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Frustrated with "hotel" mentality of patients, is your hospital the same?

Posted

Specializes in Emergency. Has 3 years experience.

Hi all!

I've been working in my current ED for a total of three years, two as an RN. I do practically everything by the book, kiss my patient's a$$ even if they're there for something ridiculous (because that's who gets the surveys and we need good scores), get run around by some of the more manipulative and keep a smile on my face with no attitude 95% of the time. I'm frustrated because if there's anything that is ever not PERFECT between me and a patient, somehow it gets to our main managers instead of being settled with charge nurses. And even then I try to resolve any issues before the charge gets involved as it's my job, in my opinion. However, I'm getting burnt out feeling like I put so much thought and care into my patient yet if they don't get their narcotics or if I don't get back to them immediately for a pillow, it seems like a complaint is filed and it feels like management is more like "well why didn't you delegate?" when there is no staff to delegate to (but they don't want to hear that). I think I'm just feeling a little burned out at the moment but I work myself so hard every day I'm there and just want to know if other people have those PIA patients that no matter what you do, you can't make happy? Do you get complaints about you from them? I rarely give attitude back to a patient when they're being super rude yet the nurses that either have a ton of attitude back to patients or are stone-faced and don't show how they feel one way or another don't seem to have issues although maybe it's just not talked about. Or maybe I'm being too nice and getting walked all over and then management knows they can blame it on me. Just wondering how other EDs are and if this is the same for anyone. Still developing a couple more layers of thick skin 🙂

That's the price we pay for these customer surveys that allow the gubberment to pay big bucks (or not) to hospitals. I mean somebody's gotta pay to keep the lights on and it ain't the patients. It's the same everywhere, not just the ED.

I'm polite with most of our ED patient's to a degree. I don't remember names well, so it's always "ma'am" or "sir" when I talk to them. If they're being PIA, I will tell them to stop it in a firm voice. I has told more then one patient that they aren't my only patient, they aren't my sickest patient, and that I'd get back to them when I had a moment but they needed to be patient.

I have also set time frames with some--I'll check on you every 30 minutes. If you don't ask then, you have to wait 30 minutes.

Some PITA we switch helping, or make the MD do it. One threated to sue all the nurses, so the doc got to give her meds because we wouldn't go into the room. She had her camera up and was recording everything.

Hi all!

I've been working in my current ED for a total of three years, two as an RN. I do practically everything by the book, kiss my patient's a$$ even if they're there for something ridiculous (because that's who gets the surveys and we need good scores), get run around by some of the more manipulative and keep a smile on my face with no attitude 95% of the time. I'm frustrated because if there's anything that is ever not PERFECT between me and a patient, somehow it gets to our main managers instead of being settled with charge nurses. And even then I try to resolve any issues before the charge gets involved as it's my job, in my opinion. However, I'm getting burnt out feeling like I put so much thought and care into my patient yet if they don't get their narcotics or if I don't get back to them immediately for a pillow, it seems like a complaint is filed and it feels like management is more like "well why didn't you delegate?" when there is no staff to delegate to (but they don't want to hear that). I think I'm just feeling a little burned out at the moment but I work myself so hard every day I'm there and just want to know if other people have those PIA patients that no matter what you do, you can't make happy? Do you get complaints about you from them? I rarely give attitude back to a patient when they're being super rude yet the nurses that either have a ton of attitude back to patients or are stone-faced and don't show how they feel one way or another don't seem to have issues although maybe it's just not talked about. Or maybe I'm being too nice and getting walked all over and then management knows they can blame it on me. Just wondering how other EDs are and if this is the same for anyone. Still developing a couple more layers of thick skin 🙂

I think your language tells a bit about the issue.

"It is not a question of striking a balance of having "attitude" and being "nice". It is a question of being professional and setting boundaries.

When you are unable to meet a patient's perceived needs, document when possible. One of the crappy things about nursing documentation is that it is viewed as though you only have one patient. You don't mention the patient in the adjacent room with an ABC problem in you hangnail PT chart. Although, I sometimes sneak it in.

"PT expressed dissatisfaction with wait times. I have explained to pt the challenges of caring for low acuity PTs during times of high census/acuity." "Education provided regarding role of PCP and available walk in clinics."

When called to task by managers, explain the nursing judgement you used to prioritize and allocate resources. In a non-defensive, matter of fact way. At least act as though you are open to their suggestions on how to do it better. (I suppose, in theory, your manager could conceivably have a good idea.)

If your managers don't realize that, when done properly, ER nursing is going to generate complaints, they are ignorant. I am pretty sure this is common.

Imagine how you would feel if you prioritized your nursing actions to avoid complaints and generate good reviews. Would you be able to sleep at night?

This is the major reason why I stopped being a manager. It is not only the patients, family and regulators, it is the staff as well. I managed a nurse who wanted me to include how well they could control their bathroom habits in their annual evaluation, when I refused they called 1800 I hate my boss on me. HR backed me up but the time it took me to defend my "non-actions" I could not take anymore.

The way we "cater to patients, and families" is really taking time from direct patient care and needs to stop. You can blame the US Government and congress because this is resulting from CQI CMS involvement. There are decision makers who have never stepped in any kind of floor nursing in their life and their reality shows.

amzyRN

Specializes in ED, Cardiac-step down, tele, med surg.

My hospital encourages this, they even compared a hotel experience to the experience at our hospital, that the experience begins when they arrive. Survey scores and patient satisfaction scores are tied into this phenomenon and it's one of the things that make me want to leave hospital based nursing. Its bad for patients and bad for health care providers.

KeeperMom

Specializes in ED. Has 10 years experience.

I'm polite with most of our ED patient's to a degree. I don't remember names well, so it's always "ma'am" or "sir" when I talk to them. If they're being PIA, I will tell them to stop it in a firm voice. I has told more then one patient that they aren't my only patient, they aren't my sickest patient, and that I'd get back to them when I had a moment but they needed to be patient.

Some PITA we switch helping, or make the MD do it. One threated to sue all the nurses, so the doc got to give her meds because we wouldn't go into the room. She had her camera up and was recording everything.

Recording?! Oh hell no!! Security would have been in that room in seconds and that pt made to delete any video. It is a posted policy so if they get all butthurt PD gets involved.

And I am alll about some "sir" and "ma'am" like my mama raised me to be. You have to establish boundaries. If the first thing a patient or family member asks for is a warm blanket and coffee I politely remind them that all medical needs will be addressed before any comfort needs. Setting a boundary and a level of expectation is essential to our work!

I had a priority 1 pt... vent, art line, central line, 4-5 drips, warming, blood on hotline...the whole nine yards. Difficult intubation too and we had to bougie the pt.

Alarms going off, tittering drips or changing bags, I'm continually in the room or getting meds for this guy. I haven't sat down in like two hours because we were constantly hands on w this patient at the BS.

I walk across the room to sit down to chart. Wife comes and pats me on the arm and says "honey, I'll take a cup of coffee just as soon as you make a fresh pot." I kid you not. I am about to explode at this point. It took all I had to not rip her a new one. I did tell her that making coffee was not a top priority for me today but being the one thing that stoood between her husband and the grave was my priority. She looked at me like I had three heads.

Even crazier was the pt's daughter was an OR nurse at our outpatient facility and she got bent outta shape because the ETT was pulling on the side of his mouth. I nearly bit my tongue right in two.

I hate that we are in the business to please folks and our reimbursements are based on an unrealistic expectation of what is actual patient care.

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

Points for KeeperMom for not busting a coffee pot over someones head.