Accept and Adapt or Warning Sign: Attention-Needy Patients Burning Me Out

FolksBtrippin, BSN, RN · Feb 12, 2020

On 2/10/2020 at 9:04 AM, 2018RNat44 said:
I am a later in life RN (46 yo.) Nurse for 2 years. 1 yr hospice, 1 yr skilled/rehab unit in LTC. Hospice: too many HOURS so i switched to 3-12hrs on a rehab unit. I dont like what its doing to my PERSONALITY. Since its an ltc, a LOT of our pts are more "attention needy" than medically needy. Ex: call lights to "empty garbage" or "pick my lettuce off the floor" kinds of bs. Pts ringing like crazy for DUMB stuff or coming to nur station 30+ times a SHIFT. Not to mention the faaaamily members expecting 1 on 1 specialty treatment. Lots of pts are more hospice/LTC approp than "rehab"...Ive tried setting boundaries, pts acknowledge,apologize and then just REPEAT behaviors. Feel like im growing to HATE ppl and dont want to turn into that nasty burnt out nurse we all dread. Feel like Im dealing with a bunch of needy self absorbed, tantruming toddlers all screaming at the same time!
Coworkers tell me "its just nursing, it does that to you". Thinking about switching to hospital setting but afraid of the unknown. Any advice?

It sounds like you need some help with setting boundaries. Setting boundaries is more than telling a patient what is acceptable.

Setting boundaries means you change your response to the behavior.

Make some rules.

Example: call light is for emergency symptoms like I can't breathe, I'm in pain, I fell. Being wet or soiled, needing help to the bathroom.

I round x times per day. That is when I pick up dropped items, chat for a moment, help with the TV, empty trash.

When you round, you ask if anything needs to be picked up, etc.

If the call light goes off and you expect someone rang it for something inappropriate, you call the room if possible and ask what the matter is. If not, one of the allowed things, you remind of the rule and you tell them it will wait until rounds. If it's not possible to call the room you stop by and ask what the need is. If not appropriate you don't indulge. Even if the paper on the floor is right there and it will take you 2 seconds. Importantly, you do these things without expressing emotion.

That's setting boundaries.

Swellz · Feb 12, 2020

On 2/10/2020 at 4:13 PM, 2018RNat44 said:
I guess i just wonder if the INTENSITY of BS in hospital would be a little less onslaught than LTC rehab where i get yelled at for laundry, housekeeping and even kitchen problems by pts AND fams. Ppl forget our priority is their meddddical needs.

I have only ever worked in the hospital and I will tell you the level of BS and non-nursing issues I deal with is astounding. But, there is always something to be said for dealing with that from fewer patients!

2018RNat44, ADN · Feb 12, 2020

Thank you so much! Yes! I am still learning and need help with boundaries! Your suggestions are very helpful! Thank you for the tangible tools :).

shiftingtides · Feb 12, 2020

Have you considered trying nights? Far less BS than during days, in my experience.

2018RNat44, ADN · Feb 13, 2020

Not a fan of nights.

TriciaJ, RN · Feb 13, 2020

On 2/11/2020 at 7:31 AM, Wuzzie said:
I think the BS may even be worse honestly. Not saying the job is harder but there are just so many more players in the hospital.

Yes, including the kitchen, laundry, housekeeping, pharmacy, etc. who all seem to have a list of things they don't do, and try to turf it to the nurse.

For example: laundry won't wash anything with poop and nurses are expected to pre-rinse before tossing into a hamper; housekeeping won't clean up body fluids or remove linens from a vacated bed, but will stand idly by waiting for a nurse to do it. Pharmacy won't call the doctor when an order is unfillable; they expect the nurse to be go-between. Imaging techs will argue with a nurse whether an image really needs to be obtained stat, but they won't discuss it themselves with the ordering doctor. Central supply people won't provide something unless you call it by the correct name on their inventory list, but "aren't allowed" to tell you what that correct name is. Etc. etc.

2018RNat44, ADN · Feb 14, 2020

Yes!!!!!! Thank you ????

BarefootNurse3, BSN, RN · May 18, 2020

I'm having a similar issue! Patients calling again and again to ask for a pillow to be adjusted, screaming for help when the call light just went on only to find that their issue is the TV remote isn't working. Particular patient requires a time consuming treatment on top of a lot of other minor requests (adjusting position, adjusting blankets, bringing in more pillows or blankets, obtaining snacks from the kitchen, etc). So we're in the room for about an hour before moving on to our morning rounds afterwards. Unfortunately, the patient hits the call light a few minutes after I leave the room and becomes upset that it takes a while for someone to get to him again.

I think setting boundaries is important, but I too find it difficult to set boundaries because we have patients that will most likely complain to management. (I'd love to know ways to set boundaries without the fear of getting in trouble because nobody likes a nasty burnt out nurse!)

I've only been in the hospital setting during clinical for school but am eager to work in the hospital setting again. , The bright side of the hospital setting that I noticed was a faster turnover for one. And that they have more nurses staffed which means you won't get the same attention seeking patient again and again. The places I had got to do my clinical at often changed nursing assignments if there was a particularly challenging patient, and other staff would volunteer to answer the patients call light to give the nurse a break.

Where I work the turnover for a patient can be a few months until they move to our long term unit and we don't have the luxury to switch patients with another nurse since we each get a hall so the only thing to do is set boundaries which I can't seem to learn how to do yet.