a legitimate reason for it. I should err on the side of caution when it comes to accessing a chart. And if I'm a nursing student, a guest in the facility who desperately wants to pass my class and get a license of my very own, then I'd DEFINITELY better err on the side of caution and stay out of any charts that my instructor/preceptor doesn't make clear that I'm allowed to look at.

[Rascal1]

Since this particular student wasn't caring for this particular patient, then there was no reason for this particular student to look at this particular patient's chart. Being in the building doesn't give anybody, even a nursing student, the right to look through any chart in the building. If I'm caring for the patient, then I can look through the chart. If my coworker asks me to give a med to one of their patients, I can look through the chart. If I'm a case manager or auditing charts or for whatever reason being paid to be in the chart, I can be in the chart. If I'm in a chart though, I better have a legitimate reason for it. I should err on the side of caution when it comes to accessing a chart. And if I'm a nursing student, a guest in the facility who desperately wants to pass my class and get a license of my very own, then I'd DEFINITELY better err on the side of caution and stay out of any charts that my instructor/preceptor doesn't make clear that I'm allowed to look at.

No,of course not, just being in the building does'nt give anyone or a student permission to access a patient chart. How ridiculous !

[canoehead, BSN, RN]

i think the fact that this particular student was making an effort to spend extra time with the patient and make her more comfortable would certainly give her legitimate access to the chart.

[nursemike, ASN, RN]

i think the fact that this particular student was making an effort to spend extra time with the patient and make her more comfortable would certainly give her legitimate access to the chart.

Raises an interesting question as to at what point caring for a patient constitutes a caregiving role. If I peek in on a patient I had a few days ago, just to see how they're doing, I don't feel I have assumed their care. But if I silence their IV pump or get them some icewater, I suppose I'm liable for my "interventions."

In the cited example, I think I would recommend against the student accessing the chart without permission of the nurse of record. On the other hand, in the cited example for the reasons expressed, I wouldn't consider turning the student in for checking the chart. If it were truly no more than idle curiosity, I'd probably chastise the student roundly, but it seems clear in this case the motive would be benign. Still, if it were my patient, I wouldn't want someone just jumping in without clearing it with me. Under those circumstances, I think I might welcome the help, but it isn't clear that the nurses in the example would, and even I would insist that the student participated in a very limited way.

[nursemike, ASN, RN]

I was the one that mentioned the *gallow's humor* aspect, but much of what you described here also describes howI practice. Ironic, yes? A little actual humor in dealing with your patients goes a heck of a long way, I find (once you suss out which ones can deal with it, and how). I love to pop in and "hang out" for a few minutes, if time allows. If I have someone who frequently is asking for warm blankets, I'll try to offer the next one before they ask....same with pain meds, or whatever else the frequent request may happen to be. One of my favorite sayings to patients is, "if this is the worst thing that happens today, it's been a pretty good day" whether they've just dumped their lunch tray or didn't quite make it to the bathroom in time. The relief on their faces is priceless. So, I wouldn't say I've let it make me become heartless by any stretch of the imagination. :) I like to think the opposite.

I hope I didn't seem to imply that I think hideously inappropriate remarks among nurses are always a bad thing. What happens in the Med Room stays in the Med Room, and in moderation gallows humor and even a little venting can be a way of defusing the negative feelings we're bound to have, from time to time. But I think we're in general agreement that a little goes a long way.