As previously stated, I've been trying to decide how energetically to pursue jobs at other hospitals since I've been all but guaranteed a position on the ICU where I'm externing. Like I've said before, it's the safe and familiar versus the new, exciting, and prestigious. It's an admittedly prodigious conundrum, especially granted the current job market that many graduate nurses are currently facing. Like any major decision though, I've been obsessing and over-thinking it nonstop since, well, last October when I secured my externship.
Over the past month though, we've had a series of patients that have helped show me the way. I wish I could say it's been a positive process, but it hasn't.
Patient #1: A late 30s male with a long psych history decided to take himself off his meds. The resulting psychotic break landed him in our hospital, (which was frustrating in itself since we're not a psych facility,) for what may, or may not have been a suicide attempt by alcohol. At first we were keeping him sedated because he ended up intubated. But when he was extubated, the beast was awakened. He became violent, combative, and generally uncooperative. At one point he assaulted a new grad nurse, and if I hadn't been there to physically intervene (as in bodily lifting him off the ground and body-slamming him back into the bed,) he might have actually hurt her. Needless to say, and rightfully so, he end up in 4 point restraints in the bed. But then we did nothing else for him for the next 72 hours while we went through the court system to get an OPC. Nothing. No psych meds, no sedation, no Ativan, no diet, no PT. Nothing. NOTHING.
Patient #2: This mid-50s woman was brought into the ED by EMS because her husband thought she had a mental status change. The only thing longer than the list of organs she'd had removed because of cancer, was the number of pain medications she was on. The ED gave her Narcan, and holy smokes did she wake up. She was 82 lbs on a bloated day, but she had the super-human strength of a junkie whose buzz had just been killed. It took 4 of us to hold her down long enough to get her in 4 point restraints. And there she stayed for the next 2 days. Completely in pain, and withdrawing from her pain meds. She was given no pain meds, no diet, no IV. No physician would help her.
Patient #3: This poor woman ended up on our unit for a suspected stomach mass, so the docs ordered her PEG tube clamped while they figured it out. Never mind that's how she was getting her meds for her Huntington's disease. We all watched as she slowly descended into Huntington's hell. She ended up restrained as her EPS symptoms accelerated. And. Nobody. Would. Advocate. For. Her.
I don't think I can last long on a unit where the culture allows for patients to just languish with no clear treatment goals, and tied to the bed. Maybe I don't have a clear idea as to what the realities of nursing truly are, but it disturbs me that this still happens.
I know for a fact this would never, ever, ever happen on my wife's unit at her hospital. Maybe it's because she works with kids. Or maybe it's because they have specialists on the unit 24-7. Maybe it's just that good of a hospital.
Regardless, these patients have pushed me to actively look elsewhere, and at hospitals with stellar reputations. My hope is that that translates into physicians and staff that actually care.
A little clarity is a good thing.
Any experienced nurses care to comment?
Yikes. I gather this is just the tip of the proverbial iceburg. I think your instincts are correct, and you need to bail, because if you stay there, it will end up destroying you as a nurse. Seriously. You're identifying major problems already as an extern and bells are ringing. And more to the point, do you want to put you licence at risk by working in a unit which doesn't put patient safety first?
ReplyDeleteum, i don't know if i qualify as experienced, but....that sucks. what kind of hellhole is that place, anyway? no ativan? what the what the? it doesn't take a specialist to get ativan or even a precedex drip going. why would anybody detox somebody cold turkey? i don't understand. my ICU is a trauma 1 center, and we have pulmonology coverage 24/7, not to mention cardiolody, GI, trauma, thoracic surgeons, neurosurgeons, and all the rest. the only thing we don't do is peds, but if the patient is too unstable to transfer to the peds hospital, then we do what we have to. regardless of how cool my place is, i can't imagine working at the place you describe. what do the other nurses say? why won'y anybody man up and say something? did these poor people not have family there? too many questions. good luck. get our while you can, i say.
ReplyDeletehave you been reading Head Nurse? bummer huh?
ReplyDeleteAs a former nurse in the UK, I can state we never tie people to the beds (certainly not in "normal" hospitals) - and equally the policy of doing that really disturbs me. I used to work on a Liver ward, so I'm used to the site of police or security around a person's bed, deterring them from swearing, spitting, punching the nursing staff (alkies detoxing, encephalopathic people, just good old fashioned nutters). I've had my fair share of "discussions" with people as to why they should take the medicine I've given them and how they're not allowed to wander off the ward.
ReplyDeleteAnd I'm also very familiar with advocating for patients and staff when it comes to sedating the hell out of people who are having a bad time of it. I've given a crap load of chlodiazepoxide (I think that's Librium in the states?), even explaining to stressed out junior doctors how to prescribe it or when Haloperidol might be a good idea.
It sucks that you are in such a bind and certainly I think it's worth raising a stink over. Can you fire off letters to management detailing your concerns? In the UK we're actively encouraged to blow the whistle, but also made very aware that you should probably only do so when you've got another job to go to.
I really enjoy reading your blog and hope things improve for you.
TE: These instances are actually the worst of the worst situations. I appreciate your comment. It's tough not having the practical knowledge to go with the moral compass and the academic knowledge. I've been known to get all bent out of shape over little things. It's nice to have a little validation.
ReplyDeleteJ: You totally qualify. The majority of these situations happened on weekends during one particular hospitalist's coverage. Each of the nurses brought up to him their concerns, but they were quickly ignored. His rationale was, you can't give someone a drug that will alter their consciousness if they're admitting dx was "change in mental status". I can see his point to a degree, but holy schnikies a little common sense needs to prevail. And yeah, I've been reading Head Nurse's blog. Freaky stuff, praying for her.
AB: I wish we didn't restrain people too, it makes me sad. I can understand if it's to prevent sedated people from self extubating, but for behavioral issues, it wrenches my soul. I'm not convinced our hospital police officers are adequately trained. They were called to the room on patient #1, but he was much more agitated as a result of their presence than mollified by it. Somewhat in part due to the officer's antagonistic demeanor.
Thanks everyone for their comments, I still have so much to learn.
While I cannot give you advice as an experienced nurse I can tell you that I have been in the work force in general for some years. I know before I decided to go back to college that I wasn't happy in my current job and felt I could be doing something more. I think if you have the feeling that this isn't where you see yourself being happy then don't stay. After all this schooling you should be doing what you love and not dreading to go to work each day.
ReplyDeleteYou should definitely have in place a location to work at where when you leave it doesn't bring you pain to know what these people are going through. You should have pride in the facility that you work at is working FOR the patient and patient centered, not other things centered.
If you do decide to leave and go elsewhere, I definitely would suggest saying something to someone who cares or is for patient advocacy. Is there a legal dept where you work that you can bring these issues up to? But I completely agree with Absentbabinski in saying you should have something else lined up before you go ahead with that. Good luck to you XY
Wow. Just read your post. Can't believe this is still happening in hospitals! It shouldn't. Now THAT is a lawsuit waiting to happen for sure...and definitely any nurses involved may find their licenses on the line. I would run as fast as I can in the opposite direction....
ReplyDeleteA friend once told me the moment you've decided to move on is the time to do so. Sounds to me like you're at that point. It sucks to leave the comfortable behind. I know this all to well. Sometimes though, it has to be done.
ReplyDeleteIt sounds pretty bad, but have dealt with many of the same. It's everywhere. Luckily at my work, if the intern doesn't give you what you want, the resident may, and if they don't you can go to the attending. Chain of command is a nice thing when advocating for a patient.
It sounds like the hospitalist just doesn't care and is willing to put the nurses and patients lives in danger. Chain of command? Use it.
As for restraints, we use them only when needed, but I'm, glad we have them. Have had to many people that would have taken 5-6+ folks to corral that a good set of four-points worked for.
Bottom-line, as I ramble is this: you're at a perfect time to change. Pursue other opportunities, but always have a back-up plan. You don't have to tell your current place that you're looking elsewhere, at least until they need to be contacted. And think long and hard before you sign any sort of contract!
I know this post is a couple months old, but I couldn't help but respond. I know some people get all upset about restraints, but I am not one of those people. Maybe it's because I have a different view of the situation from working in psych. We use restraints as an absolute LAST resort and we've tried everything else. We also ALWAYS medicate people who are restrained. It is completely inhumane and asinine to think that strapping someone to a bed when they are agitated will help them calm down. It won't. A little Vitamin H or a 5and2 cocktail will go a long way for someone like your agitated dude. (Haldol or Haldol/Ativan)
ReplyDeleteI'm just cringing at these patients. 3 people needlessly restrained. 3 people who had an awful experience in the hospital and will tell everyone they know (if they lived through it). I would get out of there as quickly as possible. But make your concerns known before you leave. You never know...it could help a future patient avoid being treated like these were.