Have you ever requested a patient be removed from your workload?

[SilverBells]

For many of us, we encounter patients that we don't necessarily enjoy caring for.  But, as nurses, we do our jobs and we care for them in such a way that they are able to go home. 

What happens, then, when we are given a patient that we can't care for? It has nothing to do with not wanting to be the person's nurse and more so to do with the fact that we know we aren't the right person to care for this patient.  

Here's an example.  I've had a patient on my unit who has been hospitalized 4 times or once a week since she was admitted 1 month ago.  Despite my best efforts and frequent communication with the providers, she declines anyway.  No matter what I do, we end up having to send her to the emergency room.  However, she was admitted to our facility before (a couple of months prior, maybe) and was on a different unit.  She did not go to the ER once when she was on the other unit.  I'm tempted to suggest that if we do accept her back once she is medically stable that she be admitted to the other unit and not mine.  In my opinion, I have continuously failed this patient.  I also feel that by repeatedly reassigning her to my caseload, the facility is also failing her.  I might be wrong, but I'm wondering if she might do better with a different nurse overseeing her care.  

Anyone else ever been in this situation? What do you do when you are repeatedly assigned a patient you aren't capable of caring for? 

Please note: I am asking this question for the good of the patient.  If I knew what to do for this person, I would.  I really do think it's time that someone else oversee her care so she can receive the treatment she needs.  It would help me sleep better at night knowing that she's in the right hands, which I feel aren't my own. 

[SilverBells, BSN]

25 minutes ago, FolksBtrippin said:

There are some good reasons to remove yourself as the nurse. Maybe its because I work in Psych, but here are some I can think of:

The patient is in love with you or has another boundary issue that he or she does not have with another nurse.

You know the patient outside of work and feel that it would be a conflict. 

Your reason does not seem to me to be a good one. If you think the other nurse (manager?) Is clinically more competent or smarter or has better skills then you should ask his advice. 

Also, I feel like you are beating around the bush. What is really going on here? What do you really think the problem is? Are you thinking that your coworkers are being neglectful and not sending legitimate problems to the ER? Or do you think you are overdoing the ER because of a lack of confidence? 

I do sometimes wonder if my coworkers are missing something, but I also trust that if there was a need for someone to be sent in, they would be sent in.  Sometimes I think a lack of confidence contributes to me sending patients in. However, every single patient I've sent in recently was admitted, so obviously it was the right thing to do.  Maybe it isn't necessarily a lack of confidence, but moreso the fact that I often get a feeling that something is wrong...that feeling seems to be right a lot of the time.  

[SilverBells, BSN]

54 minutes ago, FolksBtrippin said:

Or... maybe you just really dislike this patient. Stop beating around the bush and tell us what the problem is. 

I wouldn't say I highly dislike this patient.  However, the fact that she continues to have issues that I haven't been able to resolve stresses me out.  She keeps getting sent back to the hospital, so I feel like I've continously failed her.  She'll come back from the hospital and I'll do everything I can to keep her out, but she always ends up going back.  Maybe she is simply a very sick patient but I also feel it couldn't hurt to see how she does under another manager.  I trust my colleague's judgment enough that if he were to send her in, something truly is wrong.  I also have faith he might be able to do a better job keeping her at the facility 

[NightNerd, MSN, RN]

If the patient goes back to your unit, can you request that this other nurse manager offer a second opinion on the plan of care? To me, it would be beneficial to hear how someone else would handle the situation, especially if it's something I don't have a ton of experience with. If they agree with what you've been doing or plan on doing, great. If they have suggestions, consider taking them. It's a learning experience, but I wouldn't think to jump right to, "I'm bad for this patient and should never be assigned to them again for their own wellbeing."

[SilverBells, BSN]

13 minutes ago, NightNerd said:

If the patient goes back to your unit, can you request that this other nurse manager offer a second opinion on the plan of care? To me, it would be beneficial to hear how someone else would handle the situation, especially if it's something I don't have a ton of experience with. If they agree with what you've been doing or plan on doing, great. If they have suggestions, consider taking them. It's a learning experience, but I wouldn't think to jump right to, "I'm bad for this patient and should never be assigned to them again for their own wellbeing."

I'm always able to just call him on the phone and ask him to come over and see the patient, if needed.  We both bounce ideas off of each other, so this wouldn't be anything new.  Also, if they keep returning this patient to my unit, maybe no one is overly concerned about the care she has been receiving.  At my workplace, if there were care issues regarding this patient, I can almost guarantee you I would already know.  I'm frustrated with the lack of progress with this patient's medical status, but others have told me that with her extensive medical history, some, if not all, of these hospitalizations are inevitable.  

 

[SilverBells, BSN]

On the flip side, I just learned that three of my colleagues' residents also went into the ER this weekend, so these hospitalizations may have nothing to do with either one of us.  It sounds like it was just a bad week/weekend for sick patients. 

[SilverBells, BSN]

I suppose it could come across as being unprofessional if I suggest that this particular patient be moved to the other side simply because she is challenging and complex from a medical standpoint.  As nurses, we can't just decide we don't want to care for someone simply because their medical condition isn't straightforward.  I just worry about her declining, but it's possible that she would decline no matter which area of the building she is in. 

[Nurse Pompom]

23 hours ago, SilverBells said:

 

What happens, then, when we are given a patient that we can't care for?

 

IDK.. sounds like you don't want to take care of the patient.. I don't blame you, I know it's hard when pt don't help themselves (keep drinking, keep eating, etc) but we all have to do it.

If you are that frustrated I would turn toward your education department or educate yourself on ways to help that pt more efficiently.

[SilverBells, BSN]

25 minutes ago, Nurse Pompom said:

IDK.. sounds like you don't want to take care of the patient.. I don't blame you, I know it's hard when pt don't help themselves (keep drinking, keep eating, etc) but we all have to do it.

If you are that frustrated I would turn toward your education department or educate yourself on ways to help that pt more efficiently.

There probably is some truth to that.  This is why I haven't actually approached anyone about sending her to the other unit if she does return.  We've already received a referral for her again, stating the patient wants to return, so she's obviously not overly concerned about her care.  I don't know, but it's possible it could be seen as me taking advantage of the fact that my colleague is very intelligent as a way of avoiding taking care of a patient who challenges me more than other patients do.  I don't mind learning ways to take care of her, really, I just don't want her to decline because I didn't know what to do.  My colleague just seems to have a knack for everything and is able to "put pieces of the puzzle together" in ways that I don't.  That's why I feel she might do better under his care.  With that said, it's not reasonable to assign him every challenging patient simply because he is very bright.  

As far as reaching out to education...he actually was just in the staff educator role prior to accepting the management position, so that makes him all the more a great person to reach out  to.  At the same time, while he is a great resource, it would be wise to be not to take advantage of him. 

[SilverBells, BSN]

However, on the flip side...doesn't it make more sense to assign the more complex patients to the more intelligent nurse/manager? 

[hppygr8ful, ASN, RN, EMT-I]

22 hours ago, SilverBells said:

I do sometimes wonder if my coworkers are missing something, but I also trust that if there was a need for someone to be sent in, they would be sent in.  Sometimes I think a lack of confidence contributes to me sending patients in. However, every single patient I've sent in recently was admitted, so obviously it was the right thing to do.  Maybe it isn't necessarily a lack of confidence, but moreso the fact that I often get a feeling that something is wrong...that feeling seems to be right a lot of the time.  

If the patient has Medicare and or Medi-caid they automatically get 3 fully paid days of acute hospitalzation. If youthink your clinical practice is lacking then figure out how to improve it.

Hppy

[SilverBells, BSN]

2 hours ago, hppygr8ful said:

If the patient has Medicare and or Medi-caid they automatically get 3 fully paid days of acute hospitalzation. If youthink your clinical practice is lacking then figure out how to improve it.

Hppy

I agree with improving my clinical practice and it is something I strive to do every day.  However, should improving my clinical practice come at the expense of a patient? I’ve already been given 4 chances to keep her out of the hospital.   I think it’s time someone else oversees her care.  Plus, sometimes there is no substitute (e.g.  willingness to learn) for natural intelligence, which is what my colleague has

[SilverBells, BSN]

Any suggestions on how to boost one’s natural intelligence appreciated.  With that said, this patient deserves a manager who already has this