When nurses have a bad day

I had a mostly wonderful experience today. I used to teach medical surgical nursing with nursing students and today I was afforded the experience of observing and “evaluating” a nurse educator on a medical surgical floor. I think I was more excited to be there on the floor then anybody else; I still love the bedside, though my academic endeavors have taken me away from that experience.

I found myself more co-teaching with the instructor (as you know if you are experienced teacher, it is pretty difficult to sit back and simply observe) and getting to know the patients better while the students and instructor were scanning meds. This afforded me the opportunity to act as a role model for the students and help them to get to know their patients better, but the students were nervous about doing injections and having me along as a second observer may have increased their anxiety a bit. Speaking with the patients and really connecting with them made me long for that experience I realized I had been missing, the transpersonal caring space.

The rose colored glasses were soon to be abruptly removed.

We had gowned and gloved up to go into an MRSA patient’s room. A woman (wearing no identification, no lab coat, and none of the required PPE) admonished us after we knocked and stated we had medications for the patient. She angrily and abruptly came to the door and shut it in our faces, stating she had to talk privately with the patient, that she was arranging discharge. I could hear her abrupt and angry tone with the patient and after a few minutes she swung open the door to leave.

The instructor I was with said in a very friendly and positive tone, “Oh did you know this is an isolation room?”. And the reply of the discharge nurse was, “I didn’t touch a single thing in this room and I certainly know what precautions are”. She maintained her angry and abrupt tone and without washing hands she left the MRSA contaminated room and headed off to the next patient.

The instructor and I were both taken aback and after finishing the work with the patient and student, I asked her what she thought of the situation, should she perhaps “report” the discharge nurse to the manager. The greatest concern of course was patient safety; and the nurse’s failure to take proper PPE precautions was of concern to me as she was now potentially putting more patients at risk for contracting MRSA. This is how MRSA usually spreads in hospitals, from healthcare workers who fail to take the proper precautions of using PPE and washing hands.

My secondary concern was that this nurse’s palpable anger was being directed wherever she went: toward patients, students, instructors, other nurses. Her anger and stress were creating an environment of stress activation for others and we know that stress leads to a hindered immune system response and impacts one’s ability to heal. The nurse was, all by herself, impacting others in a negative way and she seemed either unknowing or uncaring about the impact of her actions.

The instructor and I agreed the incident should be reported and later when we saw the nurse manager, we made our concerns known. But as an instructor this can create a bit of a tenuous situation; we absolutely must act as the patient advocate, but we are not employees of the hospital, and if the complaint is followed through properly, the discharge nurse will indeed know who made the complaint. As the instructor relayed the incident to the nurse manager, she mentioned several times, “maybe the discharge nurse was just having a bad day…”.

And this is what I am left struggling with, because the discharge nurse was definitely having a bad day…or week… or month… or maybe even life. I am even now struggling with finding my compassion for this nurse who I intuitively sense as being in stress mode and likely burned out. The safety risks she was willing to take for having a bad day are in my mind inexcusable, and yet how do I find ways to let go of my anger about the situation (which would also impact my immune system!) and move toward a place of caring and compassion for this person? I suppose if I was there for longer then this one time of a few hours, I could devise ways to care for her myself better, to eventually ask if she was having a bad day, and to let her know I would like to support her. Or perhaps I could just create a “vibration” of love and caring around her, letting my heart’s electromagnetic field reach out to her unspoken pain and anger.

As we head into Nurses’ Week 2014, I would love to see nurses banded together in practicing self-care and caring for and loving one another. I want to see us also create room for supportive, loving, and constructive conversations for those nurses who are seemingly continually difficult and angry, whose bad day after bad day turns into a life driven by unresolved anger, compassion fatigue, and stress. We all deserve love and care, and if you find you cannot have overt conversations with the tried, angry, and frustrated or with difficult colleagues, patients, or family members, then I would suggest taking this action on internally, and seeing if things change over time.

For instance we know that HeartMath(TM) is used in many hospitals to assist providers in creating caring- healing presence. This is all about a process of tuning into your heart space, and hospitals have used it to help support staff in creating patient-centered healing experiences. However, one can also simply imagine coming into a full heart space, and imagine oneself as overflowing with love for this person who is clearly suffering. Sometime it helps me to picture the person as an infant, or a young child, in need of love and I send that love out with an intention for healing. I am not perfect at, but when I catch myself thinking negatively about someone, I strive to turn that feeling around. I then often include them in my loving-kindness prayers for well being and healing.

As we enter nurses’ week, let’s follow our caring-healing guiding nurse theorists, like Jean Watson and Savina Schoenhofer, and see that our work as nurses extends towards creating caring-healing environments. To celebrate this special week, let’s strive to remember that we can care for love all we come into contact with.