I’ve been a nurse for 2 years. I generally think I’m a pretty decent bedside nurse. I’m thorough, I work hard and I care tremendously about people and their health. Lately I’ve been burning out. Tonight I think may be an example of how burnt out I have really become.
Patient is a younger man in his late 20s. Came to our facility for pt/OT after an injury and surgery to both his legs. He’s been with us for a couple weeks. Came to us with massive amounts of pain meds to the point where our doctors were uncomfortable prescribing him that much and scaled him back a bit to OxyContin scheduled and oxycodon PRN.
9pm rolls around and he’s scheduled for his OxyContin. I give it to him at 925pm (I have 30+ patients, so I’m feeling pretty on track here). Facility policy we must wait +1hr before administering the oxycodon. Patient knows this and says he want his oxy at 1030. I tell him I will do my best but to put his call light on.
1000 rolls around and he’s calling for his pain med. It’s early and I am caught up helping other patients so I do not answer him but two CNA tell him I will be there as soon as I can.
By 1030, he is screaming and banging a stick against the wall. He’s calling me all sorts of names and screaming "pain meds, pain meds, pain meds" at the top of his lungs. I wait a little while hoping he will calm down and I can get in there and hand him his meds.
Well, it doesn’t happen.
He gets more verbally aggressive to the point where something tells me - don’t go in there. Just a weird gut feeling of not feeling safe around this man. So I start charting hoping he will tire and calm down. He eventually gets quiet so I pull his meds and walk to his room. As I’m almost there he starts screaming again and banging against the wall. I stand in his door way and tell him point blank: I do not feel safe walking into your room, so I’m not going to be helping you until you can behave in a way that shows me I can feel safe approaching you. Well this made him angry and I walk away. He proceeds to yell and scream for the next hour, calling me everything under the sun. Eventually he chills a bit and the charge nurse goes in and hands him his meds.
I feel like I did the right thing here? But now I’m not sure.
Your handling of the situation you posted about is a good move towards protecting yourself and conserving emotional energy, actually. If you can become more comfortable with responding the way you did (as far as the actions you took), that will be a good thing.
It is okay to remember that although you are there to provide nursing care and although compassion is associated with this profession and mostly a benefit to the work of nurses, you are separate from your patients' problems. You are there to interact with them therapeutically, which is hopefully going to help them in their healing but is never going to remove or solve their every problem. Know that the way you handled this situation is very similar to how someone who is not feeling particularly burned out or fed up may also have handled it.
Having some limits (with your patients, your boss, others in general) is crucial for self-preservation. You are not expected to fix everything or perform beyond human capacity. Even our desire to care for patients as they deserve 100% of the time is not possible. It is not your fault. This is one of the more difficult realizations that newer nurses experience.
Anyway. Get some rest and relaxation whenever you can. Do your best to keep things in perspective. Take good care of yourself.
Specializes in Nurse Leader specializing in Labor & Delivery.
22 hours ago, Davey Do said:
Focusing on the pain med management is a little off the mark.
Having been in a similar situation as a patient at about the same age with, among others, multiple orthopedic surgeries, a slight addiction to narcotics was one thing with which I had to deal.
As nurses, we have witnessed first hand that patients get dependent upon narcotic medications. When those narcotics are, as in this case, not given on the spot, right on time, pain can be unable to be stood.
But, come on now- an inappropriate emotional explosive display when a reason for the delay is given is not totally pain control.
This patient has the earmarks of being an addicted brat who demands immediate gratification. That's one reason I gave multiple kudos to Grande_latte who handled the patient's inappropriate behavior like I would have handled an acting out psych patient who wasn't getting their way.
That's why Hoosier recommended a social work consult as well.
Specializes in Neurosciences, stepdown, acute rehab, LTC.
6 hours ago, JKL33 said:
@anewsns - not picking on you, but your post made me go back to what the OP said about burning out. And I do have something to say about it. ?
On second take, I am curious what burning/burnt out means to you. Is it something like feeling fed up? Feeling like you don't care? Or something else?
And, is there a particular thing that someone who is not feeling burned out would have done differently in this scenario?
Since written word often doesn't convey intent/feeling, be assured that my motivation for asking is only to discuss an interesting topic, hopefully in a way that might be of use to you. ?
I think this is a good question! Im not sure if you were asking the original poster or me. Burnout is an official medical condition now, and one of the symptoms is irritability, esp with coworkers and patients. When I read the original post, I gleaned that the original poster felt irritated with the patient, which is very normal. A lot of nurses are passive and feel like if they set boundaries, they cross a line. I feel like she was asking if her response to the patient was too rough and my answer was no, even if youre burnt out (including irritable) your response was healthy. I think we have all seen other nurses who become very rude after working in a place too long. I think thats often from severe burnout.
Edit: I just read to your response to the OP and completely agree. How to set boundaries appropriately is something I think about a lot.
Specializes in New Critical care NP, Critical care, Med-surg, LTC.
As others have already said, you handled the situation very well! I am sorry that you're dealing with short staffing, high ratios, difficult patients and trying situations. So many of us can understand your feelings and empathize. I hope that you're able to get the well deserved rest that you need. For this particular patients, as others have mentioned, the situation appears to be far more complex than straight forward pain management. You should not be experiencing verbal abuse or feel threatened by patients. You were working within the appropriate time constraints and you had made the patient aware ahead of time. A very professional approach under difficult circumstances. Take care.
Specializes in Neurosciences, stepdown, acute rehab, LTC.
6 hours ago, Grande_latte04 said:
@JKL33 I think when I saw burnt out I mean fed up with my current position. Not to complain about my job…. But because you asked… I feel fed up with the constant understaffing, feeling like I can not help people like they need to be helped, like they should be helped. I just can’t do it with 33 patients. I feel myself physically and emotionally dragging under the weight of so many peoples needs. We have some easy patients and we have some exhausting ones- the ones who need round the clock pain meds, the psych patients who have complex medical needs as well who want to go AMA. I just feel tired. I feel bad for the people I can not help like they need. I feel tired with covid, I feel tired with my boss who calls me at all hours of the day and night asking me to cover shifts on my day off.
It sounds like you are a very caring and empathetic person, which is probably what got you here in the first place! When I tell my husband about similar situations at work, he responds that if I was being rude or cruel then I wouldn't be asking that. It's usually the very nice people who ask if they went too far. Other people put us in a situation where we MUST put our foot down, they take advantage of our niceness and feel they can trample our boundaries and sometimes they won't respond unless you are very firm! Personally, I hate having to be very firm all the time to all sorts of people, that leads to burnout!
I think there are a lot of good comments here about the pain meds. Did you know pain became the 5th vital sign in the 90s? If I remember right, the company who makes oxycontin were doing all these "studies" about the use of oxy for chronic pain and were considered a major scientific source for practices in managing peoples pain. They said that oxy was only truly addictive in a very small portion of the population who have addictive personalities. Back in school in 2010, thats what I learned too! It brought on our great big obsession with bringing the patients pain level down AT ALL COSTS and in my opinion, got all tied in with patient satisfaction. I think thats why we feel we have to keep up with the extremely demanding patients who are addicted to opiates and even put up with some level of verbal abuse from them.
Real pain control is very important. I feel bad for patients whose pain is impossible to manage and there is not much we can do. I also realize addiction can make people say and do crazy things. At the same time, you need to protect yourself from that type of behavior and as others said, bring in other services who can help ACTUALLY fix the problem.
After reading comments from others and being in the situation myself, I disagree. The “delay of care” was well within reason given the patient load I had and given n my safety was in jeopardy. Yes I could have taken someone, but no one was available, so that was just not possible.
totally unprofessional would be ignoring the entire situation which is not what happened here. I set a limit… basically the patient verbally contracts to be safe before I approach him.
If you did this to my loved one, I would consider reporting you for delay of care.
morte - unless I'm missing something here, there WAS a delay of pain med. I agree with you. I thought I was the only one thinking so.
Grande - I agree with others & believe you were absolutely 100% en point in your dealing with this pt, only up unto the point when you did delay the med. You DID delay the med! And you never let the pt know why up until the other nurse went in to give the med an hour (?) later.
It makes no matter in this scenario that you felt the pt load was too heavy. ABSOLUTELY yes, your safety concern was very valid. But hosp exist for pt care and his was delayed (maybe a little bit tit-for-tatfully?) But to make him wait without an in-between explanation was NOT approp. I really don't see an approp reason for 'delay of care' as you've described the situation. Not as 'totally unprofessionally'. He wasn't totally ignored, but perhaps 'partially' unprof.
You set a limit; he didn't comply. His med was held and his pain need wasn't met, and he was escalating.
JKL33
7,038 Posts
Understandable and thanks for explaining.
Your handling of the situation you posted about is a good move towards protecting yourself and conserving emotional energy, actually. If you can become more comfortable with responding the way you did (as far as the actions you took), that will be a good thing.
It is okay to remember that although you are there to provide nursing care and although compassion is associated with this profession and mostly a benefit to the work of nurses, you are separate from your patients' problems. You are there to interact with them therapeutically, which is hopefully going to help them in their healing but is never going to remove or solve their every problem. Know that the way you handled this situation is very similar to how someone who is not feeling particularly burned out or fed up may also have handled it.
Having some limits (with your patients, your boss, others in general) is crucial for self-preservation. You are not expected to fix everything or perform beyond human capacity. Even our desire to care for patients as they deserve 100% of the time is not possible. It is not your fault. This is one of the more difficult realizations that newer nurses experience.
Anyway. Get some rest and relaxation whenever you can. Do your best to keep things in perspective. Take good care of yourself.