Hospital frequent flyers??? Whatever happened to it being an acute care facility!

ZippyGBR, BSN, RN · Sep 2, 2011

I try and assign the lazy pt's who are capable to the nurses who will kick their butts into gear (or at least best possible outcome). Generally works.
We have a few nurses who have been known to bathe ambulatory 30 year olds.
Ends up setting the tone for the patient's stay. I either warn them or avoid assigning the pt's. Nothing like an extended stay because the nurses have babied them into feeling like they have to do nothing. The patients do not improve due to lack of mobility.

had a bit of a battle trying to get some of my colleagues to play the game with a lad we had who was a serving soldier ( too sick for Headley Ct , but too well for Birmingham - so we got him for speciality rehab input ) getting him to play the game and pull his weight and not to baby him - yes he was a young lad injured on his first op tour but he was and is a serving soldier - iirc he is soldiering on after we got him well enough for headley)... given the choice i'd have had him sticking to routine and not growing a half orificed beard for several weeks of his stay with us - but none of my colleagues have any prior service ...

anotherone, BSN, RN · Sep 3, 2011

This drives me crazy but what can you do. I have ha da couple of those, "hold the urinal" that i knew were bogus. I grew a backbone and said, "you can do it yourself." that got me a bed strip at shift change. sometimes it is faster to do it and "help them" they don't want to be helped in any real sence of the word anyway. some of these people get a thrill out of their fake "helplessness"

OCNRN63, RN · Sep 3, 2011

What is "woo sha?" I never heard this expression before.

xtxrn, ASN, RN · Sep 3, 2011

LOL, nursing is a respected profession? Gallup can kiss my A$$, because I sure don't see any respect.

It's earned...as individuals :)

carolmaccas66, BSN, RN · Sep 3, 2011

I have always refused to hold anyone's member: I just don't think it's appropriate for female nursing staff to do this. And blokes will try it on with any females, especially the young ones. I just tell them to hold it themselves, or push the bottle up around their member. Call me a prude or whatever.

We get many frequent fliers, who keep falling over (the Drs keep sending them home with no follow up), the diabetics, the alcoholics. Social services get involved, but one guy told me he just doesn't bother taking his diabetic med's at home. We get many psych patients who's families kick them out - there are more social problems in our area than anything else. But we have to treat them, time & again. It is a waste of time & money; many of these people could see their own Dr or get treated in outpatients, but they see the ED sign and just rock up, time and again.

In our state of Western Australia, you will not be treated in some EDs if you have a condition that can be seen by a doctor in a 24 hour clinic, or which isn't deemed an emergency, and you can see a doctor the next day. I think this is good policy, but could be dangerous sometimes. However it seems to work and WA has benefited from this policy. I think other states should toughen up, but there would probably be a huge outcry.

Just do the best you can, and try as a nurse not to get too involved: leave the social problems to the social workers. Otherwise you will drive yourself silly worrying about everyone.

Anna Flaxis, BSN, RN · Sep 3, 2011

DKA can kill. These people who are doing this to themselves are gambling with their lives. This is clearly self harm, along the same lines as cutting or suicidal gestures. They have adopted the sick role, because this is how their need for love and belonging is met.

The answer is consistency among care givers. The message needs to be "I care about you, and I don't want to see anything bad happen to you, AND I am not going to wipe your behind for you, because you can do that for yourself."

The one nurse that wipes the person's behind ruins it. The message to the person is that the one nurse who wipes their behind is the only one that cares, and the rest don't, further reinforcing the helpless behavior, i.e. "If I am helpless and people do things for me, then that makes me feel cared about."

It's basic behavior modification. Reward the person with what they value (feeling cared about) for behaviors that you like (taking care of their own needs). But, in order for it to work, everyone needs to be consistent.

Crux1024 · Sep 3, 2011

DKA can kill. These people who are doing this to themselves are gambling with their lives. This is clearly self harm, along the same lines as cutting or suicidal gestures. They have adopted the sick role, because this is how their need for love and belonging is met.
The answer is consistency among care givers. The message needs to be "I care about you, and I don't want to see anything bad happen to you, AND I am not going to wipe your behind for you, because you can do that for yourself."
The one nurse that wipes the person's behind ruins it. The message to the person is that the one nurse who wipes their behind is the only one that cares, and the rest don't, further reinforcing the helpless behavior, i.e. "If I am helpless and people do things for me, then that makes me feel cared about."
It's basic behavior modification. Reward the person with what they value (feeling cared about) for behaviors that you like (taking care of their own needs). But, in order for it to work, everyone needs to be consistent.

Agree 100%. Consistantcy is key. If everyone refused to treat med seekers to narcs just because (not saying they shouldnt ever get them, but you know what I mean), they would stop or at least lessen the visits.

I refuse to hold a member or wipe an ind. pt's butt and I hear "Well, the last nurse/aide did it for me". I always say "We are working on getting you sent back home and we need to be sure you can do for yourself." I get some griping, but i dont budge. Heck, Ill even surpervise and tell you a little to the left, but im not holding it. :nurse:

However, you better believe im holding a lip, nip or some other skin when its needed.

Anna Flaxis, BSN, RN · Sep 3, 2011

If the person is somehow physically and/or mentally incapable of managing their own member (i.e. demented little old man or guy with mangled arms), I generally scoop it up into the urinal. Anyone lacking in any disease process that impairs their member handling ability is on their own!

RNdiva505 · Sep 3, 2011

Lol....I agree...Woo shaa (close your eyes and pray to baby jesus to relieve your stress with this paitient) :bowingpur Thnx for all the story tellings....Keep them coming... Question: Does the hospital eat the cost for frequent flyers who have medicaid or no insurance, if those patient's are not out of there in a certain amount of time?

xtxrn, ASN, RN · Sep 3, 2011

With a DKA wuss, I'd have a hard time not telling him that diabetics lose certain functions with ongoing hyperglycemia, and he may need more than someone to help him pee. Find out in a hurry how important the little brain is to him :mad:

kcmylorn · Sep 3, 2011

I think these are perfect examples of the "customer satisfaction" craze that has been sweeping healthcare and nursing by our business minded jacka**es. The business majors don't know about these patients. Unfortunately for us nurses we know them all too well- every facility has at least one.

Hospital eats the cost every time one of them comes in- EMTALA and state funded charity care. These patients hurt those who are really in need with no insurance. Also, the end result of these patients- it eventually costs nursing FTE's. This is why hospitals cut nursing staff numbers. If they operate in the red because of no reimbursement from their usual sources, they start eliminating jobs( of the little guys/gals of course never the big cheeses salary) INHO- if the CEO salaries were cut- that money saved in their salary could be dumped back into the hospital system- hire more nurses, provide a cushion for these frequent flyers with no insurance, and depend less on state funding(our taxpayer money, which in some areas, is larger than others) They need to keep their paws out of our taxpayer pockets and start reaching into their own.

belgarion · Sep 3, 2011

Working in a small hospital where 80% of our pts. are swingbed we get this all the time. Fifty plus year old daughter wants to go out of town. Calls doc at 5AM to report Mama has had NVD for three days and is getting weaker. Doc calls hospitial and orders direct admit. Daughter shows up with Mama during middle of shift change, says "here she is" and splits. Mama with NVD and weakness demands bacon, eggs, biscuits and gravy, and coffee for breakfast. Refuses wheel chair and outruns staff to her favorite room. After three days as acute care doctor orders swingbed status so she can stay for another 21 days or until daughter gets rested and agrees to take her back home. After a couple of months, repeat process.

Another scenario. LTC pt., A & O, comes to us for AECOPD. Dr. admits and later swings pt. Every time Dr. mentions pt. returning to LTC pt. comes up with some new symptom so he can stay a couple of more days. Why should he want to go back? We baby him, he has a room to himself, meals in the room, television in the room, PT and OT give him one on one time (gotta keep Medicare happy with swing bed status), and life is good. A month after discharge pt. is back with a new ailment and we do it again.

The majority of our swingbed pts. really are sick and the swing status can often be the difference between getting to go home or ending up in an LTC. But there are a few who milk it for all it's worth and their doctors play right along with them. Welcome to life in a small, rural, county-owned hospital.