How to deal with a patient’s rude remarks?

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I am a home health nurse and work with a 22 year old female patient who is a ventilator-dependent quadriplegic.

There is a ton of work which must be done during my 10 hour shift. The problem I’m having is she expects me to stand next to her bed for my entire shift while she tells me “open my phone. Open Instagram. Scroll down. Down. Tap her name. Tap on following. Tap the first girl. Block her. Back to new feed. scroll. Scroll. Go back” FOR HOURS. She will interrupt me in the middle of a procedure so she can look at her own Instagram profile for the millionth time.

I have tried introducing her to Apple’s voice control accessibility, it does not recognize her voice d/t her trach. I have tried suggesting eye-gaze technology and she said she tried it and did not like it “it’s easier if you just do it for me”. I have tried telling her nicely “I’m sorry I won’t be able to do your iPhone/iPad for you since I’m going to be doing this procedure and it’s important that I keep my hands clean” she doesn’t listen and interrupts me 3 minutes later. Sometimes, I give in and stand by her and control her phone for her, and I’m sorry, but I just don’t look excited while doing it. Other times, I don’t indulge her and reinforce that I have work to do and ignore her subsequent requests. Its a mix of both, I never spend an entire shift ignoring her. But I’ll admit, standing by her to control her phone... it’s frustrating, it’s absolutely demeaning, and it is not promoting independence where it could otherwise exist.

Her other nurses all enable this behavior and sit by her bed for hours and scroll on her phone endlessly. Since I don’t give in to her requests all the time/don’t look happy when doing so, she does not like me. She has taken to making comments about me in front of my face to the aide (she comes for a 3 hour block during my shift). She’ll say things such as “did you smell it??” “Thank god only one hour left (with me)” and “bye! (to the aide) I’ll miss you SO much. Don’t worry. I’ll be okay with you know who”.

How should I deal with this situation? It’s clear to me that this patient is never told “no” if I don’t give in and be her phone monkey I’ll just be the “mean nurse” forever. I’m thinking I may just quit and move on to a more appropriate job because honestly, this is not what I went to nursing school for.

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Specializes in Pediatric Hematology/Oncology RN.

Tbh and Im sorry to say this but you cant just say because you dont like helping her do something she cannot do, it means its a toxic behavior that other nurses are enabling.

You dont like doing it for her, cant find a way to communicate to her when you have to do procedures (that is a part of your job as a nurse).... You need to just get another case.

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Pffff.

Quit this case.

No way.

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7 minutes ago, Nurse.Kelsey said:

Tbh and Im sorry to say this but you cant just say because you dont like helping her do something she cannot do, it means its a toxic behavior that other nurses are enabling.

You dont like doing it for her, cant find a way to communicate to her when you have to do procedures (that is a part of your job as a nurse).... You need to just get another case.

Thank you for your reply. I will definitely be looking for a patient who is a better match.

I just want to say though, realistically challenging a patient is not “TOXIC”. How many patients are excited for pt immediately after surgery?

Controlling her own phone is something she CAN do

Take a look at Apple’s new voice control (different from Siri) feature, or even Dragon dictation. These are attainable for this patient with the help of speech therapy. She has expressed desire to go to college and I see these suggestions as tools which will enable her to reach her goals. The nurses will not be able to write an essay for her one word at a time while there’s so many other tasks to complete.

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31 minutes ago, Nurse.Kelsey said:

Tbh and Im sorry to say this but you cant just say because you dont like helping her do something she cannot do, it means its a toxic behavior that other nurses are enabling.

Arguably true but way beside the point. There is nothing about this that is a nursing duty. Does the patient need care that must be provided by a nurse, or not? If so, that is what the nurse is primarily there to do (not that we all don't do thousands of little things that a lay person can do....but we certainly aren't focused on only those things or commanded by patients to neglect our other duties so that we can do things lay people can do).

I don't care as much about whether they are enabling toxic behavior...but for sure you can bet that the company is not being reimbursed for nursing level care so that RNs can sit there and do that for hours.

With regard to the toxic behavior aspect. I do believe that therapeutic nursing could be employed in this situation, for example having therapeutic conversations with the patient, encouraging her independence where possible and all of that...BUT (and it is a hugggge "but") -- is there support for that these days? I no longer see much evidence that it is supported.

This patient doesn't like that this nurse is trying to attend to her other duties and therefore cannot constantly scroll social media as the patient commands her to do.

This is a dangerous situation for the nurse. Right now the patient is "just" making mean and rude comments. If this nurse continues to do what she believes is professionally correct, this patient is very likely to up the ante.

ETA: It isn't the activity itself that is the problem, AT ALL. It is the manipulation and attempted triangulation.

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Just. Leave. The. Case.

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This is a bad situation for both of you. I think you should make both of you happier and find another job ASAP.

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Can you arrange a compromise? Tell her what procedures you need to do for her and about how long each will take. Make a schedule with her.

It sounds like you are on the busiest shift, so maybe the other nurses do have more time to help her with her social life.

Her social life is extremely important, of course. Probably just as vital as doing all of the physical care a quad needs. Do you agree, OP?

Picture yourself completely dependent on a nurse who seems to disrespect and neglect her need for social interaction. It's an ugly, ugly situation. You wouldn't like it any better than she does.

Put the pt's needs first, as you believe you are doing. But she is only going to dislike you more and more if you don't start finding a way to meet her phone usage needs.

If you can get another case, it might be best for you and for her.

The technology you recommend for her - can she afford it? Who will pay for it? Who will arrange for her to get it? Can the Speech therapist or whoever give her a demonstration of it? Is there a youtube video that can show her about it?

Please try to remember the severe limitations she has to live with for the next 50 years or so. I honestly don't blame her for being upset with you, even if she doesn't see life from your point of view now.

I wish you the best.

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Specializes in ER.

I suggest committing to phone scrolling for a particular time, and the patient agrees to cooperate with your procedures during particular times. Once all the work is done, you can both sit and scroll as much as she likes, but the treatments come first.

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Specializes in IMCU.

When not involved in procedures etc I’d help her out. During procedures I’d simply say something like “of course I’ll help with that, when we are finished with this”. I’ve had inpatients freaking out about their phone and how I need to charge it, dig in their belongings to locate it, and so on.
I just politely agreed to do so after whatever care they need (hang antibiotic, finish dressing change etc.) which takes priority.

They’re usually ok with it.

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