Bossy Patient

[KittyLovinRN]

I'm fairly new to home health (~6 months, did hospital nursing for 3 1/2 years before running for the hills!) and so far am enjoying the new challenges of the position.

My question comes from a patient of mine with horrible stasis ulcers to her left leg. She's very bossy and particular about her wound care. She's seen by vasc MD weekly and our wound care RN has been in numerous times to make changes/suggestions to wound care. It had been draining A LOT but has since been reduced greatly. I've had her since November and Medicare is getting pretty ticked about the supplies. She's INSISTING on covering her entire leg with abd pads with an optilock despite the reduced drainage.

How do you put your foot down with patients who manage everything you do? She's quick to talk about nurses to other nurses but I need to find a way to politely let her know that things aren't going to be run by her anymore...help! I'm a terribly weak human being and hate confrontation but something must be done!

[chrisrn24]

Could you say something like, "well I can't do that anymore because it isn't covered by your insurance. But you see how it has improved right? it Used to be xyz now it is like abc... today ill do this kind of dressing to it."

[KelRN215, BSN, RN]

Where is she getting the supplies from? Your agency? If so, just stop bringing those supplies into the house and, as the PP said, tell her "your insurance will no longer pay for that extensive a dressing, this is what we're going to use from now on and is all that is required." If she's that insistent, she can feel free to order her own supplies and pay out of pocket.

There is a reason why she has a nurse coming in to do the dressing and isn't doing it herself, right? Put your foot down.

[nursel56]

I'm a bit surprised to hear that Medicare is providing supplies with an open-ended time frame. In my prior agencies supplies came from an independent company with strict monthly limits so as not to eat the cost of non-reimbursed supplies. If the client used all their supplies in 2 weeks there were no supplies unless they paid for them. I've had patients order vinyl gloves, and their own briefs when they didn't like the brand supplied by the medical supply company.

[eatmysoxRN, ASN, RN]

I'd tell her "Mrs. Bossy, we are going to try it this way today to see how it works. If you don't find it satisfactory, we will talk about how you can order more supplies since your insurance won't supply them anymore."

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

[paradiseboundRN]

I think I had this patient :)! I always put the blame on Medicare restrictions/regulations, which is usually true. Some patients can be really hard to deal with. If she doesn't want to do it your way, you can ask her if she would like to speak with your manager, but make sure you explain the situation to your manager first.

[KittyLovinRN]

Thanks everyone, I appreciate your advice! I'll do my best! :***:

[tewdles, RN]

tell her that the insurance won't pay and you would like to help her transition to a dressing that they will pay for...so she wont be out money...be a hero