Needy Ned pts & end of shift requests

[CaffeinePOQ4HPRN, BSN, MSN, LPN, RN]

As Golden Girls' sweetest charmer, Sophia Petrillo, would say: "Picture It..."

It's 5-10 minutes before the end of your 12-hr shift. You have been on your feet the whole time catering to the whims, fancies, and actual needs of your increasingly heavy total-dependence patient assignment.

You've almost reached the finish line, and with just 5 minutes left to your shift, you are fast and furiously charting your progress notes and other documentation so you can commute home and provide self-care (like toileting, a shower, nourishment, sleep, etc). But wait! Don't kick off your sweaty nursing shoes just yet, because it's Mr. X calling for the umpteenth time this shift to make several "little" requests (which could take a min. of 15 minutes or longer)... and although you offered to do these "little" requests before you sat down to do your charting he refuses. Requests, such as: "I'd like my muffin warmed up now, I want to change my socks(again), I know I asked you to open my blinds but now I want them closed again, I want a coffee..." It's perfectly reasonable for you to refuse and communicate these things at shift change, but if you do you'll have to chart the conversation because Mr. X is a known **** disturber, loves to keep admin busy filing complaints for any/everything because his niece is a nurse and we're all negligent... blah, blah, blah

He has been assessed, and his cognition is fine. His attending physician has admitted that Mr. X is a bit of a jerk but brushes him off as just a needy-Neddy with a vindictive streak, and says "you nurses can handle him!". The family refuses to hire a sitter although their finances can accommodate this. So, you take a deep breath and oblige because you figure the sooner these "little" things get done the closer you are to a shower, a meal, and a reprieve from this insanity! Also because, you're so exhausted that trying to reason with an unreasonable person seems fruitless.

On my unit we have over a dozen Mr. X's. Do any of you have a Mr.X? What was that like for you?

[Pangea Reunited, ASN, RN]

I let them know requests made during shift change will be delayed and make sure to check in with them before starting report. Honestly, they call anyway ...but they're somewhat more understanding when they're made to wait- even though they're not 100% happy.

[KatieMI, BSN, MSN, RN]

"Mr. X, in 30 min. I am going to start my shift change. It is very important, because if I do not tell the incoming Nurse about your (whatever sounds more significant for Mr. X), she will not know it and your care will suffer (substantiate whenever possible). So, around 7 PM we all be very busy and your requests may be delayed. If you need something, say it NOW".

Do it day# 1 and keep your word. Even better, introduce a bit of unit routines during admission. Doing CNAs shift change 15 -20 min before nursing also helps, as new CNA shift hits the floor right during these last 10 min before nursing shift change.

I also try to medicate those of my patients who need pain control 45 to 60 min before shift change.

BTW, since when request of warm muffin, fluffed pillow and low blinds requires nursing note? Unless patient is not only known "high needs" but also on "special observation status" (i.e. appears to drifts toward psychosis, aggressive, there are suspicions of criminal activity in the room, clearly dysfunctional family, etc), such requests totally belong to nursing assistant's duties and do not need to be charted.

[macawake, MSN]

But wait! Don't kick off your sweaty nursing shoes just yet, because it's Mr. X calling for the umpteenth time this shift to make several "little" requests (which could take a min. of 15 minutes or longer)... and although you offered to do these "little" requests before you sat down to do your charting he refuses. Requests, such as: "I'd like my muffin warmed up now, I want to change my socks(again), I know I asked you to open my blinds but now I want them closed again, I want a coffee..."

I thank my lucky genes that I'm a muscular 6'1'' (6'3'' in my clogs ) and while I look friendly enough when I smile, I have a very stern looking neutral face and am not above using "the glare" when I feel that it serves my purposes. Actually not many people attempt to treat me like the charming Mr X (at least not the ones in possession of all their marbles), but if they do it usually only happens once. I realize that this might come off as a bit arrogant and slightly grandiose , but I simply cannot stomach people who are being deliberately rude or playing ridiculous power games for their own twisted satisfaction. I understand an anxious patient over-utilizing the call bell but some do it just to be obnoxious. I refuse to reward that type of behavior.

If I was certain that Mr Needy was only doing this to be a pain in the behind, I'd simply tell him that he's an adult and that I'll show him the courtesy of addressing him as one adult to another. Then I'd go on and remind him that I asked him if he needed anything before I started charting/giving report and that he declined. Now I'm busy making sure that the next shift gets the information they need to provide medically safe care for him as well as my other patients and that I recommend that for my next shift he let me know when I ask him if he needs anything and not postpone it until shift change. I'd conclude with that I'm convinced that he, being a reasonable adult understands the rationale behind my prioritization. His darn socks (no pun intended) do not remotely resemble a medical emergency and can wait (that last part I won't actually say, but the meaning will be clear).

I don't work the floor anymore but when I did I was fortunate enough to have nurse managers who had our backs. Of course it also helps that I work in a healthcare system that isn't for profit and patients haven't been brainwashed by glossy advertisements into believing that they are staying at a five-star hotel and that the nurse is at their beck and call to tend to any random whim of theirs. We get a few entitled persons, but they're a minority. We're first and foremost there to provide safe, high-quality healthcare and the blinds will be adjusted and the muffin served when it fits into our schedule.

[loriangel14, RN]

I say " sure, I'll let the next shift know, we are just getting ready for shift change. Bye".

[CaffeinePOQ4HPRN, BSN, MSN, LPN, RN]

"Mr. X, in 30 min. I am going to start my shift change. It is very important, because if I do not tell the incoming Nurse about your (whatever sounds more significant for Mr. X), she will not know it and your care will suffer (substantiate whenever possible). So, around 7 PM we all be very busy and your requests may be delayed. If you need something, say it NOW".

Do it day# 1 and keep your word.

I appreciate your advice. Unfortunately, we have all tried to orient him that way since Day 1 and he is resistant. He wants things when he wants them! We don't have nursing assistants to help us, we do everything...we have to chart everything to CYA because the legislation has a lot of grey areas where I live... dismissing or refusing a request can be seen as neglect. A friend of my was disciplined by the college of nurses because she rolled her eyes at a patient's family member. I'm not kidding. We have to chart to CYA against trivial accusations that could cause us BIG headaches as nurses. Our legislation has so much grey that almost anything can be categorized as abuse or neglect by patients and their families. They have so much power that we are charting until our fingers bleed just to combat the constant threats.

[CaffeinePOQ4HPRN, BSN, MSN, LPN, RN]

...I realize that this might come off as a bit arrogant and slightly grandiose , but I simply cannot stomach people who are being deliberately rude or playing ridiculous power games for their own twisted satisfaction. I understand an anxious patient over-utilizing the call bell but some do it just to be obnoxious. I refuse to reward that type of behavior....

Exactly, we don't want to enable him...but we feel helpless because he's gotten so many nurses in trouble already over trivial things and our manager is not standing up for us.