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?
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.
Just learned that the patient who was going to move to my unit is very upset because we haven't been able to accommodate this move yet. I feel bad and as if I have failed her. It's frustrating that it's because some of the other patients are making things difficult. It's a struggle knowing that her care is being negatively impacted by other patients' lack of cooperation and overall refusal to participate in the process. Now, I almost wonder how my rapport with her is going to be affected because I have failed to fulfill her request and meet her needs.
Specializes in Work Comp CM 3 yrs & Cardiac PCU 27 yrs.
I feel Nurses should be rotated. If a Nurse can handle certain patients / Family better makes sense to assign them to that patient. Maybe a trade off is they take 1 less patient than everyone else. Some type of compromise that's a win win for everyone to just make it through their shift. Just a thought to throw out there....
I never understood making multiple residents move out the room they know, away from the room mate if they have one that they know, likely the reasonably consistent staff that they know and that more important know them just to accommodate one PITA resident.
It shouldn't be about the staff and who they want or don't want to care for when the decision to move upends the routine of five other residents. Didn't anybody consider them in the decision to move this person? I'm guessing not as one of them is now refusing to move putting a monkey wrench into those plans. So now you have at least three of the residents involved upset to one degree or another. The one that is refusing to move, the one who wants to move and can't unless all the pieces fall into place and the original always difficult and probably always upset about something resident who started the whole thing.
But who knows, maybe if that person is as manipulative as you say and believe me I've dealt with resident's like that so I get it, maybe that is the one person who's feeding off the ensuing chaos he caused and enjoying it. No matter how this ends up playing out he's going to feel like he won and likely be that much more difficult to deal with for awhile at least.
Why is the solution of only having two people move rooms that you had mentioned in an earlier post not an option? Is one of those two residents refusing to move?
Just learned that the patient who was going to move to my unit is very upset because we haven't been able to accommodate this move yet. I feel bad and as if I have failed her. It's frustrating that it's because some of the other patients are making things difficult. It's a struggle knowing that her care is being negatively impacted by other patients' lack of cooperation and overall refusal to participate in the process. Now, I almost wonder how my rapport with her is going to be affected because I have failed to fulfill her request and meet her needs.
I find this disturbing. I worked LTAC for a few years and I get the problems associated with multiple room changes. Honestly, I can't blame the residents getting upset at having to move. As I am sure you know, we are to consider the SNF their home and their room their personal residence. Moving is hard at any age but these residents must find it very hard, especially if there I no perceived benefit for them.
Your thought that the residents are to blame for negatively impacting that particular resident's care make no sense. You chose to start this very complicated process so you actually are to be "blamed" ( I don't like that word but you used it yourself)
You have not failed her. She is getting care in a better staffed unit. Your rapport with this resident is a whole other issue you need to examine.
You have not failed her. She is getting care in a better staffed unit. Your rapport with this resident is a whole other issue you need to examine.
I do feel like I've failed her, though. Today I had to spend a long time trying to explain to her why the move hadn't occurred. I eventually had to refer her to the social worker and upper management because she felt as if she wasn't important. She had finally started to feel as if things were going to get better and is depressed because things are taking so long. I reassured her that I was doing my best to strongly advocate for her, but obviously these are empty words at this point as nothing I have done has been successful.
On the other hand, I did let go a bit. She's not getting the care she needs on the LTC unit, which is why we are trying to move her. With that said, the possibility of moving her to the other manager's unit was discussed again. I did state that it might also work and accomplish the same purpose if this patient is in agreement. In other words, if she needs to be switched to someone else's care to meet her needs, then so be it. She doesn't absolutely need to be on my unit.
I do feel like I've failed her, though. Today I had to spend a long time trying to explain to her why the move hadn't occurred. I eventually had to refer her to the social worker and upper management because she felt as if she wasn't important. She had finally started to feel as if things were going to get better and is depressed because things are taking so long. I reassured her that I was doing my best to strongly advocate for her, but obviously these are empty words at this point as nothing I have done has been successful.
On the other hand, I did let go a bit. She's not getting the care she needs on the LTC unit, which is why we are trying to move her. With that said, the possibility of moving her to the other manager's unit was discussed again. I did state that it might also work and accomplish the same purpose if this patient is in agreement. In other words, if she needs to be switched to someone else's care to meet her needs, then so be it. She doesn't absolutely need to be on my unit.
One thing I have not understood from your first post is why she is not getting the care she needs on the other unit?
One thing I have not understood from your first post is why she is not getting the care she needs on the other unit?
There is an ongoing conflict between her and one of the primary nurses who works on that unit. Their clashing personalities are making it difficult, if not impossible, for that nurse to complete her cares. This patient no longer wants to work with this nurse and the only way to make sure this happens is for the patient to switch units.
Ironically, while I felt the male patient was too manipulative, others have used the term to describe the female patient as well. I don't see it myself, but maybe my judgment is somehow clouded. Anyway, there are some people that feel that switching the female patient will only be a temporary fix. Their thinking is that she'll be happy for awhile, and then decide there is a different nurse or other staff member that she doesn't like. On the other hand, maybe she will do well with the switch. It's possible that she would even benefit with a fresh new set of staff members, including a different manager.
Update: The female patient is going over to the other manager's unit instead of mine. We simply weren't able to convince the other female patient to switch. She was unchanged even after hearing about how awesome the nurse manager and staff on my unit are. I've decided to no longer fight for her to be on my unit, mainly because it won't change things and there's nothing I can do about it.
On the other hand, it's possible I dodged a bullet with those patients coming over to my side. We are not staffed well enough for the one patient. I also feel that if the other patient feels that strongly against being on my unit, it's possible she would be an unpleasant patient to add to my workload anyway.
SilverBells, BSN
1,108 Posts
Very true. Thank you.