Nursing Lyfe 101
Welcome to Nursing Lyfe 101! 🩺✨
Join Colby and Christopher, two seasoned nurses navigating the highs and lows of healthcare, as they share personal stories, practical advice, and insights on nursing, wellness, and career growth. Whether you're a student, a new grad, or an experienced RN, Nursing Lyfe 101 is your go-to for real talk on life in scrubs, mental health, and tips to thrive inside and outside the hospital.
Tune in, connect, and find your strength with us – because nursing is more than a job; it's a journey. 🎙💙
Nursing Lyfe 101
Urinals Fly, Boundaries Apply: Real Talk on Handling Difficult Patients
Conflict is inevitable in healthcare, but how you respond to it defines your nursing practice. In this raw conversation, Colby and Christopher tackle the challenging reality of patient aggression toward nurses – from verbal abuse and name-calling to physical threats and inappropriate touching.
Drawing from their combined experience, they share powerful stories that illuminate the daily challenges nurses face. Christopher recounts being called racial slurs by patients, while Colby describes an incident where a confused patient attempted to pull her into bed. These aren't isolated events but common occurrences that nurses traditionally accepted as "part of the job." The hosts challenge this outdated thinking, emphasizing that healthcare professionals have rights and deserve safety.
The conversation delves into practical conflict resolution strategies that maintain professionalism without sacrificing personal boundaries. Using Brené Brown's principle that "clear is kind," they discuss how direct communication with patients about inappropriate behavior often leads to better outcomes than avoidance. The hosts examine the critical thresholds that indicate when it's time to request reassignment: when your safety is threatened or when you cannot provide safe care due to your emotional response.
Two compelling spotlight cases illustrate these principles in action. In one, a patient with endocarditis refuses critical antibiotics while demanding only pain medications, escalating to verbally abusing staff. The hosts explain how documentation and proper protocols led to an "administrative discharge" – a rarely-used but important tool for healthcare facilities. In another case, a patient experiencing steroid-induced psychosis leaves the hospital without notice, later falsely claiming a nurse had threatened them.
Whether you're navigating difficult patients or workplace conflicts with colleagues, this episode provides essential guidance on maintaining your professionalism, knowing your rights, and protecting your wellbeing in challenging situations. Subscribe to continue learning how to thrive in nursing's most challenging moments.
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Welcome to Nursing Life 101, the most important nursing class you never got to take. In nursing school we will be traversing different objectives like interviewing, what to do in nursing school, boundaries burnout and so much more, if this interests you. I hope you are taking good notes because class is now in session.
Speaker 3:Hello and welcome to Nursing Life 101. We're so excited to have you here with us as we dive into the world of nursing, sharing our experiences, insights and a little bit of fun along the way. I'm Colby and I couldn't be happier to introduce my co-host, hey guys, it's Christopher.
Speaker 1:Together, we'll be bringing you real stories, practical tips and discussions about all things nursing, Whether you're a fellow nurse or just curious about the life behind the scrubs. We're thrilled to have you join us.
Speaker 3:So the topic today is conflict resolution.
Speaker 1:And this kind of delves a little bit into what's kind of pertinent today, with some interesting stories about patients attacking nurses a little bit. It's not as in-depth as it will be That'll be a different topic for a different day but it was.
Speaker 3:It is kind of like a hot topic that is being talked about quite a bit right now. I see it on social media every day. There's like a big movement and just making it more well known the treatment that nurses face on a shift to shift basis every day because you interact.
Speaker 1:it's very much in terms of customer experience and customer service as a restaurant, because I mean, yes, it's different because they're paying for a service, they're paying for a food and it's not necessarily their health, but you have to be mindful of, like, how you interact with a patient because of this whole patient experience. And then that also builds into Medicaid and Medicare and how the hospital gets reimbursed but people. People are mean and can be mean.
Speaker 3:Yes.
Speaker 1:And it can be even worse because they're sick Now.
Speaker 3:Granted, they're probably being a jerk and have always been a jerk, but even when, it doesn't change the fact that when someone's acting a certain way that they it doesn't change the fact that they need medical care Right, and ultimately, that's what we're there to provide.
Speaker 1:Yeah, and so I guess you know that comes up with the question of like. When a patient doesn't like you, how much do you take Like? When's your breaking point?
Speaker 3:I mean I'm not. I think every nurse has the right to feel safe in an environment. So the second, that if it's immediately that person feels unsafe, you can take absolutely nothing and be like nope, I'm not doing this today, I'm going to get a reassignment and you're totally. I totally support that and I've, as charge nurse, have made quick assignment changes, um, when needed, and just you know you have to explain to people what's going on. But I mean, that's just part of the job. Unfortunately.
Speaker 3:I think probably every single person has faced something sketch, at the very least sketchy, if not actually scary um, that works in health care and so everybody's understanding when something like that pops up, but outside of like your, your, your feeling of safe being threatened, um, I mean, I think you have to always remain professional and remind yourself that you're there to perform a job. But at some point, like again, even if you don't feel like your safety is being threatened, you can, you can just say I can't do this anymore, like, and I have also done that personally and have or been on the other side again as charge nurse and remade an assignment. Everybody is individual and I don't think that like my, my point of break of telling myself okay, I can no longer care for this patient because their, their treatment of me is going to like, diminish my ability to care for them, so I I know when to walk out.
Speaker 1:But I mean I get that and I do understand, but like there's a point where we have to be a little bit tough skinned, I mean you can't. Legitimately I've been called the N-word, I've been called all kinds of words under the sun that was derogatory to me, being a black male. And now, granted, I probably shouldn't have taken it and I should have changed my assignment. That you know like I should have said something. But I one know who I am and I'm very confident in who I am.
Speaker 1:And them saying something is not going to change how I deliver my care. But there are points where even something as simple as or simple as like you're slow, you know like people, and people have allowed themselves to not have as tough of a skin because people are more willing to change an assignment. And I'm not saying you as a charge nurse, was doing the wrong thing, I just feel like them just doing a simple like you're taking forever today. Or you know, like people I don't know, maybe you haven't had that happen I've seen people try to change an assignment because it was something as simple as that.
Speaker 3:That's silly, honestly. You know it's silly, but it does happen. Now that I'm thinking about it Like it's, I've definitely seen people try to like tiptoe it that way and be like they don't want me to be their nurse today and I'm like, you're still their nurse today. Like there's sometimes people like if it's a patient that's like a particularly difficult patient and where we like, we'll rotate, we'll like quote unquote rotate those patients so like nobody has to take care of them more than just one shift.
Speaker 3:But I definitely have had nursing staff go into a room and like purposely say something that's like just a little off to piss off the patient, yeah, and then be like, oh, they don't want me to be there anymore today and I'm like, come on, man, you provoke that, right. But I've also seen people not necessarily provoke it, but the patient just is already starting as soon as they open up their eyeballs and start saying stuff like that and I'm like, no, like I'm not redoing the assignment. So, and sometimes the patients will be like I want a different nurse as soon as they open their eyes and you have to set boundaries with them.
Speaker 3:That was like you don't even know this person. They haven't. You haven't even given them a chance. We're not going to do this today. Like you can't fire every nurse that comes into your room. You're here because you need medical. Like you have to remind the patient, like one, why they're here and what our job is and that we are doing our job. And that's annoying and unfortunate that we have to, but that's reality.
Speaker 1:It is, and that's why I was like, like, how much do you take it? Like I know you also have gone through a very tough situation and have toughened your skin and have allowed yourself probably to go a little further than what you probably should have.
Speaker 3:Yeah, I would say in the past, definitely, probably should have. Yeah, I would say in the past, definitely. But also because of my role in as the save champion, which is situational awareness of violent events and basically are just kind of like the safety champion. It's like, you know, going to all the meetings at the hospitals, changing policies and all this stuff is just like bringing it back to the floor. That's basically what the champion role is, and then we have some like with different like subjects I guess. But anyways, as my that was a tangent but in my role as the save champion, I think we're trying really hard as a health system to change the narrative of nursing, just kind of like taking abuse from patients, right, and just kind of the old mentality of it's just part of the job. So I am actively trying to kind of change people's thoughts on that and like, yeah, I, I have.
Speaker 3:I've been a nurse for 10 plus years and, yes, I've had a urinal full of urine thrown at me, I've had been spit on, I have been cussed out, I have been my life has been threatened. Patients have lunged at me, I've been hit, like it, and at one point it was just, it is what it is, but we have rights as staff, and so I just liked for people to be educated on that and like what the hospital will do to support us if something was to happen. To be educated on that and like what the hospital will do to support us if something was to happen. What laws are there?
Speaker 1:to protect us that kind of stuff. Yeah, and I you know it's it's definitely a difficult line to to cross and there I appreciate the the save committee because it does. We as staff members have rights and we as humans have rights. Like I mean, you, just you can't, can't go threatening somebody.
Speaker 3:Yeah, you can't walk into a grocery store and tell somebody that I don't even know something crazy. I honestly I'll. I'll use an example of what. Something that actually happened last week on our unit. I'll say what happened, but put it in the case of going to the grocery store. Oh, interesting week on our unit. I'll say what happened, but put it in the case of going to the grocery store. How interesting. Okay, you can't go to the grocery store and grab the cashier and pull her into you and kiss her neck and say hurry up and come back, so I can do.
Speaker 3:Quote unquote oral sex on you later yeah, and the and the nurse that got told that did nothing to provoke it was only being professional, and this patient was just like to do that is disgusting.
Speaker 1:Yeah.
Speaker 3:Yeah, if you can't go to the grocery store and do something like that, what makes you think you can grab a nurse and do that? That is gross, so disgusting so gross yeah, absolutely repulsive, like were they okay? Yeah, luckily, but, like the, in the way that I would have highly considered pressing charges oh, I would have probably just punched them and I mean yeah, uh I don't like being touched in the first place, so yeah, like Just absolutely disgusting.
Speaker 1:But yeah, wow, I can't believe people so like, how do you, how do you set boundaries? Like there's a point where we as nurses and all of you know there's something called the daisy and those things are somewhat coveted as a nursing achievement. You were able to get this daisy and were seen as a nurse that does above and beyond just the normal call. So how do you set those boundaries to get the daisy but also not lose your sanity? Like we said this in the first episode or second episode, you've never gotten one oh, I've gotten one since then.
Speaker 3:Oh, my first daisy boundary is setting and like when is when it? Like when do you give up the dream of the daisy right?
Speaker 3:and just like I need to get through this shift I mean, let's be honest, the patients that are giving us the hardest times, they weren't gonna write us a daisy regardless. But let's be like, let's be really honest. But no, I mean it's most important to send boundaries like immediately. And I'll give you another example like we had this old man. He was a little bit confused and honestly he might have just been like milking the kid could not hear thing, like refuse to hear where he is and just acted confused.
Speaker 1:Selective.
Speaker 3:Yeah, selective deafness, like he did it to a few different staff members. And then I went in and I, you know, checked on him how are you doing, how are you feeling, having any pain? Yep, you know. And he said no, no, no, I'm good. Okay, you look like you're enjoying breakfast. Is there anything else I can do for you? And he was like well, and then grabbed my hand and kind of pulled me a little bit and said you can get in this bed with me. And I was like, sir, I met your wife. What do you think she would say if I told her what you just told me and three other staff members today? I don't think she'd be very happy. And he said, oh yeah, you're right.
Speaker 3:So sometimes a little shame is not frowned upon. You should just go ahead and shame them. I mean, but read the room, because obviously somebody else isn't going to respond to that but like there are little ways that make it less awkward or make the person feel like I mean not to say that you shouldn't make them feel this way, but like you can say things that wouldn't make them feel like accused of doing something bad, you know, because sometimes that's going to further, like snowball into a more difficult or, you know, it will continue to get worse. Right.
Speaker 3:If you say the wrong thing to someone, so like a confused-ish old man who thinks he's being kind of cute like you can kind of let me be real cute right back I want to tell your wife on you and it's okay. But then there's some people where you do have to have like a more direct conversation, right?
Speaker 1:yeah, and it all depends on the person, right like it. If it's a person that's an old man, he probably is very much a old timey person. So by this time if they're still married, divorce is probably not a thing and saying something to bring up that he is married is going to bring shame onto him and his name right. But if it's just a 20-year-old who you know had just got married and is thinking about getting a divorce already, like he doesn't care if you're going to tell his wife, so you sit and you say, sir, this is not how you're going to talk to me. We are going to be here for your professional as a professional, taking care of you and making sure that you are in a healthy state and you being sexually aggressive is not appropriate.
Speaker 3:Shut it down Right.
Speaker 1:And that's okay. And you didn't say anything out of the way. You didn't say any slander.
Speaker 3:Yeah, you just put it out there, just out there there's a.
Speaker 1:There's a um inspirational speaker slash author, who her name is Brene Brown, and my manager absolutely loves, yeah, okay so both Colby and my manager love Brene Brown and one of her her sayings is clear is kind.
Speaker 3:Clear is kind? Yes, it is.
Speaker 1:And so being very clear and telling people because really and truly, we as nurses and I think we've said this before we have to build trust with our patients. And building trust with your patients means that you are going to tell them how it is in the best way possible that you can tell it, and the best way possible is for you to be clear. So you're going to set that boundary and say this is not how I'm going to be handled and I'm going to be professional and ensure that you get the best care that you can, but you saying this is not allowing me to do that.
Speaker 3:Right.
Speaker 1:And, as you're clear to them that, honestly, it might at first seem like it's cutting a bridge or tearing down a bridge, but they're going to be like, oh you know what, I'm sure they're probably going to actually take care of me because they took guts to say stop that.
Speaker 3:Yeah, a lot of times you'll find like after you kind of just like are very straightforward. It's almost like, oh, okay, I'll respect them now.
Speaker 1:Yeah.
Speaker 3:And this is so annoying, like we shouldn't even have to have these conversations. You'd think people would just be normal human beings, but apparently the normal is that they're all weird, like my normal is not the majorities no. Is what we learned.
Speaker 1:And it's interesting because there are so many nurses that truly want a daisy. They truly want a daisy. They truly want a daisy. And those, those patients that are sexually aggressive or sexually inappropriate or just straight nasty are not. Don't be the ones that write you a daisy more than likely. So you know just forget about that. You know, really focus and put your energy in the ones that are nice and probably will write you a good review assignment, but like how do you, how do you go?
Speaker 1:about asking for a new assignment and I guess think of it as a Clin 1, who is probably new and is kind of timid and like oh my gosh, I'm picturing like a Clin 1, just like not asking and like praying that somebody helps them. And goes home and like cries themselves to sleep I it's like I had the worst day ever.
Speaker 3:I need to quit this job.
Speaker 1:I'm out, which is not what we want.
Speaker 3:No, I hope that, as a new grad nurse or graduate nurse or Clin1, whatever they call you at your facility, like I hope that you have some like faith and trust in your leadership. I mean literally, yeah, um, like faith and trust in your leadership.
Speaker 1:Mm-hmm.
Speaker 3:I mean literally.
Speaker 1:Ooh.
Speaker 3:Yeah, because really, I mean, if you were just getting off orientation and you're having you got like a shit assignment and you like somebody is just cussing you up and down and you're frozen like I'm seeing it, like you're frozen Right, you don't know what to do, I hope somebody's watching you like I hope someone's looking and and not like watching you like we're watching you get yelled at, I mean, like I always feel like somebody's.
Speaker 3:I hope someone is like mama bearing you or papa bearing you like, like keeping an eye out and watching you throughout your day and checking in so that if they, if that way, you either one felt comfortable enough to come tell that person, whether it's a charge nurse or another nurse that's just working, or your manager or your sister nurse manager like I hope that you have at least one person every shift that you were like this person's looking out for me, like that you could tell and, at the very least, that you, that your charge nurse, is actually looking out for you because that's a part of your job as charge nurse is to watch the like watch everybody, but keep an extra special eye on on the new grads that are off orientation and now flown the coop and are out there, you know, floating like trying to hang on like doggy paddling.
Speaker 3:They're doggy paddling out there and you just need to make sure you know you can throw like trying to hang on.
Speaker 1:They're doggy paddling.
Speaker 3:They're doggy paddling out there and you just need to make sure you know you can throw them a bone if they need one. So it's like I definitely keep a close eye on my grad, like my new grad nurses, once they're off orientation and if I and I work, my unit split to two units. We have a big unit and like a 12 bed unit and this isn't just go for my new grad nurses. Like I have walked in on rooms, like my ears, my hearing is great, like if I hear a voice raised, you better bet I'm walking.
Speaker 3:I'm doing a drive by at least Like are you handling the situation? Do you need backup? Because I'm here and I'll walk in.
Speaker 1:Well, yeah, and you know, the interesting thing is that you, you, you are, you've, you're. I have worked under you one as charge and then two. I've seen how you just are interacting with other patients and coworkers and it really is interesting how quickly you're able to like analyze a situation and be like, yeah, I'm stepping in, Like I'm not doing that, your unit, like I said once again, my unit is just so much bigger.
Speaker 3:Yeah, I know, yours is geographically massive, right bigger.
Speaker 1:Yeah, I know yours is geographically massive, right, yeah, and so like it is so difficult to have our church nurses be as attuned, because there there's no way your ears can hear that yeah um, but there was a time where one of our new clint ones came up and was like, after it was like a day or two, and I just happened to hear it from someone else, and she came into my office and was like you know talking. I was like hey, I heard patient so-and-so, was like really rude to you. And she was like yeah, and she tells me the story. I was like I am so sorry that you didn't feel comfortable enough to come and talk. You know to tell me that, but next time do not allow that to happen.
Speaker 1:And please come and get me Like I'll roll up and because that's not, that's not appropriate and that is not fair to you, that that's ridiculous.
Speaker 3:Yeah.
Speaker 1:And you know I really did. I felt really really sad that I did not like I failed her yeah, you do.
Speaker 3:You feel I can definitely imagine that because, like, where your heart's at is wanting to protect everybody right and then you feel like that person. Not that you didn't know about it in time, so you couldn't but like that that person wasn't protected by someone like oh, that kills you you're like this is crazy. That's bullshit. You should never had to go through that.
Speaker 1:I'm so sorry, you really shouldn't. Yeah, and, and you know we we're really focusing on clint ones, but clint twos, threes, fours, experienced nurses, however you want to call yourself everybody experiences the abuse, yeah. And you shouldn't have to take it.
Speaker 3:Yeah.
Speaker 1:Even if you're the veteran on the floor like you are looked up to, but you should still have like you might. You might be the charge nurse, but you should be willing to talk to your assistant nurse manager or your manager director, somebody, because that is not something that you should be experiencing or putting up with, like the occasional name calling, if it's the. You know it's hard to say name calling is mild, but I guess it really does boil back to what you said at the beginning, colby If you feel like your safety is in jeopardy, you should not. That's the line.
Speaker 3:Yeah.
Speaker 1:If you're jeopardy, if your jeopardy is in danger, if your safety is in danger, then pull the plug, pull the cord.
Speaker 3:Yeah, that's it.
Speaker 1:That's it. That's all you have to really focus on If you do not feel safe or if you don't feel like you can give safe care.
Speaker 3:Yes, because that can be different. I was just going to say that.
Speaker 1:Yeah, that can be different.
Speaker 3:Yeah, if the treatment on you is making you feel like you know what, I don't think I can deliver optimal care to this patient at this point because I'm so upset or I'm so angry or I'm so hurt, I'm going to step away, right? Unfortunately, you will experience that if you don't know what we're talking about, it's going to happen Like you can be the best nurse in the world, but if somebody does or says something to you, you're going to hit. You're going to hit your wall and you're going to know when it is, and you're gonna be like you know what. I physically can't go back into this room again.
Speaker 1:I'm one of those people that internalizes a lot of stuff and just lets it sit and fester. I've gotten a lot better, but when I was younger I could just remember and my dad I'm sure remembers this story and if he's listening he probably will kind of chuckle but I had just gotten over a labral repair, had just finished that, and it was kind of rehabbing my arm and my dad and I played baseball and so we were playing baseball and doing all these things and I was rehabbing in the hallway of our room of our house and I'm rehabbing, rehabbing and not doing things right, and dad was like you know, take a break. And I was so pissed and it just like everything up until then had just really boiled and I went to go hit my dad and I was like that's not the right thing, thought better and so I punched the wall and punched a hole in the wall.
Speaker 3:Oh no, that wasn't good either, yeah.
Speaker 1:I was like well, had to patch it up.
Speaker 3:Learn a lesson Whole thing, lesson learned. But let that be your lesson listening to us today and not let yourself get to a point where you explode like that, because then you're breaking your professionalism. You're not there delivering the care that your job is. The patient has now won.
Speaker 1:Right.
Speaker 3:Basically. I hate to say it like this, but that really is what it's like. It's like they're like oh, I won. You are a terrible person You're. You're scaring me. You were brought to the edge by this person. It's you. You have to recognize when you're getting to a point where that's it. We're not doing anything else here.
Speaker 1:Yeah, and you know it really also is finding and we'll talk about this later too is finding a way to mentally be able to heal yourself and make sure you're healthy in spite of having all these terrible things going on Codes, people dying, abuse by patients, co-workers that get on your nerves, like all those things build up and you can't allow it to just fester. You have to find that outlet in a very healthy way and do things outside of work, Even in your 30-minute break, because I'm going to emphasize that again, you need your 30 minute lunch break, because that needs to be a time where you decompress for that first half of your day and because, who knows, you might have three patients that code on you in one day and you have to still work.
Speaker 3:Yeah, you have to keep going.
Speaker 1:And you can't break down. Nursing is a strong profession break down, you've you nursing is a strong profession.
Speaker 3:You have meaning that you have to be strong, right, um okay, so is getting a new assignment mean your failure?
Speaker 3:absolutely absolutely not. Let me make that not a little bit louder. Absolutely not. I mean honestly. If anything, it means that you are, you are in tune with yourself, right One, like you know. Ok, I've got to step away from this. You should be proud of yourself to know, like when, what your boundary is, because it's hard to find, especially as a new grad. So much stuff that I shouldn't have, and I've seen coworkers take way more than what they should have. Um, and seeing you know leadership, step in and be like you. Don't. We're not doing like, you don't have to do this anymore. We'll figure it out Like we'll reassign Um yeah and really and truly like.
Speaker 1:It's not a failure on your part and it's okay to spread the love. Like it it's not love, but like in terms of like. If you can only take care of that person for one shift, if you genuinely know tomorrow will be the shift that breaks, you go ahead and tell the charge nurse, you know, if you can just remove me from this assignment, if you want a whole completely new assignment which colby talked about a couple of shifts, or a couple of shifts a couple of podcast episodes ago, but also if you're just like I can't have room five anymore, like that's okay, that's totally fine yeah, we do it all the time.
Speaker 3:There's always notes at the charge desk that says room five no, blank, blank, blank, like all these names because we were rotating them.
Speaker 1:Like it's just, we can only do one day otherwise we're gonna quit this job kind of situation and there are one and done patients is what we call them one and done one and done, that's okay, and to those that make that one and done two or three days more power to you.
Speaker 3:Yeah.
Speaker 1:But you don't have to, especially if it's known that this patient is difficult.
Speaker 3:Yeah, and that's the mentality in every hospital that I've ever worked at. It's like it's the mentality and the reality of life is that there's always going to be difficult people, whether that's someone you're passing by on the street or the patient you're assigned to to take care of for the day. And I think it really, it really like helps to realize, when you realize that, that you don't feel that like guilt for, oh, I can't take care of this patient, the like. Does that mean I want everyone else to suffer? No, that's not what's going on. We are all of the same mind, we all understand what that person's going through and we just expect it and sometimes we make changes on the fly.
Speaker 1:That's healthcare, it's true, and in order to keep you safe, it's okay to document some of these things. I know certain health electronic health records allow you to put in notes and then kind of hide it from patients to make sure that they don't see it in their personal like mobile record where they can see their mental medical records on their phone, and it's okay to put those notes in and being like patient was verbally aggressive, stating blank, blank and blank yeah, it's always good to quote right because that's what they said right, and if it's, if it's curse words, put those explicits in there, like it's okay I do, yeah, okay, I'm like oh, that's what you want to say to me, and our personal electronic health record has behavioral flags and it's
Speaker 1:able to really emphasize the what this patient is doing. That's inappropriate and in a court of law, if something was to happen, if you were to press charges on someone you need that information there because you take care of so many patients you might not get that court date until months after.
Speaker 3:Yeah, documentation is super important. You just you need to create a paper trail when yeah, when these adverse behaviors start developing, um, and what you did to try and mitigate it. Education that you provided um medical team. Notifications of the behavior, like these are all. It's all important to prove that, like, if, like, if their behavior is um adverse, uh, like adversely going with their care plan, then and they don't want to participate in their care plan, and then they're doing.
Speaker 1:You know what I'm saying like I know this story okay oh well, this is.
Speaker 3:This story is for every single patient oh okay, never mind but and when I say every single patient like any, when we're talking about documentation, this is what I mean. Like most of the time, the difficult behaviors that we're running into are impeding care that they're there for.
Speaker 1:All right, it's time for this episode's spotlight case, where we write, break down real-life nursing scenarios that left a lasting impact. Some cases challenge us, some teach us lessons the hard way and some, well, they remind us why we love or question this profession.
Speaker 3:And today's case is definitely one to remember. Picture this you're mid-shift, everything seems somewhat under control and then, out of nowhere, things take a turn fast.
Speaker 1:So let's set the stage for each of us, and here's what happened.
Speaker 3:Okay, well, literally, quite like I just said, everything was fine and then we're going awry real quick. We have had this particular patient quite a few times on our unit, which often you will find when dealing with a patient who is admitted with infectious endocarditis related to IV drug use. Unfortunately, this patient came back again for the first I don't know maybe the third or fourth time this past year with worsening infection. I don't think that they ever truly cleared it.
Speaker 3:As you can imagine, a patient with a history of IV drug use or abuse can have pretty difficult personality traits to deal with. At times the patient had been with us probably for about four weeks and intermittently manipulating team members, medical team members and nursing staff into getting what they want. Often, for an example, would start screaming and yelling at staff and refusing to participate in the care plan. He refused medications, telemetry monitoring, vital signs, the patient was a diabetic, refused glucose checks, insulin, ended up on an insulin drip because their sugars got so bad. So fast forward, that's to set the scene. Yeah, it's a lot, a lot every day doing the same thing over again, arguing and trying to educate and convince and it feels like it's not worth it.
Speaker 3:It feels like it's not worth it every day. Yeah, and it feels like it's not worth it. It feels like it's not worth it every day. It all came to a head after I, on track over the last few weeks. I'd been off for a couple of days apparently. The day before things got pretty heated. He was out in the hallway raising voice, screaming, using cursing language, and I don't even know, I don't even remember what about. It could have been anything, truly, and it was usually like the smallest things and then, in order to get him to calm down, staff was just going downstairs to the cafeteria to get him a meal that he would prefer, like sushi or which came out of the unit budget.
Speaker 3:Yes, it comes out of the unit budget. It's not like the hospital like pays for it right all right, so he would do things like this.
Speaker 1:We're not that fancy, yeah we are not that fancy.
Speaker 3:He would do things like that, like refuse antibiotics until he got the sushi that he wanted for example, and it would be a knockout scene.
Speaker 1:Oh yeah.
Speaker 3:So the day I come in, Oscar winning Sorry.
Speaker 3:Oscar winning scene. Every time, the day I come in, the nurse that was assigned I was in charge the nurse that was assigned to take care of him went in to give him his medications, to which he immediately replied I'm not taking any of it, except for the suboxone and gabapentin or anything that'll treat my pain. Refused the antibiotic, refused the antifungal, refused all these important medications that he needs to take for his blood pressure and all this stuff, and the nurse took all the medications and said I'll be back when you're ready to take everything.
Speaker 1:Which is a great boundary to set.
Speaker 3:Yes, and she was walking out of the room prepared to go send the doctor a message to let them know that the patient does not want to take the medications, except for the ones that he the two medications that he said that treat pain, medications that he said that treat pain um, and he followed her out of the room aggressively, starts screaming calling her offensive names, of course saying all kinds of crazy stuff that she's like withholding his meds because he just wanted the pain meds and didn't want the antibiotics and all that stuff that he had been refusing for more than 24 hours.
Speaker 3:Documented. The nurses just say charted, refused, let the doctors know. The doctors were aware, like everybody's been letting this man get away with all of this for multiple days in a row. I was sitting there when he comes out of the room and I said his name and I told him you need to go back to the room to which he was then redirected, his anger and screaming towards myself and I was not the one, no, but I did remain professional. I told the patient again to go back to their room. They refused. I picked up the phone and I dialed our emergency number, which got our operator to send a behavioral emergency response team. I also asked for the police.
Speaker 3:The patient then realized that I wasn't joking around and went back to their room but was still screaming at us from the doorway when the police came. So did the doctors, our hospital security, our nursing supervisor, our assistant nurse manager and myself as charge. We all went into the room. The patient seemed to calm down, said that, then became agreeable to take all of their medications and so I go in there. I told the nurse, you don't have to go back in there, we're going to figure this out. And we told with the medical team, since this has been greater than 24 hours just flat out refusing the medication that he's been admitted and being treated for, let's get him on an oral antibiotic and discharge him. So I said, great, I'll take care of him until he walks out the door.
Speaker 3:I go in, I get all of his medications, I gave him all of the orals. I go to hook him up to his IV. And I had to go get the scanner from across the room and right before I like right, as I'm scanning everything he is, can I go to the bathroom? And I was like, no, I'm going to finish doing your medications. You can bring this IV pole into the bathroom with you. So you're going up to the antibiotic. So, because of how sudden it was, and it was right, after I had given him his Suboxone, the nursing supervisor was also in the room with security and you in the police, and she looked into the bathroom because she was like that was kind of suspicious, observing was a box like a to-go food box, and so she opened it up and lifted up the washcloth, and in the to-go box was white pills in a medicine cup, a cut straw no and a used saline syringe that was dirty, so it was very apparent that the patient was crushing some sort of medication.
Speaker 3:I don't know if it was something that he had been getting at the hospital or if it was something that he had when he came in, or was it brought in. That's all. We're not sure, but it was very clear that they were using it. Based off what the syringe and the straw.
Speaker 3:So I got him all hooked up. He goes to walk into the bathroom and the nursing supervisor asked him if he had anything else in there that they need to be aware of, and he got very activated, of course he did. Because you know, his secret stash was found and was screaming all over again. We all exited the room for our safety at that time, but then that did prompt, like per our health system protocol, that his whole room need to be searched because there could be other paraphernalia or drugs in there we work more closely with the residents and then, you know, they go up their chain of command.
Speaker 1:The attendant came onto the floor and was like I'll tell you what we're not going to do today Not having this.
Speaker 3:We're not doing this. So he's going to go in. I'm going to tell him what the plan is and if he disagrees, then you can imagine. The patient did not consent to the search and did not want to consent to completing his antibiotic and participating in his care, and so the doctor said that's fine, you will be discharged. Then Did he sign out AMA, which happens a lot of times. But I learned that day after 10 plus years that there's something at our health system called an administrative discharge and it's like when you have multiple documented accounts of behavior like this, you know physical and verbal abuse to staff that the and they don't want to participate in getting better and getting the treatment that they require the hospital attending can discharge them from the hospital.
Speaker 1:I wonder if that's something that's done in all hospitals, because I feel like if they don't have that there's a problem. I mean it should be something that all hospitals should have, should use absolutely.
Speaker 3:I think sorry. Should be something that all hospitals should have. Should use Absolutely. I think Sorry go ahead.
Speaker 1:No, no, no, and the fact that you have been here for 10 plus years.
Speaker 3:It's the first time I've ever seen it.
Speaker 1:Right. I was like what, that's a problem. I mean, I also had never heard of it until and I was like, oh my goodness.
Speaker 3:Yeah, I was like I'm keeping that in my back pocket. I feel like in this day and age, physicians LIPs. They're so scared of getting sued, which rightfully so.
Speaker 2:I mean, that's a word, that's a terrible, that's a nightmare.
Speaker 3:But I think it's almost to their detriment that they keep patients or beg them not to leave because of the fear. And it's like these patients. There's so many documented accounts of them not wanting to participate in their care plan. Why are we begging them to stay? It's a waste of my time, it's a waste of your time, it's a waste of their time, and there's a hundred patients waiting for a bed in the ED right now. So what are we doing here? That's crazy.
Speaker 1:Get them out.
Speaker 3:Get them out.
Speaker 1:Yeah, and it is funny because we do have so many people that are sick and are willing to have their care being given to them. Where we do, we cater to these aggressive, combative people and it's like nah yeah if you need money, if the hospital needs money, there are plenty of people that can give it to you. Yeah, so my interesting case is I was charged also, so this was when I was on the floor and I was just a wee charge nurse.
Speaker 3:I had just started.
Speaker 1:I think it was literally my first shift off of orientation as charge. It was either my first or second. It was within the first week and I had a newer nurse who was taking care of a patient who had just had rejection of their organ and they were going on and doing steroids, pulse steroids and rabbit or antithymocyte, antithymocyte globulin and they were going through and getting the steroids, but they also had diabetes and so they were on a glucobander or insulin drip. And so I'm going in and I have a lot of the times I either wear my hair in cornrows or box braids and I was wearing my hair in box braids at the time, and so I had beads to kind of help lay and bring the hair down and make sure it didn't curl up. And it makes noise kind of like jingle, like yeah, yeah, that's my nails, that. It makes noise kind of like jingle, like yeah, yeah, yeah, that.
Speaker 3:That's my nails.
Speaker 1:That. And so I went in and talked to this patient. I was like, hey, how are you? You have this insulin drip and I was changing it. So I was like telling the client, the patient, excuse me, what I was doing and why I was doing it. And I was like, oh yeah, you're gonna be almost off of it in like two hours because we had just given the nph and blah, blah, blah, blah blah.
Speaker 1:And I went ahead and did leadership rounds. It was like, how are you doing? How's your care? They were like oh, it's great, blah, blah, blah, blah, blah, blah. And I was like, okay, cool, and so I leave. You know, yeah, and walk out and continue my leadership rounds on the rest of the patient and patients. And I come back out and my, I don't think they were clint two yet. So my clint one was like christopher and I was like what's up? And they were like patient in room 25. I can't remember which room it was. I can't find them. And I'm like what do you mean? You can't find them. And the nurse was like I have no clue. I checked the bathroom. Their stuff is gone. They're not in the bathroom.
Speaker 1:Outside of the unit I had my PCT run down and like, look at the the cafeteria and make sure they didn't just like wandered out to the cafeteria and I was like, oh my God, are you kidding me? And I had gotten to the point where I was like, oh my gosh, so what do I do? And I luckily had an experienced charge nurse this was night shift, by the way. I had an experienced charge nurse that was there and I was like, what do I do? And we had to walk through this whole process and I intercom the entire hospital to make sure they were not around the hospital. And then we were starting to call the hospital. And then we're starting to call the patient. We're like call the patient, call the patient, call the patient. No answer, none whatsoever. So much so that they started to, like you know, ignore the calls.
Speaker 3:Oh, they were just sending them straight to voicemail, yeah straight to voicemail.
Speaker 1:Wait, did they take?
Speaker 3:their IV pole with them, or did they take? So they were just yeah, straight to voicemail. Wait, did they take their iv pole with them, or did they take?
Speaker 1:so so so they had just gotten off of the okay, yeah, they had just gotten off the insulin drip because of the. It was like, right, when he had finished, uh, the insulin drip okay. And so I finally, and I finally, we were like we've got to do a well check. I mean we've got to, yeah, because they still have the IV in.
Speaker 3:Yeah, you know they still have an IV.
Speaker 1:Yeah, they don't have the drip, but they have an IV in.
Speaker 3:Mm-hmm.
Speaker 1:And so they go to this person's house, which is over an hour away.
Speaker 3:Oh, gosh Okay.
Speaker 1:And the patient's there.
Speaker 3:They were like bye.
Speaker 1:And I'm like long story short. This patient said, I quote, christopher the charge nurse threatened me and I didn't feel safe so I left and I'm like there goes my job oh my gosh, that's crazy. I'm like I am done that's so crazy, as you can probably what a dirty little liar. Oh my god it was awful, I was. I was petrified. Yeah that I was going to lose my job. Yes, Like what. Luckily, this person had had documented accounts of there you go.
Speaker 3:Documentation.
Speaker 1:Steroid-induced psychosis.
Speaker 3:Okay.
Speaker 1:And so they were able to deduce that it was the steroids, because we were giving them such huge amounts.
Speaker 3:How did they get home, though? Did they drive themselves they?
Speaker 1:drove themselves. Oh Lord, I know.
Speaker 3:Yikes, so did they call an Uber.
Speaker 1:No, no, no, no, because they came in for rejection treatment, so they drove themselves here yeah, so crazy wild.
Speaker 3:This made no so did they get brought back by the police?
Speaker 1:they didn't. They actually came, they went to their local hospital, because there was a local hospital there, uh-huh, and then from there they got um shipped to us which we no longer had a bed for them. Oh no, because it was, I mean, within I mean, yeah, someone leaves, there's a.
Speaker 3:Yeah, there's a person right there, it's a protocol that we just yeah give the bed away, and so, yeah, I that wasn't.
Speaker 1:I'm sorry, that's just a free little story there.
Speaker 3:I mean it does tie into, like the. I mean unfortunately. Unfortunately, there was like a true medical cause for them to have this thought or idea.
Speaker 1:Right.
Speaker 3:But it does tie into like accusing you of something that's not true which you'll run into.
Speaker 1:I was like, oh my gosh, and I was. I was terrified.
Speaker 3:I would have been too. But obviously I was okay, because I'm now the there were no marks on his background check after that. I still have my license.
Speaker 1:I'm now the assistant nurse manager, I think.
Speaker 3:I'm fine now. Yeah, no red marks on the resume Wow, that's so crazy's wild.
Speaker 1:All right, so that wraps up the the segment break. I'm not gonna give you another. Another case.
Speaker 3:That was the one I was thinking on.
Speaker 1:We'll stick to it yeah, so like to kind of like wrap this up. Interestingly enough, patients aren't the only ones that really test your patience.
Speaker 3:Patients aren't the only one that tests your patience. Sometimes your problem could be with your coworker Right.
Speaker 1:So when a coworker doesn't like you, what do you do Like? How do you handle it?
Speaker 3:Me personally, I just avoid them and I think honestly that's good advice across the board Like don't. If so, if you know someone doesn't like you, for whatever the reason is, like Just avoid them whenever possible, and maybe that I mean maybe someone else would say something different. Like you should try and figure out why say something different. Like you should try and figure out why. But honestly, as someone who doesn't like certain people, I avoid them.
Speaker 3:So I appreciate it if they know that I don't like them that they avoid me, but that's not to say like if they need help, I'm going to help them. That's your job. You're there for your job. You're not there for personal relationships. Sometimes your coworkers become some of your closest friends, but that's not a necessary part of the job.
Speaker 1:I mean that's true. I told you that I read this book called the Five Dysfunctions of a Team. The bottom foundation or the first dysfunction is lack of trust, and I'm learning and growing and I'm not perfect with this at all, this at all but something that I'm starting to emphasize is that to be a team, we have to learn to trust each other. That means that even in the midst of us not liking each other, if we come to you with a corrective or a criticism, that is conducive. And what is the actual C word that I'm looking for?
Speaker 3:Construct.
Speaker 1:Constructive. Okay, if I come to you with a constructive criticism that doesn't, it's not a. It's not a plight on your, your character, it's not a attack on your pride.
Speaker 1:It is for the ultimate goal of delivering excellent patient care, and so there has to be a lot of trust that you, as the one that's giving the constructive criticism, aren't doing it to just be mean or just because you think your way is the best way or the highway is the other way, and then you as the receiver have to understand that I am going to receive this constructive criticism and attempt to adjust, because I know you're doing it for the betterment of the patient care that I'm delivering and so if there is a patient or, excuse me, if there's a co-worker that doesn't like you, you still are able to give that constructive criticism. Yes, you might have to stay away from them, you might have to, you know like, but if you see something that they're doing that ultimately is not excellent patient care, you have a duty as a teammate.
Speaker 3:Yes, you have to step in and say something, and it's not easy.
Speaker 1:Like I said, I am nowhere near perfect. I just had a conversation and I'm the assistant nurse manager. I just had a conversation with one of our teammates yesterday about something that was brought up to me And'm like I've got to deliver this case, this, this kind of feedback, and it's not easy. I don't like it.
Speaker 3:Yeah, they're all.
Speaker 1:It's awkward and you feel bad because you're like I know you're a good person, but it has to be.
Speaker 3:You know it still has to be delivered yeah, yeah, I think that was a way more professional way um to give an answer than me when I just said avoid them, which?
Speaker 1:is interesting because you're one to not avoid people Like you're calling people out on things.
Speaker 3:Oh yeah, I mean, when it comes to patient safety and care, I'm going to call someone out if something needs to be addressed.
Speaker 1:I think I was taking it more of like a personal relationship approach, which was when I was saying, like avoid them, like you don't have to like sit and giggle with people or try to like figure out why someone doesn't like you because you're there for a job, you're there to take care of a patient yeah, but I think there's and I somewhat agree with that I think there's a point where not every family member likes each other, right, true, but really and truly, sometimes you spend this time with your coworkers and it's exponentially more than you do with some of the people you live in the same house with, and so like you've got to find a way to coexist coexist.
Speaker 3:Yeah, no, I agree, I think in the sense of yes. We spend sometimes more time with the people we work with than we do our families or the people that we live with. Yeah, you have to find a way to coexist, because if you don't and we've talked about this in past podcast episodes as well like, what do you do when you have, like, a disagreement with a co-worker?
Speaker 3:and like how should you handle it? Um, you need like, you need to get, you need to get some beef out of the way sometimes, but ultimately you need to remember that it's the patient that you're there for, and so you have to leave it at the door and go into. You know, go to perform your patient care to the best of your ability.
Speaker 1:Right For the patient. Really and truly, you, almost you've got to. This sounds terrible, but you've got to treat your coworker as a patient. Okay, explain, elaborate on that so ultimately, you don't know this person from Adam. You really don't really want to, don't want to get to know them, but you still have the conversation of hey, how's your day, where are you from? You know you get to build that rapport, yeah.
Speaker 3:It's not. You can be colleagues right, yeah, well, but you need to be, you need to be right you need to be colleagues, you don't have to be friends right so you can be professional with one another and just treat people with general kindness right that whole old saying like treat people how you would want to be treated golden rule that is a golden rule, right, and I think, even if you don't like someone like that is, you still have to treat them with kindness yeah, and you know overall, if that happens.
Speaker 1:and somebody interestingly enough, somebody said something about this the other day. They were like, um, oh, it was Okay, people who have Down syndrome. Okay. Are the kindest people in the world.
Speaker 3:So true.
Speaker 1:They're so kind, they're so loving, they so like non-judgmental, they just are so kind. If the world had everyone with down syndrome, we would.
Speaker 3:there'd be a lot of differences a lot of happy people, a lot of happy people, a lot of happy people.
Speaker 1:But we can learn from that, yeah for sure. Like these people who have far less abilities than someone who doesn't have Down syndrome, are so great role models of just being kind to any and everyone that they meet. And so you know, I'm using this as an example, but like for real, like you, you, you've got to learn how to not be sarcastic like all the time. Like sarcasm doesn't get you anywhere, it really doesn't, I don't like it. Like sarcasm doesn't get you anywhere. It really doesn't, I don't like it. It rubs me the wrong way all the time. But I but here's the huge caveat here I understand when people use it and I don't take offense to it. I don't like it and it does rub me the wrong way.
Speaker 3:I feel like you just said the opposite. I feel like you just said that you don't like it.
Speaker 1:But you're like I don't take offense, but I don't, I don't, I don't like it. It's not something I appreciate.
Speaker 3:Okay, okay, yeah, it's not that deep, I got it. I got it. It's like man you're just calling me out of my.
Speaker 1:Just funny how you ordered it. I might just take this out, um, sorry, I'll think about it really quick. But really and truly is what I'm trying to say is that there are things that people do that might not be the same way you would deliver or say things or handle things and it rubs you the wrong way. But you still have to. You still can be kind, you still can find a way to understand that person, not befriend them. You don't have to befriend them, but understand them to the point where you're like, uh, that's just colby, I mean you know like yeah that's just roman in my dog's name, um, and you just kind of live your life with them.
Speaker 1:But what it? How do you like avoid retaliation? Like, is there any point where you're like man, they're actually gonna come at me?
Speaker 3:Oh God, I hope it doesn't get that bad. Well, I think, and not necessarily not like coming at you with a knife, not like physical, but like maybe they're like trying to get you fired or something. Yeah that.
Speaker 1:Or they're like oh, did you hear so-and-so, so-and-so did something this way. Like we should gang up on them or you know, we shouldn't befriend them.
Speaker 3:Okay.
Speaker 1:Maybe not gang up.
Speaker 3:I think that's like such mean girl mentality.
Speaker 1:This is a very sexist statement and I will probably edit it out after this, but the nursing is mostly female. Mostly women.
Speaker 3:Yeah, no, that's true, true and that's just a fact. You don't have to edit that out at all. And I do think it's like it. Just that's the. This is.
Speaker 3:I'm a woman, so I can say it, but that's the nature of women like it gets catty. I would definitely say that I've like seen, I've witnessed like people be mean to each other for no reason, and I've, I've, and again, I I also saw it a lot more when I was younger and I would, I would feel like sometimes I'd be like involved or like in the middle of situations when I was, or my earlier days in nursing, or I was just like younger, I was in my 20s, and I feel like it was the same kind of mentality that like high school or college snooty girls had and it I don't know. And now that I'm older I observe the younger staff kind of getting catty with each other sometimes, but I'm, I think, with like wisdom, I'm like it's none of my business and I I personally maintain professional relationships with everybody that I work with and I'm not friends outside of work with very many people anymore because of experiences I had when I was in my early 20s in nursing where, like the staff, just I. It was like so involved with each other's lives in and out of work, and then when something went awry, it was too it muddled with work and it was too much, so what happened then? I mean, it was pretty like self-contained.
Speaker 3:I don't think that like management got involved or anything. Never, it didn't come. It didn't affect patient care. I guess the in the experiences that I had, I think the unfortunate thing is like unless it's affecting patient care, it doesn't really get talked about right, like yeah, because you kind of like, and I would even like imagine from a manager's standpoint you're like it's none of my business, I don't want to get involved, like.
Speaker 3:as long as the patients are getting what they need, then I don't want to look away and that's maybe not the best way to handle things, but it's probably how I was, unless it was like brought to me.
Speaker 1:Yeah, I don't know. I went through this whole the 75 hard made me really go through this, like self-developmental management and and I'm learning that management my unit that has made team culture a different challenge that both my manager and I are learning to navigate.
Speaker 3:Yeah, it's an ongoing journey, though for everybody I mean. So in a manager role like you have to figure out how to deal with these situations. It's just part of your, your job. I think if, again, like if you're on the floor and we talked about a little bit about this when we talked about our tech nursing aid episode Like if you're having a situation with your coworker and you're getting less help from them than they're giving others, or you feel like you're drowning every shift and nobody's willing to help you, like these are things that you need to speak up. You need to tell your leadership that these are your struggles, because if whatever you're doing isn't like getting resolved, whatever's happening to you or whatever you're doing isn't getting resolved, those situations again are just going to trickle down to the patient care and then the patient's not getting their needs met yeah need to talk to your leadership for sure
Speaker 1:and ultimately we are. We are here for you and or, excuse me, ultimately management is supposed to be there for you, and there are times where things from upper management or even just the health system in general can allow middle management to get so drowned or muddied in things that upper management and health system needs them to do that we can lose sight of those that we're actually there for, which is us staff members. I think that's what has been the. The hardest part for me is because, now that I had stepped back on the floor, I'm like whoa yeah you know, like there's that shift to the other side it's kind of striking right
Speaker 3:I would also like to say, like we talked, like you mentioned, like you have to have trust in your co-workers in order to have like a like, a good like work, balance, relationships, make, make the team flow, the teamwork.
Speaker 3:You need to have trust.
Speaker 3:I would say if you're in a situation where you feel like you don't have trust, and I would say if you're in a situation where you feel like you don't have trust and I mean not have trust with any coworker, with anybody in your upper management, in your middle management, hr, human resources is a great place to reach out to and that's at every health system or any job.
Speaker 3:They're going to have a human resources department and part of their role is conflict resolution. They hire people specifically in the subject and they'll help be mediators or just listen to what you have to say, to try and resolve your leg and find a solution to whatever's going on and that, like your problem might be with your manager, to whatever's going on, and that, like your problem might be with your manager and you, maybe you feel like you brought something up and there was a situation of you feel is retaliation against you. Human resources is there to step in as like a third non-biased party and look at a situation almost like an ethics consult for a patient where, like their role is the ethics, the situation that's going on, and they're there to protect you.
Speaker 3:If that's what you need to need is protection or help work to find a plan that's going to help get you back on track with the position, if that's what you really want to do, you're passionate about that and they'll help you walk through, like, if you decide you want to leave the position, like they're literally there to your benefit.
Speaker 1:Right, all right, class dismissed. That's a wrap for today's session of Nursing Life 101. We hope you found some useful takeaways to bring back to the floor. Remember, nursing is a lifelong learning journey and we're here with you.
Speaker 3:Remember, nursing is a lifelong learning journey and we're here with you. If you want to connect, find us on Twitter at NurseLife101, or on Facebook at NursingLife101. And don't forget to subscribe and share with fellow nurses. Conflict is a part of any job, but especially in nursing.
Speaker 1:Remember how we handle. It says a lot about our professionalism. Until next time, keep learning, stay resilient and make a difference.
