Demanding Patients

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Specializes in Rehab, acute/critical care.

Hi, I am wondering if anyone has any advice/tips on how to cope with the stress of demanding patients.

I work in Long Term Care, each shift I am responsible for 20+ patients. I do the night shift, so during the majority of the shift, it is OK (they're asleep), it's just when I have the 0600 med pass that things become difficult. I only have an hour window before and after the meds are due to give them. I start my med pass at 0500 then should end by 0700 when my shift ends. It always seems that the patients complain, need help finding something, or constantly are needy when I am on a time restriction.

This morning when I was giving the scheduled meds, one of the patients wanted a PRN pain med. I told the aid to tell him that I will be there shortly with it (as I was busy with someone else's meds). He then said he won't let the aids help him to the bathroom until he get's his pain med. He then threatened that he will hyperventilate if he doesn't get his pain med. When I go in there, I see he threw his Nasal Cannula on the floor on purpose (and told me he did). So he was sitting on his bed and having difficulty breathing. SERIOUSLY? I don't understand why people are trying to be so manipulative. It's like they expect me to drop what I am doing and cater to their every need. I understand pain meds are important but if I am busy getting meds out for another patient, I will NOT bring someone else's meds out onto the cart. I do not want to make med errors.

Another patient, I take all her meds to her and she says that she wants yogurt to eat hers with. I then have to waste my time looking for yogurt, which the pantry doesn't have. Then she fusses about not having any.

I then have the people who want to tell me their life story and complain on how bad their life is. I really would love to sit and talk with them, but I have 20 other people to give their meds to in two hours. Is there a polite way to tell them I am busy? I don't want to damage my relationship with the patient but it's not fair to the next nurse when I am running an hour behind.

I am just stressed because it seems my patients think the world evolves around them. If they have to wait for something, they get aggitated, complain, do threats, etc. And after I wake them up to give them their meds, they all want to get out of bed and go to the dinning room. I am the only nurse and there are two aids to help me. The aids do good work but the three of us together can't bend to meet everyone's demand. About half the patients are confused and we have to prioritize making sure the ones who are a fall risk are safe first (then the oriented ones complain).

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Specializes in LTC.

It results from a complete lack of discipline.

I come from a military background, and working in my current LTC absolutely ENRAGES me some days. The administration lets people get away with murder- even the ones who are in their right mind.

I had one man, just this morning, start cursing and yelling, because he gets his Xanax (and three other narcs he can rattle off) "right NOW G--D--- it". Nope. Sorry, I just walked in the door, it's two hours too early for all of that nonsense anyway- and- it's not my job to sit here and hear all of that mess from you. You get it when it's scheduled.

He's on another hall that I do not work on usually, and this hall is absolutely famous for not documenting behaviors and sweeping issues, large and small, under the rug. The weekday nurses pride themselves on their daily report... "Nothing is wrong, everything is OK" The residents on this hall throw tantrums, they all crowd the cart and cough and mess with all of your items and demand meds, and THESE are the ones who do not have dementia or mental deficiencies.

I have told several residents, verbatim:

1) I don't tolerate tantrums. Quit yelling, and we'll figure out how we can solve your problem. Otherwise, I'm out of here.

2) When you feel like being polite, hit your call light. I'll bring your pills then. See you in a bit.

3) I have XXXX emergency/issue going on right now. You need to be patient. Stop yelling.

There's no excuse for rudeness, and throwing tantrums like a child, unless you've got some mental issues going on, at which point I'll happily deal with all of the biting and scratching and yelling- because you cannot help it.

As far as the lonely ones, I do take time out to talk to them. I work 16 hour shifts, and so I've found that I have some down time around 2pm, and maybe again around 10pm. There's several that I go sit and talk to, (and one that 'reports' me to the social worker if I forget) If you think you might have time to come back and talk to them, just tell them you are super busy, and will 'get in trouble' if you take too long. That's usually my out, anyway.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Not that throwing a tantrum is the way to get your way....just for one moment place yourself in their position.

You have been an independent, self reliant, directed human being. You have been a parent, teacher, boss, worker. You have held responsible jobs and owned your own home. You have been on your own since you were 18. You have fought in one if not several wars, and placed your life on the line for complete strangers so they can enjoy the life they have today.

Now you can't even pee without permission. I'd be a little crabby myself.

Wouldn't you?

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I do understand what you're saying OP, but really, you can make this a bit better. Find some yoghurt before you start so you have it there for the ones who say they can't take a pill unless it's with yoghurt, even if that's only one person. It might be annoying to have to do that, but it's quicker than a long discussion or argument about 'I need yoghurt, I can't take them without yoghurt, I want yoghurt'. It will take you 2 minutes rather than 10 to give the pills if you have the yoghurt there. Get some apple puree too, get whatever you think you might need before you start so you're not constantly running back and forth.

If a resident is going to complain and have a tantrum and throw their O2 on the floor, you're better off preventing that than dealing with it. Honestly, it's easier and it's quicker. Sometimes you can't, I know that, but if in general you DO try to do things the way the resident wants, 90% of these difficult ones will cut you some slack on the days when it just doesn't work out and you can't get there at the right time or there really is no yoghurt or whatever it is. I'm not saying you should allow yourself to be manipulated by threats of misbehaviour, just choose your battles. You don't want to win the battle but lose the war and sometimes if you build a relationship first, you then have a starting point for some discussions about what is reasonable and what isn't, what you can do and what you can't do, that sort of thing.

Unfortunately I have seen nurses who get their back up straight away with residents like these and will deliberately NOT give the pain pill first, or will refuse to get the yoghurt (even whey they could without too much effort) because 'why should he/she get away with it'. You can actually see the havoc this causes and feel the tension in the air, the residents are all on edge and the nurse is cranky and fed up.

Another thing to think about is it is possible to rearrange things so you don't have to wake people up for their medications? That sounds crazy. The first thing I do when I wake up is get up and go to the toilet - there are some people who will just go back to sleep, but it's not so strange that many will want to get up.

Have you been doing this for a while or are you fairly new to the shift or the facility? It will get better when you get to know everyone's little quirks and get a bit of a routine happening.

The ones who want to talk are bit harder. I try to spend as much time as I can but we all know how that goes, there's never going to be enough time. Sometimes all you can do is say 'I'm really sorry, I have to get going now, I'll try to pop back in later'. If it's possible to go back, try to do that..... easier said than done I know.

Good luck, I hope things improve! :)

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Specializes in LTC, assisted living, med-surg, psych.

One of the best time-saving 'gimmicks' I know of is to anticipate the need. If you KNOW Mr. B. is going to ask for his pain pill at 0600 and he's scheduled for 0800 and 2000, try changing the times to 0600 and 1800, or better yet, assess him for pain and see if a call to his physician is in order, so s/he can consider increasing the dosage or the number of times/day he receives pain medications. If Mrs. G. keeps asking for yogurt to take with her pills, make sure you have it on the cart before you go out to do your med pass, then ask for an ST eval for her to see if she is having increased swallowing difficulty.

I also echo what Esme12 said: Try to look at things from the residents' perspective. They may ACT like three-year-olds sometimes, but you cannot treat them that way because they are still adults who have lived lives, raised families, worked hard, made tough decisions. They have also been someone's child, someone's spouse, someone's parent, someone's friend; IOW, they have been loved, and that alone makes them worthy of respect. There's no law that says YOU have to love them---you don't even have to like them---but you do have to put up with their humanity, because that is what you are being paid to do. :)

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Specializes in LTC.
VivaLasViejas said:
They may ACT like three-year-olds sometimes, but you cannot treat them that way because they are still adults who have lived lives, raised families, worked hard, made tough decisions. They have also been someone's child, someone's spouse, someone's parent, someone's friend; IOW, they have been loved, and that alone makes them worthy of respect. There's no law that says YOU have to love them---you don't even have to like them---but you do have to put up with their humanity, because that is what you are being paid to do. ?

I'll have to disagree with you here. If you are in your right mind, then no- you do not get away with pitching tantrums, screaming obscenities, and generally being ridiculous, just because you're an adult. Sorry. I don't get paid to be treated like a dog.

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Specializes in LTC, assisted living, med-surg, psych.

I was generally speaking about those with some (or a lot of) dementia, which is what I deal with every day. Sorry if I gave the wrong impression, for I strongly believe in limit-setting with the A&O patient/resident who is behaving badly. I don't think any nurse should tolerate being threatened, hit, cursed at or having things thrown at her/him. With the demented, it's one thing, but with someone who knows what they're doing and they're just being a jerk, I think there should be zero tolerance for that.

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Specializes in LTC.
VivaLasViejas said:
I was generally speaking about those with some (or a lot of) dementia, which is what I deal with every day. Sorry if I gave the wrong impression, for I strongly believe in limit-setting with the A&O patient/resident who is behaving badly. I don't think any nurse should tolerate being threatened, hit, cursed at or having things thrown at her/him. With the demented, it's one thing, but with someone who knows what they're doing and they're just being a jerk, I think there should be zero tolerance for that.

Oh! Yes, the LOLs with dementia get a free pass. :D

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Specializes in ICU.
CompleteUnknown said:
I do understand what you're saying OP, but really, you can make this a bit better. Find some yoghurt before you start so you have it there for the ones who say they can't take a pill unless it's with yoghurt, even if that's only one person.

And if the pt can only take meds if they're in strawberry/chocolate/vanilla pudding? Or if with this soft drink (I.e. Coke, Dr. Pepper, Sprite, Mr. Pibb, Diet vs standard drinks, orange soda, lemonade), 2% milk, skim milk, whole milk, chocolate milk, tap water, filtered water, Fiji water, Gatorade, coffee, decaf coffee, tea, chicken broth, beef broth,..........??

You can't anticipate the need of every patient. To anticipate the "standard" pt is difficult enough. To cater to the whim of each & every pt may not be possible.

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Specializes in PCCN.
Lynx25 said:
I'll have to disagree with you here. If you are in your right mind, then no- you do not get away with pitching tantrums, screaming obscenities, and generally being ridiculous, just because you're an adult. Sorry. I don't get paid to be treated like a dog.

this this and this.

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Specializes in Geriatric LTC.

I also work the overnight on a 29 bed unit. Five o' clock is the witching hour. The climbers do climb, and I also have a heavy 6am med pass with one aide. Since I have the luxury of working two units consistently, I can anticipate things. About residents wanting to wake up to go to the dining room, I usually bring snacks to the ones who usually wake up with "Boy, I sure am hungry!" And then I'm on to the next one. As for residents who want to go to the bathroom as soon as I wake them up, well, they must go to the bathroom! And while the aide is busy caring for those who are unfortunately incontinent, the one who must assist them is me. If I were them, "Sorry, I'm in the middle of my med pass" wouldn't cut it. When you gotta go, you gotta go.

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Specializes in Oncology.

I wish I had time to help patients toilet when I wake them up for meds but with 50 who all need meds, BPS, fingersticks, etc., and all up to me, they gotta wait for the aide. It sometimes takes 15 minutes to toilet someone, I just don't have time for that. I will send the aide in as soon as I see him/her though. I know that sounds mean but if I helped everyone to the toilet during med pass I would never finish, and everyone's meds would be late. =/ I wish it weren't so but it is. Granted, many of them want to get up and go but they are incontinent and have already gone (alzheimer's) and I send the aide to change them anyways I don't want to make people wait because it does make me feel guilty, but it is physically and time-wise not possible for me to toilet and do med pass on 50 people alone. On top of that, I also don't feel "above" toileting residents like many nurses I have met, but I can only do one thing at a time, and if I have 45 people waiting for meds I cannto justify toileting someone for 20 minutes and making those people all late with meds. :( I toilet patients all night when I am not doing rounds, treatments, charts, or med pass.

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