"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.

[Alnitak7]

Spreading the workload around and sharing difficult patients is good teamwork, as has been mentioned numerous times in this thread. But if you feel like whether or not you like a patient has in impact of the quality of care that you are able to provide to them, as is implied in this post and in others, then I believe that is a problem.

But I think what really stuck in my craw and caused me to go off in numerous TLDR-style posts is the idea that sometimes a client "just doesn't like" a certain nurse. While that may seem true at times, using that as a rationale for switching puts all the blame for the conflict on the patient, and allows the nurse to avoid taking responsibility for resolving it.

If there is any possibility of resolving a conflict then most times the sfaff is alert to this and they will help the caregiver. Sometimes taking responsibility for resolving the conflict means they will show their respect for the patient by not going near them.

[Boognish]

Saiderap-while it might seem like I've been getting on your case in this thread, I appreciate your input here. I'm an a CNL (Clinical Nurse Leader) program right now, and in 4 years, I'm going to be looking for a job where I will be responsible for finding ways to address these types of issues. It's good for me to start thinking about how I might respond (although my opinion will most likely change as I get more experience in a clinical setting, and progress through my CNL coursework down the road).

So I have a question for you- have you spoken to any of the nurses in a supervisory role about feeling abused by particular patients, and about trading assignments with coworkers? If so, what was their response?

This thread has got me thinking about what I would do as a CNL if a nurse on my unit came to me and told me that they were being verbally abused by a client, and asked that they not have that client assigned to them (or if other nurses were complaining to me that one of their coworkers was adamantly trying to trade one of their assigned clients away to them) and I don't think it would be too unreasonable for me to go to the client in question and 1) ask them why they became upset with the nurse and 2) tactfully express to them that I do not want my nurses being abused, and if they have a problem they should ask to speak to me or another supervisor rather than becoming abusive.

What I would want to avoid, wherever I end up working, is nurses playing favorites and trading assignments without clearing trades with myself or another nurse working in a supervisory/managerial role. I see allowing nurses to trade assignments independently as a potential source of interference with continuity of care, a source of conflict between members of the nursing team (as it clearly has been for you), and because I would want to know if any nurses on my unit are feeling uncomfortable with the work they are being asked to do. I currently have no problem helping my coworkers with difficult residents, as I tend to have an easier time with those who are resistant to care- especially those with Alzheimer's/dementia- and as a CNL I would certainly have no problem assisting a member of my nursing team with a difficult client.

[Alnitak7]

To answer your question, we did talk about this all the time.

At one time, I told someone I would quit because there was a rumor that we all had to take care of the ones that were on our group.

Later that day, the charge nurse walked up to me in a patient's room and said, "I don't care if it's only one patient..." She said, "I was told you won't have anything to do with J....." In this case, a number of charge nurses asked the patient why he was abusing me and I suspect they talked about it more when I was not there.

Telling a patient not to abuse the caregiver may enter into magical thinking with some who have dementia and chronic pain.

A few of our charge nurses said, "I don't care who takes care of them as long as it gets done."

They did not ask for us to tell them. They let us work it out.

There was one day when two girls who liked the patient abusing me, refused to trade with me and I reported it to two charge nurses and the two girls both caught an earfull. I ended up not having that patient that day.

Then a different charge nurse (who some people complained about) told me I had to take care of this one and said, "It's been a whole year...Why don't you just try it."

I always make sure I did not say things in front of the patients about trading them.

I am all for saving their faces.

I don't think someone should walk into a patient's room and announce that the nurse who traded them was mad at them as did one of my co-workers.

If I was the patient, I would prefer to have a nurse who likes me, in all but a few cases, and would like to think they are all talking about this and helping each other. I would not want a nurse who can't stand me just because the others are refusing to take me off her group.

Saiderap-while it might seem like I've been getting on your case in this thread, I appreciate your input here. I'm an a CNL (Clinical Nurse Leader) program right now, and in 4 years, I'm going to be looking for a job where I will be responsible for finding ways to address these types of issues. It's good for me to start thinking about how I might respond (although my opinion will most likely change as I get more experience in a clinical setting, and progress through my CNL coursework down the road).

So I have a question for you- have you spoken to any of the nurses in a supervisory role about feeling abused by particular patients, and about trading assignments with coworkers? If so, what was their response?

This thread has got me thinking about what I would do as a CNL if a nurse on my unit came to me and told me that they were being verbally abused by a client, and asked that they not have that client assigned to them (or if other nurses were complaining to me that one of their coworkers was adamantly trying to trade one of their assigned clients away to them) and I don't think it would be too unreasonable for me to go to the client in question and 1) ask them why they became upset with the nurse and 2) tactfully express to them that I do not want my nurses being abused, and if they have a problem they should ask to speak to me or another supervisor rather than becoming abusive.

What I would want to avoid, wherever I end up working, is nurses playing favorites and trading assignments without clearing trades with myself or another nurse working in a supervisory/managerial role. I see allowing nurses to trade assignments independently as a potential source of interference with continuity of care, a source of conflict between members of the nursing team (as it clearly has been for you), and because I would want to know if any nurses on my unit are feeling uncomfortable with the work they are being asked to do. I currently have no problem helping my coworkers with difficult residents, as I tend to have an easier time with those who are resistant to care- especially those with Alzheimer's/dementia- and as a CNL I would certainly have no problem assisting a member of my nursing team with a difficult client.

[Boognish]

OK, so you are talking about a client who has dementia- yeah, trying to address the client to ask them to change their behavior isn't really an option there.

But it sounds like you're working in a somewhat hostile environment, if your coworkers seem to be taking pleasure from watching you take abuse from a client.

I don't think someone should walk into a patient's room and announce that the nurse who traded them was mad at them as did one of my co-workers.

Agreed. That is totally unprofessional behavior. If they didn't want to trade with you, they shouldn't have done it. After agreeing to trade, they should have taken full responsibility for the assignment and not brought any of the workplace drama into the client's room.

I would not want a nurse who can't stand me just because the others are refusing to take me off her group.

I really don't think that whether or not you like a patient should affect the care you give them. I would certainly prefer to be taken care of by someone who is kind to me rather than someone who is cold indifferent or downright rude- but learning to be kind, compassionate and caring towards people who you do not like is part of learning to be a good nurse.

By the way, what type of setting are you working in? Are you working in a nursing home?

[Alnitak7]

OK, so you are talking about a client who has dementia- yeah, trying to address the client to ask them to change their behavior isn't really an option there.

But it sounds like you're working in a somewhat hostile environment, if your coworkers seem to be taking pleasure from watching you take abuse from a client.

Agreed. That is totally unprofessional behavior. If they didn't want to trade with you, they shouldn't have done it. After agreeing to trade, they should have taken full responsibility for the assignment and not brought any of the workplace drama into the client's room.

I really don't think that whether or not you like a patient should affect the care you give them. I would certainly prefer to be taken care of by someone who is kind to me rather than someone who is cold indifferent or downright rude- but learning to be kind, compassionate and caring towards people who you do not like is part of learning to be a good nurse.

By the way, what type of setting are you working in? Are you working in a nursing home?

What I've been describing in this thread was in a nursing home. Their staffs seem to be known for immaturity.

I know at least one book that's been written about it which is now out of print.

When I've worked for home nursing agencies and ask them not to send me back to a certain client, they are usually much kinder than in the nursing home. One scheduler was reprimanded for making me go back to a

client who I had asked not to see.

[Boognish]

What I've been describing in this thread was in a nursing home. Their staffs seem to be known for immaturity.

I know at least one book that's been written about it which is now out of print.

When I've worked for home nursing agencies and ask them not to send me back to a certain client, they are usually much kinder than in the nursing home. One scheduler was reprimanded for making me go back to a

client who I had asked not to see.

It seems that when it comes to senior care in general, not much emphasis is put on quality of care by the management companies responsible for administration. I've never worked in a skilled nursing facility, but in assisted living and memory care, the training is bare-bones and they'll often hire just about anyone off the street (at least just about everyone in a nursing home has to be certified either as an RN, CNA or certified medication aide). Maybe the maturity issue is related to nursing homes being more willing to hire nurses fresh out of school than other clinical settings? I don't know, just a guess. In any case, that's an issue that could be addressed with a good solid initial and ongoing training regimen, But that would cost $$, and the investors have to get their cut of the action, no? Who cares if clients are receiving good care as long as Mr. Moneybags can afford to buy a new BMW every two years.

When it comes to home nursing, it definitely makes sense to me to take care to pair nurses with clients who are a good fit for them, because there is no one there to step in and help out if there are problems.

[klone, MSN, RN]

I think that it indicates a need for further training when people feel wholly unequipped to deal with certain situations

That's my opinion in a nutshell.

OP, it sounds like you do a lot of trading. I think there is something wrong with this picture.

[Alnitak7]

That's my opinion in a nutshell.

OP, it sounds like you do a lot of trading. I think there is something wrong with this picture.

For over a year, I was trading only one patient out of fifty. The others liked this one so most times they did not mind helping me. They knew they could give me one of theirs if they had to.

[Alnitak7]

That's my opinion in a nutshell.

OP, it sounds like you do a lot of trading. I think there is something wrong with this picture.

It makes a difference if you're feeling slighted and annoyed by a patient or if you're feeling violated on a deep level. Sometimes when they talk about more training, it really should enter into therapy. If health care staffs had

therapy groups, it might increase the number of pateints they could handle and at the same time would make them see why trading can be good.

One day I was play-acting with another caregiver and I was supposed to tell her, "No."

She said, "This one raped me one time, can you trade with me?" I said, "We'll work together on him." In this case, does someone really need more training or is getting someone off your group a healthy reaction?

[klone, MSN, RN]

It makes a difference if you're feeling slighted and annoyed by a patient or if you're feeling violated on a deep level.

And does this happen to you often?

And I'm sorry, but who hasn't felt slighted or annoyed by a pt? Deal with it! It's part of the job.

[Alnitak7]

And does this happen to you often?

And I'm sorry, but who hasn't felt slighted or annoyed by a pt? Deal with it! It's part of the job.

Let me try to re-phrase this.

I said, "It makes a difference if you're feeling slighted and annoyed with a patient or if you're feeling violated on a deep level." What I was trying to say is in behalf of nurses who have been deeply violated by their patients and when the patient is literally a threat to their welfare and a threat to their mental health. What would you say to a staff member if a patient on her list had committed a criminal

act against her? I would not just tell them to, "deal with it."

"Any patient who verbally abuses or threatens you, or sexually harasses or touches you is a criminal! Talk to your supervisor first,but if that does work,call your local police and press charges. Several states now have laws which protect nurses from these criminals." Originally posted by montroyal

https://allnurses.com/general-nursing-discussion/can-nurses-refuse-49107.html

[klone, MSN, RN]

What would you say to a staff member if a patient on her list had committed a criminal

act against her? I would not just tell them to, "deal with it." [/url]

If you would reread what I said, you would see I said "deal with it" in response to feeling "slighted or annoyed" by a pt. But feel free to twist my words in order to bolster your argument.