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The patient populus can make or break you.  If you like your patients, even the things that annoy you about the job itself don’t bother you as much.  However, if you don’t like your patients, if they are mean spirited, manipulative, and needy (*cough), then you are in hell.

I tell you this so as a new nurse you remember to ask lots of questions during your interview: what’s the patient populus like?  age? gender? conditions? co-morbidities? pain levels? how heavy is the med load? stable?  nurse/patient ratio?  Asking all the right questions can’t necessarily prepare you cause there’s nothing like first hand experience but it’s better than going in blind.

Maybe you decide the populus doesn’t matter cause all people suck.  That’s ok too.

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Let me take some time to discretely explain my patient populus, why it is difficult and why many of the new RNs on our floor leave in less than a year.  It is a 36 bed, high-acuity, specialty med-surg floor.  Our floor has a reputation in the hospital as one that is basically “ICU unlabeled” with extremely high standards and difficult patients.  Night crew nurse to patient ratio is 5:1 (which is far too many for the type of patients we have but whatever).

Let’s examine a typical atypical scenario (i.e., this doesn’t happen every time I work but at least every couple weeks).  I have five patients.  I start rounding at 7:30/8pm.

Patient #1

A 44 year old male whose procedure went south.  He’s actively dying.  Family is in the room, mourning.  He doesn’t respond to questions.  His skin is cool, pulse weak; he’ll die in a couple of hours.

Patient #2

A 34 year old female with pancreatitis, addicted to pain medications, asks immediately for IV Dilaudid with Benadryl (she has a “slight allergy” to opioids), IV Ativan (she gets “nervous” in the hospital) and surprise, surprise, she’s also nauseous (enter: IV Phenergan).

Patient #3

A fresh post-op patient just delivered from the ICU.  Insulin drip?  Check.  PCA pump?  Check.  NG tube, foley, feeding tube, wound vac, JP drain?  Check.  An insane amount of meds to give that will take 30 minutes to administer because you have to crush them all?  Check.

Patient #4

An off service patient from the ER (there’s no where else to put them).  No notes from the doctor.  No plan established yet.  Patient is nervous, they have a fever, they’re vomiting, can’t speak English. You pretend everything’s fine and this is all normal.

Patient #5

Frequent flier.  They’re either needy & lazy (the kind who just pees & poos on themselves even though they can walk) or they are unpleasantly bossy (even though they are the ones that put themselves in this situation since they stopped taking their LIFE SUSTAINING MEDICATIONS).  They will ask you immediately for ice, water, and a snack.


The epic nursing school question: who do you see first?  I get a plan in my mind, go into the med room and pull medications.  Pancreatitis chick calls, “I need my medications.  I’m in pain.”  The tech calls, “The patient with no plan just vomited all over the bed.”  The family of the dying patient calls, “Can you come in here please?”

So much for plans.

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I go to the dying man first.  They ask me to listen to his heart, “Is he breathing,” they ask.  I place my stethoscope on his chest.  I hear “lub” and it trails off.  He’s gone.  Damnit.  I wish he would have waited for at least another hour or two.  Now the pacing of the evening will be so chaotic.  I explain the process to the family and give them time.  I leave the room.

I call the tech for the post-op patient, “She has an insulin drip.  Wanna check her sugars on the odd hours and I’ll do evens?…… Drainage?  Well she has a JP drain so she should have drainage.  Just tell them it’s normal, er… ya know what, nevermind, I’ll go in.  Thanks.”  Fresh post-ops; so paranoid about everything.

I hear a loud moaning down the other hallway; it’s Dilaudid Home Girl agonizing over her pain level.  I enter her room, remind her she can’t be loud like that with other patients on the floor.  I tell her the meds aren’t due yet and I can’t bring it all at once because it’s too sedating so she can pick two.  She huffs.  Complains.  Tells me other nurses give all of it to her at once.  It takes all I have to not shake her, “Do you realize people die here?!  A spirit just down the hall is gone forever and left a room full of tears behind. Don’t you know how small and insignificant you are in the grand scheme of things?!”

I leave the room.  The fresh post-op patient’s family member calls me, “Doesn’t she have 9 o’clock meds due?  It’s 9:15.”  A tech mimes to me while I’m on the phone, a throw up motion from the mouth with hands up to represent the room number.  Damnit.  Behind her, I catch a glimpse of Frequent Flier walking off the floor with his IV pole and a pack of cigarettes in his hand.  Well… at least he’s not on oxygen.


This is a common scenario that most every nurse can relate to.  The chaos.  The unsafe level of multi-tasking.  The ignorance of patients.  Anxiety control for families.  Pain control that’s uncontrollable.  People yelling, talking, chatting, calling, asking, complaining; it’s never ending!

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Some floors, however, have a larger mix of varieties, such as ours.  We can have pain control/withdrawal issues in one room, end of life care in another, a fresh post-op with high acuity needs, and other patients who may be stable but because of our floor’s specialty, they are getting high risk medications that require us to leave a crash cart outside their room (how comforting) or blood administration or restraints due to confusion and aggression.  The range is huge and it’s exhausting, especially when our patients are so ungrateful, so needy, so down right mean in most cases.  It becomes disheartening, it hardens you, you start to not care about them.

I know the patient population who I enjoy working with.  It’s hospice and it’s veterans.  I should have pursued that harder and plan to do so now that I understand how much of a difference it can make to work with patients you truly enjoy helping.  That’s my advice to any new nurse: if you like a populus, go for it.  Immediately.  If what you like requires experience (like hospice), then get as close as possible to it and constantly pursue other jobs even if it’s through volunteer work.  It will save your spirit.

 

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