Difficult patients and families

leem · Jun 27, 2000

Originally posted by tweetieRN:
Hi bunky - one of the areas of dissatisfaction on a recent survey was the IV stick. They hurt! Well, duh. No kidding.

TweetieRN, and Bunky

Regarding your characterization of IV stick being a "ridiculous area of complaint".

You would be of a different mind if when getting and IV you were stuck 10 or

12 times before the nurse got it right. Blaming someone as just being a "hard

stick" only goes so far. The issue really is more related to the skill of the nurse.

Without question some are just fantastic at putting in an IV, while others just don't have a clue. They just keep pokin' and hope for the best. If you've ever been "man handled" by a clueless one you have definite cause for complaint, and would realize that it is not a "ridiculous complaint."

Lee

snickers · Jun 27, 2000

Having not ever worked in the American system......please enlighten me and share what theses surveys are all about......how often, how long, actions taken based on these surveys and by whom?

Thanx.

sj.

MissyS · Jun 27, 2000

I agree that "customer service" is great. I have no problem including the family in the care and keeping them informed of what's going on. However, the hospital I work for has decided it spends too much money on free coffee, so now we can't give that to them. There is no food available at night for diabetics that need it. I have no problem giving a blanket to a cold relative as long as I have enough to give to my patients that are undressed and ill. I think one of the biggest roles the RN plays is in setting limits on people's behavior in the ER. Explainations do go far for most people but there are always holdouts. No matter what you say to them, they won't be happy. I feel like telling them, I didn't ask you to come in here, you know, you chose to. You couldn't handle the situation at home, so now please listen to me. That is a 2 edged sword too. Customer service is great on days when volunteers are there to meet those needs. At night, it just isn't going to happen. How can we educate the public on what their expectations should be so they are not disappointed? Maybe that's where this should go. With the government making new regulations every day, nurses, as patient advocates, should let the public know what their government is doing for them.

PPL, BSN, RN · Jun 27, 2000

You people are absolutely cracking me up! I have thoroughly enjoyed these posts, and I can totally relate! How many times have I answered my patient's trivial complaint with, "oh-oh, better call Keller and Keller" or when I'm having to be a gopher (go for this, go for that) "What do I look like, a short order cook?" Generally, this gets a laugh and gets the patient/family member to look outside themselves for a minute. I too have offered to show them how to file a complaint and referred them to my immed supervisor, because I know I have done everything humanly possible to satisfy their need/want/and/or demand. One I remember especially, was a homeless person, who left the mission "beacuse they expected me to leave for two hours a day to look for work!" Then, "I haven't worked for years!" This person left a months supply of anti-seizure meds at the mission, (paid for by guess who?) then when he got close to his threshold, showed up in the ER for admission for impending seizures, which he did have, then blamed me for not getting his medication to him quick enough! Please!!! We also had one psychotic wandering and s--t--g in other people's rooms (and NOT in the toilets!) Three drunks in various stages of detox with hourly ivp ativan, detox protocol, etc. Add to this mix a couple of borderline personality disorders, and you get the idea. Oh, and did I mention diabetics? Of course, once the drunks slept it off, we had to order up some trays so they could eat. True story; my boss actually called me up at home the next morning when she came in, because I'd forgotten to remove the dirty trays that evening before I went home! So HOW IN THE HELL, with management like THAT, can you get any backing; I ask you? Thanks for your posts and thanks for making me LOL!

bunky, BSN, RN · Jun 27, 2000

PPL are Keller and Keller lawyers in your area? Here we have Maloney and Maloney who advertise that sometimes in nursing homes your loved ones are subjected to "Diabolical acts of torture" and Ms. Maloney says this in a voice that sounds like she enjoys this idea a little too much, like she is doing an ad for a 1-900 sex hotline. LOL! And PPL would you just look at Snickers question?! SHE doesn't know what a SURVEY is all about! LOL! See what I MEAN!

PPL, BSN, RN · Jun 28, 2000

Stop Bunky, you're giving me cramps! yeah, I thought everybody knew Keller and Keller, but you get the idea! And no, Snickers question/comment re satisfaction surveys was NOT lost on me! LOL! Keep her in the dark and innocent as long as we can, or she'll never come to the states to work with us! We better stop talkin'trash! LOL!

Mijourney · Jun 29, 2000

Hi bunky,

When I read your post and other posts, this brought to mind the many discussions I have had with teachers who regularly deal with difficult students. No doubt we are dealing with the students' relatives.

There are alot of factors that contribute to the demanding nature of patients and families. I agree particularly with the post that included giving the family and/or patient 5 minutes of your time. When I have done this with an affixed facial expression of caring and compassion on my face and a calm tone of voice, I have found this action to work in 90-95 percent of the cases. I know that it is difficult to present yourself in the "smiley" mode, but believe me, in the long run it does help save your sanity and a host of other problems including potential legal issues.

What I began to do when a patient or family member called me in the room to fluff a pillow or pour water from the pitcher into a cup (oh yeah, they did) was to pleasantly give them permission to perform this task. I would tell them to feel free to do this or that after I initially performed the task myself. Maybe they simply needed the nurse's permission to do something, because they did not want to be in the way. I would make sure that I checked in with them somehow at the required intervals. As always, I introduce myself and give them a summary of how I planned to "service" them. I would ask if they had any questions and so on. Yes, that is considered "brown nosing", but this is the age of customer service, and I don't see it going away any time soon. A future opportunity may depend on it. I think if we can find one bright star among the patients we take care of that should get us through the day. I really empathize and sympathize with you bunky. I must admit there are times when I grinch my teeth providing service. But I keep saying to myself, they have the problem, not me. Hang tough.

Nancy1 · Jun 30, 2000

Lee,

Thanks for your comments. I admit I tell my staff they cannot use the phrase "We are working short today." This is because we do not believe in staffing at minimums. For 40 ICF residents I have 2 nurses and 4CNAs, I admit there are days when I have call-ins that cannot be replaced so there may be 1 less person on the floor which may take the to minimum, but not short. Missing 2 people would make it short by the numbers. I realize that people do not want to hear that, but I find that the staff has plenty of down time, and as management I resent the saying we are short, but we have time to sit and do nothing.

It is easy for someone to use the phrase, we are short, but somehow everyone gets their cigarette breaks and lunch breaks.

My daughter who is a waitress tells me she puts up a sign when she is working that says 'If you have time to lean, you have time to clean." I think of that when I hear staff complain. I am very forward and remind them if they did not complain so much, they would have more time to do the work.

I personally feel that there are people out there that are using this shortage to their own advantage. NA

Roach · Jun 30, 2000

How come patients feel that it is "O.K." to pass gas loudly or burp really loudly in front of the nurse. I always wonder if maybe when you are in uniform there is a "loose all manners" sign on your back. You cannot tell me that they would all do this if you were passing by them in the grocery store or in line at the gas station. Would they just hike a leg and let one rip right next to you in line at K-mart.

Oh, and I am so glad I don't work for Nancy. Whew. Ten patients per NA(ten baths and linens and buts to wipe) and 20 patients per nurse. Whew. Maybe I am spoiled but even on a team of two nurses we don't usually have more than 9-10 patients. And we sometimes don't get lunch and we don't smoke!!! Course I do hospitals not Long Term Care so there is probably a difference.

Roach

justanurse · Jul 1, 2000

Nancy, just because you get your lunch breaks and legal 15 minute breaks doesn't mean we don't work short. Most days I don't get a lunch break other than 15 minutes to go get it and scarf it down, unless I can beg someone to bring me something back, so it'll take less time. I don't get paid for lunch, I get docked 30 minutes of time for a lunch break. And, if I don't take it, I'm told it's my own fault. And, legally, I have a right to a couple of 15 minute breaks during a shift that I work. You can bet I don't get that either, nor get paid for it.

No, we shouldn't tell everyone our dirty business & I don't tell anyone "we're short today." because: 1. I may get reprimanded extremely hard for it. 2. It doesn't sound good to the patients. I usually tell someone who asks me "It's busy today." That way I'm not really lying, but they usually know I'm not telling the whole truth. I'm not comfortable with what that does with my "trust" level with that patient.

When my spouse was in the hospital, I tried to be as helpful as I could. I wanted to do as much for him as allowable. I wish all people were like that, wanting to accept some responsibility to care for their own loved ones, like give a bath, brush hair, back rub, other personal things. It can be as good for the patient, as it would be for us, and can help the family members gain a little control in a sometimes out of control situation. But, I can see the other side that sometimes happens, families tired after having cared for that patient at home, or caring for other family members at home.

Mijourney, I've done that "brown nosing" many times with my patients. I would prefer to do it every day with everyone.

And, I would have LOVED it if it had been done for me when I was one of those "difficult family members". Yes, I was demanding in some ways, but it was the little Docs who I had the problems with, the nurses just happened to be there to hear the beginnings of it. It helps so much when you know just what's going on.

bunky, BSN, RN · Jul 1, 2000

Mijourney, my nose is SO brown it obstructs my vision some days! The best thing that I find myslef doing a lot more of these days: I see the call light and know "Oh God it's THEM again! I answer it in the worlds most efficient sugar coated voice. Then as I go toward the room, I paste on the biggest stupidest most sickening smile I can, and going down the hall to obey, I repeat "I love my job! I really love my job!" And by the time I get to the room, I am almost laughing at myself, and my co workers are cracking up. Then I can be pleasant and take everything they are saying with a grain of salt.

The ones who you just can't please, who you just can't be fast enough for even if you had turbo boosters in your shoes, I document it ALL! I document EVERY negative comment, every complaint, and how I answered them and tried to meet their needs. This came in handy on one occassion when the woman complained the next day to her doctor about lack of pain management, and a long list of her annoyances(home meds Prozac and Xanax, HINT HINT). Of course it was blamed on nights (by day charge nurse) but I just opened up my nurses note and showed them all that she was bitching from the moment I walked in, and that I'd called the doctor on call, etc, etc, and there was nothing they could say. CYA! It works when all else fails.

leslie :-D · Jul 1, 2000

God, some of these families are nuts. Of course, professionally speaking, I must acknowledge their anxieties and ambivalences re: their loved ones in a snf. But that perspective only lasts so long, and yes, I have been known to come across as a ***** (I like to call it firm limit-setting). This limit-setting is applied to both pts. & families. Sometimes it works and sometimes it doesn't but more often than not, I have found,"I HAVE DONE EVERYTHING I CAN TO ACCOMMODATE YOU AND WHEN I AM ABLE TO FIND YOUR MOTHER'S MISSING PANTS, THEN I WILL!!!" works.