You can’t fix everyone.
It’s unfortunate and sad and my least favorite part of the job. You spend so much time trying to change the life of a child and sometimes, you can’t.
When I worked in residential, I had days where I would leave at the end of my shift and cry the entire way home.
Did I do enough? Did I say the right things? Did I say the wrong things? Should I have done something different? What can I do to make this child engage? What could I have done to better connect with the child? How can I make these children love themselves again after facing so much hatred? Am I able to make a difference?
I had multiple patients in residential whose histories tore at my insides. I mean, you’ve read some of these posts already. You get it, even if only a little bit. Most of their childhood’s sucked. How do you come back from that? Abuse and neglect and domestic violence and homelessness and substance use. And that’s just a typical day at “home” for these children.
How could we seriously take a child whose life was torn upside down, now is struggling from severe mental illness, and “fix” them?
I would be lying if I said I enjoyed taking care of every single patient that I’ve had. I’ve had some patients who would make me so frustrated. I’ve had patients cuss at me, throw things at me, kick me, hit me, and spit on me.
And then the next day they want something from me: Nurse Brandy, can I eat lunch with you? Can you do my hair? Will you go for a walk with me after med pass? Will you play a game with me before you leave?
Seriously, kid! You spit in my face yesterday and dumped water all over my clothes and now you want something from me?
Obviously, no matter how frustrated and impatient and angry I would get at some of these children, I would never let them know.
I would often make agreements with the kids after incidents like those mentioned above in order for them to do better next time. I had to remind myself more than once that it is not their fault. Their behavior towards me has nothing to actually do with me. They’re hurting and experiencing emotions that I couldn’t imagine in my wildest dreams.
But that doesn’t mean it’s always easy; and it doesn’t make their behaviors okay.
I had a patient in residential who, for lack of better words, drove me absolutely nuts! He was so defiant and was always getting in fights with everyone, calling everyone names, stealing from other kids, bullying everyone who walked in his path. Every morning at medication pass, he would call me some sort of name or tell me that I was a terrible nurse or that my hair was ugly or that he hated my shoes. But I always told him to have a great day and to ask for me if he needed anything. He was in restraints every single day. Literally. Every. Single. Day. For at least a month. There were times when I had to walk away because I was so frustrated. Nothing was working. Tough love, trauma-informed care, therapeutic communication strategies, and I hate to say it, even bribery. One day, he had gotten into a huge fight on the unit and was being restrained.
Let’s take a break for a second and talk about restraints.
Physical restraints are when people are physically holding you, preventing you from moving. The kids hate it. The staff hate it. It’s uncomfortable and can be traumatizing for everyone involved.
Unfortunately, sometimes it is needed to keep the child and everyone else around them safe.
I will never forget the first time I saw a restraint. I had no idea what to expect. It was my very first day working at residential and I was following around one of the nurses. There was a call on the walkie asking for help and the nurse told me to follow her, so I did, not knowing what I was walking into. When we arrived on the unit, I saw a girl who was at least twice my size. She was throwing anything that she could get her hands on. The nurse I was with told me to stay back and just observe.
Thank God, because that’s exactly what I wanted to do.
I watched as two grown men wrapped their arms up under hers and carried her off of the unit to the time-out room where they did most of the restraints; that way it was not as traumatizing to the other kids.
I watched as they restrained her and she continued to try to fight her way out of it. They held her arms in theirs and leaned in together with their hips to touch her sides, limiting as much movement as they could from her as she continued to attempt to break free. She was cussing at them and at the nurse and even me, who she didn’t know. She then started spitting on the two men who were restraining her. After about fifteen minutes, the girl was calm enough to be released and she slid down to the floor and cried.
The nurse I was shadowing did an assessment on her as well as the staff who did the restraining, making sure everyone was okay.
And then we walked away.
What in the world did I just witness? This was what I was getting myself in to?
I felt an array of emotions as the nurse explained to me what had happened and the entire restraint process again.
It’s for everyone’s safety.
I’ll just say it here: I hate restraints. But I one million percent feel they are necessary when all other means fail. Now, IM injections? That’s a topic for another day.
After time went on and I adapted to seeing these restraints on a daily basis, I learned how to better manage my emotions about them as well as everyone else’s involved. I learned how to process with the child and how to talk to staff if they were struggling with it as well. I had become most of the kid’s favorite nurse and I’m not saying that to boast, but seriously, they always asked for me when they were having a hard time and being restrained. They often asked for me even after the restraint and needed someone to process with. I loved being able to be that person for them.
I think that is why on this particular day, with this particular boy, I was so beyond upset. He had just gotten in yet another fight on the unit and when I arrived, he was being restrained…yet again! Of course, he instantly started to call me names. I took a deep breath and proceeded with caution as I approached him in the restraint to attempt to calm him down. It got to the point where I finally stopped talking because everything I was saying was not working.
The nurse’s job during these restraints are to ensure safety for everyone, especially the child. So when he started to scream that one of the staff members were pinching his arm, I calmly started talking again and told him I would assess.
“I need you to show me a calm body while I come closer and look at your arm. Then I can see if staff’s hands are in the right spots, okay? I am on your side. I want to keep you safe.”
Usually when I said things like that to the children, I want to keep you save, I’m on your side, I’m here to help, or my favorite I’m always team (insert child's name here), they would be more opened to trusting me.
Not this time.
As I walked around to see where he was saying staff was pinching him, the boy lifted his leg and kicked me hard in my shin. He then managed to get out of the restraint and ran right at me, spitting in my face. He punched me in my arm and stomped on my foot multiple times as I continued to attempt to back away and restrain him again.
Staff were able to slip their arms under his into another restraint before he was able to hit me a second time.
I’ve always been a calm person. Matter of fact, most of the staff and other nurses that I’ve worked with have asked me how I stay so calm and patient, especially during times like these.
Well, I guess we all have days where we don’t meet our own expectations of ourselves.
And that’s okay.
After weeks of this behavior, I was livid. My shin was throbbing. I was upset, because honestly, that had never happened to me before.
I had so many staff members get hit and kicked and bit during restraints and I would mend their injuries and process with them, asking how I could help and if they needed anything. I was these children’s safe person. I was the one they always asked for when everyone else was pissing them off. But now, I felt that I was no longer that person. What in the world did I do wrong? Why couldn’t I get through to this child?
I walked off of the unit and called for the other nurse to take my place. I needed to breathe. I walked outside for a few minutes and then went back to the nursing office to literally sanitize my face from the saliva that he spat on my cheek. I sat down in the office and cried.
That child was in residential for over a year and a half, and there was not much improvement. I think what hurt me the most at the time was that he never apologized. I know that probably sounds crazy, but before that incident, I had kids call me names and throw water at me and whatnot, and they always apologized. Always. Even if it was days later. I still got an apology.
Not from this boy; and now I am okay with that.
While this incident occurred during my first year of practicing as a nurse, it took me awhile to process everything completely. Now that I have been practicing for years, I get it. I can look back now on the situation and remind myself that his behavior towards me had absolutely nothing to do with me. This child had an awful trauma history, no supportive family involved, and he was simply broken.
It also took me along time to accept that fact that, no, I cannot fix everyone. I will not be everyone’s favorite nurse. I will not change every single life I touch and that is okay. It doesn’t mean that I’ve failed. It doesn’t mean that I am a bad nurse. Accepting the fact that I’ve tried and tried and tried again is crucial during situations like this.
I would love to think that this child is okay. We can’t diagnose personality disorders at such a young age, but he had antisocial personality disorder as well as severe PTSD and looking back now, every single one of his behaviors makes sense.
Even after experiences like this one, I still go into every situation with new patients with a positive attitude and hopefulness. I constantly tell myself that I will do everything in my power to do the absolute best that I can do to change this child’s life.
And at the end of the day, I know I gave everything I had to these children, no matter their outcome.
I cared and I will continue to care in the best ways that I know how in order to help provide the best possible lives for these children.