Which patients are you most scared to take care of?

[SilverBells, BSN]

Although a variety of patients have brought forth challenges during my time of a nurse, lately I've been finding myself getting very stressed out caring for patients with GI issues.  I've had three patients in the past year with bowel obstructions/bowel perforations who decline no matter what I do.  I've sent them all repeatedly into the hospital.  They've all required surgical intervention.  This really causes me distress, so much to the point that I can no longer sleep at night if a patient hasn't had a bowel movement.  I'm always worried about doing the wrong thing.

Anyone else experience similar things with any patients? Who are you scared of taking care of? 

[CABGpatch_RN, BSN]

Ugh.

[SilverBells, BSN]

11 minutes ago, CABGpatch_RN said:

Ugh.

I am not sure what is meant by this comment.  As nurses, we have probably all taken care of patients that make us a bit nervous.  This thread is designed to discuss this.  I understand if you cannot relate but am unsure how this comment adds any value to this thread.  

[JBMmom, MSN, NP]

I appreciate that you care for your patients, you need to find a balance in your life. Patients' bowel movements should not be impacting your sleep or quality of life. You are responsible for the things that you can control during the hours that you are at work. Do you provide medically appropriate care for the patients you are personally assigned to care for? If so, then you're all set. You are not personally responsible for all aspects of care just because people are admitted to the facility where you work. No one has that level of responsibility just because they became a nurse, even if you are in management. People with GI issues can have a complicated course of treatment and recovery no matter what happens. And dietary issues in a long term care situation are always challenging because they are trying to feed many people economically so the diets are rarely optimal, with many processed foods and scant fresh fruits and vegetables. With at least one of the patients you recently described it sounds like there were also some personality/psych issues related. I'm not a fan of neuro patients myself. Good luck.

[SmilingBluEyes]

You have GOT to let go of what you can't control. Seriously. This is impacting you in  ways that will manifest severely negatively, emotionally, physically and mentally if you don't put up boundaries now.

[ladedah1, BSN, RN]

     There is literally nothing that I have ever dealt with that has ever kept me up at night.  If for some reason there was something that would keep me up at night, it definitely wouldn't be bowel movements ?... more likely, it would be some infestation of bugs that I didn't know about ahead of time... lice, bed bugs, scabies, roaches... and even then, it would only be the paranoid itching that kept me awake. 

     My rule in life is this: leave it at the hospital.  Healthcare is 24/7... if there is something that is still unresolved when you leave, there is someone else who will be working on resolving it.  (Also, I suppose this would also apply to bugs... leave those at the hospital, too! ?)

 

 

[Pepper The Cat, BSN, RN]

COVID patients are scaring the hell out of me.

And NG tubes. Hate em.

[MPKH, BSN, RN]

You are not God. You cannot control the course of illness in patients. Sending them to the hospital does not equal failure. You are ensuring the patients are receiving the appropriate level of care.

Do what you can, to the best of your abilities, for the patients in your care in the allocated time you have with them on your shift.

Leave work at work. 

[TriciaJ, RN]

You really need to make a concerted effort to set some boundaries in your life.  If you're working long hours, it's very difficult to have a life outside of work.  If you don't have something competing for your off-work time and energy, work tends to eat around the edges and take over your whole life.

Is there any reason to feel personally responsible for those patient demises?  I second what MPKH said.  You cannot control everything or cure everyone.

If you're still working long hours you need to scale back and if you haven't already, you need to develop some hobbies or a spiritual practice.  Take a course in Mediterranean cooking.  We try to teach students and new grads that "it's not about you anymore".  In your case, you need to make it about you when you're not at work.  You need to replenish in ways that don't involve popcorn or Dr. Pepper.

And in answer to your original question:  I'm scared of anything I don't have experience in.  Until I gain the experience.  Hang in there.

[DesiDani]

None. I have yet to have a patient that I was afraid to take care of, even after I've been given a heads up about a patient's tone. I have to get pretty close to patients and plus my unit is the only unit besides the ER that has designated Legal Hold rooms with cameras.

My rationale is that it is all about the lack of control. Being a patient you loose a lot of control and family members can't control what ever is going on in their loved ones body.  How people react to loosing control can manifest into fear as well.  When people are afraid they act out.

[CalicoKitty, BSN, MSN, RN]

As a med-surg nurse, I really hated/feared trachs for a while. I joke about being a "below the neck" person. Eventually as I got more experience, I got slightly more comfortable with them, but still I would have a trach patient only a few times a year. Wounds for days. But, that suction sound, or hacking or vomiting.. I'm totally checked out and ready to throw puke bins and towels at the patients... ?

[rn&run]

'Scared' is a strong word for a work-related emotion. There are conditions it's appropriate to be... more vigilant towards, or to seek more support in managing. In my experience, feeling scared at work about something it's in my job-description to manage, isn't acceptable quality of life. Perhaps you might consider a job change, or consult a therapist.