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

Nurses General Nursing

Published

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.

After 1 night (12 hrs) with a pt who eats up all our time, we may ask at the end of the shift not to get that pt the next night (this invariably turns out to be the other 2 nights of the f/t week). Everyone's OK with that. No one can ask not to get a pt they've never had. And everyone who asks not to get a pt back takes a chance they'll get a worse one. Seems everyone can live with that. I will always swap at the last minute to take male pts from women nurses when those pts are are creepy or abusive. But the key to our system working is we always go through the charge nurse. There is no private swapping--only the charge can assign/re-assign. Anyway, the customer isn't always right, and we back each other up. I'm ex-military so if there's an ex-military pt who's giving his nurse a hard time I get called in to straighten him out. They never complain, they get sheepish and stay respectful of their nurse the rest of the shift. Others have other expertise in getting cooperation. We all complement each other. If a pt has a favorite tactic for messing with nurses, we take turns answering the bell and everyone responds exactly the same way. They give up before long.

bluejumperbunny, Yes, it unfortunately *is* the nature of private healthcare. More and more, we are "educated" by our facilities that we are to maintain a level of "customer service" and, essentially, must sell ourselves on behalf of our facility. Often, this means putting up with being mistreated and sometimes abused. It's unfortunate, but true. Even our terminology has changed - when I graduated a few years ago, all of my books referred to patients as "clients" - where I live, that term never caught on or won over "patient," but I think it speaks volumes about who we are trying to be in healthcare: the devoted servant.

Specializes in Acute Care, Rehab, Palliative.

I am surprised by the number of people saying that nurses must be stuck with difficult patients whether it is fair or not.Where I work these patients are not assigned to the same person for days on end. We can speak up if we have had a difficult/unpleasant person for a couple of days and ask for a switch. If there is one that we really don't get along with and someone else can handle them better then that person will take them on. Sometimes two people will have one pt and we will do them together.A lot of our pts are confused so their behaviour is not just bad manners but they are still difficult.

bluejummperbnunny i think that a lot of pt in the NHS are given a lot of leeway if they are unpleasant due to the fact they are ill. yes cognitive impairment may mean the pt ends up being physical verbally agressive however this does not negate there risk to staff. Also non cognitively impairment pt can be verbally unpleasant to staff or better still get their families to do it.

Now that trusts are becoming more business focussed and pt even in emergency care can say which hospital they will go to management wants us to be good representatives.

We try to communicate with our pt to prevent problems and then act to reduce the effect.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

If the patient is abusive to everyone, then everyone should take a turn. If they are abusive to you and haven't been to others I can't imagine anyone refusing to trade. I had to trade 8 hours into my shift the other day. I didn't whine or complain because it was the right thing to do, althoug terribly inconvenient. The guy trading even let me pick whom to trade with.

If I'm in charge and someone wants to switch mid-stream, they need a legit reason, not just because the patient is too much work. I always used to tell them, that there was nothing wrong with needing a break, but mid-shift wasn't the time to switch, but we'll make sure we pass the patient around to all the nurses, so we each don't burn out and share in the difficulty.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.

i want to work where you do! seriously! here in the us, you can abuse your nurse as much as you want to, and there are no consequences. patients do it, families do it, sometimes even physicians do it.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i am surprised by the number of people saying that nurses must be stuck with difficult patients whether it is fair or not.where i work these patients are not assigned to the same person for days on end. we can speak up if we have had a difficult/unpleasant person for a couple of days and ask for a switch. if there is one that we really don't get along with and someone else can handle them better then that person will take them on. sometimes two people will have one pt and we will do them together.a lot of our pts are confused so their behaviour is not just bad manners but they are still difficult.

i'm all for taking turns with difficult patients -- so long as we actually do take turns. i don't think it's fair for five or six of a staff of 90 to be stuck with the difficult patient every time they come to work and the other 80-odd take that patient only rarely if at all. that said, i've worked with some nurses who sound a lot like the op -- they don't think they should have to take a difficult patient ever. they throw fits, scream about unfairness and abuse and just generally weasel their way out of the assignment, thus abusing their colleagues. no one likes to work with the weasels.

i'm all for taking turns with difficult patients -- so long as we actually do take turns. i don't think it's fair for five or six of a staff of 90 to be stuck with the difficult patient every time they come to work and the other 80-odd take that patient only rarely if at all. that said, i've worked with some nurses who sound a lot like the op -- they don't think they should have to take a difficult patient ever. they throw fits, scream about unfairness and abuse and just generally weasel their way out of the assignment, thus abusing their colleagues. no one likes to work with the weasels.

you must work at my old job..lol yeah i also don't mind taking turns with the difficult patients and i will even go in and help. but i've had my share of nurses and cnas that think that they don't need to take care of patients that are difficult - even if they are difficult to everyone. some try to take if personal that someone is "mean" to them, when in fact they are mean to everyone.

Specializes in retired from healthcare.

Most times when I trade someone off, I am giving them to someone who they like more than me.

I have taken patients off other nurses groups who they intensely dislike

because thinking about their feelings makes their work easier.

Some of the girls I worked with were grateful that I could take patients they

couldn't stand and I also was quite relieved when they took one who

abused me but who they like.

I do agree that you can learn to care for difficult patients if you have handled your own life issues first. Even then, it still is like learning how to sing

where some people can't carry a tune. Not everyone has the same abiltiy

to handle stress and some can have mental breakdowns from it. For this reason

if someone asks to trade one of their patients, I try to understand their side of it.

Most times I always do what they ask and the patient is usually one who

does not bother me.

If you're trading off one out of 50 and it's one who everyone likes, this is

completely fair.

Most times when I trade someone off, I am giving them to someone who they like more than me.

I have taken patients off other nurses groups who they intensely dislike

because thinking about their feelings makes their work easier.

Some of the girls I worked with were grateful that I could take patients they

couldn't stand and I also was quite relieved when they took one who

abused me but who they like.

I do agree that you can learn to care for difficult patients if you have handled your own life issues first. Even then, it still is like learning how to sing

where some people can't carry a tune. Not everyone has the same abiltiy

to handle stress and some can have mental breakdowns from it. For this reason

if someone asks to trade one of their patients, I try to understand their side of it.

Most times I always do what they ask and the patient is usually one who

does not bother me.

If you're trading off one out of 50 and it's one who everyone likes, this is

completely fair.

So I think what you are asking is what do you do when others don't want to trade when you get a difficult patient? I think that's what I got from your first post. Personally if someone refuses to trade for a request that is valid, then I stop trading with them. I honestly have never asked to trade with anyone, but have had the same type of experience with helping. One girl used to ask for help all the time, but was too busy if I asked.

If you aren't asking too often to trade and if it is a person that has singled you out for abuse, they I don't see why people are not being cooperative. You might want to talk to your charge nurse or nurse manager. If that doesn't help, they you have to decide if staying at this present place is worth it.

Specializes in retired from healthcare.
i'm all for taking turns with difficult patients -- so long as we actually do take turns. i don't think it's fair for five or six of a staff of 90 to be stuck with the difficult patient every time they come to work and the other 80-odd take that patient only rarely if at all. that said, i've worked with some nurses who sound a lot like the op -- they don't think they should have to take a difficult patient ever. they throw fits, scream about unfairness and abuse and just generally weasel their way out of the assignment, thus abusing their colleagues. no one likes to work with the weasels.

when i trade patients off my group, this is not about having all easy patients. we used to talk about, "an even trade." it would mean i get a difficult patient i can tolerate instead of one who gets me in over my head.

in one case, i worked a floor of 50 patients with the same guy every shift and there was one patient i would always give to him and this put a smile on him.

he thought this patient was easy and he was in the break room making jokes about her because her head games amused him.

i usually got a difficult patient to replace her. it made both our jobs a lot easier.

Specializes in Rehab, Med Surg, Home Care.

I don't take "trading" lightly. Our charges are pretty good about ensuring that the acuity of everyone's assignment is about the same and that the most difficult pts are rotated so that everyone gets a break. That being said, there have been those that just rub me the wrong way (or vice versa). If the pt is doing something inappropriate or threatening and cannot/ will not be redirected, I will ask for assistance. And I don't think anyone has emphasized this sufficiently, but in the interest of self-protection, you need to ensure that your documentation of any unusual behavior or events is detailed, complete and neutral in tone. Document, document, document- it's the only way any issues you may have can be verified/ legitimized!

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