When Compassion and Fear Collide

I have spoken to hundreds of prospective nurses over the years telling them all of the benefits of nursing. I have talked to thousands of oncology nurses around the country who speak of why they chose oncology nursing. Whether it is the relationship they build with the patient and families, the difference they can make in the cancer journey for one patient, or the lessons they learn about life from working with those patients, it all comes down to compassion. Oncology nurses are highly skilled, purposeful, challenging, and most importantly compassionate professionals. We come to work to make a difference. We come to work to companion someone on his or her journey. We come to work and keep coming because we love what we do. But what happens when someone takes that away from us—when all the reasons for doing what we do are suddenly overshadowed with anger and fear? It is a formidable obstacle.

Last week a patient was admitted to my unit with mental status changes and failure to thrive. He had a primary diagnosis of nasoesophageal cancer with known brain mets. Two weeks earlier he was discharged alert and oriented. Things had changed. Upon admission he was obviously confused, but nothing that we could not handle and had not seen many times. Suddenly things changed. During the admission interview, the patient’s wife became very angry and frustrated with the nurse who was asking the typical questions. Things began to escalate and before you knew it, the patient jumped out of bed and hit the nurse in the face twice, quite deliberately and quite hard. The nurse yelled for help and all came running in an effort to calm the patient and keep the nurse from further harm—the nurse manager also was hit by this patient. Once the patient was calmed down, the nurse met with the manager to talk about what happened, was sent home and advised to call the Employee Assistance Program (EAP) to discuss it further. Our EAP recently added a particular person who specifically deals with workplace violence. Can you imagine, our society has come to the point that we have to have people who specialize in counseling others regarding workplace violence? The rest of the staff tried to maintain their professional, compassionate manner and cared for the patient the best they could. Security had to be involved and parameters had to be set for the patient’s wife regarding her part in the incident. Although it shook people up, at first they understood.

The next day another nurse took care of this patient. He was very calm and appropriate. The patient had gone for an MRI and upon his return, as the safety aid who was sitting with the patient helped him off the cart, when suddenly he started to leave the room again. The nurse was outside of the door and asked him where he was going. He shoved her against the wall and started down the hall. She walked after him to try to talk to him and get him to return to his room at which point he grabbed her by the head and starting pulling out handfuls of hair. As people saw, they called for help from other staff and security. The manager came and was able to get the patient to let go of the nurse, but in the interim was pushed up against the door herself before the patient was calmed.

Things had changed drastically on the unit now. Two days in a row nurses were assaulted by this patient with no seeming provocation and no warning. The leadership met with the physician team, as well as the psych team, and the attending physician to come up with a plan for this patient. A reasonable plan including medications, restraints, and help from security was put into place. But what about the staff? How do you continue to care for this person compassionately? We knew that this was not this man’s normal demeanor. We knew that his increasing brain mets was the culprit. We wanted to be compassionate and provide the best care possible, but we were also angry that this happened and rightfully frightened that it could happen again, at any time to any one of us.

We tried to support the staff daily with care conferences. We had a psych nurse come to give tips on how to deal with a violent patient as well as providing emotional support for the staff. We maintained a secure environment for those caring for this patient. But inside, I can still feel the fear and anger in some. I don’t know how to resolve that. This is not what we come to work to do. Of all the oncology nurses I’ve talked to not one said she or he comes to work to be assaulted. And yet it happens. So where do you go with that? In some manner we have to each reconcile it within ourselves. We have to know that we are still trying to companion on the journey and we are supported by many others. We take the experience, talk about our feelings, and face the next day with as much compassion as we can muster for now.