Our patient population is tough - many people with chronic health problems but also lots of (too many) people playing the system. They're demanding, most likely drug seeking, malingering.
I find myself driving to work telling myself I'm going to give my patients my best. Then I'm assigned some frequent flyer who either shouldn't have been admitted or is back because they continue their self destructive behavior or they've been totally non-compliant. And I could deal with any of that (I'm not a perfect person and I don't do everything I should most of the time) but they're so manipulative. And demanding. I hate the drama. I feel like I'm running up and down the hallways all day, administering PRNs to people who tell me they have 10/10 pain who, while they may have some discomfort, are nowhere near 10/10.
I know I'm teetering on the edge of burnout and I do have some time off scheduled. Meanwhile, how do I find a way to compartmentalize my frustration and anger? I need to find a better way to cope with this now and after my very much needed vacation. I know many of you struggle with the same frustrations. How do you keep it from eating at you? I'm tired of being tired and angry.
Honestly...I float...it might be similar drama each shift but at least it's not on the same floor with the same patients and staff members!
I float too. Unfortunately, I've been spending a lot of time on the same floor because they've been having staffing issues (I wonder why...). It helps knowing that this will not continue indefinitely. As a float though, I find that all too often we're assigned the problem patients. I suppose the nurse making the assignment is thinking "Well, we've all done a shift with patient X and float nurse hasn't so it will be ok." However, sometimes that means that we get the problem patients every floor we go to because the rest of the staff needs a break. Our manager is awesome and has actually had to remind the floors not to dump on the floats because we'd seem to get an assignment with most of the behaviors on the floor.
Your disdain for these patients has parlayed into anger. No going back now.
If you feel yourself burning out on this unit...find another position! Buff up the resume, scour the job boards to see what's out there.
Who knows... you could be doing what I'm doing. Sitting at home in my jammies, denying those admissions.
I'm not sure disdain is the right word. I read once that a lot of anger comes from fear and I think that might be the source. We have patients who, when they don't get what they want (meds, meals, etc), will immediately ask to speak with the manager. We've had some call the complaint line. We've even had a couple who had the hospital CEO on speed dial. I suppose I do have disdain for those patients. They've been well cared for but are always threatening to stir up trouble.
Another source of the anger is the fear that while I'm jumping through hoops to keep the unreasonably demanding patients somewhat happy, the other less demanding patients are in danger of being neglected. I'm always afraid I might miss something important because I'm dealing with petty stuff.
I've given serious thought to going to work for an insurance company. I've actually started the application and realized that I would miss the interaction with the good patients too much. At least for now. Which is why I'm trying to find a way to keep better boundaries and keep my head in the right place.
SO I am not a nurse yet, but I worked at the Department of Families and Children Services (CPS and Foodstamps). You have to remind yourself that they are doing what they know, the best that they can with the knowledge they have at the time, and that you may be the only pleasant or nice person that they see. Some are just jerks, but you never know what led them there. Never lose hope that maybe tomorrow they will find their own hope. Do your job to the best of your ability and show compassion without hesitation. Also, never forget that Karma will take care of all that pent up anger and resentment. If all else fails, resort to alcohol and a good laugh.
I think we all experience frustration at times. My background is all over the place however I do have correctional (prison) nurse experience. What has helped me (my belief) is knowing these people usually have what is called axis II diagnosis. If you review the Diagnostic and Statistical Manual of Mental health Disorders (DSM) this is based on a 5 axis's model. Axis's II deals with personality disorders "now known as adaptation disorder" and Intellectual disabilities. For the personality disorder you could have (all are not listed) antisocial, avoidant, dependent, histrionic, OCD...this list goes on and on. I feel these are the most taxing on health care provider's in that they are usually the ones that consume the most health care resources... it is also know as the 80/20 rule 80 percent of the resources are consumed by 20 percent of the population.
I believe in firm, fair and consistent interactions. Have great boundaries with these people. If you tell them I will check back in 20 mins....well you better or they will start down a road that you will find difficult to navigate and consume more of your time. If you say I will come back at least 2 times over the next 2 hours, do so (and it provides you the ability to direct their cares better on your terms not theirs even though they think it is their terms). When I teach people with AxisII disorders I teach in small chunks and they always return demonstrate and/or verbalize in a way that makes sense to them. You would be surprised how they interrupt what you have said even though you are very clear.
One time I instructed the use/administration of an oral antibiotic. Take one table twice daily. I had to actually have the patient pretend it was 8 AM take out a pill. Then they pretend it was 8PM and take out a pill. They got it after 10 minutes, and no they did not have an intellectual disability they were exhibiting histrionic behavior. I did document well and showed them what I documented. They did not have any problem.
Once you discover Axis's II and really understand your revelation of being able to care for your patient becomes easier. I know it has with me.
Lastly take time for your self. If we do not take care of ourselves how can we take care of others.
It's not your job to give their "pain" your permission or blessing. Just do your job, go out of the room turn your back and roll your eyes. I think everyone experiences this, and again what can you do withhold meds based on your "feelings?" Provide the patient comfort and provide yourself some headspace keep it moving and Nurse on. Everyone's had these days and played this game.
I'm not sure disdain is the right word. I read once that a lot of anger comes from fear and I think that might be the source. We have patients who, when they don't get what they want (meds, meals, etc), will immediately ask to speak with the manager. We've had some call the complaint line. We've even had a couple who had the hospital CEO on speed dial. I suppose I do have disdain for those patients. They've been well cared for but are always threatening to stir up trouble.
Another source of the anger is the fear that while I'm jumping through hoops to keep the unreasonably demanding patients somewhat happy, the other less demanding patients are in danger of being neglected. I'm always afraid I might miss something important because I'm dealing with petty stuff.
I've given serious thought to going to work for an insurance company. I've actually started the application and realized that I would miss the interaction with the good patients too much. At least for now. Which is why I'm trying to find a way to keep better boundaries and keep my head in the right place.
Alrighty then. When you get tired of trying to manage your anger and fear, apply to the dark side.
You can always pick up per diem shifts, in order to interact with the "good" patients.. you would also be reminded why you left in the first place.
Specializes in Float Pool - A Little Bit of Everything.
I had to change settings when I got to where you are. Like another poster said, floating is a great way to deal with it in my experience. Hope you find a balance, I know this feeling and it sucks!
PREACH!!!!!!! Tired of being tired....well put; I've said that myself.
Hobbies help-lots of them
A good therapist helps, really really helps
A little bit of dissociation from others, which is WAAAAY hard, maybe impossible. Can you turn off empathy for the sake of doing your job better at a lower cost to your being.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
12Our patient population is tough - many people with chronic health problems but also lots of (too many) people playing the system. They're demanding, most likely drug seeking, malingering.
I find myself driving to work telling myself I'm going to give my patients my best. Then I'm assigned some frequent flyer who either shouldn't have been admitted or is back because they continue their self destructive behavior or they've been totally non-compliant. And I could deal with any of that (I'm not a perfect person and I don't do everything I should most of the time) but they're so manipulative. And demanding. I hate the drama. I feel like I'm running up and down the hallways all day, administering PRNs to people who tell me they have 10/10 pain who, while they may have some discomfort, are nowhere near 10/10.
I know I'm teetering on the edge of burnout and I do have some time off scheduled. Meanwhile, how do I find a way to compartmentalize my frustration and anger? I need to find a better way to cope with this now and after my very much needed vacation. I know many of you struggle with the same frustrations. How do you keep it from eating at you? I'm tired of being tired and angry. jk2185, NotYourMamasRN, Cola89, and 9 otherslike this.
From Samuel Shem, in "House of God" -- The patient is the one with the disease.
Remembering that has helped keep me from burning out completely. It isn't MY disease, it's theirs and although they aren't dealing with it the way I'm sure *I* would, they're dealing with their own disease. Or not, as the case may be.
I used to work on Med/Surg, and we had some frequent flyers that came back with their GI bleeds, esophageal varices and other issues of alcohol abuse on what seemed like a weekly basis. Between them, the diabetics who thought an 1800 calorie diet meant 1800 calories three times a day and the girl my own age who came in with DVTs over and over again because the only activity she engaged in was walking from the sofa to the bathroom, I was a walking ball of anger. Then a wise old woman (who was younger then than I am now) told me "They're the one with the disease, not you," and told me about "House of God."
One of the things that has helped me the most is journaling. When I'm particularly angry or upset about some situation, I sit down and write about it for 20 minutes or 500 words or some other pre-defined length of time. Sometimes, I can't think of anything to write and at those times, I just write "I can't think of anything to write" a few times and then find myself writing about whatever it is that's bothering me, often before I even realize I have something to say. Oftentimes, what I find myself writing about isn't the same thing I THINK I was angry about. It's enlightening. You don't have to save your writing -- save it, shred it, burn it -- whatever makes you feel best. Sometimes burning or shredding your words helps to let go of the anger.
Good self-care is important, too. I like to walk and one night after an especially traumatic shift, I walked my dogs eight miles or so without even realizing it. Or I swim in the creek behind our house, or go to the gym or something physical. Eat well, make time for friends, make your home comfortable -- whatever else you do to take care of yourself. Alcohol works once in awhile, but you have to be careful there.
Get a job in a good psych hospital. It will help you learn how to deal with these people, and as an added bonus, life in general. Everyone should work psych for a minimum 2 years, IMHO.
I've worked in hospitals and had plenty of experience with the population you describe. I usually try to treat all patients with the same degree of respect (or at worst, appearance of that). I've only allowed a few "frequent flyers" to really annoy me--the key point being I "allowed" myself to get PO'd. A lot of the comments here communicate the understanding that the only thing we can change is our attitude and how we deal with situations. It can take a large stretch of imagination, but try to think of all patients as vulnerable, frightened people whose world is out of control. Look at what appears to be annoying, selfish behavior as you would shortness of breath, elevated BP, a fever--they are all symptoms.
A lot of frequent flyers are accustomed to not being taken seriously or to being ignored. Surprise them. Invest a little time initially into actively listening, saying something empathetic, and fulfilling a reasonable request. Employ humor whenever possible. You might even offer something a little extra to really throw things off balance. In most instances, your respectful behavior will be reciprocated; the fact that you simply listened and took them seriously for just a few minutes will likely beget the same treatment on their part toward you. From that position, you will be much better able to politely but firmly communicate what you can and cannot do, and thereby manage expectations and your own time. And if it doesn't work, or if the patient is too wigged out to behave well under any circumstances, take the next day off for your own mental health! You deserve it.
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Rexie
108 Posts
I float too. Unfortunately, I've been spending a lot of time on the same floor because they've been having staffing issues (I wonder why...). It helps knowing that this will not continue indefinitely. As a float though, I find that all too often we're assigned the problem patients. I suppose the nurse making the assignment is thinking "Well, we've all done a shift with patient X and float nurse hasn't so it will be ok." However, sometimes that means that we get the problem patients every floor we go to because the rest of the staff needs a break. Our manager is awesome and has actually had to remind the floors not to dump on the floats because we'd seem to get an assignment with most of the behaviors on the floor.
The floating helps a lot, though.