Any Frazzled Nurses Out There?

Updated on September 28, 2011
R.H. asks from Merrimack, NH
7 answers

I've been working in critical care for 4 years, prior to that med/surg. Recently we had a patient who was in the final stages of a horrible chronic illness. We intubated him and kept him alive for 2 months. He told us in every way he could that he wanted to be set free. Because of his young age our MD's and the patient's family decided to ignore his constant grimacing, biting of the ET tube, thrashing/trying to get out of bed, etc. and just continue with the most aggressive care possible, while tying his hands down with restraints, and using sedatives to try and calm him. We tortured him for 2 months before he finally died, peacefully and comfortably, by the way, thanks to the ethics committee, who stepped in towards the end. My dilemma is I still see his face, and it haunts me. I feel ashamed for participating in what must have been round-the-clock agony for this poor soul. I sometimes feel as though MD's have tunnel vision; they fail to see that the restrictive lung is encapsulated by the body and soul of a beautiful person, who deserves our respect and compassion. As a nurse I feel as though my power is quite limited in these situations. Have you ever felt "haunted" by one of your patients? How did you deal with it? How do you avoid imagining bad things happening to your loved ones (especially your children)? Do you think that being a mom and a nurse simultaneously creates caregiver strain to a degree that most people just don't understand?I don't even know who to talk to when I have a shitty shift because nobody really gets it. We do amazing things on my unit, don't get me wrong, (that's why I keep going back for more) but sometimes I think we do too much.

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So What Happened?

Thanks. I just want to add that ethics and Palliative care was involved because nurses spoke up. We can't order palliative care consults, the doc has to do that (often at our request), and the team refused because they felt that would be like throwing in the towel. They don't understand the difference between palliative care and hospice. All we wanted was compassionate care, not a hastened death. And I have taken a palliative care class. In this particular instance our (nurses) concerns fell on deaf ears. thanks for letting me vent!!!

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B.C.

answers from New York on

I do agree with you regarding care-giver burn out. I don't know if in your hospital the nurses are able to place consults independetly from the attending but maybe next time you want to get Palliative care involved? Your patient's will always continue to haunt you, that just means that your a good RN and you care. Try to balance the good with the bad, and see if you can take some palliative care classes or hospice courses to get you more informed of the needs of the dying and you can be the advocate that you need to be for your patient's.

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R.P.

answers from Seattle on

First I want to thank you for what you do. I to work in a hospital and shake my head wondering how some people are unable to see the harm they are doing while thinking they are helping. We have a wonderful Palliative care team at our hospital and still I don't think it is used enough. I was reading this http://allnurses.com/nursing-articles/patient-i-failed-32... yesterday and this site helps me sometimes. I hope you keep fighting for your patients because everyone needs an advocate!

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L.K.

answers from Kansas City on

Bless your heart. Reading your post brought back so many thoughts and memories myself.

I won't get into the debate of who has the most stress, because I do feel that nursing is a calling. It doesn't matter what unit you work there are those patients, patient families, doctors, co-workers, who leave imprints on our lives good and bad. I remember working med-surg and a woman, older woman who refused everything, even IV fluids, and how I struggled with that . But finally came to the conclusion that it was her right. That was really before the Advance Directives push.
Speaking of which, I agree 100% that everyone needs to have a living will. Not just have one documented, but talk about it to everyone. Give everyone copies. I have seen many cases that despite of the patient's wishes even with a living will or Advance directive, those wishes are over-ruled because there is one family member will swear the opposite.

I hadn't thought of the link between being a nurse and a mom = caregiver strain, but it does make sense. I do remember coming home physically, mentally and emotionally exhausted. And you are right that few understand. I think that's one reason why it's so important to be friends with your co-workers. Just this last year I've been scanning and organizing all my pictures and it was heart warming to see how often we got together.

I think how having children affected me was knowing all the what if's. Our 21 year old was a chronic ear infection kid and had to have 3 sets of tubs. Long story and I'd do things different now, but. . . I realize the surgery itself was/is routine but what I kept telling my husband is one little mistake at the hands of the surgeon or anesthesiologist and things would never be the same.

Reading your post and feeling your heart and frustration, is it any wonder there is a high degree of burnout? But the beauty of nursing as opposed to many other professions is that there are many ways to turn.

I worked in a large hospital 13 years in a variety of positions and did finally move on to a pulmonologists office which I loved! Except for a co-worker. That that's another story. In the office we did pharmaceutical clinical trials which I continued doing as a contractor. I also did some time in the legal industry as a nurse analyst. In each area, I found out things I really didn't want to know and probably shouldn't have known which changed my views on many things. But I love nursing and I miss working clinically. And I appreciate you and others who are working 'in the trenches' so to speak. You my dear are doing God's work!

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R.D.

answers from Richmond on

I can see where 2 months worth of this would leave his face in your brain for a while... does the hospital you work for offer any kind of free counseling for the employees, particularly debriefing and PTSD for cases like that? I can't relate on a nursing level, but I've seen quite a lot as a former EMT, and yes, some things stick in my head more than others. I try to take those experiences, learn from them, and apply them to the next patient in the same situation. Next time, speak up! Take the doctor aside, make him see what you see. Nurses are way more hands on than the doctors, you're the patients best advocate (the family is too emotional, and the doctors are too medical... you are that happy medium). Hope you feel better about it :) Like I said, next time you're in this situation, make the change in outcome, YOU be that voice :)

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D.P.

answers from Detroit on

This is exactly why people need a living will.

I was a nurse in my former life. I did a stint in SICU in a posh hospital in the suburbs and in MICU in an inner city hospital in Detroit. I can tell you a lot of stories from my inner city experience. It was supposed to be a Medical Unit but had more GSW (Gun Shot Wounds) and bleeders there in a more than we ever had in that posh hospital in over a year.

Worst story by far
A young man about 13 sustained a GSW to the head ( He was so unstable that he can not be transferred to Children's Hosp.) Father was at the bedside. He was pushing to have the plug pulled on his kid as the kid was likely to be brain dead. We all were on consensus. Fast forward to the evening news... Father was arrested apparently he was the one who shot the kid.

The one haunts me to this day was from Nursing school in my Peds rotation. A girl of about 2 or 3 with burns on her privates and buttocks area. Mom's boyfriend claims that he did not realize the bath water was so hot when he dipped her in. Problem with that explanation is that her lower extremities were not burned. The whole thing look like a barbaric way of toilet training.

There are a ton of sad stories. As nurses, I believe we should deal with these things enough to be able to do our jobs but not too much that we cease to care. I've seen it happen to many times. Patients become mere numbers. Nurses shooing family out of the room and referring to them as a bother. I guess it stems from the fear of being sued. Empathy! That was what my mother has always pushed. "Put yourself in their shoes", she would say. If I am sick I guess I want my family there too.

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K.B.

answers from San Francisco on

I want to thank you for the work you do, and as an outsider I can only imagine the toll it takes on you. I thought for years that I wanted to be a therapist, but even after a short amount of schooling for it, I turned tail and ran, suspecting that I would have a very hard time with not letting it all get to me. It takes a super (or non) human to not be affected by the feelings and experiences of those around us.

With therapists, there's a pretty strong standard to be in therapy yourself. Have you considered counseling? Just to have a safe place to go unload?

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A.K.

answers from Houston on

I am not a nurse, but a podiatrist, and I still see patients faces from many years ago - I also still see my poor mother struggling to breathe as she died.
Maybe you could transfer into a less stressful ward, I have heard that med/surg is the most stressful of any nursing situation.
Unfortunately we cannot change the euthanasia laws at the moment, we don't have right to die in this country, and ethically there was nothing you could do.
Nursing is a hard job, and you have to separate it from your life - have you ever been on allnurses.com? They have great forums, and this would be the place to ask your question.

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