Are Patients Cared for Equally? Challenges of the VIP Patient
Have you been caught off guard when asked to treat a VIP differently from your other patients? This article with explore the challenges and consequences of “VIP Syndrome”.
Have you ever been given a patient assignment and hear the words "You have a VIP"? I cringe when I am assigned the Very Important Patient (VIP)- a.k.a. Very Influential and Very Intimidating Patient. My resentment begins to bubble over and I find it offensive that I am expected to treat one patient "better" than another. I also resent the additional pressure from my supervisor, administration and the VIP. I have never cared for a famous celebrity, but I have witnessed the effects of VIP syndrome when caring for local politicians, CEOs, influential and local celebrities. Although nurses do care for high profile celebrities, this article will focus on the more frequently occurring local VIPs.
What makes an individual a VIP? Any patient whose status has the potential to influence the judgment and care of healthcare providers is a VIP patient. The first VIP image to pop into my mind is the national celebrity. However, this article will focus more on VIP status due to occupation, position or social status. Common VIPs may include hospital administrators, physicians, local athletes and any patient with influence. The ethical and moral issues surrounding the care of a VIP is often referred to as "VIP Syndrome" and results in care that can be of greater or lesser quality. Let's take a closer look at common ethical issues that surface when treating a VIP.
Social Justice
The principle of social justice implies patients will be treated fairly and with equal distribution of access to care and resources. Providing preferential treatment is often a difficult, if not impossible, pill for a nurse to swallow. V.I.P. treatment deviates from the nursing code of ethics of approaching all patients with the same level of attention and care regardless of social status. VIP Syndrome challenges the principle of social justice by resulting in greater access, attention and resources from healthcare providers, including nurses. Examples include:
Schedules adjusted to accommodate physician appointments, consults, diagnostics and treatment
Decreased waiting times (MD office, emergency department, hospital call light)
Access to additional resources (diagnostics, specialists, equipment, transportation)
When providing VIP treatment, the healthcare team often steers away from standard practices, protocols, policies and procedures. Therefore, care surrounding the VIP often becomes chaotic and pulls resources away from other patients.
Autonomy
Autonomy is the right patients have to make informed decisions about their medical care independently without the healthcare provider attempting to influence their decisions. Therefore, patients have the right to receive clear information and education regarding care so that an informed decision can be made. Let's look at a case study:
Mr. Jones is a well-known local meteorologist on a popular morning news program. Mr. Jones fell at home and presents to the emergency department with a broken femur. The triage nurse notes a strong odor of alcohol from the patient. The nurse does not want to embarrass Mr. Jones, therefore, does not complete a thorough history or physical. The physician, not wanting to upset the patient, does not determine if alcohol was a contributing factor in the fall. The patient is impatient and to avoid inconvenience, minimal lab work is ordered.
In this scenario, only a limited patient history and assessment is performed to avoid inconveniencing the patient. The VIP will be asked to make decision regarding treatment, but does not have the benefit of a thorough assessment. The patient's drinking habits are not explored,therefore, the patient will not have the opportunity to make decisions on participating in an alcohol protocol.
Healthcare providers often deviate from standard practices and protocols. Breaking rules when treating VIPs occurs when staff do not want to inconvenience, cause anxiety or tell the patient (or family) "no". This deviation places the VIP at risk for lower care quality and substandard outcomes (Alfandre, 2017)
Privacy
Privacy often becomes an issue for VIP patients. In my career, I have been tempted to share details a VIP's situation and had to make a conscience effort to maintain confidentiality. Staff may bend rules safeguarding privacy and share details of the VIPs situation to other staff or individuals outside of the hospital. To protect privacy, high profile patients may be moved to a more secure area of the hospital.
Tips for Care of the VIP
In 2011, The Cleveland Clinic published "Caring for VIPs: Nine Principles" to address the challenges of VIPs. Although the principles are geared towards physicians, the article provides several "takeaways" for nurses.
Do not bend rules. Provide care with effective clinical judgement and practices congruent with standards of practice and the institution's policies and procedures.
Work as an interdisciplinary team and communicate frequently.
Avoid assigning only certain nurses to care for the VIP. This will help to maintain the usual flow of care.
Always protect the patient's confidentiality and follow your institutions policies and procedures regarding communication with media.
Be careful about accepting or declining gifts. Speak with a supervisor if questions regarding gifts.
Caring for VIPs brings the potential of ethical dilemmas to healthcare providers. Being aware of common challenges will help to reduce pressure and frustration when assigned a VIP. What challenges have you personally experienced? What tips would you like to share with readers?
VIP Residents. In the wing I work in, 90% are comatose or unable to make decisions or care for themselves. Some of these residents have family members that are there daily, some a few times a day. Some are there to care for their loved, they allow us to do our jobs, but sometimes when staff is busy with another resident, they do some care themselves, and wait for assistance as needed. They see that the single staff member caring for their loved one has 10 to 12 residents including theirs and they understand the reason why staff is not on their beck and call all the time. Others not so much, it's like they expected staff to be at their residents bedside and to clean them ASAP. There are regular bed checks done to check if the resident is soiled, why blame the staff member for not coming right away when they are busy cleaning XL loose stool from another resident? I know it sounds cruel but when the other staff member is getting meds ready on their cart to give out, you can't expect them to drop everything that second and assist you, it's not a CODE, your loved one is soiled. We have to put the meds away first, less some resident or curious person come down the hallway and take it. When I've secured the Norco and the locked the cart, yes I'll help you. We treat everyone the same. I feel bad for those that think otherwise.
I had an experience in which a physician researcher put pressure on my group of research nurses to "put a patient at the top" of a wait list for a for experimental treatment because he had previously made generous donations to our research department. Our department has a strict policy of first come, first served for these treatments. When we nurses objected to doing so and pointed out the ethical issues, the treating physician backpedalled. We nurses have the responsibility to speak up! I'm so glad I wasn't intimidated and stood my ground.
The list you gave regarding the Principles of Caring for VIPs....You state it was geared to physicians but have take aways for nurses....TO ME...It's clear principles that apply to anyone caring for a VIP. I don't see the distinction between physicians and nurses in any of the listed statements.
My intended approach in caring for VIP patients is that I will care for them as I do any other patient.
However....There were always the more nervous feelings that would pop up from time to time as I had felt as though I would be under closer scrutiny, or more worried than usual about displeasing them somehow or making an error. I never did anything out of the ordinary or gave them "special" treatment (consciously), going out of my way, so to speak to do anything "extra" for them. I'm not a Pollyanna, but my values and principles go against that, and rub me the wrong way.
But as the patient...I don't want to tell my nurses that I am a nurse because I don't want them to feel nervous around me. Eventually they would find out, and I would tell them...Please do not worry about me being a nurse. Just know that I understand what you are up against and will not judge you.
I refuse to prioritize someone simply because they're wealthier than the patient next to them, despite recommendations to do otherwise. They become so accustomed to special treatment that being told they'll have to wait for something is a complete shock to their system. The entitlement and constant demands wear on me. Should I lose my job or be penalized somehow for treating everyone equally, so be it. I grew up homeless and wouldn't want someone putting me last on their priority list because of that. It's completely unethical despite the norm.
To answer your questions though, the challenges I face are these entitled "VIP" patients constantly hitting the call light and having family members flag random staff down if we're not there at the snap of their fingers to address something non-urgent. Their wealth and status has them completely out of touch with reality and unconcerned with the time constraints us peon nurses are facing. They're much more likely to complain to management, so my suggestion is to contact your manager if you get any inkling of any idea that your entitled patient is nearing their inevitable meltdown over something benign. They'll appreciate the heads up. Lastly, I'd suggest rotating nurses as usual, however, avoid assigning your newer nurses to these patients. They'll often consume more time throughout your shift than 2 rapid responses so assigning nurses with top time management skills is key. If you have supportive management, that may be less of an issue.
FYI, I'm saying this as a newer nurse living in a very wealthy area. Catering to politicians and celebrities was included in our orientation and I'd highly recommend avoiding working for boutique hospitals in these types of areas. Burn out could not have been escalated faster for me. God speed.
First of all...I admire your ability to overcome your background circumstances and take care of yourself the way you have. I came from a troubled family/childhood and can relate.
Also, your points on this topic are well-stated and I am in agreement. In particular, the issue of assigning a less experienced nurse should be avoided for the reason you stated, and in general, a less experienced nurse could aggravate that "special" VIP and cause more problems than there would already be potential for.
(Forgive the grammar)
I haven't read every comment yet, so forgive me if this was already mentioned...
There are VIP people in the world who are kind, respectful people. So aside from the ones who are "entitled" jerks, I think many from privileged backgrounds simply do not have the knowledge/perspective to behave appropriately at times. Their unreasonable expectations are born from ignorance.
Specializes in Tele/Interventional/Non-Invasive Cardiology.
I work at a clinic associated with a hospital that is known as the "hospital to the stars." I really hate the VIP concept. Most of the patients, because it is in a wealthy area, think of nursing staff as "the help." There have been plenty of racist and sexist commentary. Staff is supposed to just deal with it because both the doctors and their patients think of themselves as celebrities. It actually made me miss the "unwashed masses" (sarcasm here) who I felt I was actually helping. I am not saying rich people don't deserve quality care, but the sense of entitlement, elitism and classism is gross. And this facility actually makes a name for itself based on these attitudes. it is really disgusting. I miss feeling like work was for the greater good as opposed to the privleged.
We had a VIP in my hospital once when I was an aide. I was "technically" assigned to that room but told not to answer the call light, the nurse would take care of it. Well, the call light went off and NO ONE ANSWERED. I thought, "This is stupid," and went in to check on the patient. Their family was in there and they were very upset because apparently no one had been in to address the patient's pain and housekeeping never went in to empty the trash/clean the room up (it is common for housekeeping to do this at least twice a day for all other patients). I apologized for what they experienced, emptied the trash, tidied, changed the patient's sheets, and reported the pain level to the bedside nurse. In this situation, the patient actually experienced worse care than other patients because the nurses were afraid to let anyone in the room and didn't want to go in themselves for fear of screwing up somehow and landing themselves in trouble.
It was quite silly in this case, because the patient was very easy going and if I hadn't been warned that the person was a "VIP," I would never have connected the patient in the bed to the person I saw on TV.
Caring for VIP patients can be a nightmare, and your stories of demanding, unforgiving VIPs are beyond frustrating! On the other side of the coin though, I think sometimes hospital administrators, unit leaders, etc. put those "VIP treatment" standards on themselves.
I've been lucky and this often isn't the case, but I've found that several of my "VIP" patients simply wanted to be left alone and treated on a person-to-person level, so they could build the casual, "nurse lets their guard down" rapport that ordinary folks enjoy. Some VIPs have the same fears, insecurities, and feelings of powerlessness that most inpatients do. Yet management/leadership orchestrates clearly over the top measures in an attempt to impress that patient, assuming that's what they want. It can come off as so superficial and fake--as if we care about the patient's "name status" and how they might perceive us more than we care about their illness, or connecting with them personally. Granted, I haven't taken care of anyone beyond a "local celebrity". But I've heard that from a few folks, including a retired attending I took care of, and a local gov member--definitely stuck. Something to think about!
I work in LTC and we have had a couple of what could be considered VIP's. A local very popular retired newscaster and a fairly high ranking Catholic church officiant. Neither got any particular VIP treatment. Coincidentally both were total jerks!
Specializes in Education, Informatics, Patient Safety.
I will never forget the elderly russian lady we took care of on my unit. She had been on a flight to the US from somewhere in Russia when she had a massive stroke. The nearest place to land was our neck of the woods, and somehow (you know how bed control works!) she ended up on the oncology unit. She never regained consciousness. We knew her name of course (passport), but were unable to locate any relatives. She lived for another three weeks as we provided care to this woman with an unknown past. Oncology nurses know how to send someone out in style - she was comfortable and loved. I spent many hours talking with her, trying out some of my broken Russian from back in college when I stumbled through a year of course work in that lovely language (Xorosho!). She was the opposite of a VIP, yet I recall the CEO coming for a visit to ensure she was receiving excellent care. A local celebrity preacher used to come stay with us at times as well, but he never asked for VIP status - he just wanted to remain anonymous, and we certainly kept it that way. In the end, they both passed on.
nurseguy213, LVN
26 Posts
VIP Residents. In the wing I work in, 90% are comatose or unable to make decisions or care for themselves. Some of these residents have family members that are there daily, some a few times a day. Some are there to care for their loved, they allow us to do our jobs, but sometimes when staff is busy with another resident, they do some care themselves, and wait for assistance as needed. They see that the single staff member caring for their loved one has 10 to 12 residents including theirs and they understand the reason why staff is not on their beck and call all the time. Others not so much, it's like they expected staff to be at their residents bedside and to clean them ASAP. There are regular bed checks done to check if the resident is soiled, why blame the staff member for not coming right away when they are busy cleaning XL loose stool from another resident? I know it sounds cruel but when the other staff member is getting meds ready on their cart to give out, you can't expect them to drop everything that second and assist you, it's not a CODE, your loved one is soiled. We have to put the meds away first, less some resident or curious person come down the hallway and take it. When I've secured the Norco and the locked the cart, yes I'll help you. We treat everyone the same. I feel bad for those that think otherwise.