Tag: nurse drama

Categories
intensivecare

I dreamt I died

Work has been shit lately. Covid is still surging in my ICU, and we’re busy with other things too.

Last week was an especially difficult week for our heart failure service, as every patient on service was deemed “not a candidate” for advanced heart failure treatment. Bottom line: this is end-stage heart failure and hospice is the next step. For many patients, this means removing a piece of equipment that’s been helping their heart do it’s job (like an intra-aortic balloon pump, or an Impella). This can mean almost immediate death, but many patients do go home from the ICU to die there. It’s emotionally exhausting but incredibly important work.

And it’s so important to spend some quality time with these patients. Last week, I helped a gentleman who was just days away from getting his Impella out to go home on hospice. He was itchy from laying in bed. I washed his back with real soap and water and washcloths. The put on lotion with a little massage. 20 minutes including gathering supplies. And it made his day! We chatted about traveling and life’s simple pleasures. These are the important moments at the end of life, and I was so happy to be there for him.

But despite that part of my job being so meaningful, there are other parts that are nearly unbearable. There is a day shift charge nurse who is mad at me no matter what I do, and who demands a ridiculous amount of report on our patients. She wants a full head to toe but the 90 second version. Do you know how long it takes me to prepare a cohesive and comprehensive 90 second head to toe report that also includes the plan and updates from when she was last on shift??? It takes about 5 hours to do it for 30-36 patients. And when I don’t give her all the info she wants, she asks for it in aggressive tones. If I don’t know the answers, she will eye roll, sigh and slam turn the pages of her printout. Actually, she does that sometimes anyways if she’s annoyed by something, anything.

I find this to create a workplace so toxic that it gives me panic attacks. I dread giving her report. I get short of breath talking to her. I often cry after interactions with her.

So what do I do when I tell my managers about this and nothing changes? That is the million dollar question facing me right now.

Oh, I almost forgot my dream. I had a left ventricular assist device (LVAD) in my dream, but it became dislodged internally. FYI, I’ve never ever seen this happen in real life… I was bleeding to death, surrounded by work mates. They could do nothing. And finally, as I was about to die, one of the help pressure on the bleeding spot as the warm feeling spread through my chest and I lost consciousness.

Whoa. Is that symbolic? I hope not.

Categories
Quick Notes

2 observations from the week from hell, maybe 3 ok???

  1. Covid. Still everywhere & people are dying. It is going to take MONTHS, maybe the entire YEAR of 2021 to roll out the vaccines. Keep wearing your masks, stay home & stay distant.
  2. There are some heart attacks that should kill you, in my opinion. Maybe I’m just traumatized by my job, but when your heart is so damaged that you need A NEW ONE, it seems like life just wasn’t meant to be.
  3. People always talk about nurses not being able to pee for their whole shift. But when you extend that metaphor, having a job where you can’t sneak away to take a poop is also horrible. Gas pains hurt really bad!
Categories
intensivecare

When patients’ families get TOO involved

We have a patient here in the ICU whose been admitted to the hospital for two months. That is a long time to be anywhere that’s not home, especially when you’re sick. She has been in the ICU for more than a month.

During the course of her hospitalization, her mother has become her rock—as you would expect. But what the mother has become to the health care providers cannot be described so nicely.

Is she controlling? Yes. Is she demanding? Yes. Is this understandable? Yes.

But has she turned her adult child into a will-less person who can’t speak for herself? Also yes. Does she coddle her and tell the nurses she won’t get out of bed because she’s tired when getting out of bed is literally the only thing that will help her get better at this point?

Does she ask the doctors for opiates and benzodiazepines on behalf of her daughter’s severe pain and anxiety? Does the daughter as a result always looked totally out of it and unable to participate in her own care?

I can actually feel myself getting angry as I write this. Then why am I even doing it, you may wonder? Because today, we were presented with a list of unacceptable and acceptable nurses to care for this patient. And we were gifted with a daily schedule from her mom, in coordination with our supervisor.

Really? Taking directions from a non-nurse.

So, apparently the mom has caught on that the incentive spirometer is important. But she doesn’t seem to realize how important anything else is, nor does she seem to care that nurses may be off schedule due to their other patient’s medical condition or unavoidable delays in pharmacy or dietary.

Also, giving a critical care nurse a schedule like this insults the years they spent an education and training in order to become skilled enough to take care of patients who are trying to die all day every day. Not to mention that each critical care nurse usually has their own internal clock, rhythm and way of doing things. It follows the same trajectory as all the other nurses but also has individuality.

This is a DOCTOR’S ORDER that mother requests no tv watching. WTF?

In the end, do you know what’s really happening here? This mother, who can’t come and be with her daughter right now, and who feels very lost because she cannot control the diabolical illness affecting her child, has chosen to lash out at the only thing she feels she can control. The nurses.

But we are not her employees, nor her slaves. We do our best to accommodate the families of our patients but in the end, WE DO WHAT’S BEST FOR OUR PATIENTS.

And in this case, it might be forcing her to get out of bed, go longer in between doses of Ativan and the big D Dilaudid so she can wipe her own face and FaceTime her own mother. Because, just to remind you, I work in an adult ICU.

Categories
intensivecare nightshiftlife

Not your nurse mom, nope

There are a lot of things that bug me about how other people practice nursing. But I’ve been a nurse long enough (more than a dozen years!) and through enough failed relationships (plus one marriage!) to know that you can’t really change people. Plus, at least in nursing there are actually a lot of ways to get the job done.

Some RNs will always be better talkers than doers. Honestly, those nurses get assigned to the patients who literally need someone to just listen to them, while more organized self-starters are going to take the busy potentially unstable post-ops.

I’m ok with this and try to value each nurse on my unit for what they’re good at— and help them both grow and deepen current strengths as appropriate.

There are 2 problems with this laid back philosophy: first, there are always some nurses who want everyone to be like them—and these are usually the very Type-A quick & bossy types. These nurses are usually very good at their jobs, earning them coveted roles such as float nurse or RRT or frequent 1:1 assignments.

But as I mentioned, there are many ways to nurse. And sometimes you need the quiet and patient (read: slow) nurse for a patient who reacts badly to too much change. Sometimes you need a nurse with social skills to smooth things over. Sometimes you just need the biggest strongest guy on duty to make sure the sexually inappropriate young male patient with a TBI doesn’t act out with the female nurses. This list goes on and on. Patients develop specific tastes or show preferences that we try to accommodate in order to prevent resistance to treatment. It’s both ridiculous and sensible when you think about it.

But I digress. So what is the first problem with my laid back attitude to the variety of skill/methods in nursing? Well, that one groups of nurses I mentioned who are particularly type A and like all the other nurses to be like them? Well, let’s call them the A Team.

The A Team terrorizes all the other nurses. In their misguided desire to “improve” the unit, which to them means make everyone like them, they bully all the other nurses and often managers too.

Then I have to follow behind them saying “don’t worry, they’re just being dramatic.” And trying to unruffle everyone’s feathers. This can reach crisis proportions when the other nurses start fighting back. It’s really hell on my days off, though, as I get flooded with text messages from both sides.

Oh, and what’s the #2 problem for my laid back ways? Sometimes people develop bad habits. And bad habits are hard to break. IV med bags in the patient’s sink is one of my biggest pet peeves. Also leaving your trash for someone else to clean up in med room. Here’s one I found while sending a nurse on break. Note: I did nothing. I’m not your nurse mom & I’m not gonna clean up your mess.

Someone changed all the CRRT (read: dialysis) bags and left the old (read: dirty) ones in a chair. Then threw a pillow on top, like a cherry on a sundae.