Happy Nurses Week, Day Two! Well, it’s actually Day Three since it started on Friday (assuming to include the weekend??), but I’ll do it how I want, ha. I asked on Twitter last week if there were any topics people would be interested in hearing about (still taking ideas!), and someone asked how/if I can disconnect between the stress of the job and separate it from my non-work life. Thanks to @WitoldW for the idea! It’s definitely a topic of conversation in nursing since you deal with stressful situations on a shift-ly basis. Sometimes those stressful situations include death, so it’s something you take with you, and it affects everyone differently.
At my first job, I cried all the time. Every shift, you could find at least one nurse crying in the medication room. It was such a toxic place to work with poor staffing, needy patients, and not enough time to get everything done. At my current job, I can specifically remember three times I’ve cried, and I think they sum up some of the difficulties and stress of the job.
my first intubation
I was recounting this moment with a nurse sometime within the past few months, and no one really remembered it. But I do. Quick basic burn lesson: When you sustain a large burn, your capillaries get very leaky, and you leak fluid into your interstitial space, so we have to give you lots of fluid to maintain your blood pressure and organ perfusion. This fluid also leaks into your lungs, and eventually many people with large burns get intubated (have a breathing tube placed) because they can’t breathe adequately on their own anymore because of the fluid in their lungs. Often times it’s not a matter of if, but when.
I had a patient with a “granny burn,” which is a made up name for a burn as a result of catching a robe/sleeve on fire over the stove, sustaining burns on the arm, armpit, and flank. Roll up those sleeves, please! Anyway. I had a patient overnight with a large burn as a result, and we talked most of the night. Super sweet lady. Allowed to have ice chips but nothing else in case she needed a breathing tube – you don’t want anything in the stomach because there’s a risk of aspiration (fluid going into the lungs) with intubation. I was still fairly new the ICU, so I was so busy doing everything that I forgot to get her a cup of ice that she asked for. I remembered her joking with me about it, saying it was okay. At 5am, a blood gas (measuring your oxygenation) came back poor and it was time for the breathing tube. Anesthesia was called, and I apologized about the ice chips – she said it was okay, no worries. Breathing tube in. I was so sad when I went home that morning – not because I couldn’t prevent her from getting intubated, that’s just the burn process. But the ice chips, I felt so bad. Also the possibility she wasn’t going to make it. I don’t remember how long she was alive for, but she ended up dying.
the one you do everything for, and it’s not enough
I understand that being in the hospital, or being under any medical care, can be very frustrating, especially if things don’t go as planned. I once had a patient who didn’t have things go as planned due to expected possible not so great outcomes. Everything ended up being fine, but it took longer than originally planned because of the patient’s previous state of health. Both the patient and the family were upset about this and made it clear. When we make decisions in the hospital, they often revolve around the safety of the patient, even if it’s not what they want. (Although if you push hard enough as a patient, you can mostly get whatever you want. We just try to educate you on what’s best. This is not always appreciated.) This is vague, I know.
I had this patient for two days in a row. The first day was challenging. Asking if they could walk off the floor with invasive lines such an arterial line – even the resident was like, “Well, why can’t the patient walk outside with it?” Welllll, if they need close enough monitoring to have it, then they should be on the unit. Not to mention what would happen if that line came out – bloody everywhere. Why doesn’t the hospital have a babysitting service for the visitors of patients? It’s a hospital? I don’t know? Why does every meal tray come up wrong? I’m your nurse, not a waitress, but I can order you more food. The second day was more stressful, as the patient was scheduled to leave, but the attending was in surgery and the patient couldn’t be cleared. Both the patient and family berated me multiple times over this, and eventually I got the resident to speak with them. Can we call the doctor even though he’s operating? Would you want someone calling in while you’re being operating on to discuss someone else? No, we can’t do that. Finally we got the okay for discharge, and then I spent an hour making sure at least four different follow up appointments were correctly arranged. In the meantime, family members not present called me to ask what was taking so long. I explained that I was making sure all the information was correct and the more people who call me, the longer it takes to get done. Just trying to provide a safe discharge. Nooooope. I finally got it all figured out with all their requests, walked down to the room, and found out they left angry about five minutes earlier. I sat down and cried out of frustration.
It sounds so silly now, but I put everything into those two days to give them both what they needed while adjusting to what they wanted, and they walked out. As I said yesterday, it’s so hard to work to give people what they need and educate them, just to have them not care. I headed home and went for run. I remember crying through it, then I drank a lot of wine. It’s hard to want to help people who don’t want to accept your help, belittle you, or think they know better.
the ones who are just mean
We work with the general population. A sick general population. People from all walks of life. Sometimes we have super nice people – people who have worked in the medical field and just “get it.” Nothing in the hospital happens fast. To be honest, you don’t want it to. I had a patient yelling at me once because they had been waiting “forever” for their CT scan. You know what? You don’t want to be the one with the STAT CT scan because that means something REALLY bad is happening. I know it’s frustrating. But the medical system isn’t perfect, and we really trying our best. I want the best for you in the best way you can have it, but sometimes that’s hard. As a nurse, I’m on the front lines of that and receive the brunt of complaints even if it’s not my fault.
A patient not too long ago made me cry. Nothing I could do was right. I’m very non-confrontational and will walk in and out of your room eight times if that’s what it takes. I can’t go into details on this one, but I recently had a patient who was so passive aggressive and flat out mean that I walked out of the room and cried. I don’t care who you are, where you came from, what you did that got you admitted to my unit, I will help you. But we deserve at least a little bit of respect. (A thank you and maybe some coffee doesn’t hurt either.) Luckily another nurse took the patient from me, and I promised I would take care of the entire unit if it meant being away from this patient.
I know it sounds completely devoid of emotion, but having a patient die isn’t that hard for me. I have had a few patients die under my care in my seven years of nursing. The bright side of where I’ve worked throughout my career is that we often know when death is near, even if it’s unexpected. My first job was on a medical/surgical/oncology/hospice unit. I saw many people die of colon cancer, and some of the worst death I’ve seen. Long and drawn out with lots of edema. Most patients were in their 40’s with young children. Seeing the patient die wasn’t hard, but seeing their family was.
The hardest moment in my first year of nursing was when I had a patient who could walk, talk, be a normal person….and I realized he was going to die. I still remember his name. I wrote about him on here way back in the day – he was such a sweet, sweet man. His daughter came to visit once, and he pointed at me. His daughter asked, “Is that her?” and he nodded. She explained, “He says you’re the nurse who is really good at her job.” My first year of nursing was really, really tough and hearing that was amazing. When he was alone at one point, I told him I’d come back and check on him, and he said, “I’m counting on it.” I walked out of the room and realized he was going to die – I teared up and one of my fellow nurses asked what was wrong. I was sad he was going to die, and she told me to pull myself together. He ended up dying a few days later. I looked up to see if the family was doing anything for his death because I was interested in attending, but they didn’t have anything.
I’ve had some burn patients who have died. When a really bad burn comes in, of course we want to save them. But sometimes you ask yourself if it is worth it. Is it worth the pain? Is it worth the quality of life after? We can do miraculous things with medicine and machines, but sometimes the body just can’t heal itself. Quality of life is highly debated and certainly changes from person to person, and I don’t think that’s something that can be answered just sitting on the couch not in the situation. I remember having a 100% burn who had family that said hello and left. The patient came in and died on the course of my shift, and it was one of those nights where I put on Frank Sinatra’s Fly Me to the Moon, held his hand, and told him it was okay to go. I’ve watched movies like the Fault in Our Stars where people are in the hospital telling people it’s okay to let go. Eric laughs at me when I start crying, but I’ve been there. Not with my own family member, but with people who may need to hear that. I don’t know if it works, I don’t even know if they hear me, but there’s something to be said for telling people it’s okay to die.
Watching people die isn’t hard. They’re not awake and telling you they’re scared to die, at least not how our patients die. Having a family member nearby can be heartbreaking. One patient was in the process of dying, and I had a frail family member visit. I asked if she was done visiting, and she replied, “I don’t want to let go. I don’t ever want to let go.” I almost lost it myself. I was sad for her pain, but watching the person die was not hard. Maybe it sounds cruel, but watching someone else’s pain from loss is much harder than seeing someone reach death where they won’t suffer anymore.
on getting through
Nursing is not easy by any stretch. Sometimes people die (mostly not, thankfully). Sometimes patients, families, doctors, nurses, they yell at you. It can be high stress. The best part of nursing is your fellow nurses. The ones who get it. I come home many shifts and try to explain to Eric why my day was so stressful. Sometimes we just need to get it out. On my unit, nurses will often sit around and talk about experiences we’ve had with patients. It may be about how encouraging patients to put their socks on by themselves or how poorly someone treated you. We have lots of crazy moments on the burn unit, and it’s hard to talk it out to someone who isn’t in the burn world with you. Most of the time, it’s easy to brush off what happened after a little talk. Sometimes we get drinks after work, just like every other profession. If you’re having a tough day with a patient, someone else will answer your call light just to give you a break. It’s a team effort, and you rely on your fellow nurses to help you get through. This is one thing that I especially love about the burn unit – our staff is like a family. Sometimes you go to other units where no one helps each other. People always pitch in on my unit, and it helps you enjoy going to work.
So I guess going back to the original question/topic. Yes, nursing is very stressful and sometimes it’s something I bring home with me. Bad things happen and it’s hard to shut off when you clock out. But no matter how bad the day is, I remember that I get to go home. When it’s 8pm, I’m out the door and someone else takes over. Yes, sometimes things follow me home. Sometimes work saddens me, makes me angry. Sometimes I walk into work and hope I don’t have a specific patient because I just can’t handle it that day. The perk of caring for others is that it’s not happening to ME. Or to someone I know or love. The stress of the day can wash away. Wine helps too.
Sometimes the difficult times in nursing make you better. Everything is important, but that cup of ice can be the icing on the cake. Although it’s challenging, I’m lucky to be a position where I’m with people at some of their worst points, and I get to make them feel better. I recently had a patient who was frustrated with everything, and he/she kept telling me, “You just don’t understand.” Maybe I don’t (although my never ending hip pain might say otherwise, but I kept that to myself), but I will do whatever I have to do to make you feel better, and that’s a pretty awesome responsibility to have.
But it’s not all challenging. I’ll never forget the old crazy patient who serenaded me with, “You’re just too good to be true, can’t take my eyes off of you…” for an entire hour. The good outweighs the bad, for sure, even if it doesn’t feel like that some days.
Nurses – what do you do after an especially difficult shift? Any stories to share?
Non-nurses – we all have challenges in our careers, I’d love to hear your perspective!