F/U Appt

Just following up on my previous post about moral distress and ethical issues since, well, I've been doing a lot of thinking about it these past few days.

What are some ways you guys deal with the stresses and emotional tolls of nursing?

I've been considering getting another job lately, especially after recovering from a musculoskeletal injury this past spring.  Maybe if I can't leave my work at work, then I'm not cut out for ICU nursing? My husband says I have changed since I've become an ICU nurse and when I ask him how, he can't really put his finger on it. While that frustrates me, I have noticed a change in myself as well that I can't quite put a finger on. I guess I just haven't wanted to admit it to myself.

I don't know about any of you other Critical Care nurses out there, but there's a certain cynicism I've gained since ICU. Maybe it's just seeing things for how they truly are now and not being afraid to say it. I don't know what it is.. but has anybody else had a similar experience?

Nurse Shotgun

Moral Distress?

Yup. So I'm now discovering the joys of ethical/moral distress in nursing. Not that I haven't had nursing experiences in other areas of work that pushed me morally.. but this past week of work has been especially trying.

My last few shifts have really started to weigh on me heavily. To the point where I have come home crying and upset with family for no reason. So what is moral distress? The American Association of Critical-Care Nursing (AACN) says moral distress happens when:

• You know the ethically appropriate action to take, but you are unable to act upon it.
• You act in a manner contrary to your personal and professional values, which undermines your integrity and authenticity.

Certainly, I encountered patients and situations in my years on the Medical floor that I had moral and ethical issues with. Doctors and nurses withholding pain medication from palliative patients, confused patients being restrained in Geriatric chairs in the hallway, etc. You know, stuff we have all came across in some form or another during our nursing careers. But since starting my job in ICU, my eyes have been forced open. Wide.

A patient who has been sedated on a short term sedative infusion for almost 2 weeks longer than what is recommended by best practice guidelines.. and now starting to show signs of long term neurological effects from this. A patient whose significant other is being kept in the dark by physicians, since they don't want to admit they've screwed up on several things during their stay with us. Physicians who, after doing your job and advocating for your patient, ignore your concerns to spare their egos... not caring that the patient is suffering because of their arrogance. Not caring that this patient may never experience a quality life off of a ventilator because of their neglect and ignorance to concerns. It really speaks to our tendencies as human beings to cover our tracks to spare ourselves.

My other patient, an elderly patient who has made it clear they did not want to be intubated, now finds them-self restrained to a bed with a ETT down their throat. With only PRN Benzos for sedation... when presented with the option of intubation, was never given an honest picture of what this would mean for them for the rest of their days. That the ventilator will be what they will now depend on to help them breathe. That they will probably never leave the hospital and go back to their home...

Something that really bothers me is when we allow family members to make decisions for perfectly competent patients. Some days I even wonder why I bothered with all of those stupid Ethics courses in University. I mean seriously, they mean nothing in the real world of the workplace it seems. I know in my heart that what is happening to these patients is cruel and nothing short of a crime.. yet, no matter what, somebody needs to look after those patients and provide quality nursing care. The physicians at our facility have the gonads the size of peanuts when it comes to having honest conversations with patients and families about risks and major decisions about their care. Is it some kind of secret that discussing these things with patients and families is a crazy hard thing to do? Or that it will constitute a large part of your time as an ICU physician?

I found the article linked about from the AACN very helpful in helping me sort through my moral distress. Please give it a read and share your thoughts on the subject if you have any!

Keep it real. Until next time,
Nurse Shotgun

PS - Voila! The newest addition to my collection - my Browning BPS!!

Progress Note

Well...


Yeah, it's been a long time, I know it. Not that I have a large following who are sitting at their computers all day anticipating my posts... But I digress.


So, in the past few months, life has taken a few turns and made a few changes. This guy I was seeing, turned out to be somewhat of, well, what the French call a "douchebag". He's a nice guy, but because I don't get shitface-drunk every weekend... and the fact that my life doesn't revolve around acting like a teenager who hasn't taken their daily dose of Ritalin with my "buddies", it wasn't going to work. Whatever.


So at work lately, they have been assigning me to the charge nurse role on most night shifts. This is a pretty big assignment for somebody who has only had their nursing licence for a little over 12 months... and our unit is the biggest in the hospital. Yes, I had taken the odd shift as charge since Christmas time, but this is a big step. Yes, it'll look good on a resume.. but the crap we have to deal with is not worth the extra $0.65 an hour. Btw, after taxes, is enough for me to buy a Quarter Pounder with Cheese when I get my pay check. Fabulous.


I have been thinking of looking for a job in Critical Care. Med/Surg nursing just isn't cutting it for me anymore. Yes, I still learn new things every shift, and there is a lot more to learn.. But I have now conquered the basics and am ready to specialize within the next year or so. The options are not plentiful in this small corner of the world, but I will see what turns up.


The work load at work these past few months has been overwhelming to say the least - not to mention unsafe for both the nurses and patients. It being summer and all, staffing is always an issue. Of the past 12 shifts, we have worked 10 of them short staffed (down at least 2-3 nurses/aids each of those shifts) But being the only RN on a floor of 25 patients is a bit much. Running between the Heparin gtts, Lasix infusions, telemetry, drains to be flushed, various IV meds, assessing and caring for the unstable patients.. even dealing with verbally abusive family members (which once was an uncommon occurance) is becoming more and more frequent.


Oh the life of a nurse. Can somebody remind me why I CHOSE to do this?

The Inaugural Post

Well, here it goes - my first post.

This blog will basically be filled with the ups and downs (...there will be a lot of downs- don't say I didn't warn you) of the busy, messed up life of a 4th year nursing student... maybe even some funny situations from the clinical area. 

I'm hoping blogging about my experiences, frustrations and joys will help me enjoy my final leg of my nursing-school life journey... here's to hoping.

I'm working on some graphics in Photoshop and will hopefully have things looking snazzy soon.

-- toodle-doo!