How do you deal with demanding/unreasonable patients?

Posted

I am referring to patients such as your drug seekers, call bell pushers, the one- shifters. What have you said or done that is not disrespectful but firm and effective in putting such patients in line?

cheezwizz90

cheezwizz90

Specializes in Critical/Acute Care, Burns, Wound Care. Has 4 years experience. 59 Posts

It is hard to be RESPECTFUL yet firm when the patient is a total jerk or needy. I tell them that I have other, sicker patients that I need to attend to, but that I always have time for them also. I remind them that myself or the PCT will round AT LEAST once per hour and that they need to wait at least 5 minutes after pushing the call light before they are alllowed to yell into the hallway for me, since the needy ones tend to wonder through the halls with their IV pumps to find me, or if non-ambulatory, they scream "NURSE!!!!" I say NOT to scream out for help unless they are hemorrhaging to death, or having chest pains/stroke symptoms. A cup of apple juice can wait until I round again. Sometimes I give them a pad of paper to write down their list of desires until I round again. We try to round more frequently on this type of patient and to switch nurses halfway through the shift because they are so exhausting. If those measures fail, I have a very staunch, stern and sassy charge nurse to "put them in line" the hard way. That way, I don't have to be the enemy.

loriangel14, RN

Specializes in Acute Care, Rehab, Palliative. 6,923 Posts

What do you mean by one shifters? The drug seekers, all I can do is give them the meds they can have as ordered. What else could you do? The bell ringers GET UP out of bed and away from the call bell. If all they are going to do is ring they have to be removed from the vicinity of the bell. I have done it in the middle of the night. You gonna ring instead of sleep? Up you get.No choice is given.Or else they get a lecture, nice but firm.

Edited by loriangel14

macawake

macawake, MSN

Has 14 years experience. 2,141 Posts

I am referring to patients such as your drug seekers, call bell pushers, the one- shifters. What have you said or done that is not disrespectful but firm and effective in putting such patients in line?

I personally don't like the term drug seeker. If the patient reports pain I'll assess and administer the pain meds that are prescribed and evaluate the effect. These patients actually very seldom get on my nerves. I've made a conscious decision to not let it rob me of mental energy. I currently work in PACU and anesthesia and whatever "drug seeking" that takes place is usually very much legit since we do in fact cause trauma. But even when I worked in the ER I seldom had problems with so called seekers.

As far as other demanding patients go, I respond differently depending on what I perceive is the reason for their attitude.

If it's fear, anxiety or pain that makes a person act up, I'll tell them that it seems to me that they're having a tough time and ask questions to try to get to the root of the problem. It's been my experience that many times just taking five or ten minutes to listen to the patient and their concerns/fears will be enough or else allow me to together with my patient, come up with some sort of a solution/course of action to help them. This usually results in a calmer patient who won't push the call bell every two minutes.

If they are being truly unreasonable, rude and obnoxious just for the heck of it, I usually tell them that an attitude like theirs won't generate any more of a positive result with me than it would elsewhere in society and that I expect them to show me the same courtesy/manners that I show them. I'm a nurse and I'll go to great lengths to make my patients both be and feel comfortable and safe, but I'm not a punching bag.

dirtyhippiegirl

dirtyhippiegirl, BSN, RN

Specializes in PDN; Burn; Phone triage. Has 8 years experience. 1,571 Posts

All of the listed patients need to be handled in different ways. If you approach each annoying patient with the idea that they all need firm boundaries (or whatever), than all you are going to have at the end of the day is a headache.

Drug seekers get all of the medications that I can give them. If they want more, I call the doctor. If the doctor says no, I tell the patient "sorry the doctor said no more, your next dose is due at X time."

Call light patients get a quick run-down of their needs before I leave the room each time. Food, drink, pain, room temp, bathroom, all belongings within reach, comfortable position in bed. Check? Check. Patients who persist are often lonely or frightened. Spending a few minutes with them (if you can) can make a difference.

Patients who are curt or rude -- I kill them with kindness. For a lot of these patients, it can be a lack of control issue. For paras, quads, chronically ill folks (or their parents), I immediately approach the situation with "how do you want me to do this? How would you do this at home?"

Sometimes I give context when I cannot fulfill a request right away. "I can't do this now because I am in the middle of my medication pass but I can come back in one hour."

Sometimes it's about showing empathy or compassion in the face of manipulation; hard to please, manipulative, or lying patients will make your life harder if they don't believe that you're on their side. A little tut-tutting about that awful doctor or a sympathetic ear while a patient sheds crocodile tears builds a friendly rapport that you can hopefully fall back on when you have to deny a request or limit their call button use.

Pangea Reunited, ASN, RN

Has 6 years experience. 1,547 Posts

I try to remember that I can't "fix" a personality that's been broken for years and years. The best I can do is contribute to getting their body better so they can move on to the next place. Until then, I feel out different types of interaction to see what the patient responds best to. I frequently ask for psych consults and PRNs for anxiety, too.

ArtClassRN

ArtClassRN, ADN, RN

Specializes in Med Surg. Has 8 years experience. 630 Posts

I am referring to patients such as your drug seekers, call bell pushers, the one- shifters. What have you said or done that is not disrespectful but firm and effective in putting such patients in line?

I am completely honest and straightforward with them. I set clear boundaries for behavior, communicate the MD's plan, and I take care of them the best I can.

Does this "put them in line"? Don't care. I can't control what patients think.

mindlor

mindlor

1,341 Posts

Lets just say I pass out a lot of AMA forms

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience. 5,047 Posts

What do you mean by one shifters?

Those are the ones that, are not assigned to any one RN twice in a row; if possible only one shift, period.

To the OP, with patients who are deliberately nasty I will say in a calm but firm tone, "There is no need to speak that way to me." If the nastiness is part of a request, e.g. "*****, get me some water," I'll say "I don't respond to '*****.'" and walk away.

I'll give pts their prn's as requested, but I won't follow instructions to "push it fast."

I might put some extra effort in to accommodate their requests that are reasonable. I did have a pt recently who was extremely difficult, and no doubt had pain but was actively addicted also and had some manipulative behaviors. I told her "No, I can't do that" when she asked me to bring her q 1 hr prn fentanyl q 45 minutes instead. However, when she asked if she could get 10 mg oxy q 2 hrs, vs. 20 mg q 4 hrs (the order was 10-20 mg q 4 hrs), I said "Absolutely. If you think that would give you better pain control, we will try that."

I've had patients that have requested us to do things that were not safe for us, e.g. lift them manually instead of using the mechanical lift, when they were 200lbs and unable to bear weight. I said outright, "No, we won't lift you."

In extreme cases of white-on-rice call light ringing, we have resorted to telling them, "This is an ICU. It's not appropriate to ring every five minutes because we have critically injured patients to attend to." (Generally it's SD/floor boarders who ring incessantly.) "We will come in every hour, and do ring if it's urgent, but other requests need to be made when we round."

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience. 5,047 Posts

I give them a pad of paper to write down their list of desires until I round again.

Good idea! :up:

Tenebrae, BSN, RN

Specializes in Mental Health, Gerontology, Palliative. Has 10 years experience. 1 Article; 1,775 Posts

Try to find out whats causing their aggro.

Realise that while this patient might be an utter pain in the ass, they are dealing with the situation the best they can with the tools and resources they have avaliable to them and realise theres a very good chance their anger/annoyance is a direct result of how they are feeling about themselves.

Get them involved in the process. Its well proven that if a patient understands why a particular treatment is ordered they are much more likely to calm down.

Its amazing how that 'difficult' patient calms down when they've been allowed to have a damm good rant and had their feelings validated. It may not change the treatment plan at all.

Safety Coach RN

Safety Coach RN

Specializes in Behavioral Health. Has 9 years experience. 103 Posts

I am referring to patients such as your drug seekers, call bell pushers, the one- shifters. What have you said or done that is not disrespectful but firm and effective in putting such patients in line?

10mg Haldol/2mg Ativan IM