Dealing with Difficult Patients

The other night I had a particularly difficult patient. On top of being in acute alcohol withdrawal, this individual also had an extensive psychiatric history and history of previous substance abuse. This is a winning combination that leads to a busy night. First this patient had been getting better during the day, and for the beginning portion of my shift, this patient was fine. Then as the night progressed and my other patients drifted off to sleep, the patient began to escalate. Everyone that is a fall risk in the hospital has a bed alarm on so that we as nurses know that patient is getting out of bed and can run in there to prevent any harm or falls to the patient. This patient was setting off the bed alarm at an increasing rate. I was giving this patient Valium 10mg every hour as that was how his PRN (as needed) order was ordered. The patient was not responding to Valium, and I even tried giving a dose of Ativan, which had a temporary fix for about an hour before the patient was climbing out of bed again.

12 hours worth of this is enough to make anyone lose their mind, but as nurses we need to keep our cool and treat each patient with the respect and courtesy everyone deserves. There are a couple of ways that I have found that work for me when I do this.

  1. Remembering what the patient is here for and that patient safety comes first. I will be the first to admit after the 203 time the bed alarm rang I was tempted to just turn it off. But this of COURSE would be dangerous for the patient, and neglectful of me, so of course I did not do this, but just taking the extra moment either before running into the room to steady the patient, or after settling them back in to remind yourself that they don’t know any better and are there because they need your help is a good way to keep yourself sane.
  2. Speaking with your coworkers about it. Just allowing a little bit of your frustration to leak out and have someone who understands validate your frustration can help relieve some of it.
  3. Speaking up and knowing when to ask for help. We are nurses. We are strong. We are patient. We are also human and have our limits, so knowing when to ask for help is crucial. On my particular unit we all work as a team, so my fellow nurses would occasionally run in there as needed when I was running behind or with another patient. I of course reciprocate as needed when my patient load is not as crazy, and someone else has a difficult patient.
  4. After work activities. Make sure that your shift doesn’t totally get to you! I know this probably sounds ridiculous with the above story I just told, but have a glass of wine or cocktail with friends and just vent it out. Especially with some nursing buddies, they can relate and maybe even give you advice about how they deal with it. I included a picture enjoying some time out with friends. Or just do whatever you enjoy doing to blow off some steam.

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This is just one example of a difficult patient and they come in many different forms. What’s the most difficult patient you have ever had? Leave it in the comments

~Niki

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Sleeping and Nights

I have finally been able to switch over to night shift! YAY! This is a win for me, as I tend to be more of a night owl than a morning person. But there are a lot of people that have a hard time adjusting to nights. This post is going to be about what works for me to be functional on non work days, and everyone is different so I please keep that in mind when reading this article.

I am already naturally a night person so some of these things are much easier to me. To begin, I have skewed my schedule so that I am up until 0200-0300, and sleep until 1100-1200, typically 0300-1100. This sets me up to stay up to 0730 the next morning when I need to work.

Setting an alarm the next day after your last night shift and getting up to go for a walk or go do something active definitely helps you get over that feeling of being hit by a freight train.

I always wake up parched and with a mild headache, the getting up and moving helps with the headache, and a good glass of water and rehydrating all day helps with the parched feeling. However the parched feeling is not exclusive to nights for me, I am never drinking enough water when I am working, which is a personal issue and potentially the topic of another post ;). I enjoy my hot yoga, going for long walks outside, and some gym time. I get bored easily so I try to keep things varied, so I don’t burn out on one thing.

One thing I have also realized for me is caffeine. Oddly enough contrary to probably what almost every other nurse out there is going to say, I need to stay away from caffeine. It makes my sleep cycles really strange and too much of it actually exacerbates any anxiety I might have. So I have been weaning myself off of my caffeine, although it’s slow going, I definitely enjoy a cup of coffee every now and again (hey, don’t forget to feed the soul and do things that make you happy 🙂 ).

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I am so tired by the time I get home and go to bed I don’t really need black out curtains, but a lot of people benefit from them. I used a throw blanket (which worked just as nicely) for a while, but then I find that for me it is extra difficult to get out of bed after having slept for my 4-6 hours, so I have left them behind for a brighter future (pun intended 😉 ).

I usually pass out and am sleeping for a solid 4 hours before I wake up, but if I have had a particularly trying or emotional night and am having trouble getting to or falling asleep, I have melatonin. I rarely use it, but it is rather reassuring to know that I have it should I ever need it. It is over the counter, but I spoke with my doctor about dosing before beginning to take it, so I would never recommend to take supplements without knowledge about what you’re doing.

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Any other tips and tricks out there about working nights and sleeping during the day? I know I am still testing different things out to see what is going to work best for me, so this is a preliminary list of what works for me :).

 

~Niki

Tough Calls

Yet again as I continue on my journey into the nursing profession, I had a first time experience that truly didn’t sit well with me, but is something that we find to be a norm in our society. I had to discharge my first long term patient, which is emotional and trying. In addition to  discharging this particular patient, I had to discharge him/her to the street because he/she had no where else to go. His/her family wouldn’t help him/her and he/she didn’t have the funds to go elsewhere so he/she was unable to put him/herself up in a hotel or motel.

In San Diego, we don’t get truly cold below freezing weather, but we still get weather that is chilly and not something you would like to be stuck outside with. This happened to be in December in San Diego, and just before a day where it decided to rain. One of those rare days I find to normally be a treat, but on this particular day, my joy of the freshness rain brings was dampened by the cold wetness it would bring to someone newly homeless being sent to the street to survive. I had this patient more than one day in a row so we were able to prepare him/her the day before that he/she would be discharging the next day and told him/her we would give him/her a list of shelters and to contact whoever he/she could to see if he/she would have a place to stay. My mentor that day tried to find a place for the patient to go if everything else fell through, and then we realized once we found out there was no where for the patient to go, other than waiting in lines. He/she had come in to the hospital in September a much warmer month, and didn’t even have pants or a sweatshirt with her. My coach decided that if no one else had anything to offer up, she would buy something for the patient so there was at least one substantial set of shoes and a sweatshirt to somewhat protect from the cold.

At the last moment a family member was able to pick the patient up from the hospital, but they were unable to bring the patient home with them. It struck me as a sad reality that from our standpoint, we housed this individual for several months and now he/she was going to the street to fend for herself.

There are some things I take for granted that I shouldn’t. I can provide food and shelter for myself, had not become a struggle for this individual. It seems we are missing a part in our social structure if we have people that need to go to the street after leaving the hospital. Especially if they didn’t come from the street to begin with. Understandably we as a hospital and from a medical standpoint can not house people simply because they have no where else to go, but it just felt like such a horrible thing for me as one human being to have to tell another I’m sorry you’re medically clear so you can not stay here, and quite frankly it is not my problem where you go after this. I didn’t have to say that last part but I was in with an administrator who had to do that and it was such a shocking harsh reality to hear someone say that. We as nurses care for people not only as a profession, but fundamentally most of us have a heart that truly want to help others. Period. End of story.

I had never felt as terrible about doing something as I did that day. It saddened me and broke my heart. For the first time after beginning my career I went home and cried about something I had to do at work. A place I am sure I will go again, but hopefully next time I can help make the outcome just a little bit better.

What’s the toughest thing you’ve ever had to endure in your nursing career? We all have those stories that just stick with us, and if you would like to share your story please do so in the comments below.

 

~Niki