[id_ocad]

How stressful would you rate your job? 1-severe 5- mild

[cassioo]

mine would depend on the day and minute by minute of that day: ie last day I worked was Friday...labor and delivery everything going real good 1 induction my only patient not too many other pts in and out thinking they are in labor and had someone to do triage, other nurse had and induction, we'd ordered out chinese, had 2 scrub techs on duty. My baby looked great all morning on the monitor, mom doing great not too much pain hadn't required medication yet, then had a little drop in heart rate that came back up then 30 seconds later a big drop in heart rate then a heart rate that disappeared. Called the OB out of his GYN surgery, got anesthesia all there within 3 minutes, got to the OR at 1306, cut at 1308 and baby out at 1309 with apgars of 2,4 & 8 the time between the loss of heart rate and baby out was stress level over the top plus mom bleeding like a stuck hog...she'd abrupted in those few minutes but mom left recovery room by 1500 baby off O2 by 1700 and in the room and alls well that ends well. The rest of the day was fine as was the first part of the day. It could have been much worse if it would have been the middle of the night with a doc at home, with less experienced staff, if electricity had flashed off from construction for a minute and that decel gone undetected 1 minute more.... you never can tell.

[hsieh]

mines not stressfull. i work in long term for the medically stable - almost assisted living. i don't make as much as others but i love my job.

[Ricu]

Working in critical care, generally speaking, my job can be rated at around 4.5-5.0 for stress. I wish I could say that it was because the level of care was that technical but often that is not the case. Frequently the stress comes from this increasingly common scenario. The ED calls because they have a patient for us. He is very elderly, has advanced dementia, lives in a nursing home and has no local family. He has multiple comorbid conditions and currently presents with sepsis and dehydration. The patient is a full code and the prognosis is obviously poor. We contact the next of kin who hasn't seen the patient in a year but remembers being smiled at, maybe recognized then so, we are told they will arrive in a few hours and to do everything. We intubate, insert a triple lumen catheter and begin fluid resuscitation. The labs show the patient has poor renal functions, is very anemic and the white count is of course, through the roof with a shift. We culture everything and begin broad spectrum antibiotics. Soon we have to begin pressors but none of it's tolerated well. We hang blood, the fluid starts thirdspacing, we start the Lasix drip and the kidneys fail. Soon the chest xray is whited out and now the patient is in rapid afib. We start Cardizem and add more PEEP. Eventually we're faced with dialysis. We sit down with the family and present the situation and ask if they believe we should continue. Let's try. We should do everything to give the patient an opportunity to declare himself. Why?

At the risk of appearing callous, I firmly believe that none of this should've happened. This poor old man declared himself when he became septic. The family hadn't seen him in some time and wasn't aware of hiis failing health. Were they aware of his wishes? Perhaps guilt drove them to make decisions with unrealistic expectations. Was it fear? Emotional baggage? Perhaps his physician was not comfortable pursuing a DNR status. Regardless, I believe that the last matter is where the responsibility lies; the attending physician. He or she knows the patient, his condition and is obligated to work in his best interest including making end of life decisions. If necessary or if requested by the patient, family or other appointed person can or should be involved. In the presence of several failing organ systems, this critical discussion is paramount.

Let's go back to the situation outlined above. The patient deserved to be put into palliative care, made comfortable and be allowed to die with dignity. Instead, he was tortured with critical interventions and died anyway. I think nurses can do a lot to facilitate this process but first we have to sort out our feelings about such matters. Eventually our helathcare delivery will take on a more humane approach but we're not really there yet.

R