Challenging Residents

[Neats, BSN]

So I am an experienced Licensed Nursing Home Administrator who wanted to go the Nursing route. I got my BSN and my first job is a Sub Acute Unit in a Skilled Nursing facility. Hooray!

Now I can smooze with the best of them but I find some residents really challenging. Some residents want to be waited on, hand and foot even though they can "do for them self". My nursing beliefs are if you can do it you should so you do not loose mobility and or mental functioning. It is not because I want to be lazy I just want the best for my residents. In fact I think it takes longer to have the resident do for themself than just do it for them.

If a resident asks me to push them down the hall and I know they are able to ambulate with their feet and hands I tell them they need to push themself I explain the benefits of doing it themselves.

I do not answer resident phones in their room, this includes cell phones. This has always been a policy of mine.

I experienced a resident on the phone talking and I had a wound dressing to change. I told the resident I would be back soon. I came back 10 mins later, the resident was still on the cell phone. I came back 20 mins later...still on cell. I came back approx 2 hours later to change the dressing. The resident was angry they had to wait. I informed the resident that I have other responsibilities and I did come back 3 times and those times "you raised your hand to me letting me know you were not ready". The resident stated " You should know when I will be ready". I told the resident I came back several times to assist them and I am not a mind reader. We came up with a period of time that would fit their schedule for me to perform dressing changes. (I just think it is a control issue with some residents). This seems to work but the resident is now decreasing their need requests with me and waits until the next shift to get what they want.

What if any "boundaries" do geriatric sub acute nurses have or am I just being too mean? I hope not.

Thanks for any input you all have.

Neats

[cardiacmadeline, RN]

I don't think you are being mean. Many times, I have patients that expect me to do things for them that they very well can do themselves, like someone opening their mouth expecting me to put the straw in their mouth so they can get a drink of water. I just tell them they need to start doing things for themselves so they can get stronger and leave the hospital. Most of them will then do it themselves. (And then the family will come in and start hovering and spoon feeding the patient!) Although, I have to admit sometimes I do end up doing stuff for the patients that they should be doing themselves if I am extremely busy, because as you stated, it can take a lot longer if patients are doing things themselves. And the phone issue can be very frustrating sometimes, but I find if I am in the room, most patients will say they have to hang up because the nurse is in the room. I think the idea of setting up a time with the resident for the dressing changes was a good one. You worked with the patient and allowed him to have some say in his care. We as nurses have to remember that when patients are in the hospital or nursing home, they feel like they have lost any say or control over their cares. So working with them to develop a schedule/cares works wonders with some patients.

[StNeotser, ASN, RN]

"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

People can often confuse nursing with maid service. I also work sub-acute rehab. If the person is alert and oriented I will tell them in a firm but polite manner that me or the CNA's doing ADL's that they can perform themselves (and seem to have no problem in front of PT/OT doing themselves) will not help their rehab and possibly push back their discharge date. One woman who was due to be discharged in 30 minutes time was demanding I wipe her butt. I asked who would be doing this once she got home and she got the message and wiped it herself - this was someone who had been doing all ADLs herself until she saw me show up in her room with discharge papers.

[NurseKatie08, MSN]

I also work sub-acute rehab, and I'm a new grad (9 months into working). I've ad many patients that I've had to do some firm limit setting with. Most recently, I've had a patient in for rehab secondary to ORIF of the hip. The minute PT/OT cleared to to ambulate to the BR with RW & one assist, I shot down her requests for the bedpan. When she told me (in front of her daughter no less) that she needed the bedpan, I simply said "Well, I heard how well you did in therapy today--let's show your daughter how great you can do at walking to the bathroom." She walked to the bathroom with the walker...and after that, the bed pan requests stopped. That was last week...today I walked in and she was transferring herself into the w/c independently. A little firmness goes a long way sometimes..

[CoffeeRTC, BSN, RN]

Nope....you have to set limits. I would also chart about refusal of care. If I have 20 or so other residents, I can't be coming back and doing that for everyone.

[RANCH GIRL]

I can wholly relate to this! No, you are not being mean at all. I'm a fairly new RN working in the sub-acute unit of a LTC also. I was absolutely unprepared not only for patient's who want to be waited on, but for those resident's who make mean comments to the nursing staff. One patient said to me, "Okay, who is playing nurse today!" That's just the beginning . . .

We must encourage our patient's to do as much for themselves as possible to promote the restorative pathway and to promote a sense of control on their part in the healing process.

I wonder to what degree the nonclinical marketing guru's have played in patient's attitudes since these facilities are now marketed as spa resort-like?

[southernbeegirl, BSN, RN]

off topic comment...

i cant wait to hear your thoughts on the nursing dept and its issues now that you are in nursing as opposed to administration.

[CapeCodMermaid, RN]

Of course you need to set limits with all the residents. We are NOT maids...we are NOT servants...it is NOT a spa. I had one woman get out of her chair, walk across the room, get into bed, and ring the call bell so I could hand her a cup of water which was less than 6 inches from her hand. I looked at her and burst into laughter. I really couldn't believe it. She told me the admissions person said we'd be happy to 'do' for her. I told her I'd be glad to help her do anything she really couldn't do, but if she wanted someone to hand her a cup of water after she walked across the room to get into her bed, she should call the admissions person and let her do it. She quickly got the point.

When I am the patient, I am the exact opposite and usually refuse anyone's help even though I could benefit from it...makes you wonder.