Leaving Patients Behind: New Grad RN Learning to Cope 

Next week will mark four months as an RN in Telemetry. It’s hard to believe that I am already a quarter of the way through my first year as an registered nurse.

Frequently, I encounter situations I was not prepared for in nursing school. One of these new situations that I am having trouble coping with is the idea of leaving patients behind.

Nursing they say, is a 24 hour job, meaning that while you only work a twelve hour shift, there is still another twelve hours of work to do. We endorse what we can’t finish, or endorse what we did finish but would like continued. It’s success relies both on the strength of the staff but also on trust and teamwork.

I frequently get things endorsed to me, and I always try to do my best to get them done. Because I’m a new nurse, I hoped the staff could trust me to do these tasks but understood if they were leery. I never thought about it the other way around, that perhaps I could not trust them with my patients.

For example, on Wednesday and Thursday I had the same four patients. Three of them were pretty taxing, and the other needed little. On Wednesday night I learned that Nicole, my fifty-something year old patient, was going through some issues with her husband of forty years mainly due to the fact that she had recently found out he had assaulted a female family member years earlier. The issue never came up with Nicole and myself during my shift, and I only knew from reading the physician’s H&P. On Thursday night, I worked a lot with Nicole explaining test results, and even sat down for forty minutes to go through the side effects, action, implementation, and purpose of each of her new medications the doctor had prescribed earlier that day. It was a luxury I rarely am allowed. I got to answer all of her questions. Nicole was so grateful that I had taken the time to help, and I was grateful for the opportunity to really teach and provide the kind of nursing I went into this field to perform.

Shortly after, her husband called up to the floor to see if he could come up and visit. I asked Nicole, and she said, “Oh, I just don’t want things to get out of hand, but yes he can.” Feeling her trepidation, I told her that we would create a code. I told her that if she uses the call light and asks any of the staff or the unit secretary for Graham Crackers, I would know she needed him to leave and make up a reason why he could no longer stay. Nicole’s eyes grew wide and was so pleased to have an out. About thirty minutes into the visit, she asked for Graham crackers and I found a reason why her husband could no longer stay.
In the morning, Nicole said that she had never felt so empowered, and that she felt like maybe she had the strength to leave him for a while to straighten her head out and work on her health for a while. She asked that if her husband called tonight, that we make an excuse why he couldn’t come up, and that also she plans to stay with her sister after discharge and would love some help from the social worker.

The social workers get on after the end of my shift, so I proudly endorsed this all to the day nurse. To my surprise the day nurse scoffed at her plans, “That women is crazy, I saw her when she was admitted she was hugging her husband and loving on him. She’s just crazy she has a history of depression.” I was shocked. More than shocked, I felt totally powerless. I was so proud of my creativity last night, the extra work I was able to do with Nicole, and I was so happy she felt so empowered to put herself first. And after all that, the next twelve hours is no longer mine, I can only do my twelve hours.

I work again tomorrow, but I imagine Nicole will be long gone. I can’t help but think about her. Did she get to see the case worker? Did the day nurse respect her wishes? Did Nicole simply get left behind? After all, you can only do so much and just have to trust that your team can continue it.

That same day, I learned a long time patient of mine who essentially lived on the floor, had died. She was a med-surg patient, recovering from a stroke but doing so so much better. She was just awaiting placement. She was a difficult patient for some, because she shouted one word only “EEEYY” and then you would have to see what she wanted through a sort of guessing game. She would nod when you got it right. I didn’t mind the shouting because I knew I could meet her needs as long as I was patient. We kept her close to the nursing station. Finally, med-surg got a bed opened the house supervisor asked us to transfer a patient up. We have so many total patients on our floor that are med-surg, that I chose her to move upstairs. I felt torn about it because we had been working with her for three months and the staff knew her pretty well, that it would just be easier to keep her and transfer a newer patient upstairs. But the other part of me was angry with the med-surg floor, because they always transfer down the heavy total patients and keep the quick discharges upstairs. This makes it also very difficult when the med-surg nurses float to tele because they have a caseload of all total patients. I moved her upstairs and didn’t think twice about the fact that they moved her into the furthest room down the hall — just didn’t cross my mind.
She was on aspiration precautions of course, and only allowed ice chips if you stayed in the room with her. She usually did really well. Turns out she was given ice chips, alone, and aspirated and died. Alone in that room at the end of the hall.

I’m not sure how to deal with leaving patients behind, feeling like you can’t trust the nurses and staff around you. A part of me wants not to get so invested so that my heart doesn’t break, and so that I don’t lie awake at night thinking of their faces. But the other part of me that is deeply in touch with why I became a nurse, demands better. I don’t want to leave any patients behind, but I don’t work every day and I only work twelve hours.

I’m not sure what the solution is, but I hope it will grow easier with time, after all, I’m only four months in. When I find out a solution, I’ll let you all know.

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