I work in acute care and often deal with many demanding and "difficult" patients. Some of which are worse than others. I'm happy to help and usually do so with a smile. My problem is being assigned the same run of difficult patients for days on end. It wears me thin and by the end of the shift I am ready to quit.
A resolution! Rotate the difficult patients among all nurses so no nurse has the difficult patient 2 days in a row.
The problem is that if I need to be able to define a difficult patient with objective data. As some may know caring for bariatric patients is physically taxing, so it would be easy to say patients with a BMI >50 are put on the rotating list.
Does anyone know of a suggestion for objective data in defining a psychotic patient or verbally aggressive/demanding/demeaning?
The issue for this is that I don't want to end up having it being simply floor nurse discretion, as it could turn out that all of the patients are now on the "difficult patient" rotation list.
Specializes in psych, addictions, hospice, education.
Why not just rotate all patients regularly? Then you wouldn't need to make lists of whose bad, worse, worst. Also, it would mean everyone had a chance to care for those who are truly lovely.
Meh, people get busy. I know for myself, I post a lot in spurts, but then life gets busier and I don't come back for a while. it's not always a sinister motive.
Yes. This exactly. But those that go running when they see that name on the tracker can kiss my grits. I am usually first in line, because I feel that while they are taxing for any variety of reasons, for the most part they still deserve respect.
True. I find that sometimes, everyone agreeing to tag-team on the patient can be a good approach- that way, no one nurse has to take the brunt. Plus if everyone is on the same page, that minimizes staff-splitting.
I disagree with the attempt to standardize this. Let's face it - every single patient has varying degrees of ability and disability, which is rarely dependent on diagnosis, BMI, or any other cookie cutter you aim to use.
In my opinion, if the primary nurse labels a patient "difficult", then they are difficult. Maybe my unit is a rare gem, but everyone I work with is mature and professional when difficult patients are in their group. It's rare anyone asks to have a patient be reassigned.
Additionally, what is difficult to you may not be difficult to me. I had a total care, mostly non-verbal and incontinent woman at the end stages of dementia. During my time with her, she lost ability to swallow and the decision to not get a PEG tube was just made. She was a technically easy patient. Only meds were some q6h and q12h abx. She was very low maintenance and was incapable of asking for a single thing.
She required frequent clean ups, which she hollered during. She was in pain because her perineum and buttocks were excoriated. She had become a ward of the state recently because she had no surviving family members capable of providing her the care she needs.
My grandmother was just diagnosed with Alzheimer's almost 2 years ago. I hope to god her body fails her before her central nervous system does. I couldn't help it, no matter how hard I tried - counter transference was an absolute beast when I had that patient. After the second day, I asked if she could be reassigned. To me, she was a difficult patient.
Obviously you'll have the more obvious types of difficult - the violent ones, the demanding ones, the mean ones. We have one frequent visitor who is absolutely hateful to most of the staff. I shared him with one other nurse for a three day stretch and he was the sweetest person to both of us. We treated him with dignity and didn't let his initial grouchiness turn my mood sour. We respected his space. Everyone else would call him difficult. Us? We looked forward to seeing him.
Hydrocodone APAP
14 Posts
Difficult patients do not happen, there is a serious condition.