To ask HCPs how you avoid taking work home. ***TW attempted suicide***

[Overwhelmed0305]

Namechanged as potentially outing to colleagues.

End of programme student nurse here, just finished an awful shift. A teenager was brought in earlier having taken a massive overdose of prescription drugs and alcohol, the aftermath was horrific to watch and now I’m home, I cannot get the images of her out of my mind. It’s the first case like this I’ve seen and it’s unlikely to be the last. I just wondered if any more experienced HCPs have any tips on how to block this shit out when you get home, because all I can think about is her little face and the damage she’s done to herself. Sorry to put this on AIBU but I just can’t shake this one off.

be good to yourself and your colleagues
Upon qualification you’ll have a job that’s a huge privilege we get to see huge ups and downs
We experience a huge gamut of emotion because we chose this career because we want to do it
Day I don’t want to do it is day I’ll walk.i am really lucky to have a career I love

@Lougle- I disagree- I think that it's fairer to say different people choose to deal with it in different ways. I do leave it at work- it's work. Doesn't mean I'm not compassionate whilst there, but it's not my situation (thankfully) to deal with long term. I did my best, the team did their best, and that's what matters for those involved professionally. I find it works to walk out the door with it still, I'd rather leave it where it is/ the workplace not my personal life.

I agree with the above about talking to your mentors. I also find writing a reflection about the experience gets it out of my head onto paper. I don't forget it, but I can rationalise my feelings and reactions. It's also handy to let your mentor read the reflection so they can understand what you are feeling.
I am a mentor now and I'd hope that my students would feel they could speak to me about difficult shifts.

My daughter has recently qualified as a nurse and now works in a very busy A&E as a staff nurse. Whilst she was a carer for two years doing her access course and then as a student, she regularly came home and debriefed to me. I am an older nurse so confidentiality was assured under my NMC code of conduct and I told her that situations we discussed should not include any patient identifying information. Her fellow students often told her that she was fortunate, because they often struggled with this aspect.

My daughter would often have found it hard to talk with her practice mentors in some cases. Ideally this should be the first point of accessing support, but when they are responsible for signing off placements, it may be hard for students to be candid with those responsible for doing so.

Back in my day when we all mostly lived in nurses homes, the debrief took place in the common room with fellow students and was extremely supportive. This is no longer an option for many students.

Perhaps talk to your university lecturers about how to handle this aspect of your work. Most universities offer confidential student counselling which maybe another avenue for support.

You can't talk about it at home because of confidentiality
Of course you can talk about things at home. "How was your day?" Oh crap day had an arrest call and lost a patient or had a really difficult patient with an abusive family shouting at me, got spat at, got kicked, my favourite patient died etc. You can talk about your experiences, esp traumatic ones without breaking confidentiality.

Definitely agree with a debrief. Our area has something called a Critical Incident Stress Management (CISM) team that will conduct a confidential debrief of staff after a difficult or challenging situation.

Other things that might be helpful:
-talking about what happened with your supervisor or a coworker who was also involved
-practicing meditation and/or mindfulness
-journaling
-engaging in an activity or hobby you find relaxing
-engaging in spiritual or religious practices according to your beliefs

Probably not much use to you as a student, but may well be if you end up in ED as a qualified nurse, the hospital resus dept (in my last trust they also ran all the ILS/PILS/ALS/EPALS training courses) were privy to the details of the unsuccessful ED arrests we’d had and would do a lot of the communication with the coroner if the trust were asked to attend and so they can be a useful resource for a debrief. It’s not immediate it can be months and months later, but it can give a little bit of closure down the line to find out what the cause of death was and have that reassurance that absolutely everything possible was done for them.

Several months after the paediatric arrest mentioned above, I went for my PILS recert and stayed behind after to talk to the resus officer and she was able to debrief with me about some of the difficult aspects of managing that arrest and what the eventual cause of death turned out to be.

In another upsetting case with a young woman who arrested in department, one of our consultants made a point of following it up as it was long and protracted, and the PM inconclusive. But when he finally found out the details, almost a year later, he made a point of speaking to absolutely everyone who’d been involved in the arrest to let us know we couldn’t have done any more than we did. It gave us reassurance that nobody who looked after her that day could have seen it coming or done anything any sooner or in any way prevented it. There aren’t many comforts in this job, but there are good, thoughtful clinicians out there who will do their best to look after your resilience and mental wellbeing. Mould yourself on these people and look at how they cope and what they do to stay well, because nursing can all be very cut throat sometimes, and a lot of time it will feel like a competition to be as hard faced and unfeeling as you can possibly be (or maybe that’s just the ED ).

I start University in January to become a paediatric nurse. Alot of people say they couldn't do that job, due to it being about children.
I want to become a palliative nurse in the end, but completely understand it is going to be hard and there will be instances that will never leave me.

So sorry to hear this. It's so hard. No 2 cases are the same some affect you worse than others. But get in contact with your mentor ASAP or any of the staff you felt most comfortable with and talk through. Normally it's such a hectic situation there's no time to prepare for what's about to happen and it's later when it hits the reality of what's happened. Also use this as reflective. This is why the uni bang on about placement reflection it helps to work through difficult situations. You can show your mentor or your lecturer And find out when the debrief is as it also helps to know what happens next to process what's happened.

You speak to your clinical Mentor and get this thread removed. Surely Confidentiality means something OP?

The OP has hardly disclosed sufficient detail to have compromised confidentiality.

OP, as you're still a student, there should be a pastoral mentor you can talk to, or a clinical supervisor. Failing that, you could try asking at work if there is someone you can "debrief" with.

One of my friends used to house-share with a junior paediatric doctor - she used to come home in bits regularly. It's hard, but as has been said, the day you stop caring is time to quit.

I hope you do manage to debrief successfully - you can get past this, but you'll learn to manage your reactions, not to forget.

@Layza101 have you read 'with the end in mind'.? I would recommend this if you're looking to do palliative care

NewYoiker no I haven't, but I absolutely will. Thank you!

I used to work as a palliative care nurse. I only stopped because I moved away.

Next to what I currently do, it was the best job I've ever had. There are a few instances that stayed with me - the two months where I had a death every week (and I only worked 2 nights as a week as I was in grad school so that was almost every shift!), the time I had 14 patients and came back the next day and 3 of them had died, for example. But overall it was very rewarding.

firefighter99 So, where is the patient? What hospital and what is their name? Nothing about this breaks confidentiality. I did 2 extra shifts last week and had 3 teen girls with OD's. What she has posted is in every single A&E up and down the country.

My dad, who's recently passed away, spent many months in hospice. While he napped, I would chat with the volunteers. They were all incredibly kind and grounded. They inspired me and fascinated me; how do they cope with bereavement on such a regular basis? Debriefing certainly but also the fact that making end-of-life more interesting and yes, even happier, for patients and their families was a good thing. She didn't say this but I understood that anything is better than lying in a bed, staring at the same four walls, waiting to die.

My point being that were it not for you, OP, and others like you, the rest of us would not have the care and compassion that we all so desperately need. Be proud of yourself.

I worked frontline emergency services for years, (now not so front line role). But talking about things really helps; you will probably notice those around you have a weird sense of humour as well. This isn’t making light of any situation however many use it as a good coping strategy for the horrendous things that you come across in the role.
You will find something that works well for you OP it will just come in time.
For me even after years there were some cases that just got to me, (those involving young children) this was because I had a v young DC at the time. I recognised this and highlighted this and developed strategies to help me

I want to say thanks for doing the job you do OP.

I'm a Vet Nurse and I am still affected by things that happened years ago as well as recent stuff. I have to take other jobs now and again to get a break from it. Talking is vitally important. That and gallows humour.
My DH is a cop and he come home and has to talk for hours sometimes just to get the key in his back to unwind. A horlicks isn't going to cut it, put it that way!

I wasn't saying that a HCP can't talk in vague terms about their day, but sometimes details can be identifying. For example, especially if you live rurally, saying something like "I looked after a 17 year old girl who...." could be identifying.

I've been in the situation where I've been into work and seen somebody I knew from another walk of life. I then had several people tell me about this person dying, expressing sadness and shock, but not knowing many details, and I've had to make sure that I don't reveal that I knew everything about their care, or even that they were in my area of work, because to do so would be giving them information about that person.

@SD1978 I think it's fine to leave it at work - it's a coping strategy. But if you have nothing to leave, then you've lost your compassion, IMO.

I don't think that people make free choice when they abuse substances. Initially, maybe, but we know that some people have 'addictive personalities' and I think that life circumstances play a much bigger role in behaviour than we'd like to think.

I have been a doctor for 25 years now. I can only echo what previous posters have said, you never forget but it becomes easier to cope with. There are things I saw as a medical student that will stay with me for ever. Debriefing is so important. As Peaked says above, you do develop a dark sense of humour as HCP which I think is an outlet, does not mean you do not care. Find time to do things you love. There are so many highs to our jobs which make it worthwhile. Big hugs to you Overwhelmed.

It never leaves you, but that’s also important as it is what drives us and makes us better nurses.

Talk, have a debrief. Have a cry. You will also develop a really odd sense of humour as a way of coping. Make sure you have support.

OP, I've nothing to add except to say thank you so much for what you do. And to all the other HCPs reading this. That you go through horrendous trauma like this and keep doing what you do is nothing short of miraculous.

You talk OP.
Talk to your mentor, talk to PLF, do you have other student nurse friends? You can talk without breaking confidentiality.

My team deal with traumatic stuff by talking to each other. We had an unusual for my area event which the majority of team had never experienced before. I debriefed the team, people cried and went over what happened and how they felt. I arranged a specialist in the field to come and talk through the event.
We still talk about it years later.

It affects us because we care

You don't forget. Some people you 'take home' with you. I remember some from many many years ago.

You need someone to talk to about this, wither a uni counsellor or someone senior who has gone through it.

I used to call a friend who did my job at a different hospital to talk about these things.

Remember your job is to do what you do to the best of your ability. That doesn't mean saving the life of everyone who comes through the door.

Really sorry x It gets easier and you get used to it somehow. I still remember harrowing things from being a student 17 years on, but more recent things doing cut as deep although of course they do still affect.
Like others said, self care, talking to others, and be proud of your role, even if you feel you didn't do much, just kindness/compassion means to much to family, patients, colleagues.