I, on the other hand, am not panicked.  I am annoyed.  The phones of every doctor’s office in the country, and possibly a few other countries, are ringing off the hook.  Every person with a fever, every kid with a cough, every kid who sat next to a kid with a cough: They are all worried to death (or at least their mothers are) and looking to the medical profession for answers.

Unfortunately, the answers I want to provide are sarcastic.  “Do you know how many people die of influenza every year in the US?  36,000!  And do you know how many have died of H1N1 flu in the US so far?  One!  That’s how many.  So go home and take some Advil, get some rest, and drink plenty of fluids.  Trust me, the chances are pretty good that you’ll live.”

Fortunately for my patients, I never actually say what I think.  It doesn’t actually matter what I think.  What matters is that people are scared.  My job is to care for them.  In part, that’s relieving those fears, but it’s never dismissing them.  The term pandemic is scary.  It causes a low-level hysteria that rapidly grows into a high-level hysteria as news pundits discuss it day after day.  I can share my personal opinion with friends, but not with my patients.  I have to handle each person and each concern like it matters to me.

My best friend is an advice nurse in California.  She told me yesterday that they have received thousands of calls in the last couple weeks about the Swine flu.  The other day they were 6 1/2 hours behind on answering calls.  Of course, people were calling with “normal” stuff, too.  They also had to wait to be called back because of the flu calls.  It’s completely overwhelming.  But one call at a time, they go through the protocol, giving advice, making appointments as needed, and talking people off the ledge.

I guess what I’m saying is that it’s okay to feel frustrated about stuff like this, it’s just not okay to show it.  At least not to our patients.  They deserve to feel like their illness, real or perceived, is important to the ones they have entrusted themselves to.

I am really struggling with how to deal with some of these difficult patients. I just cannot understand the nerve of some people! Just last night, I was discharging a patient and the curtain wasn’t completely closed. The wife of a patient from the room next door peeked in and told me she was going home for the night.

As she began talking and asking for help, I interrupted her and said, “Excuse me, ma’am, but I’m with another patient right now. Please ask one of the other nurses for assistance.”

I have even had patients’ families actually come into other patients’ rooms while there is a code situation- or while I am doing CPR-and repeatedly ask me for pillows, test results, food trays, etc. How do people not understand that we’re in the middle of something?

I have struggled with trying to be polite, but I think in a way that only will encourage this behavior. I just don’t know how to be assertive without getting so upset at patients and their families.

1. Gauge your feelings over a long period of time (six months or more) instead of making a decision based on just a few bad weeks.

2. Choose an activity you enjoy doing outside of work, and schedule it in so it is a priority. You may just need a little distraction—then the work issues can be put in perspective.

3. Ask yourself a few hard questions:

• Am I contributing to the negativity at work? For a while, gossip had gotten out of control at work, and I had to take a hard look at myself and see how I was contributing to the cycle. Then I had to make a conscious decision to watch my own mouth. I began focusing on positive aspects of others and correcting misinformation when I heard it.
• Can I help change things for the better? There are things you can control, and things you cannot. You might be surprised what things you may be able to influence, even if they are not directly within your control. For example, morale was very low in our unit, so a friend and I teamed up to start a newsletter to recognize our peers who were going above and beyond.
• Do I need to change my attitude? Sometimes when you are stuck in a rut, your attitude gets stuck there, too. That’s when it’s important to get a fresh perspective. Make a conscious decision to start each day with a good attitude, even if it at first feels forced. For example, there maybe be a “difficult person” you’ve predetermined is impossible and miserable to work with. Try changing your attitude about that person and finding a positive trait in them. All it takes is one kind gesture to get the other person to change as well.

If you have given it a fair amount of time, and are consistently unhappy at your place of work despite trying to make it better, it may be time to consider a change. Here’s what to consider:

1. Look for something that utilizes your skills and passions in a positive way. You don’t always have to look for another job in the exact same area. Maybe your skills/passions could be harnessed through a new position or area you hadn’t previously considered.
2. Listen to your peers/family. Sometimes people see qualities in you that you can’t see in yourself. Are others always commenting that you would be great in a certain field or department? Try it out. You might just find out they are right!
3. Know it won’t be perfect. Just like your last job, you’ll work with unlikable people and patients, do tasks you won’t always enjoy, and feel like throwing in the towel. But knowing this, you can be proactive and keep things positive from the get-go.

As a new nurse grad you’re pumped up and ready to change the world. You’ve learned all about treating the whole patient; he’s a person not a room number or medical ID number; her family affects his condition, and her care and her outcomes. You’re going to spend time with your patients. You’re the best nurse ever!

Then reality hits. You have six patients, not one or two. You have to stay for the whole shift, not just a few hours. And it’s now your license if you make a mistake, not your instructor’s. You don’t get an hour for lunch to discuss patients and the latest gossip with your friends. You’re lucky if you can even go to the bathroom!

You’re responsible for all of the care for your six patients now, and all the other nurses are busy with their own patients. They no longer have to help you. You’re on your own. You feel a little lost and suddenly begin to doubt your knowledge and skills. Your patients all want you at the same time. You don’t know who to help first, and you’re way behind schedule.

You want to cry and run screaming from the building–never to return! Why on earth did you ever want to become a nurse? How does anyone ever get it all done in one shift, and who has any time to spend with the patients?!

Take a deep breath and try to relax. It will get easier, but you have to give yourself time. It may take you a year to get comfortable. The research supports this, but not all units or facilities understand this. Some facilities have developed long-term orientation schedules for new nurses and are beginning to prove that this is an essential process. If you’re not in one of those programs, you’re just going to have to get by yourself, and you can do it!

Start by making a plan for yourself that includes sticking it out for a year before you quit. First, accept the fact that it will take you this long to really become a nurse. Get a calendar and mark off the days if you have to. Then get yourself organized. Use a schedule and stick to it. Get the most difficult and disgusting tasks done first. This will ease your stress tremendously!

Stop and document each hour. Make rounds frequently–such as at the beginning of your shift, before you take a meal break and after you return, and then again about an hour before your shift ends. This can be just a quick glance into each patient’s room after you’ve made your initial assessments.

Learn to anticipate needs such as PRN meds. Learn to delegate appropriate tasks and to double team with other staff to get things done more quickly. Be a sponge and learn from your co-workers. Everyone has little tips and tricks that save time and improve efficiency. Always ask for help if you don’t understand something or have never done the procedure before.

Give yourself time to become the best nurse ever! It will happen.

The patient evaluation softened the doctor’s mood. The guy obviously needed to be seen–and we finished the day right on time.

Apologetic and sheepish, the doc seemed to recognize his overreaction.

How often do we (I’m assuming one or two of you might do this too) jump to conclusions about a situation and react rashly? We let our emotions rule the moment–and we go too far. Would it really kill us to take a deep breath and stop to think? Probably not. Would the situation worsen if we didn’t yell and scream impulsively? Unlikely.

There are plenty of things to get angry about in any given day. Many of them may be valid. The question is whether our reactions are valid.

Had my doctor said, “I’m feeling frustrated about my schedule today because I got only four hours of sleep last night and have two more meetings right after work,” I could have validated his feelings and explained why I thought the gentleman needed to be seen. We all would have been fine.

Instead he let his frustration–not his mind–take the driver’s seat.

To say it another way, “Don’t sin in your anger.” That’s how the Bible puts it. It acknowledges that people get angry, but warns not to go off the deep end. Think before you speak. Take a look at the other possible angles. Put yourself in the other person’s shoes. Assume the best of the other person instead of the worst. All those cliches are true.

You may save yourself a nasty clean-up if you stop and breathe before you act–or react, as the case may be.

We in the medical profession often ask patients to do things they don’t really want to do: from blood draws to procedures to surgeries. It’s easy for us to be judgmental because we know the importance of the test. We look at it from the scientific vantage point. We, however, are not the ones with a needle in our arm or a tube up our butt. We are not the ones who will be on pain meds for days after the procedure. We aren’t the ones feeling nauseous, fatigued, or fearful.

My little friend was being asked to undergo one more irradiation treatment. He was exhausted from the other two that day as well as the three the day before…and the three the day before that. This on top of the five years of treatments he has already suffered. After this last dose, he had hard-core chemo to face before the transplant. Then six weeks of isolation.

Fortunately, the staff he was dealing with that evening were extremely patient. They forgave his tardiness to the appointment, his bad attitude, and his lack of cooperation. They gave him the time and space he needed to pull it together. They didn’t raise voices or make him feel guilty. They were able to pull back and look at the big picture. They gave him the gift of empathy.

Is empathy a gift you often give? It makes all the difference in giving the best possible care to a patient. Put yourself in their shoes for a minute. Think about the pain of having a needle stuck through your skin. It doesn’t just pinch for a second, as we often say. It hurts!!! Which would probably explain why I haven’t had my cholesterol checked in a couple of years.

Be more patient with difficult patients.

Be more patient with difficult families.

Be more patient with myself.

Be more assertive with difficult doctors.

Be less difficult to work with.

Be more assertive with anyone who keeps me from giving my patients the best possible care.

Be more accepting of working the crummy shifts.

Be more accepting of being the “new nurse”.

Stop spending more than I have so I don’t have to keep working extra shifts.

Stop thinking about work when I’m not there.

Stop blaming others when things don’t go right.

Be more gracious.

Be more empathetic.

Sleep more. Play more. Exercise more. Smile more.

Remember each day why I decided to become a nurse.

The one who smells bad; the one who has an irritating spouse; the one who drones on about how nurses don’t treat her well; the one who constantly buzzes you; the one who complains and complains and complains about the pain no matter how much pain medication you administer; or, the one whose situation is so sad you feel morbid about life, too.

It can be a chore to go back to those patients—especially on units where patients are there for more than a couple days. Knowing what you’re in for, how can you not dread it? Day after day, you secretly hope that they might not be there at your next shift.

But they are, and somehow, you have to get over it. Or how will you survive nursing?

How do you do it? What do you do when you simply can’t stand a patient?

My guess is you have had contact with someone in the last couple of days whose world has been turned upside down by an accident, diagnosis, new baby. You’ve had the opportunity to rub shoulders with those who are shell-shocked by the sudden turn in the road. Were they angry? Depressed? Overly emotional? Flat? We are often not prepared for the emotions we feel when we know what’s coming, much less for the unexpected.

It is our privilege as nurses to care for the shell-shocked, whether patient or family. We are in a unique position to help them through the trial and error of emoting. It will not always be comfortable. It will rarely be pretty. We may even get sucked into some unhealthy dynamics.

I think the key is grace. For our patients, their families, ourselves. Emotions catch us all off guard sometimes and we behave in ways we later regret. We say things we don’t mean. We don’t say things we should. We cry when we don’t want to. We yell.

Are you able to let it go? Are you able to walk back in to the patient’s room after they’ve been unkind and let them have a fresh start? Can you take the burden of bad behavior off their plate so they only have to worry about the impending surgery? It takes maturity to do it. It takes someone who is able to put the patient’s needs above their own. It takes a nurse who knows the next sudden turn may be in her own road.