I'm not normally a pessimistic person. Yesterday, though, I forgot to take my usual allergy medication. I ended up grumpy and snotty by about 1700 and so made a list of Things That Bug Me About My Job.
Abusive patients and patients' family members top the list. For some reason, it's seen as okay, in the hospital world, for patients or relatives to shout at, curse, or insult nurses. I've been told in the last week that I'm incompetent, that I'm robotic and lack a sense of humor (okay, that was from a woman who was clearly off her nut, so I'm ignoring it), that the patient in question could get better care at Podunk General. Given that Podunk General was the facility where that particular person had a completely jacked-up surgery she didn't need, I doubt that last.
What do you do when this happens? In nursing school, there's a lot of talk about "setting limits", "defining boundaries", and "therapeutic communication." Sometimes that simply doesn't work and you have to get out of the room. Other times, setting limits with a patient is harder than you think.
For instance, I once had a guy who was a professional curmudgeon in for knee surgery. He complained about *everything*--the way the bed was made, the sex and size of the physical therapists (both small, wiry females), the food, the nurses. I finally rested my arms on his bedside table and we had this exchange:
Me: "Sir, have we done anything since you've been here that is up to your expectations?"
Him: "Oh, you can't take my complaining seriously. It's just my personality; the way I am."
Me: "Well, I've had it up to my moustache with your personality. Something has to change, and change *now*. There is nobody except me who is willing to walk into this room. Be nice."
No, that communication wasn't therapeutic. But it worked.
Second on the list comes the Insulting Doctor. Be he resident or attending, some of these folks (both male and female) think it's cute to call nurses dumb. Two examples, the first from two days ago and the second from yesterday:
Male resident: "Can you tell me something about Patient A?"
Me: reels off pertinent history, recent vitals and chem results, and general information of interest.
Male resident: "Gee, that's a whole lot better than a nurse's usual reaction of (screws up face, shrugs shoulders) 'I dunno'".
Me, with blank stare: "Well, you know, we're just here to train you guys."
Which, though sad, is often true. I get asked at least once a day what to do with a patient with intractable pain or a low Dilantin level.
Female attending: "God, it's cold up here. Why don't you people turn down the air conditioner?"
Me: "Because we're comfortable."
Female attending: "Turn it down right now. I'm cold."
Female attending, switching tacks: "Where's my patient who was in 24?"
Me: "We moved her to the pulmonary unit."
Female attending: "Oh, you guys didn't *like* her? (sneering)"
Me: "No, she's a pulmonary patient. She never should've been admitted to this floor in the first place."
Granted, I'm fond of this attending, and she, in her cold-hearted and snippy way, is fond of (or at least amused by) me. I was able to ask her later when she changed sticks. You know, the one you usually keep up your ass. It seems bigger this week.
Third on the list is management. Hospitals are the only places, I think, where you'll find managers who haven't done the work in question in years. Okay, maybe car companies are the same way, or large manufacturing concerns. But this is a hospital we're talking about--most of the folks coming up with Brilliant New Ideas have never worked in direct patient care, or haven't done so in years and years.
Middle Manager: "Here's our new piece of extra paperwork. It's brilliant! All you have to do at the end of every shift is fill out this two-page form on each of your..."
Me, breaking in: "No."
Middle Manager: "But this is brilliant! It breaks down the..."
Second Nurse, interrupting again: "No."
Middle Manager, looking confused: "No?"
Third Nurse: "All of this information is reproduced in the chart here, and here, and here. There's no need to transfer it at the end of every shift to yet another piece of paperwork."
Middle Manager: "... ... ..."
Me: "No. It won't fly. It's a bad idea."
Blessings be upon the head of this particular Middle Manager, who realized that we were right in our protests. MM looked at the chart, realized that what we were saying was true, and scrapped the idea.
Things that comfort me, post-shift:
The sound of my cat drinking out of her water glass (she's finicky; doesn't like bowls): she's the loudest drinker on the planet.
Getting a Valentine's day present so tacky, so over the top, for my boyfriend that he screamed and threw it across the bar. Perfect.
Opening the file folder of thank-you notes and props I've gotten from patients over the years and rereading them.