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.

[Rascal1]

It's the nurses who've never fallen prey to compassion fatigue that I worry about.

I'll ditto that. And the very thought of that scares me ! :smackingf

[Koyaanisqatsi-RN]

It's the nurses who've never fallen prey to compassion fatigue that I worry about.

Why is that?

[firstyearstudent]

Why is that?

Because they're psychos or martyrs? Not normal?

[LesMonsterRN, ADN, RN]

Compassion is essential to what we do. Sometimes we can care too much for too long and therefore run the risk of having that caring "used up" if we don't take care of ourselves. Those who claim to have never been close to it and never worried about it (or maybe just gave up) might not have felt that compassion in the first place, IMO.

[Koyaanisqatsi-RN]

Compassion is essential to what we do. Sometimes we can care too much for too long and therefore run the risk of having that caring "used up" if we don't take care of ourselves. Those who claim to have never been close to it and never worried about it (or maybe just gave up) might not have felt that compassion in the first place, IMO.

Why is it either/or though? Is it actually impossible to both care for yourself, and for others for a length of time? I've known people who can do both, so I'm not yet convinced that it one or the other only.

[nursemike, ASN, RN]

I think my true problem was not so much the restraints itself (although it was extremely emotional to see it), but rather the lady being called, by multiple staff, a crazy old lady. She used to be someone's mother, sister, daughter, etc. I guess I just think it wouldn't be too stressful or take too much time out of the day to refer to someone as an actual human being.

I definitely understand this now better today than I did yesterday. Thank you everyone for explaining this. I looked up some more information and i'm a little surprised we weren't taught that in school. We were pretty much only told that there were 'physical restraints, and then chemical restraints'.

I know what you mean. I guess I've just seen some nurses attempt it more than others, and that's the type of nurse I would like to be, at least to try for. Even just this semester alone I've gotten some good perspective on why things are the way they are.

I hope to continue learning like this (if maybe a little less emotionally ), and despite how terrible I felt yesterday, I think it was a good experience, because I definitely learned a lot about restraints and why they are used, and how people react to them. Thank you everyone for your help and encouragement.

I've quoted several of your remarks out of context, not to address them in particular, but because I see in them a trend I would like to both commend and expand upon. I don't have much to add to the topic of restraints: I hate them, and I use them. They suck. They save lives. 'Bout sums it up. Also, a couple of recent posts stoled what I was about to say about compassion fatigue. It sometimes seems like the nurse who'll ask me, "Hey, when you get a minute, would you go see Mr. XXX and slap him around for me?" is the nurse who is least likely to crack up and actually slap him around. We all have negative emotions, from time to time, and those of us who aren't angels, or even saints, are at least spared the stress of pretending we are, for whatever that may be worth.

But the point I really want to make, to the OP and anyone else willing to hear it, is that we all want to be treated like the caring, competent professionals we are, but if we can't extend that respect to each other, who on earth will? Now, clearly, not all nurses are equal, and a handful are downright bad, but I am arguing that when another nurse does something, our presumption should be that it was the right thing to do. I know some of my instructors taught that I should expect to see more experienced nurses using out-dated and/or sloppy practice, and not to fall into that, myself. A valid lesson, to be sure, but no more valid than what I've learned for myself, that pretty much every nurse I work with is a good nurse who cares as much as I do, is at least as smart as I am, and is probably a lot more experienced than I am. Now, it's always possible that if we disagree on some solution to a given issue, I could be right and they could be wrong. It's even more possible that we could both be right--that there are multiple right answers and the one we choose is a matter of style or personnal preference. But I find I've learned a lot just by recognizing that what I think, or even what I was taught, could be wrong.

I think the OP has been shown, and grasps, that restraints are not an absolute evil. Clearly, they aren't an absolute good, either. They should never be used to punish a patient, or even for a nurse's convenience. But I would encourage us all to think that if a nurse and a doctor believe tying a patient's hands is in the patient's best interest, they probably have a good reason for thinking so. A facility with a No Restraints policy is saying, in effect, that the suits and bean-counters are better judges of patient care than the people in scrubs are, and if we work from the presumption that the other nurse is wrong, we're buying right into that. Again, I don't mean to bust the OP's chops, or anyone else's, but in the light of this experience and the comments in this thread, does it seem like a reasonable idea that when you see something you don't understand, or even don't agree with, you start by thinking, "A nurse did this, so it's probably right." Then try to figure out why it's right. Then, if you still have questions, ask them.

"A nurse did this, so it's probably right." It's a huge leap of faith, and there will be situations where the evidence doesn't bear it out. Sometimes even good nurses are wrong, and some nurses are wrong a lot. But think about the converse: "A nurse did that, so it's probably wrong." Because every working nurse will eventually encounter that from someone. It's discouraging, degrading, and dangerous, but if you get through a shift without getting it from someone--a patient, a doctor, a patient's family--you're lucky. The smartest, most compassionate, best nurses I know have to put up with it. But how great would it be to at least know that you won't have to put up with it from a fellow nurse? So I'm asking the OP, and anyone else who'll listen, to take that leap--not blindly, to be sure, but not hesitantly, either. If we can do that, who knows? Maybe someday, others will, too.

[Tweety, BSN, RN]

Why is it either/or though? Is it actually impossible to both care for yourself, and for others for a length of time? I've known people who can do both, so I'm not yet convinced that it one or the other only.

Most of us are both. I don't think the poster was saying that it's impossible to have compassion wile being self-nurturing. We just have to be self-aware enough to be able to step back sometimes.

Calling a patient a "crazy lady" isn't exactly self-nurturing, it's demeaning and dehumanizing. It's probably someone's way of coping with the harsh reality of aging in America where elders are tossed aside.

Also, it's very easy to judge a person we see in the hallway talking about the crazy old lady. It's not really fair to judge a person's insides by their outsides. Their one-on-one interaction with this patient could be filled with compassionate care and unless you read minds or are a fly on the wall, you shouldn't judge. You don't know what they've gone through with this patient. She could be a sundowner who screams all night, pulls out all her tubes, falls out of bed, completely off the chain, that sucks the life out of staff with confusion.

[heron, ASN, RN]

Why is it either/or though? Is it actually impossible to both care for yourself, and for others for a length of time? I've known people who can do both, so I'm not yet convinced that it one or the other only.

Of course, it's not one or the other! If it was, there wouldn't be any caring nurses in the world. The balance is what's critical.

Sometimes compassion fatigue is transient ... occurring when you've been rushed off your feet for the 4th or 5th shift in a row and patients/families/nursing students look at you like you're the devil incarnate because you can't muster up one more "you poor thing, here ... let me help" if your soul depended on it. Usually cured by a good night's sleep or a vacation. Regrettable, sometimes avoidable ... but it happens.

Sometimes it's bone deep ... too many shifts dealing with too much misery, mickey-mouse managers and patients/families who never heard of the word "thankyou". It's like pushing a rope, sometimes, to do your best and be met with the b------t you've seen described on this site. Harder to deal with because then it becomes part of a general burn-out syndrome ... sometimes it takes a complete break from nursing or a particular specialty area to get a grip on it.

Sometimes it manifests as a coldness ... a seeming inability to get worked up over the particular tragedy that's in front of you. Sometimes it manifests as a kind of bleak, black, cynical humor. It looks different in different people, just like any other emotional or physical phenomenon.

Compassion fatigue is NOT a sign of weakness, stupidity or failure. It is a normal emotional response to intense emotional demands over a period of time. Some of us learn to deal with it better than others.

You will find that self-care, though simple in concept, is often easier said than done. Especially those of us with families that also need care, educations to further, etc., etc. In this country, we don't even acknowledge the critical role of sleep in maintaining physical or mental health ... if you refuse a shift, or to do the laundry/make dinner/take the kids to soccer practice because you're tired ... just watch the eyes roll!!!

[LesMonsterRN, ADN, RN]

Most of us are both. I don't think the poster was saying that it's impossible to have compassion wile being self-nurturing. We just have to be self-aware enough to be able to step back sometimes.

This is what I meant to convey in my last post. I've been trying to think of a way to restate it, but you said it just fine, Tweety.

[wooh, BSN, RN]

...But the point I really want to make, to the OP and anyone else willing to hear it, is that we all want to be treated like the caring, competent professionals we are, but if we can't extend that respect to each other, who on earth will? ...

..."A nurse did this, so it's probably right."...

...So I'm asking the OP, and anyone else who'll listen, to take that leap--not blindly, to be sure, but not hesitantly, either. If we can do that, who knows? Maybe someday, others will, too.

What a FABULOUS post. Would love to see it posted as an article on the site.

I'm so tired of us beating each other up. The whole "eating our young" thing is crap, we're beating each other up, whether younger or older. I have to totally agree with your post. It would be so wonderful if we could assume other nurses are doing things right rather than assuming things are being done wrong. It may hurt our need to feel superior to others. But don't we want others to assume we're right until finding out differently rather than assuming we're wrong until we prove to them we're right? And don't we deserve that respect from other nurses, and especially nursing students?

Also agree with the above about compassion fatigue. There are so many days I want to strangle someone. Because I DO care so much and it's ridiculously frustrating to deal with conditions we have to work in. Isn't it better that I make an off color joke about it to my coworker than well, actually strangle someone? Because I agree, the people that express their compassion fatigue are dealing with it, the people that make Mary Poppins look like Hitler are the ones that tend to finally snap and leave the profession, or become REALLY lazy.

I also have to say, I've often called someone a "crazy old lady." I've called my grandma that. With the history of Alzheimer's in my family, I'll someday probably be one myself. Sorry if it offends people. But I have always ADORED my crazy old ladies. I've been requested to take care of my coworkers' families that fall into the crazy old lady category because I'm great with them. I flip them, fluff them, and will play in THEIR world as long as I can when I have them. I'm a master of redirecting them. I've talked them down from attacking other staff members. I've made them stop crying when they were frustrating. If you'd rather have someone refer to your grandma as a "demented elderly female" but have them crying and upset the whole time and breaking their hip when they fall out of bed, that's mixed up priorities in my mind.

Could I use more flowery language? Yep, but I'd rather reserve my limited emotional resources to actually care and respect my patients, rather than prove to someone that I do with my flowery language.

[sicushells, RN]

To the OP... the problem that you seem to be coming back to over and over that we (exp. nurses) might not be addressing is how the nurse talked to you.

From your post you didn't see the nurse interact with the patient at all, right? So you didn't see the nurse go up to the patient and say, "You're just a crazy old lady, stop asking for help." (which would be atrocious).

What you seem to be upset about still is that the nurse told You the patient is just a crazy old lady. Maybe she really doesn't care and is extremely burned out, or maybe she's spent most of her day in the room caring for a patient who can't remember what year it is, let alone why she needs to stay in bed. Yes, it would have been NICE if the nurse you talked to (the tech or whoever you talked to first seems to not have been taking care of the patient, or really known what was going on, so i'm disregarding them.) had said, "Oh that sweet dear... she just doesn't know what she's doing." Instead of saying "yeah, she's crazy, ignore her." It's easy to get frustrated. So... sorry the nurse wasn't super sweet and patient with you. Sorry she let some of her frustration over caring for a patient who is very out of it, out on you... but the nurse has a responsibility to her patient, not towards you. (You weren't shadowing her, she wasn't working with you, she wasn't your preceptor, right?) Suck it up, try to remember to be calm and patient and explain what's going on with your patients to every attending, resident, med student, extended family member, and nursing student that wanders by. And when you slip up and snap at one of the above, or say something less than angelic about your patients to another clinician.... forgive yourself. It happens.

[Tweety, BSN, RN]

This is what I meant to convey in my last post. I've been trying to think of a way to restate it, but you said it just fine, Tweety.

You made a most excellent posts that explains it well. Thanks!