How do you handle cares for patients that are known troublemakers? I have bumped into this recently. Add in the mix any sort of known behavioral problem and it seems 10x worse. Management knows that these people are quick to write up nurses over ridiculous things, but yet they don't seem to step in to politely reorient the patient to reality.
So, the question is, how do you deal with patients like this without compromising your license each day? Part of me wants to say to management "you deal with them then", but of course that would not go over nor ever happen.
i was advised it was far worse to take something like that home. even with the names removed it is a hipaa violation, since patients involved in a situation could be identified via the date events happened and certain specific details.
i understand some do this, and i know i won't be able to persuade the advocates of doing this one way or another. i have worked long enough in the legal field to see how things can get twisted in court and the victim be made to look like the perpetrator or at least tangentially culpable. it's what plaintiffs and insurance companies pay the big bucks for.
example:
attorney: so, what else do you remember about that night 4 years ago?
nurse: i remember that this guy smelled like garlic and was cussing his
wife out on the way to the hospital.
attorney: really? you remember all that?
nurse: yeah.
attorney: you sound like you have a photographic memory. do you remember details like this from all your patients?
nurse: (pick response) 1) just the memorable patients
2) no, i actually write down details from some incidents after the fact if i get a funny feeling about things.
Specializes in Case Mgmt; Mat/Child, Critical Care.
I was advised it was far worse to take something like that home. Even with the names removed it is a HIPAA violation, since patients involved in a situation could be identified via the date events happened and certain specific details.
I understand some do this, and I know I won't be able to persuade the advocates of doing this one way or another. I have worked long enough in the legal field to see how things can get twisted in court and the victim be made to look like the perpetrator or at least tangentially culpable. It's what plaintiffs and insurance companies pay the big bucks for.
My 2 cents.
I'm thinking this would be for your own private use. Not for attornies or for a lawyer to even know you have. It's a way for you to be prepared, something to jog your memory....for your eyes only.
How do you handle cares for patients that are known troublemakers? I have bumped into this recently. Add in the mix any sort of known behavioral problem and it seems 10x worse. Management knows that these people are quick to write up nurses over ridiculous things, but yet they don't seem to step in to politely reorient the patient to reality.
So, the question is, how do you deal with patients like this without compromising your license each day? Part of me wants to say to management "you deal with them then", but of course that would not go over nor ever happen.
Thoughts?
How many nurses do you know that have "lost" their license for anything other than stealing or drugs? Why are nurses so afraid of losing thier license?
Understood. But if you have such information, how likely would it be to let slip that you are referring to it? Then there is the whole issue of discovery.
Attorneys have ways of making this info come out, then making you look bad.
HIPAA is a federal law, nothing I want to mess with. :)
How do you handle cares for patients that are known troublemakers? I have bumped into this recently. Add in the mix any sort of known behavioral problem and it seems 10x worse. Management knows that these people are quick to write up nurses over ridiculous things, but yet they don't seem to step in to politely reorient the patient to reality.
So, the question is, how do you deal with patients like this without compromising your license each day? Part of me wants to say to management "you deal with them then", but of course that would not go over nor ever happen.
Thoughts?
When you have "frequent flyers" that are known troublemakers, it can be a problem. I usually document every request they make and and the outcome of that response.
One pt was on the call bell every 5-10 minutes- "I am too hot or cold. I want some tissues. I want you to pour me a glass of water, etc.
Patient X had the nerve to tell their family that I ignored them all shift and never once came into the room to check on her. Since this was prior to Hippa, I showed the family member my documentation of how often, I was in the pt's room. Case closed. The family member went back to Patient X and confronted them. There was no more complaints from that pt, for the remander of their stay.
Do not enter into arguements or provide remarks that marr your professionalism.
Document objectively the patient/visitor/family behavior as well as your own actions.
No subjective charting.
HIPPA.
AMEN!
I once dealt with a pts son everyone "Knew" was planning on suing. His Mom had been "dropped" on the floor after knee surgery when getting her oob. Since then, she was always given to the agency nurse, or float pool nurse. The DRs wouldn't come when he was here, exacerbating the problem. I took a deep breath, and had a heart to heart with him, telling him everyone was doing the best they could. His initial response was,"I don't think so". I said I was sorry he felt that way, but, I reiterated that NO ONE came to work to injure anyone, and that we all came to work hoping to get our pts better so they could get out of here. I went on to say we are all human beings, caring for human beings and that is the best we can do. I was indeed sorry for what had happened. That calmed him down to where we could have a conversation. ANd eevn when handled well, it is exhausting. Just DON'T take it personally.
i was advised it was far worse to take something like that home. even with the names removed it is a hipaa violation, since patients involved in a situation could be identified via the date events happened and certain specific details.
you don't "take something like that home." you go home and write your own private recollections and lock them away. identifying anyone from my notes would require not only the notes themselves but unfettered access to hospital records for cross reference of dates as well. and to what end? in order to violate hippa, you have to communicate the information and i would not have done so. not even to my own attorney.
example:
attorney: so, what else do you remember about that night 4 years ago?
nurse: i remember that this guy smelled like garlic and was cussing his
wife out on the way to the hospital.
attorney: really? you remember all that?
nurse: yeah.
attorney: you sound like you have a photographic memory. do you remember details like this from all your patients?
nurse: (pick response) 1) just the memorable patients
2) no, i actually write down details from some incidents after the fact if i get a funny feeling about things.
outcome: either way you're screwed
this is not at all the intended purpose.
i'm thinking this would be for your own private use. not for attornies or for a lawyer to even know you have. it's a way for you to be prepared, something to jog your memory....for your eyes only.
exactly. it's not meant to gather ammunition so much as to help you reclaim your hold on the situation at the time. this stuff can come back to haunt you many years later. charts can take weeks to produce and may be incomplete. meanwhile, you have to stew over who and what the suit is about.
i'm not trying to convince you to do it my way. i only want to clarify so that if we differ, you are disagreeing with what i actually am saying. i do understand your concerns, but i don't see that hippa precludes me from looking out for myself in a judicious and careful manner. i would rather take precautionary steps to help myself remember pertinent circumstances years down the road than trust my memory alone.
everyone has to decide for herself which practice she believes to be the greater risk.
I once dealt with a pts son everyone "Knew" was planning on suing. His Mom had been "dropped" on the floor after knee surgery when getting her oob. Since then, she was always given to the agency nurse, or float pool nurse. The DRs wouldn't come when he was here, exacerbating the problem. I took a deep breath, and had a heart to heart with him, telling him everyone was doing the best they could. His initial response was,"I don't think so". I said I was sorry he felt that way, but, I reiterated that NO ONE came to work to injure anyone, and that we all came to work hoping to get our pts better so they could get out of here. I went on to say we are all human beings, caring for human beings and that is the best we can do. I was indeed sorry for what had happened. That calmed him down to where we could have a conversation. ANd eevn when handled well, it is exhausting. Just DON'T take it personally.
You know, this is one of the best ways to deal with crank patients. There are a handful of professional complainants out there, but they are not the norm (and they DO leave a trail that raises questions about their credibility).
For the genuinely disgruntled, if you can find any way to connect on even the tiniest thing, sometimes that is the pinprick that lets all the hot air out of the balloon. Refusing to take things personally, offering compassion to the undeserving, doing something without being asked, making a concerted effort to act as if you like the person--I have seen all of these disarm the cantankerous and get them to put the tug of war rope down. Kindness doesn't always work but contention almost never works.
I can also speak about this from the other side of the bedrail. I was hospitalized twice in ten days earlier this summer. I had a lot on my mind and I felt uncomfortable and just plain out of control. I had several nurses who were good to me even at my crabbiest and, boy, did that put me in my place in a tender-hearted way. After a couple of good crying spells, I thanked them for their patience and started behaving myself.
How do you handle cares for patients that are known troublemakers? I have bumped into this recently. Add in the mix any sort of known behavioral problem and it seems 10x worse. Management knows that these people are quick to write up nurses over ridiculous things, but yet they don't seem to step in to politely reorient the patient to reality.
So, the question is, how do you deal with patients like this without compromising your license each day? Part of me wants to say to management "you deal with them then", but of course that would not go over nor ever happen.
Thoughts?
I like what has been said about the use of certain words like non-compliant, uncooperative - they are so power ladden. The patient has the right to refuse treatment, education, whatever. Nurses seem to think without a shadow of a doubt that what they have to offer a patient is what the patient wants, and they are so vulunerable to our power as if they do not do "as they are told" they may not get better - we did not make them sick nor do we have all the answers, the stroppy ones keep us on our toes and humble enough to realise what a power profession nursing can be
When you have "frequent flyers" that are known troublemakers, it can be a problem. I usually document every request they make and and the outcome of that response.
One pt was on the call bell every 5-10 minutes- "I am too hot or cold. I want some tissues. I want you to pour me a glass of water, etc.
Patient X had the nerve to tell their family that I ignored them all shift and never once came into the room to check on her. Since this was prior to Hippa, I showed the family member my documentation of how often, I was in the pt's room. Case closed. The family member went back to Patient X and confronted them. There was no more complaints from that pt, for the remander of their stay.
As an idealistic first year nursing student, I did see an elderly patient vocalizing her angry feelings of inadequate care and threatening legal actions. She was being very distruptive on our floor that day. This was a very well run floor and there were no credible reasons for her anger (in my humble opinion). The nurses were very professional with her. I was not assigned to this patient, but in some way I wish I had been. From a distance I could see how frightened she was. I could be wrong, and very, very naive - but I felt a heavy dose of handholding was in order or at least an understanding ear. Would it be appropriate to sit by the bedside of this patient and let her vent her concerns? Often I feel that ranting and raving is the only way some people know how to communciate their concerns. Laying in a hospital bed, helpless and powerless can bring out less-than-stellar behavior in some people. Maybe she had experienced a medical mishap in the past and this was her way to try to protect herself. I felt her behavior was masking something else she was unable to communicate and I wish I had the opportunity to help her discover this.
I realize on a busy shift this kind of one-on-one time is probably not possible and psychotherapy is outside the scope of nursing practice. Would it be appropriate to get some kind of counseling for a patient in dire straights from a behavioral specialist, if one is available? Do hospitals have policies for dealing with these situations?
I have often thought about what I would have done if I had been the nurse assigned to the angry patient. As a nursing student I would like to devise a course of action for dealing with patients like this in the future. I would really appreciate hearing more feedback from seasoned nurses who have been successful in these situations. How did you get through to your patients?
hipab4hands post made me think - being mindful of HIPPA, are there other ways of responding to inaccurate accusations of neglect by summarizing (verbally) what has been documented for the frequency and type of care given to the patient and shared with the inquiring/accusing family member - or does this, in itself, violate HIPPA?
Of course, there are many people out there who want to support themselves by suing for anything they can. Many of the other posts suggesting extensive documentation and professional behavior at all times seem like the best way to deal with this.
Specializes in Clinical Research, Outpt Women's Health.
I always use the word "declined" as in the patient declined to be weighed etc... It does not have the same connotations that refused and noncompliant have and it is objective.
Everyone gave a very intelligent advice if i may add first document every incident try to observe how that patient is with family and other health workers. does the patient give other nurses a hard time?Check his background. is the patient educated?Psychologically is the patient fit?What precipitating factor do you think makes the patient act or behave unfavorally,does the patient have a certain medication that might triger a certain behavior.Lastly in whatever situation you might be in may it be good or bad act Professionally and handle everything as a case of "Care". Nurses are always in a case situation.
IMustBeCrazy
439 Posts
i was advised it was far worse to take something like that home. even with the names removed it is a hipaa violation, since patients involved in a situation could be identified via the date events happened and certain specific details.
i understand some do this, and i know i won't be able to persuade the advocates of doing this one way or another. i have worked long enough in the legal field to see how things can get twisted in court and the victim be made to look like the perpetrator or at least tangentially culpable. it's what plaintiffs and insurance companies pay the big bucks for.
example:
attorney: so, what else do you remember about that night 4 years ago?
nurse: i remember that this guy smelled like garlic and was cussing his
wife out on the way to the hospital.
attorney: really? you remember all that?
nurse: yeah.
attorney: you sound like you have a photographic memory. do you remember details like this from all your patients?
nurse: (pick response) 1) just the memorable patients
2) no, i actually write down details from some incidents after the fact if i get a funny feeling about things.
outcome: either way you're screwed
my 2 cents.