Published Jun 8, 2009
So we all know the type of patient who is constantly on the call light, constantly wants pain meds (and has them available every hour), or one of her other large variety of prn medications, or just wants some random thing, and calls you and the CNA constantly (and calls the nurse when the CNA doesn't get the item fast enough), monopolizing both of your time. What is the best way to tactfully handle these types of patients so they don't interfere with your other patients' care? Anyone have some good tips to share?
eriksoln, BSN, RN
I've had a lot of these. Best is when you get 2 or 3 or them at the same time. Or even worse, they are room mates.
I assess their "health" first, see if they are in any acute danger or not. If they are not, I put their requests where they belong on the priority list and get to it if I can. Not going to make someone else wait for a direly needed breathing treatment so I can arrange someone's pillows for the third time in half an hour. Just isnt fair to the other pt.
I guess thats all I can do. Make sure they dont "monopolize" my time, make sure I get to the other patients too.
Had a manager tell me once awhile ago while I was a travel nurse:
"Dont waste your time making one person happy when it will make 4 or 5 other patients unhappy. When someone just cant get enough and is never going to be satisfied, just let'em be angry. We will absord the poor PG scores, but make sure the other 4 or 5 are happy as can be to deflect it."
Makes sense to me.
I agree. When I worked step-down, we always had these types of patients. Sorry but they are going to have to wait their turn when there is something more critical going on. ABC then everything else.
I Like that ... A darn good point. :)
An experienced nurse that I worked with at one time actually gave that difficult patient his 10 mg of IV nubain that was ordered, and when he was knocked out actually went in to his room every hour, woke the pt up, and asked if he needed anything. She did this about three times, and the patient did not use his call light the rest of his stay, unless he really needed something.
I'm a CNA, not a nurse, and this probably wouldn't work for people with pain med issues...but as far as people who are constantly on their call light; when I was working on a general medical floor I would tell people "I am going to (check on other patients, pass lunch trays, whatever) and I will be back in x minutes. Is there anything you need before then?" or say "Your pain med is for every 2 hrs, want me to write the time you can have it next on your white board?" for the people who would either forget when they could have it next or think you told them otherwise. Not much help but maybe a little?
Sometimes, depending on the time of day, you can offer distractions. You can give them a puzzle to do or let them visit with another resident (im assuming this is occurring in a LTC facility.) If none of this is possible I agree with others, let them know there is one of you and X amount of other people that you also have to take care of. I used to tell my patients that sometimes its about priority...
Ooh, that's cold!
(I love it )
I love my cat!
Oh boy, do I know about the call light addicts. Ugh.
Now, the individuals calling for pain meds brings up an interesting point. I truly feel that many, many patients are undermedicated for their pain issues. This leads to clock watching and being on the call light non-stop checking for their next dose. I truly believe that if patients are medicated appropriately (meaning the MD writes orders for a PCA w/ a sliding scale + other pain meds/sedatives for break through pain) patients would be on the call light a lot less often.
Patients get scared.
They are in pain.
They are worried that their meds will be forgotten or late and using the call light like a Jeopardy! answer button, they are easing their anxiety r/t to their pain issues.
Virgo_RN, BSN, RN
One strategy I use is to be proactive and pop my head in when their call light is NOT on. Maybe I'm on my way to do something non-urgent, or maybe I have a free moment, or I'm going to the blanket warmer/pantry/Pyxis anyway, and I might as well consolidate trips. If I know someone is clock-watching, I'll make every effort to get there BEFORE they ring for their med. It only takes a few minutes to give someone a pain pill, and usually I can budget that time out for that. The only problem comes when something comes up and I am not able to get there at eight o clock (or whatever time) on the dot because I'm involved in something that takes a higher priority. I've found though, that people are generally pretty forgiving of that if I've already established a pattern of being reliable and established a friendly rapport with them as well.
Sometimes, there's not much you can do. Some people are just plain needy and all you can do is do your best and let them be upset if they want to.
I set limits. Politely.
RheatherN, ASN, RN, EMT-P
I have acutally just explained to the pt what my day is like, and what my flow is and tell them that i make it a point to stop in as much as possible. with what the cna said above, i do this often- with pain meds or other meds they may possible worry about i will write the next dose on their white board. i will explain many other techniques of relaxation and that if we are in there consistenly, that they will have more pain because we are moving them, or re-adjusting them only can cause more issues. i try and convince them to try a position for a while, possibly til next pain med due. then i will write on my sheet and make sure i am in there.
and like someone else said, i go in there before they even have the chance to call.
and i LOVE the idea of waking someone up!!! i am going ot have to do that for my next narc'er.
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