I Despise Myself Sometimes

When I was a nursing student doing clinicals, my fellow nursing students and I would comment on how cold and jaded the nurses seemed towards patients, nursing students, and just their jobs in general.  We couldn’t understand how anyone who was so cold hearted and jaded could be a nurse and be in a profession that is about caring about patients, families, and people in general.  We vowed we would never be “those nurses”.  However I am sad to say that I now understand how those nurses seemed so uncaring.

Nursing is a very emotional profession.  Unlike professions such as, accounting, managing, waitressing, bartending and many other professions which allow an emotional space between the employee and their clients or customers, nursing requires nurses to be emotionally tied to each and every one of their patients all the time. However we are not only tied to the patient but also to their families.  Because of this, nursing is a profession that can mentally and physically drain a person. 

In my job, I care for a lot of patients who are active drug users or alcoholics.  These patients all deserve the same amount of care as any other patient.  However, many times it is harder for nurses to keep an objective mind towards these patients, because the majority of these patients are not trying to better their health or their lifestyle. 

It is very frustrating to emotionally invest in a patient, only to have them pay no regard to their own health and safety.  Many times, the patients with active drug use or history of drug use are long term patients because their number one ailment is an infection of some sort, which requires extensive antibiotics.  The usual plan of care is IV antibiotics; this means the patients are stuck in house because doctors do not like to discharge these patients home with IV access to decrease the risk of unintended drug use by patients. 

Recently our unit was caring for a lady who was in for an abscess.   The doctors went in and surgically cleaned out the area, but the patient was going to require long term antibiotics.  This patient had an impressive history of drug abuse and was going need to stay in the hospital.  The patient was not happy about this at all.  She did not want to go through the withdraw process or even stop taking the drugs at all.  The doctors were able to convince her it was in her best interest to stay and receive the antibiotics.  However it was a daily battle with this patient.  She was constantly wanting to leave against medical advice or constantly wanting to disregard the doctor’s orders and leave the floor to go smoke.  She was told she was going to have stay most likely for six to eight weeks. 

The patient managed to make it six and half weeks in the hospital before she completely broke down.  She began to tell the staff that she wanted to leave no matter what, she didn’t know why she was staying since she was just going to get into the drugs again when she left and she didn’t want to change so why were we making her. 

One day I was drawing some blood on her when she looked at me and asked me “so I have been thinking about leaving 10 days early.  If I leave now what will be the risks?”  I looked at her for a minute while I considered my answer.  I have learned that some cases require a sugared down answered but in this case I decided to be honest.  “If you leave early, you are setting yourself up for the infection to come back stronger and with a vengeance and you may die before you get help.”  Of course, at this she began to cry.  “I just don’t know what to do, I need to leave here and I can’t wait any longer.”  We talked for a while and I convinced her it was worth finishing out, especially since at this moment she had been clean for almost seven or eight weeks and she was almost done.  If she finished it out, the doctors were going to refer her to a place to help her with her drug substance problem.  She agreed very unwillingly. 

As I left the room, I caught myself thinking “Well, maybe she should just leave.  There are many other people who want her bed.  These people would be willing to actively participate in their care and who want to get better.  She shouldn’t be here.  Maybe it would be better if she left. It’s not doing any good, she’s just going to use drugs again when she leaves, and end up right back here with another infection, or worse yet die.”  When I realized where my thoughts had gone, I stopped dead in my tracks.  I realized I had become those nurses that I couldn’t stand as a student.  After thinking about it longer, I came to the conclusion that it is way too easy to become that person.  The person who makes judgments based on a person’s choices or their history, and the person who decides who is worthy of my care and who isn’t.  Unfortunately this patient did leave that afternoon against medical advice. 

After being a nurse for two years, and seeing many new nurses begin their careers, I know how easy it is to fall into the trap of being cold and careless towards patients.  It doesn’t take long for new nurses to begin to stereotype patients together and make generalized statements regarding patients.  We need to all work a little bit harder on remembering that everyone who comes to us for care, deserves our best whether we think they appreciate it or not.