Which patients are you most scared to take care of?

[SilverBells]

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? 

[Rose_Queen, BSN, MSN, RN]

I wouldn’t say scared but really more uncomfortable- donation after cardiac death. In the OR, we just don’t deal with comfort care, but that’s what these patients get in the OR after they’ve been prepped and draped so that once they pass and family leaves we can get in there and procure organs for transplant. And then sometimes we have the ones that keep hanging on to the point that the organs are no longer viable, and you can just see it in the family’s eyes how they’re trying to do something positive in a horrible situation and then that path gets blocked. 

[Davey Do]

On 4/21/2021 at 10:48 PM, SilverBells said:

Who are you scared of taking care of? 

[TriciaJ, RN]

21 minutes ago, Davey Do said:

Are you scared she's going to jump up and work circles around you?  Drop a couple siderails and she'll probably have all your baths done by the time you get back from coffee.

[Davey Do]

1 hour ago, TriciaJ said:

Are you scared she's going to jump up and work circles around you?

Migod, TriciaJ!

How'd you know?!

 

[TriciaJ, RN]

40 minutes ago, Davey Do said:

Migod, TriciaJ!

How'd you know?!

 

You're lucky she didn't fall hopping over those siderails.

[Davey Do]

1 minute ago, TriciaJ said:

You're lucky she didn't fall hopping over those siderails.

Yeah.

Then she'd be known as ShatteredBells.

[CommunityRNBSN, BSN, RN]

I work outpatient and I like my patients upright and talking to me. Anything lower than that level of functioning freaks me out. 

[NightNerd, MSN, RN]

I'm a total 'fraidy cat. Anything I haven't seen before scares me. Fortunately after seven years I've seen enough that now I know 1) who and what my resources are, and 2) I'm a prudent nurse and I'll figure out the right way to care for my patient.

Example: I've taken care of enough trachs now that I'm not so much scared as merely uneasy - which still doesn't feel great. I feel like I rarely have these patients, so it's easy to forget the finer points of managing trach care. But, I met a wonderful respiratory therapist who helped me out a bunch with my most recent trach patient. She checked to make sure I'd put all the right supplies at the bedside, we quickly reviewed the care I needed to do for the shift, and since she had a minute and was there anyway, she made sure I was comfortable changing the inner cannula and helped me put on a new trach collar. That was above and beyond, but it reminds me that I'm capable of learning since I *did* have all the right supplies at the bedside, and that there are people and resources available for any questions I still have.

I think it's important to remember that you are never alone in trying to take care of your patients - though I'll concede there are many days when it feels that way. If something makes you nervous, or you encounter something unfamiliar at work, do your research into how to manage the situation. Figure out as much as you can about what the plan should be, then check in with someone who can give you feedback. It's a good way to learn, and also provides a confidence booster when you realize what you already know.

[hppygr8ful, ASN, RN, EMT-I]

I have a T-shirt at home that says "You can't scare me! I take care of psych patients. I don't actually wear it ( I think that would be in poor taste) It was a gift. Still I didn't always do psych but once I know what the care is all about I was rarely afraid. Perhaps concerned would be a better choice of words. Since you bring up patients with bowel issues I would suggest that you look over your facility's P&P with regard to bowel maintainence.  Many patients should simply be on a regimen of fiber and fluids as well as PRN laxatives to ensure that they have regular bowel movements. This way you are not waiting until constipation has reached the level of a reportable event to take action.

Except for my first year as I nurse I can't think of the last time I lost sleep over a patient. My home life and sense of work/life balance won't allow that. I stopped trying to save the world a long time ago

Pardon me for saying so but it appears from your posts that you have moved up to a management position rather quickly without gaining a lot of experience in assessment skills or bedside care. You have stated that you feel uncomfortable in this area. This may have a lot to do with your not catching these things early when sending to the ER could be avoided. 

Perhaps it is time to take a step back and look at where you are now and where you want to be in say 1 year, then 5 years etc... I don't mean to get all new agey on you but start to positively manifest your goal path. You need to make some healthy changes and you need the guidance of a therapist of life coach to do it. With all the hours you work you should have insurance and if you don't use your companies EAP it's free and confidential. What do you plan on doing with your master's degree? I always thought nursing research and/or drug studies would be fun or since I am approaching 60 maybe a nice clinic job.

Peace to you 

Hppy 

[cardiacfreak, ADN]

Kids and babies scare the H E double hockey sticks out of me!  When I worked Progressive Care I was assigned a 6 y/o that got into Grandma's metoprolol and amiodarone, I traded her for the trach patient in isolation who was on the call light every 1/2 hour.  

The kiddo was fine all night but I wasn't taking any chances and didn't regret my trade at all! 

[Sour Lemon]

As someone who’s more than a bit clumsy, I am terrified of chest tubes. On the rare occasion that I see one, I find myself saying a “Please, universe...” pseudo prayer. So far it’s worked. 
And like the poster above me, I will trade an “easy” child for a difficult adult. They’re just so small. Can’t do it. 

[CommunityRNBSN, BSN, RN]

2 hours ago, Sour Lemon said:

As someone who’s more than a bit clumsy, I am terrified of chest tubes. On the rare occasion that I see one, I find myself saying a “Please, universe...” pseudo prayer. So far it’s worked. 
And like the poster above me, I will trade an “easy” child for a difficult adult. They’re just so small. Can’t do it. 

YES I am clumsy too. One of the reasons I never aspired to a field like ICU was that I just knew I’d trip over the trachs and knock over the chest tubes.