advice on philosophy of pt. care...are we called to patronize them?

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Specializes in Hospice.

So I work at a rehab hospital. There's a patient on my hall who has a reputation for being abusive. Yelling, belligerent, etc. She wanted her fentanyl patch c hanged at 8pm, and I had 2 new admits and was working alone the other night. Priorities for diabetics and the 2 patients who happened to have seriously low BP's at admit.

The not too nice patient went nuts because I was an hour late changing her patch. Not a problem. She filed a complaint saying I caused her "pain and suffering" lol. But I'm the only nurse working again tonight, and this woman is just off the hook with pscyh issues.

My DNS told me to just give her what she wants, be in her room at the time she specifies w/her narcs and let her have whatever she wants.

So my question is sort of philosophical. We take an oath to be a part of the healing process for the people who's care we're charged with. Does patronizing them in the name of "customer service" really help them? It's not that I want to c hange t his woman, I simply don't want to be a party to enabling her. We have an hour before and an hour after a med is ordered to get it to the patient. Nurse doesn't not = maid.

The other day PT was with this woman and our PT guy was so furious he came out of her room with his face so red it was almost purple. When does it get to the point where we say "the insurance money isn't worth it. we're not going to be a part of you abusing yourself or anyone else. no more"?

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Specializes in Nurse Leader specializing in Labor & Delivery.

I don't see how giving her her meds when they're due is either patronizing OR enabling.

When does it get to the point where we say "the insurance money isn't worth it. we're not going to be a part of you abusing yourself or anyone else. no more"?

Right about when you start looking for a new job.

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"Choose your battles ..."

Lousy situation -- best wishes.

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Specializes in Hospice.

I was the only nurse on a hall with 24 patients, 2 of which had just been admitted. Her patch change is q72 hrs. When this patient yells, we're told to do what she wants. Give her whatever she says she needs. I refuse to deny a diabetic insulin to appease a woman screaming for narcs.

That is patronizing and enabling her....

and really I CAN'T CHANGE HER. I dont' care about that. What I mean is, is this a regular part of our job? I guess I'm saying that I thought I understood but I don't know if I do now.

The "they're paying us we have to give them what they want" thing just doesn't seem right to me.

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Specializes in Hospice.
"Choose your battles ..."

Lousy situation -- best wishes.

I agree. I learned that lesson. It's not worth fighting over. I'm asking this in a more broad sense.... is this part of being a nurse?

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Specializes in School Nurse.

If she were in for detox or addiction related things it would be detrimental to her recovery, but since she isn't, I would tend to keep her as happy as possible.

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Specializes in Nurse Leader specializing in Labor & Delivery.

That's not patronizing. That's catering. That's "the squeaky wheel gets the grease." All you can do is continue to prioritize your care - you are the nurse and that's your job.

Patronizing would be if you decided NOT to give her her meds because YOU think that's what's best for her.

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Specializes in floor to ICU.

It's all about setting boundaries. You are not going to change people like this. It always amazes me how some people who seem to have serious mental health issues are discharged home. I wonder if they act just as bizarre at the bank, grocery store or while interacting with their kid's teachers?

As far as this particular patient, maybe she feels a loss of control? Sounds like she has chronic pain issues too- maybe this plays into her personality? I am not excusing her behavior. She probably counted down from the 72 hour mark for the patch change. All she knows is that she is supposed to get her patch changed at 8pm and you were late. I try not to let patients like this get to me. Just try and set boundaries. It's hard, I know. :rolleyes:

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Specializes in Critical Care, Education.

Is it possible to obtain a psych consult (nurse, physician, social worker) to help develop a behavioral mod plan for this patient? They are also a wonderful resource for the care providers - developing coping skills & mutual support. I am sure that the investment would be well worth it.

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Specializes in Medical Surgical Orthopedic.

I look at it like this- they may not always deserved to be catered to, but it makes my life easier to play along. That doesn't mean I'll come running to their room with ice when I'm in an urgent situation with another patient. But when they scream and say I should have been there 20 minutes earlier, I'll agree and apologize that I was not able to get there sooner. I'm not going to get myself worked up trying to fix someones broken personality.

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Specializes in Hospice.

I'm over thinking. Thanks for teaching me. I'm new to nursing outside of geriatric clients. And I scratch my head at the dynamic sometimes. I need to just shut up and do my job sometimes. I'm not upset I just wonder..why? If the dx in her chart is anorexia nervosa... with multiple other pscyh dx's.... I just don't understand how as a nurse, I'm helping this patient w/constant PRN and ordered pain meds, and responding with "yes ma'am" every time she yells . at one of us to get her her drugs...immediately. it takes away from the other patients and does nothing to help her.

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Specializes in Hospice.
That's not patronizing. That's catering. That's "the squeaky wheel gets the grease." All you can do is continue to prioritize your care - you are the nurse and that's your job.

Patronizing would be if you decided NOT to give her her meds because YOU think that's what's best for her.

Yeah I'm not a doctor. I have no right to alter orders per what I think about anything. lol. I offer alternatives to meds and attempt to divert attn. away from the pain. Otherwise, whatever the dr. orders unless it's a wrong dosage or some such, what's best for the patient is for me to follow the plan of care and work within my scope of practice. Thx for clarifying.:o

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