Arguing Over a Patient Assignment

Nurses General Nursing

Updated:   Published

Specializes in Rehab/Nurse Manager.

Who decides who gets the difficult patients?

Has anyone ever been in a situation where there has been a conflict in deciding who would take which patients? 

Recently, at my workplace, things have gotten a little heated when it comes to deciding the placement of a patient who is particularly unlikable, and who is accompanied by nightmare family members.  He is non-compliant with everything and family has expectations that cannot be met.  He's recently been on my unit and is coming back.  All of my efforts to get the facility NOT to take him back weren't successful, so unfortunately we have to make room for him.  

The problem is, it has been nonstop conflict between myself and the family.  I believe he would do better with the other manager who has a stronger personality than I do.  He will never be satisfied on my unit, but he might do okay on hers.  I have asked multiple times to have him switched to the other unit. 

The other manager, however, is not happy about this since she knows he is difficult and feels she already has enough challenging patients.  At the same time, I know he won't get what he needs if he stays with me, so really, I'm actually advocating for him by pushing for the switch. 

Another reason that I'm wanting to switch is that if he stays,  he will interfere with the plans I have for another patient.  I am strongly pushing for another resident to actually come over to my unit so I can better monitor and manage her care.  There was talk of having this patient go to the other manager's unit instead, but I am advising against this.  I do not want this patient's care to be transferred to the other manager as this patient and I have a long-standing, good relationship.  I know what works with her, and with this patient's history of anxiety, I fear that being switched to a different manager would be upsetting to her. 

Frankly, it makes no sense to continuously assign me a resident that I don't work well with in exchange for one that I do very well with.  Problem is, neither one of us managers wants the PITA patient, so I'm worried she might say something that would result in an unfavorable patient assignment. 

I just don't understand the need to repeatedly accept a patient who makes everyone's life a living hell.  He shouldn't be at our facility at all, but they don't seem to get it.  He doesn't even have good insurance or a good income, so I'm not sure why we need to bend over backwards for him

 Anyone else ever been in a situation where nobody wanted a particular patient? What was the solution and how did it pan out? 

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Specializes in Critical Care, Capacity/Bed Management.
13 hours ago, SilverBells said:

He doesn't even have good insurance or a good income, so I'm not sure why we need to bend over backwards for him

I am deeply troubled by this statement; patients deserve attention and care regardless of their insurance carrier and income. I think this is an opportunity to do some introspection and attempt to resolve some of the issues at hand so you can provide care that is equitable and appropriate in line with other residents. 

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Specializes in Rehab/Nurse Manager.
2 hours ago, Okami_CCRN said:

I am deeply troubled by this statement; patients deserve attention and care regardless of their insurance carrier and income. I think this is an opportunity to do some introspection and attempt to resolve some of the issues at hand so you can provide care that is equitable and appropriate in line with other residents. 

And I would agree in regards to the finances.  My thought process with that statement was trying to figure out the benefits or the incentive of readmitting a patient who is never satisfied with anything and that, in my opinion, is a liability to the facility since he and/or his family are the type to report everything.  I can foresee issues with the state by keeping him here and I'm not sure why the facility wants to take that risk.  

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Specializes in school nurse.
2 hours ago, Okami_CCRN said:

I am deeply troubled by this statement; patients deserve attention and care regardless of their insurance carrier and income. I think this is an opportunity to do some introspection and attempt to resolve some of the issues at hand so you can provide care that is equitable and appropriate in line with other residents. 

I think that this is a side issue, ie the socio-economic aspect of the post that you're referring to.

We ALL know of nightmare patients and patient families that will resist every attempt at resolving issues. They simply gain too much from their anger, entitlement and chaos-causing. "Resolve" one issue and two more will pop up to take it's place. The facility should focus on minimizing this patient's adverse effect on the unit, the staff, and other patient's care...

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

Anyone who has ever worked in long term care has had these patients, and their families, that make a headache for everyone. Unfortunately if a patient leaves the facility for something like a hospital admission, there are legal requirements for refusing to accept them back. We had a similar situation with a couple patients and even our management acknowledged that they wouldn't take the person back if they didn't have to. But once they're there, it's nearly impossible to refuse readmission, according to the people I worked with at the time.

As far as placing this person on your unit vs the other, I don't really understand what you think that person will gain in better patient care by working with the other manager. How will that person better address the patient's needs? You mention your personality isn't a good fit for this person, but if you end up with this patient, you may just have to figure how to best work with them and the family. I understand it's easier said than done, but you have some time to get ready. Good luck!

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Specializes in Med-Surg, NICU.
6 hours ago, Okami_CCRN said:

I am deeply troubled by this statement; patients deserve attention and care regardless of their insurance carrier and income. I think this is an opportunity to do some introspection and attempt to resolve some of the issues at hand so you can provide care that is equitable and appropriate in line with other residents. 

Yeah, that post really rubbed me the wrong way, as if she thinks only rich people and those with great insurance deserve good care.

Yikes.

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Specializes in Rehab/Nurse Manager.
23 minutes ago, ThePrincessBride said:

Yeah, that post really rubbed me the wrong way, as if she thinks only rich people and those with great insurance deserve good care.

Yikes.

Not true.  I just was trying to find an incentive for them to readmit a patient known to cause problems extensive enough to cause problems with state.  Sometimes, they readmit patients solely because of finances--and not whether or not they are a good for the facility--which is where that came from 

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Specializes in Rehab/Nurse Manager.

As an example: This patient had not been here at the facility for more than 10 minutes before issues had already escalated.  A nurse was actually sent home today because the patient and his family made false accusations. 

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Specializes in Rehab/Nurse Manager.

After being very vocal, I have finally succeeded in making arrangements for this patient to be transferred to the other unit

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12 hours ago, Okami_CCRN said:

I am deeply troubled by this statement; patients deserve attention and care regardless of their insurance carrier and income. I think this is an opportunity to do some introspection and attempt to resolve some of the issues at hand so you can provide care that is equitable and appropriate in line with other residents. 

Yes it is deeply troubling but money is what drives these places, unless you believe they do everything they do with the best of intentions and out of the goodness of their heart to provide excellent care to all. Surely that's why they have 2 nursing assistants doing all ADLs for dozens of patients, for example. Or one nurse to push a cart and do all treatments, etc., etc. for a whole unit. 

I think you've been a little eager in assuming this was a statement of personal belief.

 

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I'm going to skip over the whole why are we taking this PITA back as that has already been addressed.

We are all adults and because this is anonymous we can be honest. No one wants to work with the PITA or the Family From Hell. Using the fact that someone else has a stronger personality/ is more able to stand up to their behaviors is an incredibly unfair justification for dumping difficult patients/ families on a particular person or team.

You are basically asking to put this difficult patient, who came from your unit onto the other unit in exchange for a patient you work well with, an easy patient.

If I was the other manager I would 100% be fighting you on this. I think you need to stop trying to swap difficult patients for the ones you like and start focusing on new strategies for dealing with the patient and their family. Having been the person who spent years always being assigned the difficult Doctors/ patients / families because "I could deal with them", I can tell you keeping your emotions under control and adapting your approach to how you deal with them  makes the world of difference. 

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In what ways, specifically, are the patient and family difficult?

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