Difficult patients and families

Trauma Columnist · May 6, 2000

I think you're being honest. I have noticed more demanding patients and families in recent years/ I have been told by pt/families "this is what they pay you to do" which is then followed by: get my visitors some coffee, change my child's diaper (not a patient), etc. I have also been called every name inthe book from tthe B word on down the alphabet. I work in a large ER, so a lot of pts/families are low- income, substance abusers, etc., I just take a lot of it with a grain of salt. I do however, tell people very calmly that I will not be sworn at, hit at spit upon or anything else intolerable. I then leave the room. (If possible) If not, I have the visitor escorted out by security or restrain the patient. It just seems the general culture is one of increasing rudeness. Good luck.

Nancy1 · May 6, 2000

This is a touchy issue no matter which area of nursing you are in. I work in long term care and have had a family member say "I don't want to hear you have 25 other patients, when I,(notice I) put on my husband'd call light I expect you to drop everything and answer it." This was to the nurse, she did not consider a nursing assistant answering the light.

The management gave us some tools to use: 1) Say: "In order to provide care to all our residents on an equal basis, I needed to finish what I was doing, what can I do for you, now?" 2) Always ask if there is anything else the patient needs? Again focusing on the patient and that we are not here to care for others. 3) If it was too unbearable the manager would step in.

I think that some family members are so fixated or perhaps guilty about this person needing nursing care that that they lash out at the nearest and most visible person "THE NURSE."

Now that I am in management I have given these tools to my staff along with one more, ask "Would you like to speak to Nancy?"

I am not saying this is any magic formula, because I still have family members telling my boss that I was rude, but I am woring on those relationships.

The issue about asking the nurse to change an infant's diaper has me puzzled. I wonder why the family would expect that, unless some other nurse saw the child fussing and offered to help with the child.

The coffee issue again, if the patient is very ill, my staff will offer coffee or to have a meal sent up, but again this is a kindness at usually an end of life issue.

I am not sure if this helps. But ask your management for an In-service on dealing with difficult people.

If you like, I will check my files at work, I think I have something that may help. I will be back with it, if I find it. Good Luck. NA

monica f · May 7, 2000

Every night I have atleast one patient that thinks your should serve them. I agree that they deserve to have adequate care, but that does not mean call me every 5 seconds so that I may adjust your covers. I don't mind helping, but some people I think just sit on the button. The real kicker is when one of the family members is a laywer and sits in the room pointing out everything you do and telling you it's taking to long to answer the call light. (Never mind the fact that she's not the only patient in the hospital that needs care) I think that this is all a part of nursing....and don't see any changes ahead. I just do the best that I can and hope that my patients appreciate what I do for them.

YADA-YADA · May 7, 2000

Im glad you brought this subject up. This area drives me nuts. We are not there to fetch coffee but to provide nursing CARE. We are supposed to be able to back up from the patient and see the big picture, answer the question of "is this pts progress proceeding along a normal path or is there something impeding the healing process. And if the latter is the case, then what is it? Is thept getting infected?, labs off?, pain? etc"

It drives me nuts that while Im in with someone who is cirling the drain another pt will call,who is 2 hours from discharge and very well demands to be seen so I can fluff their pillow. GET REAL!

bunky, BSN, RN · May 10, 2000

See?! Exactly what I think too! I get so tired of butt kissing to avoid trouble. Bringing family members this and that, it takes time away from my real patients who are also depending on me and it seems very unfair to have one patient usually in better shape then the rest of them monopolize my time like this. They act like I am their handmaiden. Sometimes having a family member stay the night is more of a huge hinderance than a help. You know if I was staying the night with a family member, I'd be staying to help the person not lie there in a cot to put on the call bell for the person to get the nurse to do things that I am capable of doing. We, one night had this patient who was a frequent flyer, who was able to live at home and function OK, come in and you'd think she was the queen on medicaid no less. Her daughter stayed the night and kept putting on the call bell to have the nurse do things like turn off the lights, ask questions about the next RT tx's, and at one point we were stunned to see the daughter get out of the cot (she actually was able to move) wearing one of our hospital gowns, open at the back, no underwear on!! Does anyone think that maybe this customer service idea has gotten out of hand? Like maybe we shouldn't start restricting visiting more so that we can focus more on our patients? Our patients are so much sicker these days and our staffing doesn't reflect the acuity levels, something has got to change as we are being pulled in so many directions except toward the patients who need us. I get so angry to have my time monopolized by independent people who treat me like a maid and they are always the first to complain too! My favourite though are the families that leave an elderly parent to stay the night with the other elderly patient/parent, and you find out that the visiting one needs more care than the patient. I call this the two for one special. I once had one elderly woman visitor keep coming to the desk and asking if we could give her a laxative. I don't know if she somehow got hold of one but the next thing I know she's got diarrhea all over her all over the floor, and thus you have the two for one special! I even had a patients daughter come in and secretly drop off her two kids to sit with grandma and sneak out to go to work! The kids were young, and at lunch they came to ask us to feed them, which is when we realized that poor sick grandma was BABYSITTING! Then the daughter gets mad when we call her and tell her to come and get her kids. Hasn't this gotten out of hand people?

Nancy1 · May 11, 2000

I checked my files, I am not sure if this will solve the problem, but it does give you a tool to help defuse anger, whether your own or a family member.

The title is 21 Ways to Defuse Anger, there are audio tapes as well as a type of work book. I think CareerTrack puts it out.

I hope this is helpful NA

NurseMom · May 15, 2000

Bunky.....

I also have had a two for one special recently. I work in a Rehab facility, and the wife of one of our patients came to visit her hubby. We came to the realization that the wife had Alzheimer's, and a neighbor was dropping her off every day to spend my shift with her hubby...helping him to the toilet( a fresh hip ), getting into bed with him, etc. She was very unsteady on her feet, very confused, but also sweet.

I had to let the neighbor know that we couldn't be responsible for her while she was visiting anymore, and luckily that took care of it.

------------------

Laurie :)

so many patients...

so little time.....

tweetieRN · Jun 5, 2000

I replyed in this vein in the 'whats the fuss about customer service'. Our hospital has open visiting and has recently installed futons in all rooms - even ICU. I understand what all of you are saying, and when management doesn't care, it makes it doubly hard.

I want to take care of my patient - and help his husband/wife/children as much as I can. Often they're so stressed and appreciate a little kindness and education. But I'd like to kick the rest of them out. I heard one patient mention to a visitor that he needed his hair washed and the visitor says"Well, just tell that nurse. Thats what they're here for." As tho that was the only thing we do. I've found that most people have little idea what we do because most of it is hidden from their view.

I hate it when the patient says 'oh, I'm not going to give you any problems' then keep me busy for an hour doing this and that. I wonder sometimes what they do at home when they want a drink or their blankets pulled up - call the neighbor?

snickers · Jun 6, 2000

I frequently find older women to be more demanding,

Seems like since they have been the caregivers all their lifes,when they get sick, they want everything done for them.

Many like beached baluga whales.

??How about the patients who walk past the nursing station,,saunter to their rooms, then ring the callbell, you answer and then they ask you for analgesia.

Twenty minutes post injection they have somehow recovered enough to walk outside to the smoking area!!

Go figure!!

sj.

JillR · Jun 6, 2000

Oh don't get me going on the analgesia . We have a frequent flyer that does this. She once went out to smoke 23 times in one 8 hour shift, coming back only for her percoset or librium. We counted only because we got sick of the docs not believing us about this. The last time she was in whe was working very hard to keep her eyes open and DEMANDING more pain meds. Why is it that my post op patient can get one tylenol three qid for pain but this patient can get two percoset q4 hours and librium in between when she is showing absolutley no signs of detox.

I had one lady tell her husband that he had to stay in the hospital because she didnt want to nurse-maid him. thats the exact words she used. I dont know if it was the words that bothered me or the tone of voice.

leia · Jun 6, 2000

You truely hit a nerv with this topic.I guess we all had pt/families that behave badly,sometimes I think there must be a flyer at the Main Entrence saying:'Leave your good manners at home , if you have it with you make sure not to use it!'

But for real I usually tell them that certain things are not in my job discription , if they think I am rude I let them know where they can file a complain

( most of them never do )and I let them know , as nice as possible , that they are out the line. I simply refused to be used as a doormat for the bad mood of some pt/families,and to tell you the truth I rarely have big problems with pt/families.I understand that everybody has a bad day sometimes ,even me,and I usually brush it of or ask the pts directly if they have a bad day, most of the time they feel and act better if you take 5 min to listen to them and emphesize with them and the rest of the shift goes a lot better.For major insults I talk to the doc and/or my boss to go and talk to the pt/families,because I think there are some things I don't take ( i.e. guys grabbing my butt and making sexist commands,I bet you all know what I am talking about or racist commands )I think the best advise I can give is just think -WHATEVER- and don't get into an arguement it just makes you mad and spoil the rest of your day,some people are just rude! To all the nurses out there-WE ARE DOING A TERRIFIC JOB!