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? 

[guest1163268]

1 hour ago, Davey Do said:

What was Melville doing in your toilet bowl? ?????

[guest1163268]

23 minutes ago, SilverBells said:

I assure you that this post was not written for attention, but I can understand where you and CABGpatch are coming from.  My intention was to discuss patients that we find more difficult to care for, as I think many nurses probably have patients they find more challenging, per se.  I was curious as to what types of patients other nurses find challenging.  However, I was pretty anxious and under distress when I wrote the original post, so it probably did come across as "attention-seeking."  I apologize and wish to improve this for the future.  I can also assure you that I do have a nursing license that has been valid for 7 years.  I do not necessarily feel I have no understanding of how to manage common problems, such as constipation.  I often feel that I have a good understanding of what may be going on with a patient.  I just find myself getting anxious when typical interventions are not effective because I want to prevent any and every complication possible.  Theoretically, I understand that is not always possible, but as a nurse, I went into the field to help others and find myself distressed when my patients remain sick despite my best efforts.  With that said, I do agree that I was probably promoted to my position too early in my career.  I feel this likely happened due to my "seniority" in my facility (keep in mind that we have extremely high turnover, so this is not necessarily an accomplishment) along with actually being very good at certain aspects of my job.  I am reluctant to step away from a position that in many aspects I am doing quite well at, as I continue to receive positive feedback from coworkers and supervisors, but am wondering if it might be best for the good of myself and the patients.  Anyway, this post has gotten a bit off topic from what this thread was meant for, but hopefully is more explanatory.  

I like the idea of finding CEUs, though.  However, so far I am finding it very difficult to find ones that provide information of any value.  The educational modules provided by my workplace are incredibly simplistic in that they only offer obvious suggestions such as "consider holding bowel medications for loose stools," or "call the provider for unresolved symptoms." 

Have you tried the toothpaste tube approach? Squeeze one end? ?????. I'm sure Davey can generate a relevant cartoon ????

[SilverBells, BSN]

2 minutes ago, Curious1997 said:

Have you tried the toothpaste tube approach? Squeeze one end? ?????. I'm sure Davey can generate a relevant cartoon ????

Davey probably already had a cartoon in the works before you even posted that, LOL ?

[Davey Do]

14 minutes ago, Curious1997 said:

What was Melville doing in your toilet bowl?

[Davey Do]

18 minutes ago, Curious1997 said:

 I'm sure Davey can generate a relevant cartoon

 

16 minutes ago, SilverBells said:

Davey probably already had a cartoon in the works before you even posted that

 

[hppygr8ful, ASN, RN, EMT-I]

17 hours ago, cardiacfreak said:

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! 

Well I have to say - if I was nervouse about anything caring for compley tiny people would be it!

[hppygr8ful, ASN, RN, EMT-I]

59 minutes ago, SilverBells said:

I assure you that this post was not written for attention, but I can understand where you and CABGpatch are coming from.  My intention was to discuss patients that we find more difficult to care for, as I think many nurses probably have patients they find more challenging, per se.  I was curious as to what types of patients other nurses find challenging.  However, I was pretty anxious and under distress when I wrote the original post, so it probably did come across as "attention-seeking."  I apologize and wish to improve this for the future.  I can also assure you that I do have a nursing license that has been valid for 7 years.  I do not necessarily feel I have no understanding of how to manage common problems, such as constipation.  I often feel that I have a good understanding of what may be going on with a patient.  I just find myself getting anxious when typical interventions are not effective because I want to prevent any and every complication possible.  Theoretically, I understand that is not always possible, but as a nurse, I went into the field to help others and find myself distressed when my patients remain sick despite my best efforts.  With that said, I do agree that I was probably promoted to my position too early in my career.  I feel this likely happened due to my "seniority" in my facility (keep in mind that we have extremely high turnover, so this is not necessarily an accomplishment) along with actually being very good at certain aspects of my job.  I am reluctant to step away from a position that in many aspects I am doing quite well at, as I continue to receive positive feedback from coworkers and supervisors, but am wondering if it might be best for the good of myself and the patients.  Anyway, this post has gotten a bit off topic from what this thread was meant for, but hopefully is more explanatory.  

I like the idea of finding CEUs, though.  However, so far I am finding it very difficult to find ones that provide information of any value.  The educational modules provided by my workplace are incredibly simplistic in that they only offer obvious suggestions such as "consider holding bowel medications for loose stools," or "call the provider for unresolved symptoms." 

You are never going to prevent all negative outcomes especially with a population that is in the later stages of the life span. You need to use some perspective. Older people have a lot of health issues because they are older. Many will never return to wellness and you have to be OK with that. 

I never had much luck with the "Free" CEUs offered in company learning modules. After all you get what you pay for. I have purchased some really good courses from Elite learning, Lippincot and Williams and Kaplan. The courses are pretty comprehensive and satisfy your CEU requirements for licensing. You might also look into joining a professional practice association such as The American Association of Geriatric Nurses. They will have lots of topics specific to the area of nursing where you practice. 

Hppy

[SilverBells, BSN]

On 4/22/2021 at 5:40 PM, TriciaJ said:

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.

I think part of it stems from me just wanting to do the right thing, all the time, with the expectation that by doing so, I will somehow prevent all patients from declining.  Of course, that is unrealistic, but sometimes it's the thought process that goes through my head anyway.  I also think some of it comes from the pressure related to the position I'm in.  As a manager, I feel responsible for the entire unit.  The pressure also comes from coworkers, family members and even supervisors who are constantly demanding that I do something about every thing for everyone.  If someone goes to the hospital, it is usually the manager that gets blamed, even if the rehospitalization was inevitable. 

[TriciaJ, RN]

5 minutes ago, SilverBells said:

I think part of it stems from me just wanting to do the right thing, all the time, with the expectation that by doing so, I will somehow prevent all patients from declining.  Of course, that is unrealistic, but sometimes it's the thought process that goes through my head anyway.  I also think some of it comes from the pressure related to the position I'm in.  As a manager, I feel responsible for the entire unit.  The pressure also comes from coworkers, family members and even supervisors who are constantly demanding that I do something about every thing for everyone.  If someone goes to the hospital, it is usually the manager that gets blamed, even if the rehospitalization was inevitable. 

Oh, we know why you're experiencing this.  We've all been there to varying degrees.  The question is, how do you develop appropriate boundaries before you're packed off to the funny farm?

Have you tried making an organizational chart to visually map out what you're responsible for, what you're not responsible for and what you would ideally like your personal life to look like?  I spent a good chunk of my adult life being single, and during those times work impacted me a great deal because it had little competition for my energy.  I had to figure out how to keep work in its place with or without a partner.

I wonder if your desire for your dream home is really just your desire for some sanctuary away from work.   Are there ways you can create that for yourself before you're ready to take on mortgage payments?

[SilverBells, BSN]

3 hours ago, TriciaJ said:

Oh, we know why you're experiencing this.  We've all been there to varying degrees.  The question is, how do you develop appropriate boundaries before you're packed off to the funny farm?

Have you tried making an organizational chart to visually map out what you're responsible for, what you're not responsible for and what you would ideally like your personal life to look like?  I spent a good chunk of my adult life being single, and during those times work impacted me a great deal because it had little competition for my energy.  I had to figure out how to keep work in its place with or without a partner.

I wonder if your desire for your dream home is really just your desire for some sanctuary away from work.   Are there ways you can create that for yourself before you're ready to take on mortgage payments?

Boundaries are still a struggle, because, as you've suggested, I've tried thinking through the things I'm actually responsible for.  Thing is, it ends up literally being almost everything.  Just as an example: 

-Follow up on and monitor changes in condition.  Communicate concerns to providers and coordinate labs, x-rays, new medications, etc. 

-Assist in emergencies

-Complete telehealth provider visits 

-Assist with completing admissions

-Coordinate discharges

-Attend clinical and various other meetings

-Attend Care Conferences

-Answer many family questions/concerns 

-Follow up on grievances (which can sometimes lead to spending over an hour listening to just one resident vent)

-Assist in corrective action of staff 

-Assist with investigations

-Assist with staffing issues

-Work as a floor nurse when staff unavailable

-Complete various floor duties assigned by floor staff such as assisting with weights, vitals, feeding residents, wound cares, getting urine and stool samples, answering call lights, etc

-Assist with labs as needed (I.e. getting INRs, helping lab draw from PICC line, etc) 

-Assist HUCs with orders and answering phone calls

-Obtain treatment supplies and follow up on medications missing from the pharmacy 

-Assist with setting up transportation to appointments and setting up appointments with providers 

-Follow up on immunizations, TB tests, ensuring POLSTs are obtained and code statuses entered 

-Follow up on BMs, bath refusals, new skin integrity concerns

-Daily progress notes of all events that have occurred

-Assist with completing various assessments: admission, skilled nursing notes, braden scales, morse fall scales, bowel & bladder screening, TB screening, oral screening, SAMs, pain assessments and and on and on.  

I'm probably missing a few things, but you probably get the idea.  It's nearly impossible to be where everyone needs me to be all at once.  My coworkers probably love that I am single because it means they can continue to add work to my workload while they leave on time.  Heck, sometimes people will leave work early for various excuses and I have no choice but to cover.  Ultimately, if something does not get done, it's on me.   If a patient's medical condition continues to worsen, the blame is generally on me for "not doing enough."    Maybe this helps explain why I get anxious when a patient continues to decline even when all appropriate actions are taken...somehow, someway, someone will probably find something I didn't do anyway.  And patients that especially have a history of frequently declining make me even more nervous, which is kind of what inspired this thread in the first place.  

Addendum: No time for a personal life when working 16 hours a day, 5 days a week and sleeping most of the weekend to recover.  It probably doesn't help that I don't like any mistakes of any kind so I stay late double checking everything I've done to ensure that no errors have been made and that all patients are safe and doing well. 

 

[SilverBells, BSN]

With that said, if anyone has any suggestions from the list of tasks from my previous post that could be put lower on the list of priorities or better ways of time management, that would be appreciated, thanks

[TriciaJ, RN]

1 hour ago, SilverBells said:

Boundaries are still a struggle, because, as you've suggested, I've tried thinking through the things I'm actually responsible for.  Thing is, it ends up literally being almost everything.  Just as an example: 

-Follow up on and monitor changes in condition.  Communicate concerns to providers and coordinate labs, x-rays, new medications, etc. 

-Assist in emergencies

-Complete telehealth provider visits 

-Assist with completing admissions

-Coordinate discharges

-Attend clinical and various other meetings

-Attend Care Conferences

-Answer many family questions/concerns 

-Follow up on grievances (which can sometimes lead to spending over an hour listening to just one resident vent)

-Assist in corrective action of staff 

-Assist with investigations

-Assist with staffing issues

-Work as a floor nurse when staff unavailable

-Complete various floor duties assigned by floor staff such as assisting with weights, vitals, feeding residents, wound cares, getting urine and stool samples, answering call lights, etc

-Assist with labs as needed (I.e. getting INRs, helping lab draw from PICC line, etc) 

-Assist HUCs with orders and answering phone calls

-Obtain treatment supplies and follow up on medications missing from the pharmacy 

-Assist with setting up transportation to appointments and setting up appointments with providers 

-Follow up on immunizations, TB tests, ensuring POLSTs are obtained and code statuses entered 

-Follow up on BMs, bath refusals, new skin integrity concerns

-Daily progress notes of all events that have occurred

-Assist with completing various assessments: admission, skilled nursing notes, braden scales, morse fall scales, bowel & bladder screening, TB screening, oral screening, SAMs, pain assessments and and on and on.  

I'm probably missing a few things, but you probably get the idea.  It's nearly impossible to be where everyone needs me to be all at once.  My coworkers probably love that I am single because it means they can continue to add work to my workload while they leave on time.  Heck, sometimes people will leave work early for various excuses and I have no choice but to cover.  Ultimately, if something does not get done, it's on me.   If a patient's medical condition continues to worsen, the blame is generally on me for "not doing enough."    Maybe this helps explain why I get anxious when a patient continues to decline even when all appropriate actions are taken...somehow, someway, someone will probably find something I didn't do anyway.  And patients that especially have a history of frequently declining make me even more nervous, which is kind of what inspired this thread in the first place.  

Addendum: No time for a personal life when working 16 hours a day, 5 days a week and sleeping most of the weekend to recover.  It probably doesn't help that I don't like any mistakes of any kind so I stay late double checking everything I've done to ensure that no errors have been made and that all patients are safe and doing well. 

 

"Oh, I am a cook and a captain bold,
And the mate of the Nancy brig,
And a bo'sun tight, and a midshipmite, 
And the crew of the captain's gig."

This is the third verse of the poem "The Yarn of the Nancy Bell".  It's about a shipwrecked crew who ate each other until only one was left so he had to do everything.  This started playing in my head while reading your job description.

I'm really surprised it's not your job to check the roof for loose shingles and keep the shrubbery pruned out front.  This is the job description from hell.  What keeps you there besides the fact that you have no time or energy to look for a different job?  Do you have any idea how much money you're saving them by doing the work of five people?

When you finally collapse in a heap, do you think you'll finally get recognition and accolades?  No, they'll cart you off to the glue factory and hire at least 3 people to take your place.

This job was a GREAT learning experience.  Now you've learned.  Time to move on.