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

Nurses General Nursing

Published

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.

I hear what you are saying. I know it is sad to see someone in restraints. Use this experience to help you be a better nurse. Learn about alternatives to restraints, and/or try to shadow at a restraint-free facility. You can use this knowledge to teach future coworkers about alternatives. Just for example, I never knew how great bed alarms were for fall risk pts until I came to my current hospital. Do you have any teaching projects due this term? Perhaps your instructor would let you do one on restraints, maybe even for the staff on this unit.

Hang in there. :icon_hug:

Thank you for the hugs. I needed them today.

I guess part of this is because my particular school spent more than a little time telling us about restraints and how they were very, very rarely used and how it's such a legal headache that most people don't bother with them. I guess I didn't expect to encounter them in nursing school, and I was completely unprepared for the experience, and how to react.

0 Votes
Specializes in CVICU.

I work at a large teaching facility in a CVICU, where we regularly have the sickest of the sick in our patient population. We use restraints a lot. It is not uncommon to see someone on a balloon pump with SLED running at the same time. The patients are usually on ventilators, and are typically restrained to protect their tubes and lines. Quite literally, if someone were to reach for something because they were confused, they could die. Even if a nurse is in the room at all times, it's impossible to catch every hand reaching for an ET tube or central line. While not like your example, we do use restraints, and they are extremely common in my area of practice.

0 Votes
Specializes in Medical/Surgical.

Here is a story about what can happen if you DON"T restrain a patient.

A few months ago I was floated to the medical floor. There was a very confused elderly woman in a room right across from the nurse's station. Even though she was not "my" patient, everyone on the whole floor was doing their best to keep the woman from getting up on her own.

All day long this woman was getting out of bed, out of the chair. She was reoriented to her location about every 15-30 minutes. This went on all day, and the woman was not restrained.

About five pm, less than three minutes after I had left her room after giving her a snack, we all heard a big thwack and crash. The patient was lying on the floor. Her head was banged up, and she was found to have a broken left hip as well.

The patient died a few hours after her hip surgery.

Restraints might have, or might not have made the difference, but sometimes they ARE for the patient's safety.

0 Votes
I just wish that I had at least one single nurse today explain what you guys are here telling me now. No one did. No one cared. And yes I know everyone is busy but census was pretty low today, and I think the literally 3 minutes it takes to explain some of these things wouldn't have been missed too terribly. Maybe I'm wrong about that, too though.

Well, if you'd asked me about it with the accusing attitude that I didn't care, I'd have not bothered to waste "the literally 3 minutes it takes" to explain it to you either. Someone DID tell you she kept pulling out her IVs, but that wasn't good enough for you. How were they supposed to know how long it would take to explain that facts of real nursing life to you? Especially if you're coming in with the attitude that they just don't care?

As for laziness, when I worked adult med-surg, restraints were the last thing I wanted. It's a whole heap of extra paperwork I didn't want to deal with. So even if I was heartless, I'd have avoided it. Fact is, someone DID care enough to get the restraints for her, to protect her from pulling tubes out, to protect her from falling, bottom line: TO PROTECT HER.

Does it suck? Yep. Optimally every patient could have one one one care and someone could sit with them all day and night reorienting them over and over again. But that's not happening. Getting a sitter is almost impossible. As you've been told, chemical restraints are just as bad, if not worse with the risk of paradoxical reactions and sedations increasing risk of falls. Often there's no "good" option, no matter how much one does "care" about the situation.

0 Votes

I am coming up on one year "post graduation"...I have been working now for 9 months...As one of our "posters" explained some people get into nursing for the money, job security, or as a calling!...I know I am one of those that have come to nurse as a calling...I love my "job"!...The reality of clinicals vs. the floor is (might I say) quite daunting...Staffing is horrible if not atrocious (pretty much every where...even in the "good" hospitals)...As a new grad I have worked for 6 months in a hospital where the staff morale and "caring" was non-existant!..It was horrible and broke my heart on a daily basis...I would cry (and I am NOT a cryer!) and pray as I drove myself to work everyday (afraid that I wouldn't be enough for my patients or find the support that I needed)...I was truly afraid that I would lose my license and most of all a life!..I had to leave...I have found a position in a hospital where the staff truly cares about there patients...I'm not saying pt's are not restrained at this hospital and that nurses and staff don't get frustrated from "confused" pt's...Every other resource is tried before a pt is restrained...redirecting, 1:1's (if within budget, which is NOT likely), medicating WNL (It is wrong to sedate an individual and make them immobile leaving them susceptible to infection, skin break down, etc..)...I hate, hate, hate restraining pt's...but in my short time as a nurse I understand and (gulp) appreciate the need in extreme cases...I will give you some examples (this is the real world cases that I in my short time as a nurse have encountered) pt trying to pull brand "spanking-new" trach, (lovely but pleasantly confused elderly lady) trying to pull central lines (could just envision the blood bath scene and "code" to ensue), pt successfully pulled foley (which was well placed, I made sure) x 2, trying to get OOB fresh hip fx repair-post op, etc....Many times restraints are quiet temporary and are used to get the patient over the "hump" of confusion, for example individuals w/ some level of dementia typically become quite confused out of element, the drugs that we give them (duh...post anesthesia elderly), uti's (have you seen an elderly individual w/ a uti yet?...They can become 180 degrees different until tx runs it's course!)...The (as my nursing instructor would tell me in school) "real world" is not as cut and dry...She was sooooo right!...I can see that you are (like me) one of those nurses that has had the calling...Your future pt.'s are truly lucky to have you!...Nursing is absolutely not an easy cut and dry career BUT, I can truly say this now, the highs, the saves, the "moments" (those intimate moments when you are truly a part of a pt's and families' lives) absolutely make it worth while!...Hang in there...Have Faith!...I know you will see if you have the "calling"!:wshgrt:

0 Votes
Specializes in Med-Surg., Agency Nursing, LTC., MDS..

I'm sorry that you had a rough day and I understand your feelings of frustration. Remember to keep all of the wise suggestions offered here in your nursing "toolbox". I'm sure I've had days where I have said something about a patient to another staff member,maybe in an effort to "vent" to help get me through the crazy acuity and events of the shift. It's really hard to know what's going on in the other nurses' minds,their pt. assignments ? and whatever else, their personal/work issues ? Sometimes we are quick to judge people or assume things when we really don't have all the available information and it can be also potentially dangerous or fatal to do so especially when our pts. welfare is in hands. We need to "check our bags" at the door so we can give our pts.our best. And then check them again before we get home ! You made a difference in that little old ladys' day. And I'll bet you helped a few nurses get their perspectives back into place,maybe later when they had a chance to reflect. Sorry, just my :twocents:. Keep up the good work !! ... We need you ! :heartbeat :heartbeat

0 Votes
Specializes in M/S, Travel Nursing, Pulmonary.

Sorry you had a rough day. I hate restraints too. There is a particular hospital system here where I live that I wont work for because they use restraints as a cost saving measure instead of what they are intended for.

With that said, "Why didnt they use a chemical restraint or sedate her?". Hecks no, that'd be worse. Chemical restaints are not the humane alternative or even the first/better option. This lady was, by your description, in her 80's. Her body probably cant metabolize what she is already on. You'd be risking really throwing her off her baseline and messing her up with a sedative or anything of that nature. I dont like chemical restraints any more than mechanical.

The nurses probably came off as jaded or uncaring, but you didnt have the complete picture either. Who knows what went on that they were applied. Pulling out central lines, self harm.......it could have been anything.

Also, something else you said jumped out at me. "This is a M/S unit, not a psych. unit." Oh gee. M/S IS a psych. unit. M/S units take the patients that psych. units refuse due to medical issues. If someone has psych. issues AND their health is bad, they are on a M/S unit, not a Psych. unit. Because of that, restraints are more common that most experienced nurses would like on M/S units.

Plus, you have to take HIPPA into consideration. The nurses probably knew the rational (well, no, let me rephrase that, they definately knew) but did not want to discuss it in detail with you. Thats pt. privacy. To be honest, they were not allowed to answer you in full. It is not unlikely that they would have liked to explain the situation better but could not.

0 Votes

there SHOULD be enough time on our shifts to explain and care for patients the way so many of us set out to do. it should be part of the care plan and there should be enough budgeted time to do it

0 Votes
Specializes in Med Surg, Specialty.
there SHOULD be enough time on our shifts to explain and care for patients the way so many of us set out to do. it should be part of the care plan and there should be enough budgeted time to do it

That would be nice if this was so.

0 Votes
Specializes in Med-Surg., Agency Nursing, LTC., MDS..
That would be nice if this was so.

You took the words right out of my mouth ! :coollook:

0 Votes
Specializes in Med Surg, Specialty.
I just wish that I had at least one single nurse today explain what you guys are here telling me now. No one did. No one cared. And yes I know everyone is busy but census was pretty low today, and I think the literally 3 minutes it takes to explain some of these things wouldn't have been missed too terribly. Maybe I'm wrong about that, too though.

Usually if census is low they will send home nurses, not give us a lighter load. I remember I was working one night and had a screamer patient. He was fine, he would just scream a LOT, but each time you go into his room he would be just fine, not anxious or anything, in no distress whatsoever. I was at the end of 3 nights in a row and I got to know his screams, which one was a "normal" scream and which one was not a normal scream. Lab came up to draw some blood with me on one of my patients and as we were speed walking by his room he screamed. The phlebotomist looked at me in horror, and I paused for a second to listen to see if there were any signs of distress, which there weren't. I said to her that the patient was fine and kept walking. Looking back now I can see that I might have come across as uncaring to the phlebotomist, but I knew the patient well, was confident he was ok, relayed that to phlebotomy, trusted that the phlebotomist would understand my assessment of the situation, and focused on the blood that was needed. At the time, I responded one health care person to another. Were I to have been talking with someone not in the healthcare realm, I would have done a lot more explaining, but if I am talking to another healthcare person, I often assume that other person knows that I do care and that I'm doing what needs to be done. At the time I figured a quick answer of "he's fine" to phlebotomy would suffice.

Likewise, it is possible that the nurses you talked to assumed you were more familiar with restraints and thought that a quick answer to your question would suffice. They also probably would never respond the same way to a person not in the healthcare realm.

A second set of eyes and notification to the nurse when you feel that there is a problem IS important though, even if things are fine. I greatly appreciate all those who stop me to tell me something they think is important about the patient. Did you tell them she seemed very anxious? Maybe they had just given her something and were waiting for it to kick in. Like the others have said, there are many possible reasons what why it happened as it did.

It is hard when you have multiple patients, feel like you are barely keeping your head above water, and wonder whether or not you'll get a lunch when you drive to work. We do the best we can with the limited resources and staff that we have. The system is, by many standards, broken. Would be great if we could use a sitter instead of restraints but there simply are no funds for that, and there is often no time for the nurses to watch her (though she should be getting additional monitoring automatically simply because she's in restraints). Would be great if we could have less patients to each nurse so we can have the time to sit with all our patients. I hope you keep your passion alive to work for this goal! Healthcare needs a lot of help. Its often not pretty, and is frustrating and scary many times too.

0 Votes
there SHOULD be enough time on our shifts to explain and care for patients the way so many of us set out to do. it should be part of the care plan and there should be enough budgeted time to do it

Unfortunately, this not reality. :cry:

0 Votes
+ Add a Comment