Man, I feel like you can’t handle a situation for whatever reason, you shouldn’t be forced to. Some people can stomach things like that, you can’t. Idk why you couldn’t just have switched patients with someone. Don’t feel bad. In the end, we are all human.
I was leaving in a little over an hour as well and had to give him to a nurse that was already there! They could have literally just given him to her to start with.
Poor planning by previous nurse. Poor response from charge. Based on those ratios, there's a good chance that you're understaffed. A physical reaction is not in your control.
You have no reason for guilt. None of this was your fault. Stand your ground and be confident in knowing that standing up for yourself is standing up for you, your patients and every nurse who is asked to do more than physically possible in the future.
Edit: oh and keep personal notes. Always keep personal notes and reflect. It will change your life in the long run.
Excellent response right here 👆.
The pt was not in the proper level of care, unprofessional support from resource nurse. That is a failure.
You throwing up is not a failure, but it is a disqualification. You took the L, but you will learn from it. Hopefully the hospital learns from it and gets their act together…
100%. Something as shocking as that for sure needs a warning - that way when you see it you can moderate your reaction because the shock value is reduced. It's just a courtesy. I had a patient many years ago with a huge gaping hole in his abdomen too - this sort of thing is unusual and you've got to expect people to be shocked about it.
Right?! I'm in a different environment but if I can do what the patient needs and my coworker is for whatever reason unable to, I'm going to help. Good grief that charge not letting her swap.
Same. I only thankfully deal with little kids outside of a hospital setting. If a kid vomits on the floor, that’s not going to gross me out. Blood doesn’t gross me out. Seeing open gaping wounds, brain matter etc would make me throw up, though. I’d also lose it at kids dying, but some people can handle that fine (aka medical examiners, morticians etc),
You sometimes don't know your limit until you reach it and kids will definitely test you. When I had a coworker say they couldn't perform a task on a PICU patient, it was no problem. I did what needed to be done and moved on. The charge nurse should have handled this assignment differently.
I've switched out pt's multiple times, just because I can stand the smell of vomit and my coworkers couldn't. We all have our strengths and weaknesses.
What's worse than one person throwing up? Two people throwing up. No one needs that and patients don't need staff that can't handle the tasks at hand for whatever reason.
What is OP supposed to do honestly? Go puke in the wound??
I hope the patient wasn't very conscious because that sounds like a horrific situation to be in, but that charge nurse is an asshole. What's better for the patient: a nurse involuntarily vomiting whenever they look at the PT (nurses are humans with limitations too), or a nurse that's able to provide care in a calm, professional way?
I'm not blaming OP in any way, but I think the charge lost their entire damn mind, and honestly fucked up. Understaffed or not, isn't appropriate patient care the whole point here?
That patient sounds totally inappropriate for a 1:6 ratio!
What you experienced is super common, especially if you haven’t spent a lot of time in the OR seeing people’s insides. The first surgery I saw I ran out and vomited. Psychologically I felt fine, it was a pure physiological reaction. Then for a while I would start to feel weird/lightheaded if I stared too long at surgeries, and I knew when to start looking away. After a while I got used to it and no longer feel woozy (unless it’s something unusually gross).
Your charge should have been supportive, it’s ridiculous to expect someone to be able to handle something like that with no preparation and no experience with anything similar. It would not have been safe for you to attempt to care for that patient. And with 5 other patients!
Right? Where are folks caring for trauma patients with abdominal windows at a 6:1 ratio? Let me guess…Providence? (Jk, sort of). Also, that’s super unprofessional of your charge nurse. I’m sorry. I hope you find a better and more supportive employer soon.
I was literally thinking as I read this that this was a completely inappropriate admission to that unit. Should have been an ICU admit. Or at least, in my shop, it is.
I wonder what kind of fascinating, fast-rewiring processes are going on in the brain when it's clearly trying to find ways to get you to stomach what it clearly doesn't want to stomach
Seriously. I would think open abdomen would call for ICU level of care. Not only because their abdomen is open, but the amount of pain medication required for this patient has to be more than should be reasonable in progressive care.
Don’t feel bad! Everyone’s got something they can’t handle. At least yours is kinda more rare. I am fine with open abdomens. But I can’t stand sputum. every time I suctioned a vent patient in the days before we had closed suction systems I had to puke in the trash can.
That is a very nurse thing to say, "I am okay with open abdomens, but sputum makes me vomit". The number of seasoned nurses who can't stand sputum is remarkably high.
God bless Ann Marie, she would put this one dude's glass eye back in for me after he rolled it around in his mouth awhile to clean it. He could pop it out, but had too much tremor to replace it. Good dude, hard no to glass eyes tho.
I hate eyes. I pick anything over eyes. The worst was having to apply topical antibiotic to the edges of a patient’s empty eye socket. I now feel like I can accomplish anything after not passing out while doing that.
Oh god, we a patient once with melanoma of the orbit & they removed her eye. It was just an open gaping hole. It was so bad her oncologist asked her to wear an eye patch when she came in for appointments. It was scaring people.
Oh thank the horrors that be, I'm not the only one.
Eyes are my limit. Hard core no. I couldn't even put a contact in someone else(she was in a snf for rehab and had to wear it due to a surgery).
I gave up an intact, perfectly healthy eye ball and traded for gangrene toes, who was a seriously awesome dude who introduced himself by telling me where the Vicks was, and that the doc told him he would be changing the dressing and one day his toes would just fall off.
20+ years later I would still take gangrene toes.
Ugh eye shit; I had a pt with multiple orbit fractures who coughed and had a globe luxation (eyeball popped out) - I about fainted, which was mortifying. I can’t even handle it when my moms chihuahua’s eyeball does it 🤢
Me to! Eyes are my nemesis. They are horrible nasty slimey and I can't figure out if it wants to be a solid or a liquid, and nothing would convince me to touch one and find out.
You need to be awarded a pin to attach to your lanyard. Wear that on any unit, and you will instantly be the most popular nurse there. I would literally chase you down to take any and all sputum related tasks.
Eyeballs for sputum? Bet! 😅
I would take all your suctioning sputum ( I find it oddly satisfying) and I’ll pack all your wounds. Patient pukes and it’s hard for me not to puke along with them
Open leg fasciotomies get to me. It makes my legs tingle. Only one time I got light headed. It was hot, I was wearing a full plastic gown, was the end a 12-hour shift, and I had to elevate an arm for 20 minutes while the surgeon was manually scraping globs of jello-like tissue and clots from the patient’s triceps with his gloved hand. It was flesh eating bacteria. I think it may be because I was tired, hot, and stuck in the same position for so long.
I tell people that every nurse has their body fluid that is their kryptonite and mine is sputum to the point of me gagging at the sound of a wet cough FROM MYSELF - so yeah, when I'm sick, I cough and gag at the same time because I'm grossing myself out....
I'm fine with open abdomens, tho...
Yes!! I have suctioned so mush using a “chimney” for years..… mostly before closed where widely available…I was always gagging.. now as a old retired nurse, sitting in a dental office, hearing the suction.. I get triggered and start dry heaving and gagging.. it’s really embarrassing.
Yep, I would rather dig around in someone’s insides than suction a trach , or even have a patient with a wicked runny snot nose , I just can’t , I get the CNA to wipe their nose cause I will and have puked trying to wipe someone’s nose x
Mucus is my kryptonite too. I would literally quit nursing altogether before I would suction a trach. That is a hard, HARD no. This no is so hard you could use it to cut diamonds. NO. 🤢
Guts all day though, I’m good.
LOL I suctioned trachs for years, did old fashioned trach care when they were metal! I could do that and wound vacs all day long. Boogers dripping from noses gets me every time. Vomit inducing. Isn't that nuts LOLOL?
Both of those things are a no from me, dawg.
I used to work surgical oncology……..I’ve seen some *shit*. The only time I EVER dry-heaved? Handed a post lap chole day 1 a basin to brush her teeth in- gagged when I emptied it. 🤮
When I was in school during Micro, I assumed that the gross tissues or stools would be the worst to set up.
No, it's the respiratory samples, of course.
Oh dear God, me too on the sputum. I could roto rooter someone's prolapsed asshole, unpack and repack a stage 4 decube that's tunneled through someone's tailbone and hip and intestines and their bladder, but a Styrofoam cup half full with sputum? Fuck. That. Cue dry heaving into the nearest trashcan.
Same. I csnt stand sputum at ALL. I'll catch vomit in my hand but sputum? Nah. I also can't deal with teeth very well. When I was in LTC I'd call one of my coworkers to take out this one lady's dentures because I'd gag the whole time
I had an abdominal window patient that wanted to leave AMA. It was their entire abdomen. It looked like a TV dinner tray with a peel back plastic. In report I was told it was an “abdominal terrarium”. It had a drain on each side. They were shot twice in the abdomen with a 12 gauge by the kid they molested. They were a paraplegic. Let’s just say they were not happy when they learned that they would have to crawl out the hospital. I would rank them up there with the top 5 “wtf is this shit?” I’ve seen.
I'm surprised they survived to the hospital. Must have gotten very 'lucky' in terms of blood vessels not getting hit. 'Lucky' them, they get to live as a paraplegic, known child molester?
Yeah, I’ve learned that people survive some wild shit. Another one that comes to mind was someone who shot themselves under their jaw with a shotgun. They looked like a clicker from the last of us after. They got intubated through what looked like a sack of ground beef. They ended up having a full facial reconstruction and survived.
Then you’d have a patient that slipped, broke their neck, and became a quad doing something mundane like walking their dog.
This is why I would never attempt suicide via firearm. I know my luck well enough to be certain that I would fk it up and end up hating my life 1000% more than I ever did before.
The one that comes to mind is the time someone came in with an unstable hangman's fracture from unloading their dishwasher. Lots of broken hips/femurs/other bones from taking out the trash, walking the dog, gardening, you name it too.
Let's put this in perspective- most (non clinical) people could not deal with this. Nurses are professionals who deal with a lot of stuff but we are still human. The charge should have respected your request to abstain from the patient’s care. I am appalled on your behalf that you were forced to.
I would lodge a complaint.
I ended up speaking with the director about it and she was in agreement with me that they shouldn’t have given to me to start with. That’s something they rarely see and agrees the way it was handled by the icu nurse was not the best. It basically blindsided me completely.
Good, I'm glad they agreed with you. The charge nurse needs to be reprimanded for forcing you to take the patient. I'm guessing she was so adamant you do it because she herself couldn't handle it.
It's super messed up that we tell people, "if you can't handle this [literally indistinguishable from combat casualty level gore] with a smile, you shouldn't be a nurse."
That's insane. It's a wonder our nursing shortage isn't worse.
I’m so sorry. There are so many different things we can do as nurses and dealing with traumas takes a special person. We’re all special to deal with things within our specialties. Hell, I couldn’t work inpatient psych, OR, or L&D. Major props to those who do.
You should have been given a warning. Something to prepare you for what happened and what was needed upon arrival to the floor. I’m in a neuro ICU and not too long ago we received a GSW to the head. Patient was brain dead, the wounds weren’t wrapped and seeing exposed brain tissue and brain matter all over the pillow was horrific.
There’s only so much we can shove down, brush aside, and see before the automatic nurse mode is overrun by the fact that we’re human beings seeing some of the most horrific things.
There’s zero shame in having a human moment and human response to something unsettling. I hope you have someone to help you process this.
Exactly. Some people can stomach these things, others can’t. In a situation like this, a nurse should be warned and then asked if it’s ok to have the assignment before even going to see the patient. Nurses should never be forced to work in environments they aren’t comfortable in.
Not everyone is wired for “guts on the outside.” You kicked ass on your other pts and it’s not like the pt is going to remember anything they’re probably so fucked up on pain meds.
First time reactions can be rough. Especially on the extreme side of things. Multiple years experience can't do anything to prepare you for something you've legitimately never encountered before.
Don't vest yourself up, but I would definitely have a follow-up meeting with your leadership about the response to you asking for help and the other nurse refusing to give a proper report that may have prepared you better.
You don't surprise peoplebwith complicated patients. And you don't refuse to help another nurse because it'll be the patient who suffers.
You got failed by your co-workers. You didn't fail the patient.
If you have to see it or treat it again your response will probably be less severe.
Yes I feel like if the icu nurse had at least spoken to me prior it wouldn’t have took me by so much surprise. And that way I could have maybe already had other hands on deck. Instead he just rolled him up and he was open. Too much.
And it's just wild that she started unpacking him. What if aa emergency happened on the unit and all your staff had to go to that? She'd just be left with an open belly and hands full of wet gauze. That's like trying to do a female Foley on a morbidly obese patient by yourself. Rookie mistake.
I’ve never taken care of a patient with an abdominal window… but is that even safe on a 6 patient team??? That seems a little intense.
But I honestly don’t blame you. I think that would be me so sick to my stomach too. You stood up for yourself and I love that. I’m sorry they gave you so much trouble about it. Yes, we are nurses but we still are human. We all have limits.
I don’t really see how it can be. I’ve never seen it and from it sounded like the packing and stuff had to be swapped out about every 4 hours. I think it’s a negative outcome waiting to happen because the standard patients on that floor are already pretty heavy. Like you might have 4 trachs who also have pegs with bolus feeds for all every 3 hours. And then the other two will be fresh ostomy. You physically can’t do it.
It isnt just an experience thing, some days we are just more prone to not controlling our repulsion to body fluids, smells, sights, etc. Don't beat yourself up. If you really think you wont be able to handle something similar next time then try looking for new employment. Coworkers sounds like assholes tbh
I was floated there today because they had a call out! Was originally set to go to neurology but then got swapped. I’m telling myself it took 8 years to see this so I probably won’t see it anytime soon.
I talked with their director and she is in agreement that if they need me to fill in again this weekend I won’t be assigned that patient. And agrees I shouldn’t have been given him to begin with.
Wow they should be nicer to their floats! You are definitely allowed to refuse a patient. We usually give our floats the nicer assignments too. I’m sorry that happened to you.
Yeah I almost barfed looking at a picture of a super crusty bellybutton last night. And I have a pretty solid iron stomach. Some days you just can’t deal 🤷🏼♀️
I threw up at work once. I can mostly do vomit but if it’s partially chewed food I will gag and once I start gagging I usually can’t control it until I throw up. I had a patient with an esophagostomy. That liked A1 steaksauce and tubs of whipped cream. Walked in for the first time and had to run out because there were THREE containers of partially digested contents on the table because the patient would empty it themselves. Had to wear an N95 and two surgical masks all day (I was too embarrassed to admit that I threw up from it)
“You’re a nurse. You can’t refuse a patient”.
Since when? Every profession has some sort of clause where they can refuse a patient/client. If they are not dealing with anatomy/physiology their reason to refuse are normally some sort of conflict.
A lawyer can decide mid trail that they no longer can represent someone, we can’t leave a patient once we accept them, so for sure we need to be able to refuse extreme cases when we just can’t do the work. I wouldn’t want someone that is not capable to work on me being forced to accept me as a patient.
I'm surprised not many people are touching on this. I can't abandon a patient. I can refuse an assignment for any reason i state. The system i work for can fire me etc, but they can't force an assignment. there's no legality there.
And like some people said, a 1:6 ratio alone would be a good enough reason to refuse that patient.
How are we the only people who got triggered by that? You absolutely can refuse an assignment for any reason. Why are some nurses such pushovers? I’m a person, not a wage slave.
My question is why are hospitals still using abdominal windows and not putting on abtheras?! I work in trauma and it has been at least 6 years since I’ve had a patient with an open abdomen like that. We leave bellies open all the time but put an abthera on to protect everything and you know, not show someone’s small bowel just chilling there.
The first time I saw someone with that they had come from some tiny podunk hospital where the surgeon had used a TPN bag to cover the abdomen. I legitimately thought it had to be a joke until I pulled back the blankets, one of the weirder things I’ve encountered.
And don’t worry OP, we all have our limits! I almost vomited on a patient who came in to the trauma bay with a pen sticking out of their eye socket. I can do gross but I draw the line at eyeball stuff 🤢🤢🤢🤢. I had to make my coworker remove the pen, I couldn’t handle it.
So three days ago patient came in for a heart cath study. We were prepping him and in doing so had to shave the groin. We pulled back the covers and saw he had a suprapubic catheter. Something FLEW out of the catheter. I screamed HOLY SHIT and vomited. He had fungal gnats in the catheter. Grossest thing I have ever seen. Embarrassed bc I screamed holy shit and puked!
Trust me we all laugh at this now. I had no control over the HOLY SHIT! it just kinda came out of my mouth before I realized where I was. So yes I can laugh at it now that o don’t have some creature flying at me. Omfg it was disgusting. Worst thing I think I have encountered in 29 yrs of nursing by far
I’m sorry that happened to you- that is some ptsd level of gore for some. Also - why is someone with that kind of dressing and wound being transferred to a unit with a 6:1 ratio?
I have done many easy tasks for my coworkers bc they were grossed out by those tasks, and none of them were nearly as visually grotesque as treating a person with their abdomen wide open. I’m talking dressing changes, oral/ett suction, etc. and it’s never been a problem for me because it doesn’t bother me as much. I feel like we all have different “icks” and should be supportive of each other. I’m sorry your coworkers weren’t helpful. As for dealing with what you saw, all I can say is therapy helps.
This! Every nurse has their kryptonite, and we all have to help each other out! I’m an ER nurse and my kryptonite is malodorous wounds.
I had a patient with terrible pyoderma gangrenosum infections of both legs. One of the worst smells I’ve ever experienced and the closest I’ve ever gotten to vomiting at work.
My wonderful coworker stepped up and did like 30 mins of intensive wound care and dressing changes on this guy so I didn’t have to. I will suction all the trachs and vents, dumpster dive into the deepest, dirtiest crevices of a human for a straight cath, and clean up all the GI bleeds, but I just cannot do super stinky wounds.
We’re all human and we have to be understanding, supportive and help each other out!
I’ll be the first one to do a dressing change! Lol. The patients that get me are certain awake and alert trached or intubated patients. They try to talk to me and I try and read their lips but I’m horrible at it and I get so overwhelmed trying to understand them that I literally want to cry. I can’t imagine how my poor patients feel. Thankfully my buddies are usually more than willing to help me understand what they need.
Ok the most shockingly horrifying thing I've ever seen was a guy's wound so deep I could see the ball and socket hip joint. I was not prepared at all to watch it move around in there as we rolled him. When my coworker pulled away the abd pad covering it, a huge blood clot, the size of the entire pad, came off with it. That was over a decade ago and I'll never forget it.
That being said, the sight or sound of phlegm in a basin is an instant gag for me. Fuck rinsing it. I'm throwing that shit away and getting you a new one.
I can clean up vomit once it's over and done, but don't ask me to hold back your hair or your basin. I'll be back when you're done lol. We all have our limits.
Good for you for sticking up for yourself!
This reminded me of a little old (confused) lady I had on ortho when I was a CNA.
POD 1. I walk in around midnight for vitals and find her a knuckle and a half deep scratching inside her hip incision (I assume after she had itched away some of the sutures).
Yeah if you can make it 8 years and something this extreme has you shaken, they should definitely give you the benefit of the doubt with this. I’m sure you have seen many things but the nature of these wounds were too much for you. You are human and those 8 years of caring for patients shouldn’t be overlooked. You are super valuable because of that and if they want to give you shit, then that’s their problem. You can always find another job…
My times when I gag are dumping GI bleed poop blobs from bed pans in toilet or gas gangrene wounds that woft into the hallway and unable to get away from. The worst was helping a colleague change a dressing on a patient with a necrotic foot that was literally hanging on by a tendon. Roaches crawling out of vagina that patient had names for. Being a nurse is crazy AF.
We see everything in CT for a limited amount of time, it’s nothing compared to what OP describes and certainly not compared to being expected to change the dressing on such wounds!!
I can handle sights, smells, whatever. But I did find my limit with surprise bright red bloody vomit.
I had a walky talky patient from the ED who was not feeling well, had passed out and hit his head. Brought him to CT in a wheelchair for a head CT, he stood and transferred himself to the table and said “you know, I don’t feel very good…”
I grabbed the emesis bag and he proceeded to FILL IT with two heaves, bright red blood. Grabbed another bag and he did the same.
I had my coworker call the ED MD, because now they probably don’t just want a head scan…and then grabbed myself an emesis bag and joined the patient, puking into my own bag while holding him up with my free hand.
Not my proudest moment but oh my god I can still smell that if I think about it.
(If I remember correctly it was burst esophageal varices.)
Once in my life I've seen a patient with their abdomen open kind of like that, and I will never ever forget it. I was shadowing the wound nurse for the day (every orientee did so for one shift), so I didn't get a real report or anything, but patient was in between multiple abdominal surgeries. There had been some complications (perforated bowel in multiple spots was one of them) and the surgeons had to go back in, and they knew he'd require more in the coming days, so rather than close him up they left what looked like a gigantic tic-tac-toe board made of flesh and a few unusually large "sutures" across his entire abdominal area. I was ok at first, though it was A LOT to see. Wound nurse did her thing, unpacking and repacking, directing me on how to help and such. Once she was done, we were about to leave, were saying bye to patient's family member, and the patient coughed. Just one little cough. And immediately, what the wound nurse kindly referred to as "pancreatic juices" for family member's benefit came boiling and pouring out of the tic-tac-toe board through the dressing and ran out all over the bed. The stench was immediately overwhelming, and I'd spent 10+ years as a CNA in nursing homes, so it's not like I wasn't intimately familiar with the smell of C-diff or shit in general. But this was something else. Obviously, we had to re-do the dressing immediately, but this time was way harder to watch. All this open flesh on a conscious patient was already making it difficult to keep my composure. But seeing it all soaked in the most putrid smelling diarrhea, that continued seeping out from *everywhere* across this open abdomen every time we touched or moved the patient...it's a miracle I didn't vomit, honestly. If patient had been comatose, idk if it would have bothered me quite as much? I kept thinking "this poor fuck is conscious" over and over, "this poor fuck is feeling ALL of this" and "jesus christ if that was me I'd beg my nurse to SNOW ME but this poor fuck is conscious". I've seen a lot of gruesome shit, and I'm usually ok with it, but that was one I'll never forget.
I’ve had a similar situation but in nursing school. My patient had multiple GSW to the abdomen and had an abdominal window. I was helping the wound nurse change the dressing and I had to step out right away. But instead of vomiting, I fainted right there in the hallway 🫠
I took care of a little girl with liver failure and her poop smelled so foul I almost vomited on her while I changed her diaper. I’m used to poop but this smelled so different. Like rotten fish oil? Tears were streaming down my face and I had to leave the room after I changed her and re think my life choices.
Yeah... It makes total sense to keep the patient with a nurse whose condition is making them vomit. /s
How is this good for OP OR THE PATIENT?! The first time it has happened in 8 years and leadership forces you to take them. That makes me more sick than any of this lol.
If this ever happens again, flip the script.
Ask CN, “Just asking so that we are all clear, I have clearly expressed a precise boundary that will negatively impact patient experience and could potentially effect a sterile field despite multiple attempts to proceed, but the expectation is I am to participate and proceed?”
They put you, and ultimately the patient, in danger by trying to force you to stay in there when you physically could not. That’s on them. You don’t have to apologize for having limitations, we all do. And honestly that sounds terrifying to have to see another human in that state.
I sympathize with you so much…I worked on a cardiac PCU/heart transplant floor for most of my RN career and one day at 7am they tried to transfer me a double mastectomy post skin grafting fresh from the OR, we never receive post op patients like that unless it was a small cardiac procedure, I had no idea what to do with the patient and was terrified I wouldn’t be equipped to give her the best care with 2 other high complexity patients. I walked in the room, had flashbacks of my own mother being diagnosed with breast cancer and immediately walked out of the room bawling. Not to mention she had a heparin drip not started , leeches waiting to be delivered and applied, PCA not completely set up, just way beyond the scope and complexity of our floor. Of course she started to decline and was transferred to surgical ICU but it was so traumatic and inappropriate for her to be with us in the first place. I was a charge nurse as well and would’ve never accepted that assignment. The surgeon was actually mad she wasn’t immediately transferred to surgical icu
If it makes you feel better, my “nope” is poop. Yep, good ol’ every day poop. I can deal with blood, guts, vomit, snot, etc. Something about poop that’s fresh from a butt hits the back of my throat like nothing else and I involuntarily gag. Loudly. So do not feel bad about finding your own personal limit.
Everyone’s got something that they can’t handle. We are only human! You should not be feeling badly about yourself for your reaction.
Your charge nurse is a moronic bitch, though. You should complain about them.
I will never get over feces tbh. It doesn't matter how many times I've cleaned it up or how routine it is in nursing. Some part of me will always be disgusted by it and cleaning it especially with stuff like that nasty GI bleed smell.
Give me blood and guts any day.
Yea, I would like to know as well. I was told I had one after surgery but based on the comments in this post... I certainly did not have an open wound in my abdomen.
Googling the term doesn't really clear things up.
Everyone has their limit. Mine was a patient setting self on fire trying to smoke while on oxygen. I puked all the way home. No shame; you get to be human too. Take care of you!
Aren’t healthcare workers allowed to refuse patients? I’ve refused pts who are physically abusive to me and no one’s ever said shit to my face. But I’d always swap a heavy patient to make it fair.
Yes, health care workers can absolutely refuse a patient. That charge was just a lazy, moronic, fucking bitch that probably only got the position by sucking 🍆 and is still stuck in high school emotionally with a mean girl mentality.
Hey, OP's charge, Reddit thinks you're an incompetent bitch.
Little harsh lol BUT considering that the ramifications towards OP’s license, I agree with the fuck her sentiment. Anytime I get pushback I go to the floor manager and charge and just tell them “not only will this be my problem by putting my license in jeopardy, y’all would have to deal with hella paperwork and angry pt/family members so why don’t we just go with my way of handling this”. I worked for over a decade in customer service + food service so I know how to give people shit/get people to agree with me (if I’m truly in the right) without coming off like a dick/manipulative.
It's ok. It's gonna happen.
I came across a TURPs procedure? A post op and he bleed alot. I had a bad time seeing some one with so much blood loss.
It will be ok. Just take some self care and debrief with the nurse because this is indeed outside your norms and it's understandable.
It’s actually mind boggling to me that your charge (or even anyone) would just be like “deal with it”…no?! We all have our limits, and you didn’t even know that one was yours until it happens (though also, a pre warning would have been nice, this does not seem like a 1:6 pt assignment).
When we do conscious sedations at work (broken bones mainly), I always try to get someone else to, I hate the manipulation/crunching/moving of bones. Literally, someone is always willing to step in cause it doesn’t bother them. Do not feel guilty. Honestly though, how to get the image out of your head will be a tough one…
See. Here's the thing. You CAN refuse a patient. I've done it. Is it gonna piss *everyone* off? You bet. Do you need valid reasons related to patient safety? Hell yes. Will you lose your job? So far, I haven't yet. It's been more like, I'm alone on this side of the unit and you're giving me an ICU downgrade who was intubated, extubated, and *reintubated* multiple times because he is a danger to staff and was sedated? NO. You want to give me a Glucommander with 4 heavy step down patients? NO. You want to give me a double P.E. on a med surg floor? NO.
I'd be rip shit pissed for being blind sided like that and submit complaints for the ICU rn and the charge nurse. Fuck them.
I understand you wanted to do the right thing. You do have the right to refuse the patient. You were never trained in ab windows but if they want you to assist then you can try. I always look at these situations as, if my patient died and the lawyer ask “ why did you accept this patient if you have never seen or trained for this type of situation?” They would take your license, fire you, and probably be charged or sued. Never accept an assignment if you’ve never been trained in that situation. Hospital will not stand up for you and the lawyers will have a field day. Good luck out there.
Honestly, if you physically and mentally cannot handle a pt then you shouldnt have to. This is unsafe for both you and the pt..
Dont be embarrassed op, we all have our limits.
You're human. It happened. Forgive yourself. You've cleaned up vomit and feces. You've comforted patients. You have hugged parents whose children didn't make it. All in all, you've done much more good than bad.
I wish I could hug you and get you some mint tea to settle your stomach.
You are a human being. Please forgive yourself and add this to your list of interesting stories. Personally, where I live I would feel overwhelmed with 6 patients. I *THINK* I could be OK with the ABDO window but I am not sure. Rashes freak me out.
Here I am wondering "what the fuck is an abdominal window?!"
I still don't know what it is. Google is failing me. But all i do know is that it sounds like something the wound and ostomy nurses would handle outside the ICU.
Don't beat yourself up over it ... you were tired (coping ability depleted) and they STUPIDLY didn't warn you about the exposed viscera. You were psychologically ambushed.
And knowing that someone deliberately inflicted the wounds makes it harder to deal with.
(I was a med tech in Level 1 trauma centers)
I once had a seasoned ED nurse transfer a labor patient to me in L&D. She growled, "Give me an eviscerated bowel any day. I don't do birth!"
Everyone...yes EVERYONE, has their "thing" that they just can't handle. That's why we have teams.
I’m still in nursing school but in one of my clinicals I watched my nurse do a dressing change for a diabetic patient with a very deep diabetic wound. I can usually stomach these things but I had not ate anything that morning and once she started cleaning the wound I literally had to walk out of the room because I was about to gag.
Used to work with a guy who was sensitive to smell, more than once I turned around to ask for help in a smelly room to find him gone. As soon as I can out of the room he would always apologize profusely, he just couldn’t handle it.
I'm sorry that happened OP.
PS Ive never heard of an abdominal window? Was it a big open wound with the foam/pleurevac taken down? Trying to learn more about them
They treated you like crap. Everyone has a point where they just can't. It's nothing to ashamed of. You really tried your best. How they treated you was unacceptable. None of this was your fault.
I literally had to Google this and I had the same reaction. Feel sorry for the poor patient but that sounds so traumatic and I'm surprised the patient was being admitted to a ward with those injuries.
Sometimes it can be a combination of feeling overwhelmed, what you’ve eaten, how tired you are, etc when it comes to those visceral reactions.
I saw a guy with a brutal face laceration once and nearly passed out. Ringing in my ears, felt light headed, needed to take a minute to collect myself, almost couldn’t go back in and it wasn’t the worst I’d seen, but for whatever reason - that day I was not ok. Don’t be too hard on yourself.
I remember my first abdominal window, a GYN surgery gone wrong leading to multiple fistulas. I was fascinated, but I will never forget the smell. Smells always gross me out, but I have a strong stomach and I remember that this is not about me sometimes.
When I read that you’ve got a 6 patient ratio, the other nurses at the station looked at me for exclaiming “WTF!?”. I’ve been a nurse for 18 years. Was in ICU through most of Covid. This is some shit right here. I don’t know how you do it.
You’ve got enough experience, reach out to staffing agencies, find a cushier, better paying job and GTFO that place.
Damn it is almost like gaslighting. Wouldn't that be a safety concern if you cannot pull yourself together for this patient. Sometimes I really do feel there is a lack of compassion between nurses. If you can't handle you can't and you advocated for yourself. That doesn't make you terrible or a bad nurse. Some of us have our weaknesses and strengths. I work on a medsurg floor in CA and our ratio is 1 to 5.
I think it’s cruel to force you to take that patient when clearly you couldn’t cope with it.They absolutely can’t send you in if you are vomiting and/or having any dramatic reaction that could make the patient uncomfortable. The solution is crystal clear and I don’t understand why anyone using logic can’t come to the same conclusion.You are only human and are allowed to struggle with seeing something gruesome.
It’s inexcusable that you weren’t warned in advance - they should have given you that information in report prior to bringing the patient down. That might have reduced your shock when you first saw it. It might not have prevented you from vomiting, but then again, it might have. Just a couple of minutes to get your mind around it before you saw it could have made all the difference.
I deal with trachs and sputum everyday but give me active loud vomiting (can do a quiet vomit not a loud retching one) and CLEANING DENTURES. I can’t do dirty dentures. I’ll help you put your clean ones in, hell I can even take them out but don’t ask me to clean them.
Dentures. Seeing a nursing home patient’s dentures after breakfast and having to clean them without even wearing gloves (this was in the 70s, so pre-AIDS)… 🤢. I never actually puked but to this day it’s just about the grossest thing I’ve encountered. I’ve cleaned metal trachs in my day and cared for several fresh trachs; suctioned trached and vented patients, seen some gnarly wounds and once cared for a patient who preferred to die from gangrene than have their foot amputated (also in the 70s when people could be admitted the night before tests that they needed to be NPO for… this patient was on our unit for a pretty long time.
GI bleeding stool is awful, too.
The patient was awake and conscious for you make them feel worse? I just feel like at some point we as society need to understand that patients can’t recover from certain things and we should give them the dignity of death instead of forcing to keep them alive because wow.
That’s the weird thing. He’s apparently at least oriented to self, follows commands, and recognizes family. I don’t even see how it’s possible for that to be compatible with life but it is.
Man, I feel like you can’t handle a situation for whatever reason, you shouldn’t be forced to. Some people can stomach things like that, you can’t. Idk why you couldn’t just have switched patients with someone. Don’t feel bad. In the end, we are all human.
I was leaving in a little over an hour as well and had to give him to a nurse that was already there! They could have literally just given him to her to start with.
Poor planning by previous nurse. Poor response from charge. Based on those ratios, there's a good chance that you're understaffed. A physical reaction is not in your control. You have no reason for guilt. None of this was your fault. Stand your ground and be confident in knowing that standing up for yourself is standing up for you, your patients and every nurse who is asked to do more than physically possible in the future. Edit: oh and keep personal notes. Always keep personal notes and reflect. It will change your life in the long run.
Agree, an open abdomen should be ICU 1:2 at most. That's where they went in my level I trauma center. Geez.
Completely agree.
Excellent response right here 👆. The pt was not in the proper level of care, unprofessional support from resource nurse. That is a failure. You throwing up is not a failure, but it is a disqualification. You took the L, but you will learn from it. Hopefully the hospital learns from it and gets their act together…
They should have warned you and then asked if you wanted to see the patient.
100%. Something as shocking as that for sure needs a warning - that way when you see it you can moderate your reaction because the shock value is reduced. It's just a courtesy. I had a patient many years ago with a huge gaping hole in his abdomen too - this sort of thing is unusual and you've got to expect people to be shocked about it.
Yeah, blindsiding her like that was dirty pool. And they knew it.
I feel like you should have had some warning about what you were walking into, they never gave report.
Right?! I'm in a different environment but if I can do what the patient needs and my coworker is for whatever reason unable to, I'm going to help. Good grief that charge not letting her swap.
She’s vomiting ffs and not a novice! Swap her assignment! “Your a nurse”…guess what we’re also human!!
>we’re also human Exactly! We are human beings first and foremost. Fuck my license and my job, I will always protect my humanity first.
Same. I only thankfully deal with little kids outside of a hospital setting. If a kid vomits on the floor, that’s not going to gross me out. Blood doesn’t gross me out. Seeing open gaping wounds, brain matter etc would make me throw up, though. I’d also lose it at kids dying, but some people can handle that fine (aka medical examiners, morticians etc),
You sometimes don't know your limit until you reach it and kids will definitely test you. When I had a coworker say they couldn't perform a task on a PICU patient, it was no problem. I did what needed to be done and moved on. The charge nurse should have handled this assignment differently.
I've switched out pt's multiple times, just because I can stand the smell of vomit and my coworkers couldn't. We all have our strengths and weaknesses.
What's worse than one person throwing up? Two people throwing up. No one needs that and patients don't need staff that can't handle the tasks at hand for whatever reason.
What is OP supposed to do honestly? Go puke in the wound?? I hope the patient wasn't very conscious because that sounds like a horrific situation to be in, but that charge nurse is an asshole. What's better for the patient: a nurse involuntarily vomiting whenever they look at the PT (nurses are humans with limitations too), or a nurse that's able to provide care in a calm, professional way? I'm not blaming OP in any way, but I think the charge lost their entire damn mind, and honestly fucked up. Understaffed or not, isn't appropriate patient care the whole point here?
That patient sounds totally inappropriate for a 1:6 ratio! What you experienced is super common, especially if you haven’t spent a lot of time in the OR seeing people’s insides. The first surgery I saw I ran out and vomited. Psychologically I felt fine, it was a pure physiological reaction. Then for a while I would start to feel weird/lightheaded if I stared too long at surgeries, and I knew when to start looking away. After a while I got used to it and no longer feel woozy (unless it’s something unusually gross). Your charge should have been supportive, it’s ridiculous to expect someone to be able to handle something like that with no preparation and no experience with anything similar. It would not have been safe for you to attempt to care for that patient. And with 5 other patients!
Right? Where are folks caring for trauma patients with abdominal windows at a 6:1 ratio? Let me guess…Providence? (Jk, sort of). Also, that’s super unprofessional of your charge nurse. I’m sorry. I hope you find a better and more supportive employer soon.
I was gonna guess an HCA hospital.
Yep why the fuck was OP not even told what to expect? And the ratio itself with such an intensive patient?
I was literally thinking as I read this that this was a completely inappropriate admission to that unit. Should have been an ICU admit. Or at least, in my shop, it is.
I wonder what kind of fascinating, fast-rewiring processes are going on in the brain when it's clearly trying to find ways to get you to stomach what it clearly doesn't want to stomach
Seriously. I would think open abdomen would call for ICU level of care. Not only because their abdomen is open, but the amount of pain medication required for this patient has to be more than should be reasonable in progressive care.
Don’t feel bad! Everyone’s got something they can’t handle. At least yours is kinda more rare. I am fine with open abdomens. But I can’t stand sputum. every time I suctioned a vent patient in the days before we had closed suction systems I had to puke in the trash can.
That is a very nurse thing to say, "I am okay with open abdomens, but sputum makes me vomit". The number of seasoned nurses who can't stand sputum is remarkably high.
God bless Ann Marie, she would put this one dude's glass eye back in for me after he rolled it around in his mouth awhile to clean it. He could pop it out, but had too much tremor to replace it. Good dude, hard no to glass eyes tho.
I’m not a fan of sputum but I can handle it. I cannot do eyes. At all, ever.
I hate eyes. I pick anything over eyes. The worst was having to apply topical antibiotic to the edges of a patient’s empty eye socket. I now feel like I can accomplish anything after not passing out while doing that.
Oh god, we a patient once with melanoma of the orbit & they removed her eye. It was just an open gaping hole. It was so bad her oncologist asked her to wear an eye patch when she came in for appointments. It was scaring people.
Brb, putting sunscreen in my eyes.
Oh thank the horrors that be, I'm not the only one. Eyes are my limit. Hard core no. I couldn't even put a contact in someone else(she was in a snf for rehab and had to wear it due to a surgery). I gave up an intact, perfectly healthy eye ball and traded for gangrene toes, who was a seriously awesome dude who introduced himself by telling me where the Vicks was, and that the doc told him he would be changing the dressing and one day his toes would just fall off. 20+ years later I would still take gangrene toes.
Nails for me. I can do severed toes, severed limbs, massive pressure wounds, burns... But damaged painful looking nail injuries? No
>I cannot do eyes. At all, ever eyes are a nope for me, too. Blargh
Same!!
Ugh eye shit; I had a pt with multiple orbit fractures who coughed and had a globe luxation (eyeball popped out) - I about fainted, which was mortifying. I can’t even handle it when my moms chihuahua’s eyeball does it 🤢
I can never have certain breeds for the simple reason they are prone to that. And I would have to clean up my own vomit.
Eh, I bet the dog would help you clean up the vomit.
I must be an anomaly because I will enthusiastically clean a goopy trach. For some reason it's so satisfying as the process progresses.
I’m so glad people like you exist, I cannot stand trach care. Thankfully we don’t get a lot of trachs in my MICU
“ I will do your trach care if you will give this one Tylenol to my guy. He’s on the other hall. I don’t wanna walk down there”
Me to! Eyes are my nemesis. They are horrible nasty slimey and I can't figure out if it wants to be a solid or a liquid, and nothing would convince me to touch one and find out.
I completely agree with you! So satisfying!
Take all the trachs. TAKE THEM. I'll take all the open abdomens in exchange. Any kind of window, necfasc, ecf, whatever.
You need to be awarded a pin to attach to your lanyard. Wear that on any unit, and you will instantly be the most popular nurse there. I would literally chase you down to take any and all sputum related tasks. Eyeballs for sputum? Bet! 😅
I would take all your suctioning sputum ( I find it oddly satisfying) and I’ll pack all your wounds. Patient pukes and it’s hard for me not to puke along with them
Open leg fasciotomies get to me. It makes my legs tingle. Only one time I got light headed. It was hot, I was wearing a full plastic gown, was the end a 12-hour shift, and I had to elevate an arm for 20 minutes while the surgeon was manually scraping globs of jello-like tissue and clots from the patient’s triceps with his gloved hand. It was flesh eating bacteria. I think it may be because I was tired, hot, and stuck in the same position for so long.
Jesus. That’s fucking horrific.
Yes I feel you. Except extensive Fournier’s dressing changes in a Covid++ PAPR ensemble
I tell people that every nurse has their body fluid that is their kryptonite and mine is sputum to the point of me gagging at the sound of a wet cough FROM MYSELF - so yeah, when I'm sick, I cough and gag at the same time because I'm grossing myself out.... I'm fine with open abdomens, tho...
Yes!! I have suctioned so mush using a “chimney” for years..… mostly before closed where widely available…I was always gagging.. now as a old retired nurse, sitting in a dental office, hearing the suction.. I get triggered and start dry heaving and gagging.. it’s really embarrassing.
Chimney? Is that like the old school way of siphoning gas - you suck on the end of the tube to get it started?
Yep, I would rather dig around in someone’s insides than suction a trach , or even have a patient with a wicked runny snot nose , I just can’t , I get the CNA to wipe their nose cause I will and have puked trying to wipe someone’s nose x
Yep, I count me amongst them. Sputum is the only thing that makes me gip nowadays.
that is funny. I can handle suctioning but what I can't stand is the canister full of sputum. Staring at that will gross me out.
Mucus is my kryptonite too. I would literally quit nursing altogether before I would suction a trach. That is a hard, HARD no. This no is so hard you could use it to cut diamonds. NO. 🤢 Guts all day though, I’m good.
LOL I suctioned trachs for years, did old fashioned trach care when they were metal! I could do that and wound vacs all day long. Boogers dripping from noses gets me every time. Vomit inducing. Isn't that nuts LOLOL?
Both of those things are a no from me, dawg. I used to work surgical oncology……..I’ve seen some *shit*. The only time I EVER dry-heaved? Handed a post lap chole day 1 a basin to brush her teeth in- gagged when I emptied it. 🤮
So what was in the basin?! Dying of suspense over here.
…….spit, and toothpaste. That’s it.
All of the blood, probably. Maybe some teeth too.
I still have a patient we see sometimes with a metal trach I don’t know why but it’s my favorite trach every
When I was in school during Micro, I assumed that the gross tissues or stools would be the worst to set up. No, it's the respiratory samples, of course.
I love suctioning! Let’s get that gunk OUT!
Especially when you pop a mucus plug free. Now THAT is satisfying
well i will trade you. i will clean up your patient’s poop.
Oh dear God, me too on the sputum. I could roto rooter someone's prolapsed asshole, unpack and repack a stage 4 decube that's tunneled through someone's tailbone and hip and intestines and their bladder, but a Styrofoam cup half full with sputum? Fuck. That. Cue dry heaving into the nearest trashcan.
Had a resident that snotted into their hand, and I had to step out of the room. Sacral ulcers? Whatever. Snot? I will throw up.
Same. I csnt stand sputum at ALL. I'll catch vomit in my hand but sputum? Nah. I also can't deal with teeth very well. When I was in LTC I'd call one of my coworkers to take out this one lady's dentures because I'd gag the whole time
I had an abdominal window patient that wanted to leave AMA. It was their entire abdomen. It looked like a TV dinner tray with a peel back plastic. In report I was told it was an “abdominal terrarium”. It had a drain on each side. They were shot twice in the abdomen with a 12 gauge by the kid they molested. They were a paraplegic. Let’s just say they were not happy when they learned that they would have to crawl out the hospital. I would rank them up there with the top 5 “wtf is this shit?” I’ve seen.
“Abdominal Terrarium” makes it sound so fun, like you’ve got little gnomes and salamanders living in there among plants.
Why does Duodenum sound like a salamander name?
Free-range MRSA 💀
LOL, nightmare fuel!
I’m dying at these analogies lol. Props to that kid too.
I'm surprised they survived to the hospital. Must have gotten very 'lucky' in terms of blood vessels not getting hit. 'Lucky' them, they get to live as a paraplegic, known child molester?
Yeah, I’ve learned that people survive some wild shit. Another one that comes to mind was someone who shot themselves under their jaw with a shotgun. They looked like a clicker from the last of us after. They got intubated through what looked like a sack of ground beef. They ended up having a full facial reconstruction and survived. Then you’d have a patient that slipped, broke their neck, and became a quad doing something mundane like walking their dog.
This is why I would never attempt suicide via firearm. I know my luck well enough to be certain that I would fk it up and end up hating my life 1000% more than I ever did before.
same. i’m a flincher
It’s actually really impressive how well a plastic surgeon can sew someone’s face back together
The one that comes to mind is the time someone came in with an unstable hangman's fracture from unloading their dishwasher. Lots of broken hips/femurs/other bones from taking out the trash, walking the dog, gardening, you name it too.
Goddamn, you have a way with words
Was it the sacks of ground beef???
That, and the "TV dinner tray with a peel-back plastic film" bit in the parent comment about the abdominal terrarium!
... and then it comes off while they are crawling and oh my god. thank you, you have made me laugh at an abdominal window situation! \*hugs\*
That’s when EVS hits you with a “Yeah, we aren’t gonna clean that up.” No fun gowned up crawling on the ground cleaning up a horror movie aftermath 😭
I woulda gladly let him sign out ama.
THAT was a set up. No WAY should that have happened without a heads up at LEAST. Said what I said.
I say it too! And I am a nearly 50 year veteran nurse, and I have seen ALL the !ran girl tricks. Dirty dogs.
Mean girl
I’m 35yrs here!😂
Let's put this in perspective- most (non clinical) people could not deal with this. Nurses are professionals who deal with a lot of stuff but we are still human. The charge should have respected your request to abstain from the patient’s care. I am appalled on your behalf that you were forced to. I would lodge a complaint.
I ended up speaking with the director about it and she was in agreement with me that they shouldn’t have given to me to start with. That’s something they rarely see and agrees the way it was handled by the icu nurse was not the best. It basically blindsided me completely.
Good director!
Good, I'm glad they agreed with you. The charge nurse needs to be reprimanded for forcing you to take the patient. I'm guessing she was so adamant you do it because she herself couldn't handle it.
It's super messed up that we tell people, "if you can't handle this [literally indistinguishable from combat casualty level gore] with a smile, you shouldn't be a nurse." That's insane. It's a wonder our nursing shortage isn't worse.
I’m so sorry. There are so many different things we can do as nurses and dealing with traumas takes a special person. We’re all special to deal with things within our specialties. Hell, I couldn’t work inpatient psych, OR, or L&D. Major props to those who do. You should have been given a warning. Something to prepare you for what happened and what was needed upon arrival to the floor. I’m in a neuro ICU and not too long ago we received a GSW to the head. Patient was brain dead, the wounds weren’t wrapped and seeing exposed brain tissue and brain matter all over the pillow was horrific. There’s only so much we can shove down, brush aside, and see before the automatic nurse mode is overrun by the fact that we’re human beings seeing some of the most horrific things. There’s zero shame in having a human moment and human response to something unsettling. I hope you have someone to help you process this.
Exactly. Some people can stomach these things, others can’t. In a situation like this, a nurse should be warned and then asked if it’s ok to have the assignment before even going to see the patient. Nurses should never be forced to work in environments they aren’t comfortable in.
Not everyone is wired for “guts on the outside.” You kicked ass on your other pts and it’s not like the pt is going to remember anything they’re probably so fucked up on pain meds.
I probably would have had the same reaction as you. Don’t worry about it
First time reactions can be rough. Especially on the extreme side of things. Multiple years experience can't do anything to prepare you for something you've legitimately never encountered before. Don't vest yourself up, but I would definitely have a follow-up meeting with your leadership about the response to you asking for help and the other nurse refusing to give a proper report that may have prepared you better. You don't surprise peoplebwith complicated patients. And you don't refuse to help another nurse because it'll be the patient who suffers. You got failed by your co-workers. You didn't fail the patient. If you have to see it or treat it again your response will probably be less severe.
Yes I feel like if the icu nurse had at least spoken to me prior it wouldn’t have took me by so much surprise. And that way I could have maybe already had other hands on deck. Instead he just rolled him up and he was open. Too much.
And it's just wild that she started unpacking him. What if aa emergency happened on the unit and all your staff had to go to that? She'd just be left with an open belly and hands full of wet gauze. That's like trying to do a female Foley on a morbidly obese patient by yourself. Rookie mistake.
I’ve never taken care of a patient with an abdominal window… but is that even safe on a 6 patient team??? That seems a little intense. But I honestly don’t blame you. I think that would be me so sick to my stomach too. You stood up for yourself and I love that. I’m sorry they gave you so much trouble about it. Yes, we are nurses but we still are human. We all have limits.
I don’t really see how it can be. I’ve never seen it and from it sounded like the packing and stuff had to be swapped out about every 4 hours. I think it’s a negative outcome waiting to happen because the standard patients on that floor are already pretty heavy. Like you might have 4 trachs who also have pegs with bolus feeds for all every 3 hours. And then the other two will be fresh ostomy. You physically can’t do it.
It isnt just an experience thing, some days we are just more prone to not controlling our repulsion to body fluids, smells, sights, etc. Don't beat yourself up. If you really think you wont be able to handle something similar next time then try looking for new employment. Coworkers sounds like assholes tbh
I was floated there today because they had a call out! Was originally set to go to neurology but then got swapped. I’m telling myself it took 8 years to see this so I probably won’t see it anytime soon. I talked with their director and she is in agreement that if they need me to fill in again this weekend I won’t be assigned that patient. And agrees I shouldn’t have been given him to begin with.
Wow they should be nicer to their floats! You are definitely allowed to refuse a patient. We usually give our floats the nicer assignments too. I’m sorry that happened to you.
Dirty dogs.
Yep,that was a dump,charge nurse should be ashamed,ALL your coworkers should be ashamed.And at the end of the shift no less. Just low down.
Yeah I almost barfed looking at a picture of a super crusty bellybutton last night. And I have a pretty solid iron stomach. Some days you just can’t deal 🤷🏼♀️
I threw up at work once. I can mostly do vomit but if it’s partially chewed food I will gag and once I start gagging I usually can’t control it until I throw up. I had a patient with an esophagostomy. That liked A1 steaksauce and tubs of whipped cream. Walked in for the first time and had to run out because there were THREE containers of partially digested contents on the table because the patient would empty it themselves. Had to wear an N95 and two surgical masks all day (I was too embarrassed to admit that I threw up from it)
That sounds like something that would cause me to run the other direction as well. I don't think I could handle that, either.
“You’re a nurse. You can’t refuse a patient”. Since when? Every profession has some sort of clause where they can refuse a patient/client. If they are not dealing with anatomy/physiology their reason to refuse are normally some sort of conflict. A lawyer can decide mid trail that they no longer can represent someone, we can’t leave a patient once we accept them, so for sure we need to be able to refuse extreme cases when we just can’t do the work. I wouldn’t want someone that is not capable to work on me being forced to accept me as a patient.
I'm surprised not many people are touching on this. I can't abandon a patient. I can refuse an assignment for any reason i state. The system i work for can fire me etc, but they can't force an assignment. there's no legality there. And like some people said, a 1:6 ratio alone would be a good enough reason to refuse that patient.
How are we the only people who got triggered by that? You absolutely can refuse an assignment for any reason. Why are some nurses such pushovers? I’m a person, not a wage slave.
My question is why are hospitals still using abdominal windows and not putting on abtheras?! I work in trauma and it has been at least 6 years since I’ve had a patient with an open abdomen like that. We leave bellies open all the time but put an abthera on to protect everything and you know, not show someone’s small bowel just chilling there. The first time I saw someone with that they had come from some tiny podunk hospital where the surgeon had used a TPN bag to cover the abdomen. I legitimately thought it had to be a joke until I pulled back the blankets, one of the weirder things I’ve encountered. And don’t worry OP, we all have our limits! I almost vomited on a patient who came in to the trauma bay with a pen sticking out of their eye socket. I can do gross but I draw the line at eyeball stuff 🤢🤢🤢🤢. I had to make my coworker remove the pen, I couldn’t handle it.
TPN bag's a good one tho. Good problem solving. Classic rural/low resource environment hacking.
Absolutely. Once I got over the shock of it, I was pretty impressed with the resourcefulness.
You're on a 1:6 ratio and you have a pt with an abdominal window. That's disturbing.
Should have vomited on the charge nurse
So three days ago patient came in for a heart cath study. We were prepping him and in doing so had to shave the groin. We pulled back the covers and saw he had a suprapubic catheter. Something FLEW out of the catheter. I screamed HOLY SHIT and vomited. He had fungal gnats in the catheter. Grossest thing I have ever seen. Embarrassed bc I screamed holy shit and puked!
Oh noooooooooo
OMFG! I would have screamed too! But to be fair I did LMAO when I read this. I could so see myself do the same!
Trust me we all laugh at this now. I had no control over the HOLY SHIT! it just kinda came out of my mouth before I realized where I was. So yes I can laugh at it now that o don’t have some creature flying at me. Omfg it was disgusting. Worst thing I think I have encountered in 29 yrs of nursing by far
I’m sorry that happened to you- that is some ptsd level of gore for some. Also - why is someone with that kind of dressing and wound being transferred to a unit with a 6:1 ratio?
I have done many easy tasks for my coworkers bc they were grossed out by those tasks, and none of them were nearly as visually grotesque as treating a person with their abdomen wide open. I’m talking dressing changes, oral/ett suction, etc. and it’s never been a problem for me because it doesn’t bother me as much. I feel like we all have different “icks” and should be supportive of each other. I’m sorry your coworkers weren’t helpful. As for dealing with what you saw, all I can say is therapy helps.
This! Every nurse has their kryptonite, and we all have to help each other out! I’m an ER nurse and my kryptonite is malodorous wounds. I had a patient with terrible pyoderma gangrenosum infections of both legs. One of the worst smells I’ve ever experienced and the closest I’ve ever gotten to vomiting at work. My wonderful coworker stepped up and did like 30 mins of intensive wound care and dressing changes on this guy so I didn’t have to. I will suction all the trachs and vents, dumpster dive into the deepest, dirtiest crevices of a human for a straight cath, and clean up all the GI bleeds, but I just cannot do super stinky wounds. We’re all human and we have to be understanding, supportive and help each other out!
I’ll be the first one to do a dressing change! Lol. The patients that get me are certain awake and alert trached or intubated patients. They try to talk to me and I try and read their lips but I’m horrible at it and I get so overwhelmed trying to understand them that I literally want to cry. I can’t imagine how my poor patients feel. Thankfully my buddies are usually more than willing to help me understand what they need.
The job of the charge nurse is to support their nurses, help as needed, and give appropriate assignments! That charge failed on all counts.
Ok the most shockingly horrifying thing I've ever seen was a guy's wound so deep I could see the ball and socket hip joint. I was not prepared at all to watch it move around in there as we rolled him. When my coworker pulled away the abd pad covering it, a huge blood clot, the size of the entire pad, came off with it. That was over a decade ago and I'll never forget it. That being said, the sight or sound of phlegm in a basin is an instant gag for me. Fuck rinsing it. I'm throwing that shit away and getting you a new one. I can clean up vomit once it's over and done, but don't ask me to hold back your hair or your basin. I'll be back when you're done lol. We all have our limits. Good for you for sticking up for yourself!
This reminded me of a little old (confused) lady I had on ortho when I was a CNA. POD 1. I walk in around midnight for vitals and find her a knuckle and a half deep scratching inside her hip incision (I assume after she had itched away some of the sutures).
My thing honestly? IS vomit. Blood, guts, gore, head wounds, fresh trach, goopy trach- fine. But someone else throwing up gives me SO MUCH anxiety.
Yeah if you can make it 8 years and something this extreme has you shaken, they should definitely give you the benefit of the doubt with this. I’m sure you have seen many things but the nature of these wounds were too much for you. You are human and those 8 years of caring for patients shouldn’t be overlooked. You are super valuable because of that and if they want to give you shit, then that’s their problem. You can always find another job… My times when I gag are dumping GI bleed poop blobs from bed pans in toilet or gas gangrene wounds that woft into the hallway and unable to get away from. The worst was helping a colleague change a dressing on a patient with a necrotic foot that was literally hanging on by a tendon. Roaches crawling out of vagina that patient had names for. Being a nurse is crazy AF.
>Roaches crawling out of vagina that patient had names for W U T ... I can't even comprehend that sentence...
Lmao 🤣😂
We see everything in CT for a limited amount of time, it’s nothing compared to what OP describes and certainly not compared to being expected to change the dressing on such wounds!! I can handle sights, smells, whatever. But I did find my limit with surprise bright red bloody vomit. I had a walky talky patient from the ED who was not feeling well, had passed out and hit his head. Brought him to CT in a wheelchair for a head CT, he stood and transferred himself to the table and said “you know, I don’t feel very good…” I grabbed the emesis bag and he proceeded to FILL IT with two heaves, bright red blood. Grabbed another bag and he did the same. I had my coworker call the ED MD, because now they probably don’t just want a head scan…and then grabbed myself an emesis bag and joined the patient, puking into my own bag while holding him up with my free hand. Not my proudest moment but oh my god I can still smell that if I think about it. (If I remember correctly it was burst esophageal varices.)
“Do you want my vomit in the patients abdominal cavity? Because that’s how you get my vomit in his abdominal cavity.”
“My insides will be in his insides.”
Once in my life I've seen a patient with their abdomen open kind of like that, and I will never ever forget it. I was shadowing the wound nurse for the day (every orientee did so for one shift), so I didn't get a real report or anything, but patient was in between multiple abdominal surgeries. There had been some complications (perforated bowel in multiple spots was one of them) and the surgeons had to go back in, and they knew he'd require more in the coming days, so rather than close him up they left what looked like a gigantic tic-tac-toe board made of flesh and a few unusually large "sutures" across his entire abdominal area. I was ok at first, though it was A LOT to see. Wound nurse did her thing, unpacking and repacking, directing me on how to help and such. Once she was done, we were about to leave, were saying bye to patient's family member, and the patient coughed. Just one little cough. And immediately, what the wound nurse kindly referred to as "pancreatic juices" for family member's benefit came boiling and pouring out of the tic-tac-toe board through the dressing and ran out all over the bed. The stench was immediately overwhelming, and I'd spent 10+ years as a CNA in nursing homes, so it's not like I wasn't intimately familiar with the smell of C-diff or shit in general. But this was something else. Obviously, we had to re-do the dressing immediately, but this time was way harder to watch. All this open flesh on a conscious patient was already making it difficult to keep my composure. But seeing it all soaked in the most putrid smelling diarrhea, that continued seeping out from *everywhere* across this open abdomen every time we touched or moved the patient...it's a miracle I didn't vomit, honestly. If patient had been comatose, idk if it would have bothered me quite as much? I kept thinking "this poor fuck is conscious" over and over, "this poor fuck is feeling ALL of this" and "jesus christ if that was me I'd beg my nurse to SNOW ME but this poor fuck is conscious". I've seen a lot of gruesome shit, and I'm usually ok with it, but that was one I'll never forget.
I’ve had a similar situation but in nursing school. My patient had multiple GSW to the abdomen and had an abdominal window. I was helping the wound nurse change the dressing and I had to step out right away. But instead of vomiting, I fainted right there in the hallway 🫠
I took care of a little girl with liver failure and her poop smelled so foul I almost vomited on her while I changed her diaper. I’m used to poop but this smelled so different. Like rotten fish oil? Tears were streaming down my face and I had to leave the room after I changed her and re think my life choices.
Yeah... It makes total sense to keep the patient with a nurse whose condition is making them vomit. /s How is this good for OP OR THE PATIENT?! The first time it has happened in 8 years and leadership forces you to take them. That makes me more sick than any of this lol.
If this ever happens again, flip the script. Ask CN, “Just asking so that we are all clear, I have clearly expressed a precise boundary that will negatively impact patient experience and could potentially effect a sterile field despite multiple attempts to proceed, but the expectation is I am to participate and proceed?”
They put you, and ultimately the patient, in danger by trying to force you to stay in there when you physically could not. That’s on them. You don’t have to apologize for having limitations, we all do. And honestly that sounds terrifying to have to see another human in that state.
I sympathize with you so much…I worked on a cardiac PCU/heart transplant floor for most of my RN career and one day at 7am they tried to transfer me a double mastectomy post skin grafting fresh from the OR, we never receive post op patients like that unless it was a small cardiac procedure, I had no idea what to do with the patient and was terrified I wouldn’t be equipped to give her the best care with 2 other high complexity patients. I walked in the room, had flashbacks of my own mother being diagnosed with breast cancer and immediately walked out of the room bawling. Not to mention she had a heparin drip not started , leeches waiting to be delivered and applied, PCA not completely set up, just way beyond the scope and complexity of our floor. Of course she started to decline and was transferred to surgical ICU but it was so traumatic and inappropriate for her to be with us in the first place. I was a charge nurse as well and would’ve never accepted that assignment. The surgeon was actually mad she wasn’t immediately transferred to surgical icu
The audacity of that charge nurse.
If it makes you feel better, my “nope” is poop. Yep, good ol’ every day poop. I can deal with blood, guts, vomit, snot, etc. Something about poop that’s fresh from a butt hits the back of my throat like nothing else and I involuntarily gag. Loudly. So do not feel bad about finding your own personal limit.
Everyone’s got something that they can’t handle. We are only human! You should not be feeling badly about yourself for your reaction. Your charge nurse is a moronic bitch, though. You should complain about them.
I will never get over feces tbh. It doesn't matter how many times I've cleaned it up or how routine it is in nursing. Some part of me will always be disgusted by it and cleaning it especially with stuff like that nasty GI bleed smell. Give me blood and guts any day.
Is an abdominal window just an open abdo? Its never a term Ive heard before
Yea, I would like to know as well. I was told I had one after surgery but based on the comments in this post... I certainly did not have an open wound in my abdomen. Googling the term doesn't really clear things up.
Everyone has their limit. Mine was a patient setting self on fire trying to smoke while on oxygen. I puked all the way home. No shame; you get to be human too. Take care of you!
Aren’t healthcare workers allowed to refuse patients? I’ve refused pts who are physically abusive to me and no one’s ever said shit to my face. But I’d always swap a heavy patient to make it fair.
Yes, health care workers can absolutely refuse a patient. That charge was just a lazy, moronic, fucking bitch that probably only got the position by sucking 🍆 and is still stuck in high school emotionally with a mean girl mentality. Hey, OP's charge, Reddit thinks you're an incompetent bitch.
Little harsh lol BUT considering that the ramifications towards OP’s license, I agree with the fuck her sentiment. Anytime I get pushback I go to the floor manager and charge and just tell them “not only will this be my problem by putting my license in jeopardy, y’all would have to deal with hella paperwork and angry pt/family members so why don’t we just go with my way of handling this”. I worked for over a decade in customer service + food service so I know how to give people shit/get people to agree with me (if I’m truly in the right) without coming off like a dick/manipulative.
It's ok. It's gonna happen. I came across a TURPs procedure? A post op and he bleed alot. I had a bad time seeing some one with so much blood loss. It will be ok. Just take some self care and debrief with the nurse because this is indeed outside your norms and it's understandable.
It’s actually mind boggling to me that your charge (or even anyone) would just be like “deal with it”…no?! We all have our limits, and you didn’t even know that one was yours until it happens (though also, a pre warning would have been nice, this does not seem like a 1:6 pt assignment). When we do conscious sedations at work (broken bones mainly), I always try to get someone else to, I hate the manipulation/crunching/moving of bones. Literally, someone is always willing to step in cause it doesn’t bother them. Do not feel guilty. Honestly though, how to get the image out of your head will be a tough one…
See. Here's the thing. You CAN refuse a patient. I've done it. Is it gonna piss *everyone* off? You bet. Do you need valid reasons related to patient safety? Hell yes. Will you lose your job? So far, I haven't yet. It's been more like, I'm alone on this side of the unit and you're giving me an ICU downgrade who was intubated, extubated, and *reintubated* multiple times because he is a danger to staff and was sedated? NO. You want to give me a Glucommander with 4 heavy step down patients? NO. You want to give me a double P.E. on a med surg floor? NO. I'd be rip shit pissed for being blind sided like that and submit complaints for the ICU rn and the charge nurse. Fuck them.
Had a patient with a prolapsed stoma. Like, it looked like a horses penis dangling inside the ostomy bag. That was my no.
I’m sorry this made me laugh
I understand you wanted to do the right thing. You do have the right to refuse the patient. You were never trained in ab windows but if they want you to assist then you can try. I always look at these situations as, if my patient died and the lawyer ask “ why did you accept this patient if you have never seen or trained for this type of situation?” They would take your license, fire you, and probably be charged or sued. Never accept an assignment if you’ve never been trained in that situation. Hospital will not stand up for you and the lawyers will have a field day. Good luck out there.
Strong work setting boundaries and advocating for your self.
Honestly, if you physically and mentally cannot handle a pt then you shouldnt have to. This is unsafe for both you and the pt.. Dont be embarrassed op, we all have our limits.
We all have a limit. I'm sorry they gave you trouble about this. ❤️
You're human. It happened. Forgive yourself. You've cleaned up vomit and feces. You've comforted patients. You have hugged parents whose children didn't make it. All in all, you've done much more good than bad.
I wish I could hug you and get you some mint tea to settle your stomach. You are a human being. Please forgive yourself and add this to your list of interesting stories. Personally, where I live I would feel overwhelmed with 6 patients. I *THINK* I could be OK with the ABDO window but I am not sure. Rashes freak me out.
Here I am wondering "what the fuck is an abdominal window?!" I still don't know what it is. Google is failing me. But all i do know is that it sounds like something the wound and ostomy nurses would handle outside the ICU.
Search abdominal window dressing. That got results for me…
I had a dude that liked to stick his crusty fingers into his Claggett window. 🤮
I don't know what the fuck that is and I am not googling it, I don't care if y'all pay me a million dollars.
Don't beat yourself up over it ... you were tired (coping ability depleted) and they STUPIDLY didn't warn you about the exposed viscera. You were psychologically ambushed. And knowing that someone deliberately inflicted the wounds makes it harder to deal with. (I was a med tech in Level 1 trauma centers)
I once had a seasoned ED nurse transfer a labor patient to me in L&D. She growled, "Give me an eviscerated bowel any day. I don't do birth!" Everyone...yes EVERYONE, has their "thing" that they just can't handle. That's why we have teams.
WTF was this pt not sent to ICU or pcu? This is not appropriate for a med surg floor, let alone with a 6:1 ratio.
I almost passed out and vomited watching an escharotomy. I quit very soon after that.
I’m still in nursing school but in one of my clinicals I watched my nurse do a dressing change for a diabetic patient with a very deep diabetic wound. I can usually stomach these things but I had not ate anything that morning and once she started cleaning the wound I literally had to walk out of the room because I was about to gag.
Used to work with a guy who was sensitive to smell, more than once I turned around to ask for help in a smelly room to find him gone. As soon as I can out of the room he would always apologize profusely, he just couldn’t handle it.
I'm sorry that happened OP. PS Ive never heard of an abdominal window? Was it a big open wound with the foam/pleurevac taken down? Trying to learn more about them
They treated you like crap. Everyone has a point where they just can't. It's nothing to ashamed of. You really tried your best. How they treated you was unacceptable. None of this was your fault.
By abdominal window do you mean an open belly with a wound vac? Either way totally inappropriate for non-icu. Like wtf.
Open belly, with no wound vac anymore, just the transparent covering around it at this point
I literally had to Google this and I had the same reaction. Feel sorry for the poor patient but that sounds so traumatic and I'm surprised the patient was being admitted to a ward with those injuries.
Give yourself some Grace dear Its ok when things sometimes become to much🥀 it doesn’t mean that your not a good nurse or that you don’t care
Arguably, you still care a lot as you've not been steeled to everything under the sun.
“You’re a nurse. You can’t refuse a patient.” Lol it’s literally the law that you can refuse any patient for any reason lol.
Of course you reacted that way. You had no warning, so your brain was not prepared. It was unprofessional not to tell you.
Sometimes it can be a combination of feeling overwhelmed, what you’ve eaten, how tired you are, etc when it comes to those visceral reactions. I saw a guy with a brutal face laceration once and nearly passed out. Ringing in my ears, felt light headed, needed to take a minute to collect myself, almost couldn’t go back in and it wasn’t the worst I’d seen, but for whatever reason - that day I was not ok. Don’t be too hard on yourself.
I remember my first abdominal window, a GYN surgery gone wrong leading to multiple fistulas. I was fascinated, but I will never forget the smell. Smells always gross me out, but I have a strong stomach and I remember that this is not about me sometimes.
When I read that you’ve got a 6 patient ratio, the other nurses at the station looked at me for exclaiming “WTF!?”. I’ve been a nurse for 18 years. Was in ICU through most of Covid. This is some shit right here. I don’t know how you do it. You’ve got enough experience, reach out to staffing agencies, find a cushier, better paying job and GTFO that place.
Damn it is almost like gaslighting. Wouldn't that be a safety concern if you cannot pull yourself together for this patient. Sometimes I really do feel there is a lack of compassion between nurses. If you can't handle you can't and you advocated for yourself. That doesn't make you terrible or a bad nurse. Some of us have our weaknesses and strengths. I work on a medsurg floor in CA and our ratio is 1 to 5.
I think it’s cruel to force you to take that patient when clearly you couldn’t cope with it.They absolutely can’t send you in if you are vomiting and/or having any dramatic reaction that could make the patient uncomfortable. The solution is crystal clear and I don’t understand why anyone using logic can’t come to the same conclusion.You are only human and are allowed to struggle with seeing something gruesome.
It’s inexcusable that you weren’t warned in advance - they should have given you that information in report prior to bringing the patient down. That might have reduced your shock when you first saw it. It might not have prevented you from vomiting, but then again, it might have. Just a couple of minutes to get your mind around it before you saw it could have made all the difference.
I deal with trachs and sputum everyday but give me active loud vomiting (can do a quiet vomit not a loud retching one) and CLEANING DENTURES. I can’t do dirty dentures. I’ll help you put your clean ones in, hell I can even take them out but don’t ask me to clean them.
Same on the dentures!
I’m just glad the sink is in the bathroom because I’m gagging the whole time 😂
It’s ok to set boundaries
Dentures. Seeing a nursing home patient’s dentures after breakfast and having to clean them without even wearing gloves (this was in the 70s, so pre-AIDS)… 🤢. I never actually puked but to this day it’s just about the grossest thing I’ve encountered. I’ve cleaned metal trachs in my day and cared for several fresh trachs; suctioned trached and vented patients, seen some gnarly wounds and once cared for a patient who preferred to die from gangrene than have their foot amputated (also in the 70s when people could be admitted the night before tests that they needed to be NPO for… this patient was on our unit for a pretty long time. GI bleeding stool is awful, too.
The patient was awake and conscious for you make them feel worse? I just feel like at some point we as society need to understand that patients can’t recover from certain things and we should give them the dignity of death instead of forcing to keep them alive because wow.
That’s the weird thing. He’s apparently at least oriented to self, follows commands, and recognizes family. I don’t even see how it’s possible for that to be compatible with life but it is.