...Was I being insensitive??

[Delia37, MSN]

Hi

As the title on this post indicates, I left my shift yesterday feeling kind of funny about a situation; even though, I know I didn't do anything wrong. I am charge in a busy 34 beds ICU that has turned into COVID central in the last couple of months. Yesterday, I was short staffed and my staffing office provided me with 2 nurses (both ICU travelers). Right at change on shift ,when I was about to do huddle with the day staff, one of the travelers approached  me and asked if the patient who  was pending to come to the unit (assigned to her) was a COVID patient. When I said it was, she started crying and shared that this was the first time she would care for a COVID patient after her own father passed from COVID last year. Myself and some of the staff in the nurse station expressed our condolence; however, I told her I was unable to change the assignment without assigning another staff with 2 COVIDs or taking an assigning away from one of my staff who is pregnant. At this point she is fully bowling her eyes out and it just seems anything I said made things worse. I told her to take a few minutes to herself and that I would get back to get because I needed to do huddle with the day staff, who were already waiting for me; after that, she went to the restroom. Next thing I know, she walks in during huddle still sobbing and sniffling; after huddle, another nurse came up and told us she was still crying. I pulled her aside and ask her if she would be more comfortable in another unit (we have 4 other ICUs in the hospital), because I could not accommodate her. At this point, the day shift change nurse got involved and basically told her we could not accommodate her since as a contract nurse, caring for COVID (all ICUs are saturated with them....even our burn unit) was an expectation; to which she agreed and verbalized her understanding.  I honestly felt horrible for this particular nurse; this was her first assignment and she was on week 3, but somehow had managed not to get an assignment with COVID pts. I personally think her expectation of not getting assigned COVID patients is extremely unrealistic, but I could tell she was really in distress. I just feel like I could had been more supportive (somehow) but, honestly I was so taken aback by her reaction that nothing else occurred to me to comfort her at the moment.

 

 

[LibraSunCNM, BSN, MSN, CNM]

No, you acted appropriately IMO.  There's nothing you can do about the fact that you work on a COVID unit and they gave you a nurse who doesn't want to work with COVID patients, other than what you did--tell her to find a way to work or work somewhere else.  You have to staff your unit!  I feel terrible for her loss but her expectations are wildly unrealistic.

[SmilingBluEyes]

I would take her aside and recommend she take advantage of the EAP at work and get some counseling.

I feel awful for her loss. But as time goes by, more and more of us know and have loved ones who have died of this disease. My own aunt died last year on Thanksgiving of COVID.

Also if you accommodate her, others will want similar treatment.

Good luck.

[JBMmom, MSN, NP]

That is a very unfortunate situation, but no, I don't think you were in the wrong at all. As a contract nurse she was aware there were COVID patients in the unit and had agreed to care for them when she took the assignment. It's too bad that still having a hard time related to the death of her father, which is tragic, but perhaps she should have sought out an assignment that did not have the expectation of caring for COVID patients if she couldn't handle it. And if she didn't realize she couldn't handle it until it happened, she might have to reconsider the rest of her contract. 

[Wuzzie]

An ICU nurse who doesn’t want to work with Covid patients in the middle of a pandemic surge is both short-sighted and unrealistic. Your job was to make sure the patients were cared for. She was there to do that. Although it would have been nice had you been able to switch her assignment,  your first responsibility was to the patients. Their well-being took precedence and you saw to that while at the same time expressing concern for your colleague. NTA for sure. 

[MunoRN, RN]

I wish the nurse all the best in finding resolution to her feelings around her father's death, but at the same time, she should not be an ICU traveler if that's the case.  

We pay our travelers $2k to $3k per shift, and for that they can't be picky about whether they work in Covid or not.  

[JKL33]

17 hours ago, Delia37 said:

I personally think her expectation of not getting assigned COVID patients is extremely unrealistic

I wasn't there but from your post as written it is not a given that she had that expectation or that she pursued travel ICU nursing thinking that she would be able to weasel out of caring for covid patients.

It's very possible, maybe even most likely, that she knew she was going to have to face it and when the moment came it hit her harder than she thought it would and that is what you witnessed. Maybe her grief was fresh again given the scenario plus the matter of being in a new place with new people, new routine, without some of the supports that have helped her get through the past year.

I'm sure you didn't mean this but this reads more like a opportunity for readers to be appalled at this woman's reaction/behavior. Your actions clearly were not insensitive.

 

[Jedrnurse, BSN, RN]

This is difficult, but so is nursing. Think of the other possible variations-

One's brother died in an MVA - now they can't abide trauma patients.

One's mother had a severe CVA then died- now they can't abide neuro patients.

One's spouse died after having open heart surgery- now they can't abide cardiac patients.

One's child died from leukemia- now cancer patients trigger them. 

What should an affected nurse do? I guess if you're working in an environment in which a certain type of patient will cause you to not be able to function, it's time to change the environment. At least until you can get your equilibrium back...

[summertx]

I don't want to seem insensitive either here, but crying or bawling on the ICU unit when there are sick infectious people is not appropriate.  Yeah I can see being overwhelmed or holding back tears but  that is expected to have COVID patients. Maybe she was not informed and was use to choosing her shifts, or shifts  were designated 'COVID'?

[Mr. Murse]

I'm surprised she managed to dodge Covid patients for 3 weeks. Most travelers I know just accept the fact that that's essentially why they're even needed, and they will be usually exclusively working with Covid on their assignments.

Sounds like you did a good job being sensitive but still sticking with the right decision.

[DavidFR, BSN, MSN, RN]

You did the right thing.

In nursing you cannot avoid looking after patients with infections in whatever specialities. I used to work in infectious diseases and got really annoyed with the agency nurses that would turn up to announce "I've got kids at home, I don't go into infection." "So what are you doing here?" was my standard response.

I have co-morbidities and so does my husband, who is also on immosuppressive meds. We lost his younger brother to Covid. I would LOVE to avoid the Covid patients, but I can't, period.

I'm a stroke survivor yet when I did agency shifts I accepted shifts in a neuro-vascular high depency unit and didn't go running away from the acute stroke admissions. My colleague has had lymphoma, but she works with me in oncology and accepts the lymphoma patients.

Life throws some horrible excrement at you sometimes. Sorry to be harsh, but there does come a point where we just have to get over ourselves. This nurse has had a rough ride, but if she's still crying about it at work, she's come back too soon, or needs more help than most and should seek it. She's not going to avoid Covid as a nurse, especially in ICU. And you had a busy unit to run.

[vintagegal, BSN, DNP, RN, NP]

Travelers make $$$$ 

We all have felt the strain covid has put us in. I don’t think you did anything wrong .