OR to ICU | Culture Shock
There are countless differences between working as a registered nurse in the operating room and working in the intensive care unit. But, there is one that has had a huge impact on me. I thought it was going to be having more that one patient at a time, nope. Having 4 patients (when I work on the intermediate care side) is a challenge, but it seems to be all about time management. The biggest difference are the patient’s behaviors. I am use to almost every patient being happy to see me, a little anxious, but overall happy to see then nurse who will be with them in the OR.
Even when a surgery was unexpected, but patients were generally in good spirits, polite, compliant, thankful, the list goes on. That has not been the case when working the IMC side.
Just last week I was called a “no account witch”, what does that even mean? I was also called the “b” word more times than I can count, by multiple patients. I was yelled at, told to “get the **** out of my room”. A patient threatened to “sock me in the face” while I was ensuring their restraints were secured- I’m sure you can guess why those were on. This same patient literally gnawed through the coban that was securing her IV. She also pulled off the accordion drain (luckily the actual drain was still in place). Some of these patients have had an admitting diagnosis of “AMS” or altered mental state, but some have not and are just plain disrespectful.
I had a 5 day stretch where I had nothing but verbally and physically aggressive patients. One tried to bite me and my preceptor, another kicked me in the chest, and there were many other attempts. We even had to place a patient in violent restraints- which was an experience for sure. I knew (some of) the patients I would be caring for would be awake, but I did not expect this behavior. I even had a patient told me I lied to them about me giving them their pain medication, the patient claimed I didn’t give it to them. Luckily, my preceptor vouched for me and told the patient she watched me administer the medication.
On that 5th day, I was very close to clocking out mid-shift and going back to surgery. I was very hard to return to work, but I had just hoped that my assignment would be better and that the patient(s) I would be taking care of were… nicer. I try to keep telling myself that the patients who act like this just need help, and that once they are healthy they won’t act this way. That’s the case for some, but not all. Unfortunately there is no psychiatric inpatient care near where I work, so there are times patients may be better suited to be there, but access is limited.
Caring for patients who exhibit these behaviors will continue to be a struggle for me, but I will be looking towards my peers for tips on how to navigate these patients. I feel I do a good job of not taking things personally, which I thank 10 years of surgery experience for that, but it is still not fun to be yelled at and spoken to in a disrespectful way.
