conflict resolution with patients

Trauma Columnist · Apr 22, 2007

I work at two FMC units. I am an APN employed by the nephrologists . I have a lot of interaction with the staff as well as the patients. Given the chronicity of HD, conflict is inevitable. At one unit, the patients are compliant, want to be cooperative and listen and participate in their own care. Very little pt/staff conflict. At the other unit, there is much conflict r/t:

1. Patients demaning narcotics from me and threatening me if not given.

2. A no show rate of up to 50% on some shifts.

3. Acute drug withdrawal during HD and the resulting problems.

4. Completely noncompliant patients who don't want any asst.

5. Several homeless patients.

LPN2RNBSN · Apr 23, 2007

what about those patients who have true concerns about some staff not being adequately trained especially in dealing with potential emergent situations, etc.. who is responsible, per policy of unit, to address such.. care plan, etc contract etc.. although why would a contract be needed if a patient has complaint about staff being able to provide care within safe practices?

Trauma Columnist · Apr 23, 2007

Do you mean in a code situation? Or if someone becomes hypotensive? I'm sorry, I'm trying to get a good grasp on what you are askiing. My own background is all critical care so I have been astounded that:

1. The only monitor is an AED - itsy bitsy screen which barely shows enough to determine rhythm.

2. Unable to locate ambu bag when I asked where it was.

3. Unable to know that the epi that was in the crash tray was 1:1000 and was only to be given subq not per access or IV...I'm really scared.

4. Inabilty to say exactly what would happen if a pt coded.

5. One nurse drawing up meds that another nurse dispenses...not on my license.

I could go on and on. As to complaints, they are taken very seriously and addressed. I have not heard of a complaint about staff training. I actually sat thru some of the FMC training because my background is not dialysis or renal. I thought it was very thorough: 6-8 weeks for an experienced RN. You would barely get that in a hospital. Some folks are better stickers than others, so if there is a complaint about accessing, then someone else does it.

Is this what you wanted? If not, please be more specific and I will tell you my experience, if any. Thanks.

DeLana_RN, BSN, RN · Apr 23, 2007

Both units I am in part time have been talking about patient-provider conflict and something about the ESRD Networks? any input? What does your unit do when they have patients c/o issues about staff, care they are receiving or staff not being trained enough? FMC? DaVita? Who does what in cases like this? Clinic Mgr? Regional Mgr? Area Mgr? S.W.? Seems as if staff are not focused (as I was taught) on true needs of patients and many see them as what I have heard stated 'cash cows". problem patients.. I have seen management in one unit not even address specific concerns related to training or lack of with certain staff. Seems they just do not want to hear it.. but is this not dangerous for the patient.

Patients can contact their network if they have such a complaint; the clinics will take this very seriously. However, few patients are likely to go this far for various reasons (lack of knowledge about this option, etc.)

In general, patients should talk to their social worker (who is supposed to be their advocate/liaison) and/or clinic manager/admin. If nothing is done about the complaint, the social worker should help the patient with further options (e.g., transfer to another unit, contacting the network, etc.) Talking to the medical director/nephrologist may also help.

As for "problem patients", again the clinic admin should deal with this problem; if it cannot be resolved, the patient may have to be put under a behavioral contract. In this case, the network will be notified/involved. If nothing helps and/or the pt violates the contract, s/he may be dismissed from the clinic - and possibly all clinics owned by the same company. This is an outcome the networks will want to avoid for obvious reasons (the pt may then have no other option left but the hospital, which is not intended to be a chronic provider).

I hope this addresses your questions.

DeLana :)

P.S. I worked for Gambro until 1/05; now inpatient/acute dialysis in a non-profit hospital.

LPN2RNBSN · Apr 23, 2007

Delana, thanks,. FMC has a policy re conflict resolution.. Patients that are educated do have questions when they note a staff not conducting effective infection control practices, or doing somthing on their machine that is not correct, etc. I was more curious about FMCs policy regarding the patient conflict process that which was initiated bythe networks with help from industry. my understanding is that this is for the violent patient, abusive patients, etc and not from those with true issues surrounding care. social workers in units are really not true advocates of patients for they are being paid by those they are advocating about ie if pt has complaint about someone etc then sw goes head on ... also,,, the reality is that the sw is paid bythe company and often will not take side of patient, so to speak, just human nature.