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?
You are going to start losing staff if you keep making decisions emotionally.
You chose a patient that requires intense one on one care that you are not staffed for because you like her better.
Will you be the one spending an hour everyday on her care? Or will you get more staff? Aren’t your staff already stretched thin?
You are going to start losing staff if you keep making decisions emotionally.
You chose a patient that requires intense one on one care that you are not staffed for because you like her better.
Will you be the one spending an hour everyday on her care? Or will you get more staff? Aren’t your staff already stretched thin?
I would agree. I think what I need to do is figure out what needs to happen so this doesn't occur again. A few things in mind including getting my own anxiety under control, being a better listener to others' feedback, and developing a stronger backbone.
I also need to work on developing therapeutic relationships with each patient that do not result in me either getting too attached or too distant. I think that was part of the problem in this case. I was too focused on removing the less desirable patient from my workload and keeping the preferred patient that I think I pushed for arrangements that might not have made the most sense for everyone. Just as it was problematic for me to insist that someone else could do a better job with the male patient, it was probably equally troublesome for me to absolutely insist that the female patient come to me and not the other manager.
With that said, it was always my intent to help out with her once she moved over from the LTC unit since I was wanting to keep a closer eye on her wounds anyway. The whole goal was to make sure all of her treatments get completed. In reality, this probably could have been just as easily, if not more so, accomplished on my colleague's unit where they do consistently have more staff. It definitely will be more of a strain on my staff with her being there, but since I did not consider that before requesting this assignment, I feel more than obligated to assist the staff with her, no matter how time consuming.
I would agree. I think what I need to do is figure out what needs to happen so this doesn't occur again. A few things in mind including getting my own anxiety under control, being a better listener to others' feedback, and developing a stronger backbone.
I also need to work on developing therapeutic relationships with each patient that do not result in me either getting too attached or too distant. I think that was part of the problem in this case. I was too focused on removing the less desirable patient from my workload and keeping the preferred patient that I think I pushed for arrangements that might not have made the most sense for everyone. Just as it was problematic for me to insist that someone else could do a better job with the male patient, it was probably equally troublesome for me to absolutely insist that the female patient come to me and not the other manager.
With that said, it was always my intent to help out with her once she moved over from the LTC unit since I was wanting to keep a closer eye on her wounds anyway. The whole goal was to make sure all of her treatments get completed. In reality, this probably could have been just as easily, if not more so, accomplished on my colleague's unit where they do consistently have more staff. It definitely will be more of a strain on my staff with her being there, but since I did not consider that before requesting this assignment, I feel more than obligated to assist the staff with her, no matter how time consuming.
I’ve gone back and read an earlier post you made which gave me better insight into this situation. I assume at this point you are well aware this is a “Be Careful What Wish For” situation.
At this point all I can add is based on your additional posts you have learned from this. Work much like life in general is seldom black and white, it’s often a balance of making the best of a less than idea situation. Keep working on being the best you that you can be.
I’ve gone back and read an earlier post you made which gave me better insight into this situation. I assume at this point you are well aware this is a “Be Careful What Wish For” situation.
I'm already feeling that, although I'm not entirely sure why. For some reason, it's one of those situations where it doesn't necessarily feel good that I got what I wanted. Maybe it's because I'm starting to think things through more rationally as to why the original patient assignment might have worked better than my proposed, almost forced plan, but who knows.
Initially, I thought I was being a strong advocate for everyone, but I'm not sure on that anymore. I think all of us know that both the male and female patient each deserved quality, compassionate care. It's sad and unfortunate that so many people are being inconvenienced because I felt I could only provide that care to one of them.
Based on your series of posts in this thread, you seem to have made a lot of realizations about how you should have handled this situation differently. Among other things, you've mentioned getting better control of your anxiety, considering other's perspectives, and becoming better adept at handling "difficult" patients and families.
What actionable steps are you going to take to accomplish these changes?
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.
Exactly. I took OP’s statement as relating to the motivations of the facility, not her own. And we ALL know that facilities don’t take patients for any other reason but money. We can do better than assuming the OP is classist and rude.
oh gosh Yes! I worked with a slightly more Senior Nurse and if he didn't get the assignment he wanted? He would start hinting "I'm feeling sick" and yup if it wasn't changed he'd phone in sick the next day. Another I showed another more Senior Nurse an obviously unfair assignment asking "does this look like a fair assignment to you?" and he'd glance and say "Yup" Ugh!
For 3 years on a different Unit; I almost always got the "most acute first admit" But? I got to be pretty good at it! for a locked inpatient Child and Adolescent Psych ages 5-17.
(stabbed 3 times, chair thrown at me, eye glasses smashed and punched I don't know how many times! But really? loved working with kids! ? usually it wasn't due to them they were there, how many times I wanted to send the kid home and admit the parents..
The key I found for survival is to bond with colleagues that you would watch each others back..... and when I was finally Charge? I always recognized my team and individual efforts!
There sure are some personalities of staff sometimes; I recall an LPN being very upset she had to do hands on care due to how the unit was staffed for the shift. Guess it was just me although I'm an RN I started as a CNA for three years...hated making beds but usually no need for that on the evening shift! ? oh was she ticked! slammed the Laundry detergent bottle down and it was difficult to hear the rational she had "I'm an LPN" I simply did not see the entitlement and when I assisted the CNA's as an RN? I usually was able to get the patient to help me make his bed on that Geri locked 28 bed psych unit!
There were some challenges at times, I'm not kidding three times the Nurse manager took all the staff off the floor, leaving me with the guys.... I dealt with it, one guy guarded the med cart (one RN went with her with the keys to the med room,) another guy his job was to make people smile! I was talking to a family member during this
I was very tempted to ask the one Dementia patient to answer the phone! should I have? that really happened not kidding!! ?
Pepper The Cat, BSN, RN
1,790 Posts
You are going to start losing staff if you keep making decisions emotionally.
You chose a patient that requires intense one on one care that you are not staffed for because you like her better.
Will you be the one spending an hour everyday on her care? Or will you get more staff? Aren’t your staff already stretched thin?