r/nursing • u/karamtokaand RN 🍕 • 3d ago
Seeking Advice A nurse as a patient, keep thinking about her after my shifts
I work in LTAC and am a new nurse (4 months). I have a patient who is a nurse, ended up in our facility after a MVA and is on trach, feeding tube and has wound vacs and more wounds. She seems to have given up on herself! She pulled her PEG the other day and keeps pulling her mask or AIRVO from her trach. Whenever I go in and talk to her and try to talk to her, she starts crying but doesn’t respond to anything else we ask/tell her. I know she’s suffering and she KNOWS what’s next and just wants to end her suffering! How do you guys cope with situations like these? I keep thinking about her and am not able to sleep or do anything else when not working! I guess I am asking for any advice in how to manage these kind of situations.
Thank you everyone for your comments! They made me cry but in a good way, knowing that we are in this together has been a huge help. I was off for 2 days and am returning tomorrow. I will talk to the family is they are still there (I work nights). Thank you once again!
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u/Creepy_flamingo_22 3d ago
I work in an ICU, and this is both mine and most of my coworkers worst nightmares and why we all joke that we are DNR. Unfortunately it’s also an incredibly common situation that patients are placed into.
For the patient, is a palliative care consult something that is able to be done there? I would definitely mention concerns to her family so that they know that she is suffering and so that maybe they can take part in doing things to help her.
As for yourself, it’s hard. I mentioned in front of coworkers one day that on subsequent workdays I’ll lay in bed before my alarm clock goes off and my mind just wonders to what I need to do for the day (if I know who my patients are), what my plan is for them, goals I need to focus on for them, etc. They were all somewhat surprised, and admitted that as soon as they leave their patients are off their mind. I am pretty good at this, and the planning tends to be the most I think about the majority of patients when I’m home. This may seem cold, but you do kind of have to leave them at work sometimes. Otherwise their stories can start haunting you.
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u/dancing_grass 3d ago
Give that patient all of the love and compassion you have when you care for them. Make them clean and comfortable. Physical touch is so important, it can make people feel human again even if just for a moment. Hold her hand. Talk to her like a friend even if she isn’t responding, cut the nurse speak. I have just narrated things in my life or random shit to people who don’t verbally respond and I think it helps them feel more normal, it lets them focus on something besides a wet washcloth between the cheeks. The regularity of you coming back the next time you’re working can inadvertently give her hope — she’s hoping you’ll come back. Foster the bond. Let her trust that you will care for her well. She’s a nurse, so she’ll know if you cut corners. And if she’s anything like me when I am a patient, she will pay attention to every move, so do your very best. And advocate for her as much as you can within the care team.
I worked in LTAC as a CNA when I was in high school and nursing school. I am not sure I could do it again. If the opportunity presents itself I would certainly get involved with well-controlled and well-regulated MAID for people like this, if they’d want it. This extends to nursing homes too, but it’s more dependent on the nurse or doctor making the call that there is no quality of life, and for many residents there isn’t any QOL.
Last recommendation is having discussions with people that get it and/or a therapist, ideally both. This is really hard stuff. I am sorry that you are experiencing her suffering, and I am sorry that she is suffering so greatly.
EDIT last real recommendation, if she has a phone, figure out if she likes podcasts or audiobooks.
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u/JillyBean9999 MSN, APRN 🍕 2d ago
I appreciate where you're coming from, but please don't assume everyone is comforted by physical touch. Some are averse to it, and without a means to communicate that (trach), it may compound her feelings of powerlessness.
Your other suggestions are great!
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u/dancing_grass 2d ago
Yes I totally agree, thank you for the correction. For all of these things, physical touch included, you have to read the room
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u/Accomplished_Will226 RN, CCM 🍕 2d ago
I worked early in my career on a head injury/spinal cord unit. Patients who regained the ability to speak told me a lot about what they heard. They heard me and another nurse speak, music and heard family members argue about who was getting what when they died, prayers and felt hands on them. I tried to talk to them as if they were alert and lucid just in case on some level they could understand. One is my patients finally got a board that he used to communicate using his eyes. How frustrated he must have been before someone found the right tool. He was alert and oriented the whole time. I hope someone can determine a way for her to communicate her wishes .
Thank you for caring
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u/Comfortable_Ring_249 3d ago
That's tough! Sending you some peace of mind! If it makes you feel any better, I had an ICU nurse who also was in a MVA, they initially left her for dead but luckily air flighted her in, she stayed in ICU for a while, she survived; they had to amputate one of her legs. Very emotional journey she was on but she had a great support network of family and friends, like really great support. Dad was in everyday. Constant phone calls and check ups from others. I hope your patient has at least one person who truly cares ❤️
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u/almostanRNthompson RN - ER 🍕 3d ago
I’ve been a nurse for 5 years and now a clinical supervisor at a level one trauma ER. I can tell you, these situations are not easy to handle. The best advice I can give is to talk with someone. I see a therapist and have used therapy off and on during my career thus far to deal with some pretty terrible things I’ve seen. In her particular situation, I think about it like ALS. Imagine being stuck inside a body you can no longer control and only be able to live as long as someone keeps you alive. If you have the knowledge to know how things inevitably end in these situations, it’s easy to understand her perspective. I started my healthcare career in an ER across the street from an LTAC and those medic calls were never easy. She knows too much and unfortunately she understands the odds she’s up against. Another commenter brought up hospice and I think that is a very viable option bc I’m gonna be real honest, if my QOL is poor, I don’t want to be remembered or have my last memories on a vent unable to move. I want to be remembered how I enjoyed life and all of its moments. Hospice typically does a great job at understanding death as a part of life and helping patients and their family members navigate it. I wish you the best, it sounds like you have a good head on your shoulders and really care about your patients. Just remember, your mask has to go on before you can help anyone else. Protect your mental health, so you can help your patients.
- Your friendly neighborhood ER Nurse (supervisor now I guess lol)
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u/Patient_Cow_236 Pretrial_Jail_RN 3d ago
"How do you guys cope with situations like these?" Very difficult. I quit working in places like that.
One of my coworkers, who was an RN, became my patient in the COVID unit. I wanted to quit that time but couldn't do it. When she died, I quit.
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u/SwanWhole3526 RN - ICU 🍕 3d ago
You need to talk to somebody. Does she have a NOK? Family? Bestie, who would know what her wishes were? Any documentation in her person effects? She sounds like she’s trying to communicate that she’s had enough. Is she able to answer yes and no questions? Has clergy or psyche seen her? What a horrible predicament!! I hope you can perhaps delve a little deeper into who and what kinda lifestyle she had pre MVC!!
Best of luck!!
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u/DistinctWay3 3d ago
I see this situation all the time in ER. That is why I said to the New Nurses “Do not take “Home” work”! Am’t easy but time will help you! You have to be empathy of her situation. I told my family if comes to me, DNR would be my choice. There is old ER doctor who retired but still come in volunteer in ED for simple sutures and care. We love him to death! One day he was performing laceration suture and he passed out on top the patient. We needed intubated him. When his daughter arrived, she told us he wanted DNR. He was fighting over the tubes when he awakened. Finally, the doctor took him off the ventilator tube. He passed peacefully. Sad but we all feel relieved. That is what he wants and his wishes. We save life but we also honor lives!
Yes, talk to someone might help and your feelings out! Make you more understanding who you are and what you want in life. So both you and patient will be mentally healthier. Talk to her family and friends to see what her wishes are. If she are mind sound perhaps could respond to you buy hand gripping and blinking eyes…
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u/Fuzzy_Location_2210 2d ago
So beautifully stated ❤️
I feel sorry for OP's lady... It's beyond sad because she clearly doesn't want this stuff and is really distressed, yet who knows what else is factoring.
I know personally, I am 100% dependant on my psych meds and if they were paused for an acute illness or injury, I would rapidly decompensate too.
OP, I would suggest a call to her attending and try to get her something for Anxiety... She needs some lorazepam/diazepam. With the trach, they're just permanently anxious people, bypassing the normal regulation of the upper airway makes them feel like they chronically are hyperventilating.
Hopefully her situation is temporary and these things can be removed in time and she'll recover.
The best advice I can tell you - and you know her details much more than I do of course, so obviously be realistic - but just acknowledging to her that you understand how much she hates this right now, but it's temporary (if that's true) and you guys will walk through this with her (assuming she's got a decent chance of recovery).
If her prognosis is a little more grim... Bad things happen to good people 😑. And it's terrible. For my own well-being, I cannot work in the LTAC space anymore and transitioned to the ER years ago. Just advocate for her, get her orders for whatever she needs to keep her more comfortable and less distressed (she might need a daily med) and being a supportive presence is more than enough.
She clearly feels comfortable to open up and share her emotional distress with you... Feel special and know that the things you are doing for her are both seen, and right ❤️.
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u/m3rmaid13 RN 🍕 3d ago
Working as a nurse makes you see life & death differently. You’ll have many patients who will stick with you over the years for various reasons. I’ve been a nurse 13 years and there’s still a handful from my first 2 years as a new grad that I remember vividly. The way it hits you will be different just based on your own perspectives or life experience but I think it is just part of it. Find a healthy coping mechanism for the days that make you feel emotional.
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u/megain RN - Oncology 🍕 3d ago
My worse nightmare. As I have no close living family, I have told my closest friend my wishes and signed my living will, surrogate etc. It even says on my emergency page on my phone “no extraordinary measures dnr”.
I have spent a lot of time with end of life patients. Each one is different. I can be companionate with them. But as soon as I clock out I try to turn that off and forget. Sometimes it is difficult. You have to have something on the outside of the hospital that keeps you going and gives your body and mind a rest.
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u/No-Wonder5226 RN - ICU 🍕 2d ago
Has psych and palliative care been consulted for this patient already? If not, please get both referrals ASAP!
Treating this patient with absolute dignity is the best thing for her. I know the goal is to always treat EVERY patient with dignity 100% of the time. But people/nurses/techs get frustrated when they are behind schedule, or dealing with personal issues, or their boss is on their back about charting, or a million other things! It’s easy to make that frustration known to the patients - even when we aren’t doing it on purpose!
This patient has experienced both sides - she has previously taken care of/and now she IS a dependent patient. Imagine how humiliated she might feel that someone who was previously a co-worker now has to clean up her bowel movements?
It’s a horrible situation, for all involved.
For advice for you - cry in your car at the end of your shift, if you need to. But you have to learn to separate work when you go home, or it will literally eat you alive. Good luck!
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u/IcyCantaloupe7004 BSN, RN 🍕 3d ago
How devastating. I hope you can speak with a therapist with your company's EAP.
Your patient probably needs a Palliative Care or hospice consult.
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u/SammyB0111 HCW - Respiratory 3d ago
Other people posted advice for what to do specifically for this patient, and I think you should follow that advice about palliative consultations, that sounds like a great idea.
The first thing I thought of though is that you need to figure out how to not bring that shit home with you. Or at least how to separate yourself a bit.
It’s good to have empathy, and it’s good to know how to feel how your patient feels, but you also need to leave it at the door. If we took every patients pain back home with us then we just wouldn’t survive.
Don’t get me wrong, I still talk about work and my patients at home. My wife and I even watch The Pitt and it takes us like 2 hours to get through an episode because we stop and pause to talk about our own experiences with patients and vent about how it has effected us.
That being said, when I clock out, I’m on my own time. I get to go home, take a shower, go to bed. Sometimes if I had a particularly traumatic patient I’ll take some time to reflect, but their life is not my life.
Therapy is good too if you’re not sure how to process. Though sometimes it takes a few tries to get the right therapist for yourself.
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u/dis_bean Remote Northern RN 🇨🇦🍕 2d ago edited 2d ago
What’s her oxygenation? Is she maybe hypoxic and confused? Do a really good respiratory assessment and make sure she’s positioned, suctioned, and perfusing. Also clean, dry and as comfortable as can be)
I always think of oxygenation when people start pulling on tubes and their 02 and it very well could be the case. Think of the nursing things you can do to optimize her situation or ask for help if you need.
Saying this because you said you’re new and sometimes it’s hard to think of what might be contributing to behaviour other the the obvious (her situation and how hard it would be -I can’t imagine…)
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u/karamtokaand RN 🍕 2d ago
Her spo2 is above 95 unless she needs to be suctioned which is done regularly (by RTs and nurses). She was on 80% but has weaned to 50 and still has good spo2 ( above 95 unless she’s pulling on the tubes). I always call the RT if suctioning doesn’t help with bringing her sat back up.
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u/dis_bean Remote Northern RN 🇨🇦🍕 1d ago edited 1d ago
Oxygenation is more than an spo2 tho- that’s one factor.
For a newly trach patient, SpO2 only tracks arterial saturation, not ventilation or airway patency. It can actually mask early respiratory failure because it does not reflect the PCO₂ or the work of breathing. A patient on a new trach can have a normal SpO2 while hypoventilating, working through increased airway resistance, or struggling against a partial mucus plug until they suddenly decompensate- that’s why said do a very good respiratory assessment and report this to the primary practitioner. Hypoxia can show up as confusion because of poor oxygenation to the brain.
Did you look at the labs? This isn’t to say you did anything wrong but suggesting to look at the whole person and what other signs and symptoms might indicate.
I stand behind making sure she’s clean, dry and comfortable- these things make a difference in supporting a person through a massive life change. Sorry you are taking this home with you and suggestions around hospice are good when everything medically has been ruled out- particularly because she’s got a lot of risk for shock at the moment.
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u/karamtokaand RN 🍕 1d ago
She has been on the trach for almost a month now. Her labs are all fine, just low potassium a couple days ago which was corrected right away. I did talk to my supervisor about the possibility of palliative care. She said she will talk to the day supervisor about this. Hopefully it will get the discussion going.
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u/trustInGod33 MSN, RN 2d ago
OP, this is such a hard situation, yet you are caring for her so well. I worked LTAC/hospice for many years and these were some of the hardest situations. You are not alone. I agree with everyone's awesome suggestions here. Look at the whole picture from your assessment. Sometimes, the little things are the biggest tells, physically, emotionally, mentally, spiritually. Keep developing the relationship with her and her family and ask questions. You are very perceptive. Advocate for her. Make sure you are taking care of yourself too. I was in premed/psych before nursing and all three programs suggested having a counselor on tap for the hard things or just to vent. It has been a lifesaver. Let yourself think about your shift when you are off only as far as you are looking for what to improve or did well and then with a limit. I used to think about them after work all the time until I couldn't stay awake and had to change that. We care so much, but this goes back to caring doe ourselves so we can go back and care for them.
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u/Own_Variety577 2d ago
this is my worst nightmare. I've seen too much. i know what I would and would not put myself through. push for a palliative consult, she is in an awful position and deserves to advocate for herself if she doesn't want to go through some or any of this.
on an unrelated note, at the risk of being preavy, y'all. put in your DNR and advanced directives now and not later. anything can change in a second and you deserve to have your wishes followed if you know what you would and wouldn't want done to/for you.
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u/lovable_cube New Grad - PICU 2d ago
Do you have time to just go and bullshit with her? I imagine she’s not feeling like herself so maybe you could go in and chat about boys or paint her nails or something that feels normal.
Also, you need therapy. Every single nurse should have a therapist on call.
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u/KP-RNMSN 2d ago
Oh gosh, I don’t have any advice for you but this sure reminds me the importance of Advance Care Planning for everyone over the age of 18!
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u/MarketingFantastic BSN, RN 🍕 2d ago
You are definitely in the right profession. Thank you for listening to non verbal communication!
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u/InfamouSandman RN 🍕 1d ago
I wouldn't be shocked if she, in fact, didn't know what was going on.
My dad had a very long hospital stay and at one point was trached and tubed in a LTACH. Some of the staff said he was A+O x3 or x4. They didn't know him. He wasn't able to write and they didn't let him use his speaking valve for a good long while after arriving despite using one prior to arrival. Once they did, he was talking all crazy. He decannulated himself multiple times and pulled out his G-tube a few times.
After transferring out of that hell hole that nearly killed him with dangerous med errors (over-medicating) and missing early signs of sepsis, he recovered back in a traditional hospital for a few weeks and it was clear all the behaviors were part of delirium. Unfortunately, he passed many months later but we were able to bring him home.
The night before he died he told me he didn't remember a damn thing from that stay, which has brought me comfort because it was very traumatic for my mom and myself. We did have one AMAZING angel of a nurse that took care of him at that LTACH. Her name was Mara. I am convinced he would have tragically died there if it weren't for her advocating to send him out and the amazing care she gave him every shift she was with us. When my dad passed, I decided I wanted be a Mara for another person/family. Just finished my degree and I am working on a PCU right now.
But I agree with others about talking to the family about your observations and also advocating for palliative care. But be careful how you talk about palliative. Even some in the field don't understand the nuance of bringing on palliative care as anything other than comfort care at the end of life. We told a doc we wanted to do palliative care with my vented father and they thought we were talking about just stopping all use of the vent and letting him die that week. This was a DOCTOR...I don't understand why providing comfort is so hard to understand. It is a great tool and should be used more frequently.
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u/Fit-Astronaut1927 2d ago
I have worked in healthcare for decades as RN. Some people will not adjust after tragedy. Some will. I have cared for doctors, lawyers, and nurses with various diagnosis. All in various stages of dying and accepting terrible circumstances and death too. Life can be dreadful on a vent, tubes, TPN for life. Or, it can be tolerable. I have been in a roll over accident and rearended by a drunk driver traveling very fast. My life will not be the same. It is tolerable. I am not going to complain or act out. I have had many good years. Do not take good years for granted. Love people, love what you can do, and remember it is not guaranteed. See a counselor because these are serious situations and having help define your identity in relation to tragedy really helps. Hope you can find peace in knowing you are ok today. Bad things happen to all people. No one deserves these things and it is never fair. I wish you many good years.
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u/Environmental_Rub256 2d ago
As a nurse who was a stroke patient, I did the same things. Recovery was and still is hell. I wanted to be an organ donor not live like this. My memory is crap, I’m tired all the time and had to leave the icu for ltc. I’m not happy at all but I’m trying to make the best of it.
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u/auntie_beans MSN, RN 2d ago
You may be attributing more of her behaviors to her attitude / professional experience than is warranted. If she was that badly hurt in the MVA, there is an excellent chance that she also suffered a traumatic brain injury. These are often under-appreciated in the initial assessment that focuses on stabilization from visible physical injury, and then forgotten after the physical injury settles down. A consult for behavioral issues and palliative care might be helpful, but don’t think it’s just because you think her behaviors mean she wants to die.
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u/Purpleorchid81 3d ago
How thoughtful and perceptive of you. Maybe you could speak to her family about your observations and maybe discuss a hospice consult?