"Can I take one of your patients for this one?" "No! And I resent your asking!"

[Alnitak7]

Listen to this debate from one work place.

"I don't have any I feel like trading."

"I don't want to, "give up," any of them."

"She just asked you to do something really easy!"

"If I find out she had to take care of him, I will see to it that you get written up and sent to the DoNs office."

"Your assertiveness training does not prepare you to work in this setting."

On this site I have seen discussions about trade-offs. Some people seem to think that when you are assigned to a group of patients, they are all, "your resonsibility," so that if you are feeling threatened by one and ask to trade them they interpret this to be childish and unfair. Most times, the others don't even feel threatened by the same patient so this is completely fair to everyone involved.

There used to be a patient on my group who was sexually assaultive and I would get someone to help me with him and one day I was yelled at by the charge nurse who said, "There is no reason for more than one person to be in here!" There was another patient who was screaming at me and calling me obscene names and most of the others thought this man was nice, and would take him off my group. There were other people on the staff who would try to force me to work with him when they knew he had been abusing me. One girl even started lecturing at me like I was a screwed up ten-year-old and I absolutely did not want to argue with her. Not only did it make me nervous, but they should have thought about the rights and feelings of that patient, who they all liked more than I did.

Forcing anyone on someone who is abusing them or a threat to them is immoral and in some cases even illegal. This is why some people get restraining orders and why some abusers go to jail. If you think you should try to get a co-worker used to a patient they are afraid of, this shoud be done with extreme tact. In some cases, you should go in the room with them to show them how you work with them. I think if you can work with just anyone, this is a gift you have and you should not look down at people who haven't got it. It might be different working in an emergency setting, but not in regular settings.

[PureLifeRN]

Your post is extremely hard to read, FYI. Did you mean to break it up into stanzas, like a poem?

I dont have a problem with nurses switching a patient at the end of their shift, especially if the patient is really abusive. We all need to share those patients. BUT I do have a problem with nurses who REGULARY switch patients just because they are a PIA. News Flash: there are a lot of PIA's in the hospital! You have to learn how to deal with them, because its not fair to give one nurse all the nice/easy patients while giving another one all the difficult ones.

There is one nurse who asks everyone who isn't coming back the next day, who their easiest patients were, then she would sign up for those and the next day have it soo easy while we are going crazy! SOO annoying!

[blondy2061h, MSN, RN]

There is one nurse who asks everyone who isn't coming back the next day, who their easiest patients were, then she would sign up for those and the next day have it soo easy while we are going crazy! SOO annoying!

I would totally lie. Yeah, that guy in room 14 is really easy! The call light was just ringing all night because...it was broken! He didn't really NEED anything. hehehehe

[CNL2B]

Agree with previous poster. No one should be chronically asking to switch assignments. There are always going to be those undesirable patients on the ward from time to time and if you get that assignment -- too bad for you. Suck it up. Do the best you can and don't take it personally, and don't take it home with you. And, DO NOT pass off your patients to other nurses -- your coworkers HATE THAT. Come on. Do you not believe in continuity of care? If someone is a sucky patient to you, he/she probably is to everybody else too. That still doesn't justify them having a different nurse every 4 hours just so the drama/ugliness/"abuse" gets passed around. That just means that no one really has a good handle on what is going on with the patient. From what I've seen, about 50% of the time the ugliness comes out because the patient feels crappy or gets confused/paranoid. This usually resolves with a couple of days as patient condition improves. The other 1/2 of the time, your patient has a personality problem...and then, oh well. You are still their nurse, and you have to act like a professional, which means taking responsibility for the patients you have been assigned.

That said, if it is true abuse on the part of the patient, that needs to be dealt with in the appropriate channels. There are lots of resources for that - your shift charge, the nurse manager, security, patient reps.

If what you said is true and your perception is that these patients only treat YOU crappy -- then you need to look at what you are doing and how you can do it differently. All of us as nurses need to cultivate some people skills. Some it comes naturally to, some, it doesn't. That could be the core issue right there if I'm reading your post correctly.

[Pepper The Cat, BSN, RN]

Part of being a professional is learning how to work with pts you don't like. You can't keep trading off pts everytime you get someone you don't like.

You say that you souldn't be forced to work with someone you don't like, but then you are upset when you try to make someone else work with that same pt and they won't.

That being said, there are instances when you may need to trade off. If a pt is a someone you know well from outside the hospital and doing personal care may be embarrasing for them (not you). I had an instance several months ago where a neighbour was admitted to our unit from another. He was unwell and should not have been admitted to our unit. His wife knew this and was really mad. She talked to me about it and I gave her advice. When I went to work the next day, i requested that I not take care of him because I knew I couldn't remain objective after talking to her. Instead, I acted as a buffer between care team and her - thereby both advocating for the pt, supporting the wife yet not risking breaching confidenitallity.

A second time I asked for a pt trade was when I was caring for someone who had the same disease I have (its rare, I've only seen 2 other people with it, and this lady was one of them). I was OK for a while, but after several shifts it began to effect me emotionally and I reached a point when I was losing sleep etc. So I just spoke to the charge nurse quietly, expalined my reasons for a change and it was respected.

[nursemike, ASN, RN]

When I do charge, I feel it's an important responsibility to make assignments that are appropriate to the staff. I try to make sure each nurse's workload is equitable, taking into account each nurse's abilities. That might mean one of our newer nurses gets a patient with a trach and PEG tube who needs q2h turns--busy, but stable--and a more experienced nurse gets the Acute Renal Failure who is not quite as busy and not so stable. I try not to give very soft-spoken nurses to very hard of hearing patients. I try to give rude or sexually-inappropriate patients to nurses who can best cope with them.

However, I don't agree that any of these abililities is a gift. It's true that each of us starts out with his or her particular talents, but good nurses cultivate the abilities they need. I know some patients are less inclined to abuse me because I'm male. On the other hand, some may feel more inclined to challenge me for that reason. Either way, I can usually get along with difficult patients by not taking what they say personally and by listening to what they say, no matter what language they use to say it. Little old ladies don't let me clean their bottoms because I'm so good looking, but because I treat them with respect and do my best to preserve their modesty. I know nurses who can read an EKG strip before I can find my calipers--they weren't born that way, they've worked at it. To dismiss their skills as "luck" deserves to be looked down on. On the other hand, I don't think it's right to look down on those who are still in the process of developing those skills, or to throw them into situations they aren't yet equipped to handle. "Sink or swim," is a tough way to learn, and can be pretty tough on the patients, as well.

I've occassionally adjusted assignments in mid-shift, but I wouldn't be happy at all with staff swapping patients without clearing it through me. Nobody's perfect, and I'm ready to admit it if I've made a mistake with assignments, and even if there was no mistake, circumstances can change. Still, if I'm going to bet my license on which patient needs which nurse, I don't want others betting it for me by making changes on their own.

[JulieCVICURN, BSN, RN]

That still doesn't justify them having a different nurse every 4 hours just so the drama/ugliness/"abuse" gets passed around. That just means that no one really has a good handle on what is going on with the patient.

I wouldn't trade every 4 hours, but I think that passing around the drama/abuse IS fair. In my unit, we get some frequent flyers that are well known nurse abusers and who have families that are just as abusive and difficult to get along with. We absolutely respect it when a nurse who's on her first or second of three nights says that she/he just can't handle taking that patient again. Or if they've stuck around a long time and are complete PITA's, we rotate them through the staff, continuity of care be damned. We are all capable nurses and are equally capable of giving a comprehensive report on the patient. If there are holes in the report and the nurse who had the patient previously knows that some info is left out, she'll help the nurse who got him as a new assignment. I have very little sympathy for the abusive patient and believe in preserving mine and my coworker's sanity. Believe me, they will get much better care if the current nurse taking care of them hasn't already built up a good resentment over having to take care of them.

Having said that, if you're finding that you are frequently having run-ins with patients or with patient families, you may want to consider taking a class in how to deal with difficult people. I'm a person who only rarely doesn't get along with even the worst families/patients. I roll with the punches, probably because of my past bartending experience. I can tolerate a lot. I've only twice in three years asked to not take a particular patient back. If you're having frequent personality clashes with patients, you might need to adjust your way of dealing with things.

[PureLifeRN]

There have been 1-2 times hwere I have switched a patient because they made very innapropriate comments and made me feel uncomfortable. And if I feel like my patient load is way to heavy, then I will unload a heavier patient to a group that is easier, however I have only done that a couple times. One shift I had 3 out of 5 patients on q3hour pain meds and I honestly could not get anything else done. I talked with the charge nurse about it and she agreed that my assignment needed to be split up. I never switch a patient without consulting the charge nurse, and I never do it consistently because with my luck I will get an even worse patient!! lol.

[sistasoul]

I don't agree with trading patients because they are difficult personalities. I do not like having the same difficult patient day in and day out. I do believe in continuity of care but I myself can only deal with certain patients for so long. I had this one 49 year old lady who was very mentally challenged. She had an ng tube and we had to keep mitts on her to keep her from pulling things out. This poor soul only communicated by making these very loud yelling, grunting type nosies that were so distracting that you could not focus on what you were doing. She would make these noises even if you just put your stethescope to her. She would constantly pull her oxygen out even with the mitts on and she would desat due to her PNA. I had this lady for 9 shifts. I finally spoke up for myself and told my charge nurse not to assign her to me any more. I was ready for a nervous break down and the patient was not getting my best as a nurse. Enough was enough. In these cases I feel this particular type of wealth should be shared.

[LouisVRN, RN]

If its a once in a blue moon sort of thing, fine, I have no problem with that. If its that you regularly don't want a particular patient, then the problem is with you. Your job is to care for them, not be their punching bag. You need to stand up for yourself and set boundaries about what will be acceptable behavior on your shift. I agree with the poster that said that some patients can be mentally/physically/emotionally draining and that they need to be regularly given new nurses so that their care isn't compromised by fatigue.

[bluejumperbunny]

This makes for such fascinating reading.

Is it the nature of private healthcare that has some patients think it's ok to be aggressive/abusive/sexually inappropriate?

Is it the nature of private healthcare that has you all believe that when patients are aggressive/abusive/sexually inappropriate it's just part of the job?

Do your managers not get involved in dealing with such patients?

Here in the UK, the NHS operates a Zero Tolerance policy to all forms of violent, aggressive, abusive and sexually inappropriate behaviour towards all staff, patients and visitors. There are posters and leaflets everywhere in all the Trusts.

If someone is abusive (for no medical reason), they are issued with a first and final warning so if they do it again, they are escorted off hospital premises by security or their care is transferred to another hospital - END OF!

It's good, it protects everyone and because it's policy, if your management or the Trust as a whole does not act accordingly to protect your rights, you have the law on your side.

I think it's sickening, Saiderap, that instead of supporting each other in trying to deal with difficult patients, colleagues are instead are trying to forcibly offload their responsibilities onto others. It says a lot about your team dynamics. Something needs to be done about that.

[JulieCVICURN, BSN, RN]

Bluejumperbunny, quite often it seems that here the adage is "the customer is always right". I recently had a complaint issue where the customer in question was quite literally certifiably confused and paranoid and twisted some conversation overheard in the nurses station into something that it absolutely was not. Did it matter that she was confused and simply flat out wrong? Nope. We still had multiple meetings about the situation that culminated in, "It doesn't matter if the customer is crazy, it only matters that we made her unhappy." Seriously? And with abusive patients, it has to get pretty serious before management or anyone will step in and tell them to knock it off or stop coming to our facility. We have blackballed a few patients who are no longer welcome at our facility, but that's a rarity.

At least, at my facility. I can't speak for others. The one thing we have going for us is that in my unit we are all supportive of one another. Last night my coworker had a looney patient whom we all took turns babysitting so that the coworker could get a moment here and there to care for her other patient.