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? 

[TriciaJ, RN]

1 hour ago, SilverBells said:

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

I categorized your job description according to who should actually be doing the work:

Manager:  care conferences, family questions, grievances, corrective action, investigations, staffing issues.

Resident Care Manager:  Assist with emergencies, telehealth provider visits, discharge planning, arrange transpo, assist with labs, assist floor nurse, assist HUCs,  assist with assessments, POLSTS

Floor Nurse:  Handle emergencies, do admits, wound care, assist with labs, obtain treatment supplies, address missing meds, immunizations, TB status, F/U with BM, baths, skin integrity, progress notes

NOTE:  the RCM and floor nurse will have some overlap

CNA:  Wt/VS, feeding residents, obtaining specimens, answering lights, bathing.

If you limited yourself to what I listed in the Manager column and if you assisted the RCM with some things, that is already a full-time job.  It is not appropriate for you to be feeding, bathing, taking vitals, etc.  If your hierarchy is that flattened, you should expect the CEO to come and help with some of those things, too.

[duchess78]

Patients with powerful bowel movements definitely scare the bejesus out of me. LOL.

Sorry but I had to do it. 

I feel like when I am reading these posts I am in some weird alternate universe.....

[Davey Do]

47 minutes ago, duchess78 said:

Sorry but I had to do it. 

I feel like when I am reading these posts I am in some weird alternate universe.....

With all due respect, duchess, no one made you "do it", and we should never mess up an apology with a rationale.

You must enjoy being in this "weird alternative universe" since you put down roots.

Someone who didn't enjoy it would have just passed by, and not left their mark.

[PeachyERNurse, BSN, RN]

People who can’t breathe scare the crap out of me. I can pretty much deal with anything else —except trachs and babies. Those two, I will do anything to avoid.

[hppygr8ful, ASN, RN, EMT-I]

12 hours 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

   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.  Patients that especially have a history of frequently declining make me even more nervous

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. 

 

I am formulating a reply stressing the above bolded items

12 hours ago, SilverBells said:

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

Working on that for you

[Been there,done that, ASN, RN]

I'm afraid of Borderline patients. They will control the functioning of the unit every time.

You are correct that GI patients can decline rapidly. Instead of laying in bed and worrying about their bowel patterns, you could develop a bowel control system and make sure it is monitored. The Mayo Clinic has a good example for you.

You have many off the wall threads, SB.. but I have a feeling you are just somewhat over concerned about some things.

 

[hppygr8ful, ASN, RN, EMT-I]

13 minutes ago, Been there,done that said:

I'm afraid of Borderline patients. They will control the functioning of the unit every time.

You are correct that GI patients can decline rapidly. Instead of laying in bed and worrying about their bowel patterns, you could develop a bowel control system and make sure it is monitored. The Mayo Clinic has a good example for you.

You have many off the wall threads, SB.. but I have a feeling you are just somewhat over concerned about some things.

 

Here Here!

 

[FNPtobe2020, MSN]

I’ve been an RN for so long that nothing scares me! My assessment skills are strong and I report my findings to the on-call provider. If I disagree that a patient needs to be sent out, I’ll send the patient. And I have that capability based on policy!

[SilverBells, BSN]

20 minutes ago, FNPtobe2020 said:

I’ve been an RN for so long that nothing scares me! My assessment skills are strong and I report my findings to the on-call provider. If I disagree that a patient needs to be sent out, I’ll send the patient. And I have that capability based on policy!

Wish my facility would have the same policy.  There's been numerous times that I've wanted to send patients in and was unable to due to provider and/or patient disagreement.  1 or 2 days later, they end up getting sent in and admitted, which to me symbolizes that my judgment wasn't far off.   I've been wrong before, obviously, but lately every time I've felt that someone needed higher level of care, I've been right.   Not always right about the exact diagnosis (unable to determine certain conditions without tests) but right in that the person was or on their way to becoming critically ill.  Unfortunately, without doctor's orders and/or patient requests to be seen, there's not much I can do other than make suggestions or recommendations 

[guest1163268]

On 4/24/2021 at 7:17 PM, Davey Do said:

No wonder Moby was able to capsize that boat. He must have thought he was going to a fancy dinner dressed like that, imagine how surprised he was when the brown cannon balls started raining down on him ??????

[DavidFR, BSN, MSN, RN]

I can't say I'm "scared" of any particular patients. I've always approached the unknown as an opportunity to learn and if I don't know I'll ask. 

I don't partcularly "like" looking after patients in obstruction with NG tubes on aspiration. Don't know why but my heart just sinks when I hear that word "obstruction"

I also don't particulary like stabbing for an arterial blood gas. It's probably the skill I'm least talented at, hence I just don't like it. 

[Davey Do]

5 hours ago, Curious1997 said:

No wonder Moby was able to capsize that boat. He must have thought he was going to a fancy dinner dressed like that, imagine how surprised he was when the brown cannon balls started raining down on him ??????

Oh. 

I see now, Curious, that you're one of "them".