Psych Unit?

Recently my Medical/Oncology unit has felt more like a psychiatric unit. This past week we have had patients screaming, throwing things at nurses and other people, threatening anyone that comes in the room, being verbally abusive not only to their nurses, but to the people that need to be constantly sitting with them. In the past week I can’t even tell you how many times we have had to call security in order to keep not only the patients safe from themselves, but the staff safe as well from the abuse they might take. Part of our jobs as nurses are to protect our patients, but it becomes a difficult task to protect them from themselves when they try to abuse us.

As nurses we are trained to deal with escalation to an extent, but when there are several of this type of patient on the unit at the same time, it makes it extremely difficult for us as nurses to deliver effective care to all of the patients equally. We do our best, but of course those that are more stable and less acute patients are sometimes left more to their own devices than we as nurses would like. It frustrates us as nurses to no end, and shows how lacking our healthcare system is in dealing with the psychiatric patient. One of the most acutely psych patients was realistically just on our unit awaiting placement. Which means there was no where for him to go because either the places for him to go are completely full, or they are not accepting that type of patient.

Has anyone had to deal with a patient that was just absolutely crazy? How did you deal? Do you have any recommendations or comments to share with us? Good or bad are always welcomed, we can learn from others bad experiences.

 

~Niki

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Difficult Questions

The other night I had an interesting question come from a patient, I had no idea how to answer that question, so I said I would ask someone and get back to the family member.

A little background on what happened. A patient came up from the ED, who had recently been diagnosed with something that would kill her. So she and her family members came up to my floor as we are the oncology unit and deal with a lot of comfort care patients. The patient seemed to be doing quite fine considering her diagnosis, but what one of her family members asked me was what threw me off guard. She looked me square in the eye and asked me how do I make this kind of phone call. I had never been asked that question and I had no response for it. I excused myself and said I would ask some people and get back to her. So I left the room with my head spinning and asked both my clinical coach that night and the charge nurse. They were both seasoned oncology nurses, and both gave me looks that they didn’t know how to answer that question. The charge nurse said that it was probably best to just relay the information, not sugar coat it, and make sure that the sense of urgency was understood should the patient pass quickly as she very well may have.

I was at a bit of a loss for words, and when someone was looking to me for guidance, I was unsure how to proceed. Has anyone had this experience before? Does anyone have some advice on how to proceed in this type of situation?

 

~Niki

Limit Setting

Something that has been both a struggle for me in my personal and professional life is setting limits with people. I have a very hard time saying no, especially when it is someone who is in pain or is in the hospital. 99% of people are in the hospital because they need to be, not because they want to be, but every once in a while there is a patient that is there because they want to be and are seeking medications or other services they could not otherwise obtain.

Saying no is a skill I am still learning, but setting limits is something that I needed to learn early on in nursing. I remember the first time that I needed to set limits with a patient I failed miserably. Fortunately my instructor was with my so she was able to give me some pointers, but I remember feeling like such a doofus that I was unable to steer the conversation the way I wanted to and that I allowed the patient to walk all over me. I had never had to assert myself before so this was totally new and foreign to me.

Now I am better at setting limits with my patients, but I still have a long way to go before I feel comfortable doing it. I still struggle with it every time I have a patient that is difficult, but I am getting better at it.

How do you guys handle setting limits with difficult patients? Or any patients for that matter? Was this something you struggled with? Let me know in the comments below.

 

~Niki

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

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

 

 

Interacting with Other Healthcare Providers

 

So I had an interaction with a physician the other day, and my clinical coach and I had very different reactions to the situation that prompted me to write this blog today.

So first of a little back ground, its 0730, everyone is finishing report, and I happen to get a phone call about a critical lab value for a patient. Our policy states that any new critical lab value requires we notify the physician within 30 minutes, so my clinical coach happened to notice the physician was on the floor and told me just to walk in and let him know, but be mindful it is the beginning of his shift just like us so he may be a little disoriented as to what patient it is we are discussing. So not to my shock I walk in to inform him of a critical level and he is a bit gruff and does not want to hear much of what I have to say, and after expressing to him that this is our hospital policy, I have to report this within a half hour, he informs me that this is not necessary and proceeds to ignore me further after scolding me for doing my job. At this point I am not so upset, as I almost anticipated it, but then my clinical coach was much more upset and had hoped there would be more teaching involved instead of just a scolding for doing my job properly.

Later as I am giving medications to a patient, we are called to rounds with the doctor. She agrees to go as we have previously discussed what is needed of the doctor, and allow me to complete my medication pass. When I return to the nurses station to complete more charting, I am met by my clinical coach saying the doctor wanted to speak with me, and that she had mentioned to him that she did not appreciate what had been said to a “new graduate” that morning.

As I walk into the room where the physicians may sit to do their dictations, I find that the physician that I had met that morning was much calmer and more relaxed, apologized and went over the plan of care with me for the patient.

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Something that we are taught in nursing school, well its almost drilled in to our heads at the point of graduation is to not take things personally. This is something that I bring to my practice every day, and as I try to approach every situation with a fresh set of eyes. Doctors not only are doctors, but they are human as well and are privy to emotions and stress just as everyone else. Treating everyone you work with, with respect and dignity is just part of the job, as is work in any service related industry. This mentality aids in the ability for many disciplines to work in harmony.

Anyone have a story about a fellow healthcare provider, good or bad? Or perhaps a patient or family member of a patient? Please feel free to leave your stories in the comments!

 

~Niki

Emotional Turmoil

So I was on Instagram earlier and I saw a post that made me think more than I have in a while about my chosen profession and wanted to write a little bit about some of my thoughts and feelings about it. Here is the link incase you’re curious what I saw.  https://www.instagram.com/p/-5new1Q52l/?taken-by=medicaltalks  Disclaimer, this may be a little bit of a rant so go ahead and close the window now if you’re not down for that :).

The shot showed an ER doctor that was outside grieving the loss of one of his patients, which is something that most people accept as part of our profession. However this person who posted this touched on an aspect that even I, as someone in the healthcare profession, had not put much thought into.

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Once the patient has passed away, doctors, nurses, and other healthcare professionals are expected to carry on and continue to care for our other patients, who have no idea what just happened in the other room. The purpose of this post is kind of just to let people know that yes, we are healthcare professionals by choice, but we are still human and we are not immune to emotions that come with death. I think that when you are not feeling your best and you come to a hospital, it is easy to forget about everyone else because of the pain or suffering being endured that brought us there in the first place. Yet, there is that trauma occurring in the next room where the patient doesn’t make it after 3 hours of many people working to keep him/her alive, and that is tough for anyone. Especially those directly involved that tried to prevent that tragedy. Then after all this has occurred, the expectation is for health professionals to complete the paperwork necessary, and move on to care for the next patient. There are always exceptions and if there are enough staff, we hopefully give those people the time to grieve, but oftentimes there is not the excess staff to pick up the slack, so on to the next patient it is.

It’s an unfortunate reality of working with the public and in acute healthcare settings, but despite the sadness and the drawbacks, I wouldn’t chose any other profession. We do this because we love our jobs, and it is not everyday we endure tragedy, there are days where we get to save lives and make a difference in the lives of people. We just have to take the good with the bad.

Any thoughts comments or questions? Please leave them in the comments 🙂

~Niki