How do I refuse to care for a patient

[Lauranurse2007]

I work in an outpatient hemodialysis clinic. Patients come every two days for treatments. There is this one patient who for some reason just doesn’t like me. Now for the record she has some psychological issues and so does her family. But recently she has said things about me that just are not true. Things that just don’t add up. If I did the things she said there would have been a lot of drama going on. Anyway I do not want to take care of her anymore because I feel like she is now just making stuff up just to get me in trouble. I have never had anything like this happen before. Any advice would be great.

[JKL33]

This is not to insult your professional skill/knowledge, but have you tried to really work on a rapport with her? If she has problems then causing trouble may serve any number of her psychological needs or maladaptations. Without knowing how you have handled this problem so far, I would suggest at least trying to completely change your interactions with her. Just try it...greet her, say you're glad to see her, make some small talk, etc. Don't treat her like a baby or be patronizing or any of that, but just see if it's possible to start afresh.

You should also consult your supervisor to try to glean how they might feel about this/what they might do about it/what it means for you as far as they're concerned. If they acknowledge that this woman is troubled and advise you to just care for her the best you can, that is probably adequate (unless she is doing something like accusing you of abuse or another crime or threatening to report you to anyone other than your employer).

If you can't establish a better rapport with her and your employer doesn't solidly and proactively support you (starts counseling you or writing you up based on the patient's complaints and comments)...or if the patient is making threats or allegations that other entities (police, board of nursing, etc.) would be obliged to investigate, I would put my foot down about not being assigned to her care even if it meant looking for a new job.

Hope you can get it straightened out.

PS - I have seen some nurses get really upset about patients who are just making what is essentially harmless noise. They (nurses) get personally offended and/or don't perceive the harmlessness of the situation. Make sure that isn't what you're doing...it just isn't worth it to get worked up over harmless noise. I guess to sum it up: Ascertain whether or not it's harmless noise. If it isn't, you shouldn't tolerate it. But if it is, then let it go and just do your best.

[ruby_jane, BSN, RN]

What does your documentation on these incidents look like?

I am assuming you chart on specifics - what fluid, route, complications, etc. I don't know because I've never worked dialysis!

In school nursing especially when I know I have a parent who is making allegations I will overchart. There's no way to cover everything but documenting that you asked if the patient was in pain or was comfortable (and then anything else about that like....student c/o 10//10 pain, ambulated to clinic in no acute distress, sitting up in chair, declined to rest on cot. Vitals XX, student warm pink and dry in in no actue distress...) Especially if you asked if you could do something and then if the pt accepted declined/and how the pt tolerated what you did.

Good luck...

[DeeAngel]

Just tell your charge you will not accept that particular patient assignment.

[speedynurse, ADN, BSN, RN, EMT-P]

Can you just ask to switch assignments or from some help from another coworker? I think I have only asked that maybe one time in my entire time as a nurse and it wasn’t an issue in my unit.

[explorereb96, ADN, BSN]

Your supervisor would be the first person to talk to. Tell them your problem, accept the assignment so she can bear witness. She may have the patient reassigned to another nurse to see if it's "a patient problem" or "a nurse problem." Difficult patients are often difficult people in real life. I am quite sure that there is a family member that is quite aware of this behavior. If there are multiple witnesses to this behavior, you should be fine.