How to politely tell a patient "do it yourself"

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Let me preface by saying I love my job and I love my patients. I work at a chronic hemodialysis center as a charge nurse. I stay very busy, as I doubt there is any nursing specialty that leaves a nurse twiddling their thumbs. I have many tasks to complete during the day but I am starting to find myself short on time due to taking on what I call "chores" for my patients. Now, I do NOT mind going out of my way for any patient that truly needs my help. But my day gets away from me and I am starting to get behind in my own work because patients (not all of them) are expecting me to do things for them that are quite frankly not my job...and I hate that phrase! Here are

some of the things that able-bodied, able-minded patients have asked me (a floor nurse) to do for them:

1. Make an appt. for them with another md (not even neph) and also call and schedule transportation to get them there. They have transporation to get everywhere else, just apparently not to this md appointment?

2. Call to pharm for refills - only to get on the phone with pharmacist and discover they have 8 refills. When I told the patient, they said "oh I know I have refills, I just wanted you to call to have them filled so they would be ready when I go get them later." So I took time out of my work day to wait on hold for a pharmacist so you wouldn't have to wait for your refill?

3. Request a copy of their birth certificate....?

4. Ask me to call a doctor I don't know or work for to ask for refills on a med they got from an ER doc

5. I will be in gloves and giving a patient medications or doing an assessment and a patient will call me over to them to ask me to throw their trash away for them.

These are just a few things out of many that eat up my time and have absolutely nothing to do with my responsibilities. I always try to be as helpful as possible but now I realize I'm being taken advantage of, and I need some advice...what can I say to these patients to firmly but politely let them know that I am not their maid/personal assistant/mama/etc. and that I am not responsible for handling their day to day errands that they are MORE than capable of handling on their own?

Specializes in Public health program evaluation.

I agree with your stance. We are often socially conditioned to be passive as that is perceived as being part of the profile of a caring person.

We can care without being used, and we can refuse requests without being apologetic.

I think I will need more practice at it to be honest, but I'm glad I read this thread.

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Specializes in Med-Tele; ED; ICU.
I agree with your stance. We are often socially conditioned to be passive as that is perceived as being part of the profile of a caring person.

We can care without being used, and we can refuse requests without being apologetic.

I think I will need more practice at it to be honest, but I'm glad I read this thread.

And you needn't provide a justification for refusing an inappropriate request for services. A polite refusal is sufficient. Providing a justification leaves the door open for negotiation or debate about the justification.
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Specializes in M/S, Pulmonary, Travel, Homecare, Psych..

Be brutally annoying about it.

1. Make an appt. for them with another md (not even neph) and also call and schedule transportation to get them there. They have transporation to get everywhere else, just apparently not to this md appointment?

(Face should look excited yet serious at the same time) Oh, I drive for Uber! I can't set up trans for you but I'll take you there. Usual fee of course, Uber doesn't allow bargaining. We don't need an appointment, I'll get you there in time to just be a walk-in. I do though have to keep the meter running during the appointment. Unless you want to set up someone picking you up to save some money.

2. Call to pharm for refills - only to get on the phone with pharmacist and discover they have 8 refills. When I told the patient, they said "oh I know I have refills, I just wanted you to call to have them filled so they would be ready when I go get them later." So I took time out of my work day to wait on hold for a pharmacist so you wouldn't have to wait for your refill?

(Tilt head left to right as you speak) Oh my god, your pharmacy does that? That's so cool, refills over the phone. Have you ever tried it? What is it like? Can you show me how?

3. Request a copy of their birth certificate....?

(Same head tilting) Whoa! You have a birth certificate!? Where'd you get that? I lost mine when I was like, five. Actually, mom tells me I kinda ate it but, she fibs sometimes, she's in recovery now though so not as much. I tried to get a new one but they kept sending me some other guy's cert. I ordered it three times, never got the right one so I gave up.

4. Ask me to call a doctor I don't know or work for to ask for refills on a med they got from an ER doc

(Look excited like you just saw a friend who you've not seen in years) I totally know this doctor. He's so cool. One time, I called him about this patient who was like (roll eyes and stretch the words out long) sooooo annnoying. We gave him bisacodyl (giggle a lot) and told him it was his pain meds. Oh gee, I wish he had only taken one.

5. I will be in gloves and giving a patient medications or doing an assessment and a patient will call me over to them to ask me to throw their trash away for them.

(Just look clueless, walk over to pt with visibly dirty gloves on, remove them, hold in front of patient's face) Here, hold these while I get that for you.

They'll never go overboard asking for help again. Or you'll be fired. Either way, problem solved.

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Specializes in Hospital medicine; NP precepting; staff education.
Be brutally annoying about it.

1. Make an appt. for them with another md (not even neph) and also call and schedule transportation to get them there. They have transporation to get everywhere else, just apparently not to this md appointment?

(Face should look excited yet serious at the same time) Oh, I drive for Uber! I can't set up trans for you but I'll take you there. Usual fee of course, Uber doesn't allow bargaining. We don't need an appointment, I'll get you there in time to just be a walk-in. I do though have to keep the meter running during the appointment. Unless you want to set up someone picking you up to save some money.

2. Call to pharm for refills - only to get on the phone with pharmacist and discover they have 8 refills. When I told the patient, they said "oh I know I have refills, I just wanted you to call to have them filled so they would be ready when I go get them later." So I took time out of my work day to wait on hold for a pharmacist so you wouldn't have to wait for your refill?

(Tilt head left to right as you speak) Oh my god, your pharmacy does that? That's so cool, refills over the phone. Have you ever tried it? What is it like? Can you show me how?

3. Request a copy of their birth certificate....?

(Same head tilting) Whoa! You have a birth certificate!? Where'd you get that? I lost mine when I was like, five. Actually, mom tells me I kinda ate it but, she fibs sometimes, she's in recovery now though so not as much. I tried to get a new one but they kept sending me some other guy's cert. I ordered it three times, never got the right one so I gave up.

4. Ask me to call a doctor I don't know or work for to ask for refills on a med they got from an ER doc

(Look excited like you just saw a friend who you've not seen in years) I totally know this doctor. He's so cool. One time, I called him about this patient who was like (roll eyes and stretch the words out long) sooooo annnoying. We gave him bisacodyl (giggle a lot) and told him it was his pain meds. Oh gee, I wish he had only taken one.

5. I will be in gloves and giving a patient medications or doing an assessment and a patient will call me over to them to ask me to throw their trash away for them.

(Just look clueless, walk over to pt with visibly dirty gloves on, remove them, hold in front of patient's face) Here, hold these while I get that for you.

They'll never go overboard asking for help again. Or you'll be fired. Either way, problem solved.

I love passive aggressive.

I have a few but the subject (person) of one I'm itching to tell comes to this site and I'd rather she not know this is me.

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Specializes in M/S, Pulmonary, Travel, Homecare, Psych..
I love passive aggressive.

I have a few but the subject (person) of one I'm itching to tell comes to this site and I'd rather she not know this is me.

(Mindlessly picks nose while talking) Oh my god, but if they knew you could totally have lunch and everything. Their treat of course cause (rolls eyes and stretches words out long) they are soooo the annnoying one.

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Specializes in Med Surg/ Pedi, OR.

I would say oh it is simple...... Just do X, Y and Z.... I would do it for you but I have so many other people to help.

Trust if you make a mistake they will blame you.....

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The trick is to act like you think they are asking you to do something that they think they aren't allowed to do themselves.

1. In a cheerful helpful voice say, "Oh, you can do that for yourself! That way you can set up the appointment at a time convenient to you!"

2. Again, "Oh, you can do that for yourself!" (Assume that they don't know that they can call ahead for a refill. You are just teaching them and empowering them. ) Most pharmacies have refill phone lines and allow patients to request refills on the web.

3. "Oh, I'm sure the state wouldn't let me request someone else's birth certificate. They are really concerned about identity theft now. " (You are just protecting them.)

4. "Oh, you can do that for yourself! . I'm sure your Dr will have questions about your ER visit that I wouldn't know."

5. "Oh, you can do that for yourself! The trash can is right over there." (Assume that the patient is asking, because they don't know where the trash can is. You are being helpful.)

Assuming the trash can is in reach of the pt and visible, uh, need I say more? Is the pt afraid to move around? Reassure him.

Be nice, not condescending, and do teach them the above. They likely have a cell phone and it likely can be used from your place of work. Or they might even have a tablet or some similar device. Just let them know that they have options other than you.

You have to look out for your time. Don't feel guilty that you aren't everyone's personal secretary or Girl Friday. I used to be the same way, so don't feel too badly. If you had extra time, you could help them with personal matters, although it's usually best for the pt to foster his or her self-reliance.

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Specializes in Home Health, Mental/Behavioral Health.
My wife worked at a HD clinic, hats off to you, she couldn't do it, too grueling. Knowing your schedule, I would say that making those calls is out of your scope of practice. They are sitting there for hours, can they not make these calls while they are under treatment?

Yes they can! My dad has been a hemodialysis patient for 3 yrs now and gets a lot of his phone calls/business taken care of in this time he has to sit there.

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:roflmao: :lol2:

This thread is hilarious. That's a lot of snark! While it is funny, not many of the responses are actually appropriate.

The key to this is to maintain a professional attitude. Smile, be polite, but be firm. Nice is not the same thing as passive. Look up therapeutic communication techniques.

And, by golly, don't apologize. You aren't doing anything wrong. The first time you say, "I'm sorry," you're validating their perception that you just don't want to help them. Being obsequious always backfires.

1. Make an appt. for them with another md (not even neph) and also call and schedule transportation to get them there.

Hand them a phone. "Here you go. Do you need something to write on?" Move along.

2. Call to pharm for refills -

"Have you called the pharmacist yet?" When they say no, then "Go ahead and call them. They can contact us if there's a problem." Move along.

3. Request a copy of their birth certificate....?

"You'll need to contact the appropriate people in the state where you were born." Move along.

4. Ask me to call a doctor I don't know or work for to ask for refills on a med they got from an ER doc

"If you aren't able to call the doctor yourself, you'll need to do that through your primary care provider." Move... you get the drift.

5. I will be in gloves and giving a patient medications or doing an assessment and a patient will call me over to them to ask me to throw their trash away for them.

Point at the trash can.

Dialysis patients often have family members who cater to their every need. You need to teach them by treating them like a perfectly able person that they ARE able. Just because they're hooked up to a dialysis machine doesn't mean the rest of their body doesn't work. There's no need to be rude or huffy, or even passive aggressive. Just treat them like they are patients.

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Specializes in Case Manager/Administrator.

Wow you all seem like such great nurses, I on the other hand seem like I am an old bat who makes people do for themselves. My background is geriatric and correctional nursing.

In the skilled nursing facility and correctional setting when residents/patients ask me to do things for them when they clearly can do for themselves... I say, I would really like you to do that yourself. You do not get a lot of exercise and anything you can do for your self will only benefit you. I do not baby them, I make them push themselves in their wheel chairs walking beside them (this does take longer for me) it is no easy situation for me to be in when I can just push them down to supper in less than 2 minutes or take 10 minutes and walk beside them while they push. The other nurses who work shifts after me always ask me what I do because my patients are tired and just sleep for them.

I took care of my Aunt who I inherited (came to live with us) she had contractures in legs and arms. I would make her kick bubbles and balloons each day for exercise. One day she was so made at me she did not want to kick the balloon, I said fine you can stay all curled up even more until you look like a big ball of yarn...she got so upset with me she started kicking the balloon harder. We both laughed at that later.

As a nurse I always make my patients work hard to be self sufficient. This really takes more time however I have found it to be very beneficial for me as a nurse, in that is makes me slow down and spend more time with my patients. In return I have develop some really great trust with my patients who really after they get to know me work hard at providing for themselves, I treat them not like a baby but as an adult. Not all like this but for the most part people rise to the occasion in how you expect them to behave. I would want this for myself as well.

No coddling here just plain old do it your self attitude. Works for me.

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Many people here are saying don't make excuses or apologize just take a firm approach. I've tried that and the problem in my experience is that the TYPE of person who asks you to 'itch their nose' is the type that complains about how terrible you are if you refuse and especially if you're firm with them. Even if you take the "I"m so sorry but I can't because xyz..." they still get mad at you for being a terrible nurse or something and heaven forbid you don't give a reason they say "but why" the last nurse did it. I'm still working on my approach that's firm but doesn't send them into a tailspin, have gotten better but it's an art.

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I have, on a few occasions, when a patient starts demanding the most ridiculous assistance asked them "what nursing home do you prefer because I'm concerned if you can't do (insert simple task) here you won't be able to do it at home and we can't discharge you if you won't be safe." The trick is to maintain a look of deep concern and sincerity. I've seen absolute miracles happen many times over. :up:

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