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?
In what ways, specifically, are the patient and family difficult?
Patient is manipulative. He'll tell nursing staff one thing and then call family and state another. For example, he'll state his pain is at a 0, then call family and state that no one is doing anything for his severe pain. He complains that his bladder feels full, but refuses to have catheterization performed.
The family is obnoxious to the point that they have made false accusations against multiple staff members, affecting their jobs.
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.
I can see your point. The other manager definitely wasn't happy about receiving this patient. She is stronger and does better with the more challenging patients, but that doesn't mean she wants or should get all of them. I think he'll do better with a stronger manager who is more direct and to the point, but that's probably besides the point.
Also, it turns out that by requesting that a particular patient be moved to my unit instead of hers, at least 5 room changes will need to be made. The goal of moving the one patient was to ensure that her treatments were being performed as they weren't getting completed on the LTC unit, but this probably could have just as easily been completed on the other manager's rehab unit. The patient needs to be moved, but it probably didn't necessarily need to be closer to me. I wanted her on my unit because we've worked well together for a long time, but if she'd gone over to my colleague's unit, only 2 room changes would have been required. It would have just meant I would have been stuck with Mr. Troublemaker instead.
It's possible I overestimated my role in the one patient’s care. At the same time, I probably underestimated my ability to take care of the "tougher" resident.
In a sense, I may have spent too much time insisting that someone else could do a better job with the challenging patient and not enough time figuring out how I could make it work. I think I let my anxiety take over because I panicked when I found out that I was being assigned the difficult patient again.
Unfortunately, this is negatively impacting others and is leading to more chaos as far as room changes go. All of this could have been avoided if I would have just let the other unit have the easier patient and accepted the assignment that I was receiving. I'm sure that at least one of the 5 patients who is being asked to change rooms is probably frustrated, especially if they've been in one room for a long period of time.
So, I ended up getting the assignment that I wanted--the tough male patient went to the other unit, and the "easier" female patient is coming to mine. Note: I am starting to designate gender to make it easier to differentiate between the two patients. However, in a sense, I don't necessarily feel good about this. It seems as if the only person that is pleased with this switch is myself. The other unit is frustrated because they already have many challenging, demanding and needy patients/families. They don't want or need another unpleasant person.
Some of the staff on my unit are frustrated because the female patient coming over to my side actually has more treatments and medications, and my unit isn't as well-staffed. This patient requires staff attention for an hour alone in the morning in order for all of her medications to be given and treatments to be completed, and my staff are worried they won't be able to get it done, especially in the instances where there is only one nurse and one aide for 15 patients.
The patient that I had moved over the other unit is needy, has rude family members and can be quite unlikeable, but he isn't as time consuming. If my goal was efficiency, it probably would have been smarter to allow the female patient to go to my colleague's unit, as someone suggested, where there is more staff to meet her needs. Unfortunately, I allowed personality and familiarity with a patient play too much of a factor into where I advocated for each patient to go. In hindsight, I should have checked out the other unit's assignments to see how transferring the male patient over there would affect the staff and patients who are already there.
I also should have checked with my colleague prior to even asking for a switch in patient assignments to see how she felt about it. I shouldn't have assumed she would be okay with the transfer just because she has a "stronger personality." The difficult patient riles me up to the point that I can't function, but my uncontrolled anxiety isn't my colleague's problem. Frankly, I can only use the excuse that my colleague is a stronger person than I am for only so long before it becomes evident that I somehow need to find a way to pull my own weight. I either need to find a way to be strong myself, or, if I am that weak, step down from my position because the other manager deserves a colleague who is equally capable of handling all parts of the job, including the stressful patients.
As a side note, it's clear I already knew what the patient needed. He required a strong, assertive nurse with a direct approach to patient care. I just chose to pass this responsibility onto my colleague, instead of finding a way to be strong and assertive myself.
I am confused on why 5 room changes need to be made for this one resident- this doesn’t seem like a viable solution, especially if there’s the option for only 2 room changes. Is your facility still trying to move 5 patients around? Are you still advocating for that?
I am confused on why 5 room changes need to be made for this one resident- this doesn’t seem like a viable solution, especially if there’s the option for only 2 room changes. Is your facility still trying to move 5 patients around? Are you still advocating for that?
It's hard to explain why so many room changes need to be made, other than it has to due with financial reasons. Some of these patients have insurances that require them to be in semiprivate rooms when at all possible, while others have insurance carriers that allow more flexibility and they can be in private rooms. Obviously, the patients in the semiprivate rooms need to be of the same gender.
One of the reasons they were wanting to keep the difficult male patient on my side is that he requires a semiprivate room, and the only open semiprivate room on my unit already has a male roommate in it. The open semiprivate room on the other unit already has a female roommate, so they were hoping that the easier female patient could pair with her. Now, because the female patient is coming over to my side, the two male patients on my unit need to move to the other unit and the two females need to move to my side. I'm not sure how the fifth room change plays into the scenario, but apparently moving this other person is also required in order to make this patient assignment work. Thus, it is a messy scenario.
Anyway, I'm kind of surprised this is actually moving forward. In all honesty, the other manager was very unhappy when she heard the news. Her initial response was "No, this patient is a nightmare," when she was told he would be coming over to her unit. Once the situation between myself and the family was explained to her, she did back down a little bit. However, it did initially seem likely that she was going to approach our superiors to prevent the transfer. As is probably evident in my posts, she has a strong personality, and just like she is good with difficult patients, she is also very good at standing up for her own self, and it appeared that was almost what she was going to do. I have a feeling I'll probably end up "making up" for this in one way or another, maybe even a way that will make me regret advocating for this. How I will do so is a different story, but in hindsight, it may have been best to just accept the assignment being given. I'm actually someone that gets along with nearly everyone and have always found a way to make things work with patients and family members. Realistically, I probably could have made it work with this male patient as well, but for some reason, I chose to be stubborn, give into my anxiety, and not do so.
My coworkers have also brought up a valid point in regards to this new patient arrangement. This patient may do very well with my colleague's strong, assertive approach. On the other hand, it may actually end up backfiring as sometimes the difficult patients don't appreciate that type of nurse. Sometimes they prefer someone like myself that doesn't argue with them. Theoretically, it could end up being a worse manager/patient assignment depending on how this patient and his family responds to her.
Does your facility have someone who is in charge of doing room assignments? While I’m just a student, it seems odd to me that you and your colleague are playing musical rooms with patients. Is this a common occurrence in LTC?
Is it too late to choose the option you laid out above where the male patient goes to your floor and the female patient goes to your colleague’s floor? This seems like the best solution, especially if your floor nurses are willing and able to handle the difficult patient since he isn’t as time-consuming.
Does your facility have someone who is in charge of doing room assignments? While I’m just a student, it seems odd to me that you and your colleague are playing musical rooms with patients. Is this a common occurrence in LTC?
Is it too late to choose the option you laid out above where the male patient goes to your floor and the female patient goes to your colleague’s floor? This seems like the best solution, especially if your floor nurses are willing and able to handle the difficult patient since he isn’t as time-consuming.
Yes, our admissions coordinator is primarily responsible for room assignments, but does take feedback from others. Room changes are frequent in my facility since most of our patients are short term rehab patients who usually only stay for 2-3 weeks and then go home or to another facility. We do have a LTC unit where the room changes are nearly nonexistent though.
As far as having the male patient on my floor, I think it is probably too late. He has already been moved over to the other unit. Yes, he probably could move back, but the other patients and their families have already been told of the room changes as well. There are many people involved who are now anticipating the changes.
Sadly, like I said, this could have all been avoided if I'd done a better job of listening to the feedback of other people along with spending more time finding a way to work with the current patient assignment instead of being so desperate to change it. As a leader, listening skills are very important. Being able to handle challenging situations in a professional manner is another essential skill. Unfortunately, I failed in both areas this week.
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
You HAVE to know this is wrong. You are a nurse and they don't teach this in your nursing curriculum. You selected everything but this statement on nursing exams I'm sure just so you could 'pass'. Besides, you're being paid to work at a facility, so this cheap shot should stay far from your disgruntled heart. Sometimes people are blinded by their circumstances. You might have to call in rather than work with the patient.
You probably wouldn't say this aloud for someone to hear I would assume.
SilverBells, BSN
1,108 Posts
Patient is manipulative. He'll tell nursing staff one thing and then call family and state another. For example, he'll state his pain is at a 0, then call family and state that no one is doing anything for his severe pain. He complains that his bladder feels full, but refuses to have catheterization performed.
The family is obnoxious to the point that they have made false accusations against multiple staff members, affecting their jobs.