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"?
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 agree with this. Often, in situations like this, the root of the problem is that the person has a fear (and, often past experiences) of not receiving care, being dismissed (and patronized) by healthcare staff, and feeling a sense of no control. Sometimes the "squeaky wheel" clients in healthcare are "squeaky wheels" for a legitimate reason ... One thing I've found helpful over the years with clients like this is to be proactive -- address their needs (that you can anticipate) promptly, without their having to ask, so they can begin to develop a sense of confidence that they're not going to be abandoned/ignored. You know that she has the patch change ordered at 8p, and that you have from 7p to 9p to do it -- why not go ahead and change the patch at 7p? (Or, at least, shoot for as close to 7p as you can get.) That way, she doesn't have to wait and ask for it and worry about whether she's going to get it or not, and you're free to continue on with your regular routine and/or deal with any unexpected situations that arrive without leaving her hanging.
If she's able to develop some sense of confidence that her needs are going to be met, she's less likely to keep "testing" the staff with frequent, repeated demands, and, if she begins to have some trust in the staff, you'll have a better chance of negotiating some limits on her behavior. A little extra effort on your part "up front" is likely to make your life easier as well as hers.
Umm.. Maybe it's just me here but the Dx you stated, screams alt. mental status! Keeping her calm should be a vital part of the care plan, if that involves getting her her scheduled Narc's on time.. so be it. If your unable to do this do to OVERLOAD your complaint should be about ADMIN... I for one am sick and tired of the unrealistic pt-staff ratios put on nurses... I think we should all start charting the REAL reason why things aren't done "as scheduled", THERE'S TOO MANY PATIENTS PER NURSE!!!!!
I agree pain needs to be addressed, but the OP stated she had two new admits with serious hypotension. In my book, having a heartbeat and respirations beats pain, hands down. Prioritize, like the previous poster said, give the med at 700, since you know it's an issue, and then if you have a crisis, that's one less thing you have to think about.
Specializes in acute rehab, psych, home health, agencey.
First that nurse to patient ratio for a snf unit seems a tad bit high and would be an area to address outside of the patient and her behaviors. In relation to the patient besides altering your schedule to attempt to meet her needs which may or may not be feasible can u shoptalk with the doc or try and get some type of psycheconsult to see that what is currently ordered is truly effective for her,sometimes md's truly dont know of potential interactions with patients meds. U have to constantly problem solve these challenging patients because mental health services have been cut drastically and these type of insurance paying customers that administration loves are showing up at the hospitals and then to rehab/snf units.
@OP, just because she has mental health issues doesn't mean she's not in pain.
For someone in pain, hanging on until that next dose of meds can be a nightmare. It's not as though our meds always last the 4/12/72 hours they're supposed to. You make look at her patch change as "only being an hour late", but she may have been in pain for 12 hours or more, just counting the seconds until she knows she can ask for her next meds. This is particularly true for people with spinal cord injury who suffer from central pain syndrome (neuropathic pain caused by damage to the spinal cord).
Sorry, OP, but if she's not screaming at you for her pain meds before her next scheduled dose, I'm in her corner. Whoever said it's the squeaky wheel that gets the grease is right. And as one person in a group of 24 who all need something from one nurse-- especially when that nurse admits that your pain relief is her lowest priority -- you learn pretty quick that you'd better squeak awfully loud or risk being pushed to the back of the queue because "all you need are narcs".
If I have to make a choice between being in pain or being known as a pain in the ass to get that next does of pain meds on schedule, the former will win every time.
elkpark
14,633 Posts
I agree with this. Often, in situations like this, the root of the problem is that the person has a fear (and, often past experiences) of not receiving care, being dismissed (and patronized) by healthcare staff, and feeling a sense of no control. Sometimes the "squeaky wheel" clients in healthcare are "squeaky wheels" for a legitimate reason ... One thing I've found helpful over the years with clients like this is to be proactive -- address their needs (that you can anticipate) promptly, without their having to ask, so they can begin to develop a sense of confidence that they're not going to be abandoned/ignored. You know that she has the patch change ordered at 8p, and that you have from 7p to 9p to do it -- why not go ahead and change the patch at 7p? (Or, at least, shoot for as close to 7p as you can get.) That way, she doesn't have to wait and ask for it and worry about whether she's going to get it or not, and you're free to continue on with your regular routine and/or deal with any unexpected situations that arrive without leaving her hanging.
If she's able to develop some sense of confidence that her needs are going to be met, she's less likely to keep "testing" the staff with frequent, repeated demands, and, if she begins to have some trust in the staff, you'll have a better chance of negotiating some limits on her behavior. A little extra effort on your part "up front" is likely to make your life easier as well as hers.