I'm a new nurse and have found it hard to turn down or say no to some patient requests even when I'm too busy, frustrated, or creeped out to do it. A few examples:
--It was close to Christmas time, and one of my patient's family members was trying to decorate the patient's room and wanted me to help her. That would be fun and all if I didn't have any other patients or a million other priorities, but I didn't really know how to say that nicely. When I tried to help her, she sat back and started commanding me how to decorate. "Untangle those lights...wow, you went to school for how many years and you are having trouble untangling that string of lights? () Hang those decorations on the tree but make sure they are spaced out well...No, no, that's no good, do it like this/like that." I felt like just walking out of the room and getting to my truly important tasks. Of course, I didn't...
--Another example: There was a patient (not my patient) who needed help to the bathroom. I was alone at the nurse's station, so I ran over and helped him out of bed, to the bathroom, and back to bed. That's fine, except when I was leaving, he asked me to massage his neck. I needed to get back to the nurses' station to watch the phones and call lights, but I thought "What the heck, 10 seconds won't hurt". But when I tried to stop and leave the room, he told me not to stop and to keep massaging his neck and to also start massaging his head. I was a little creeped out, but I didn't really want to say that, so I did it for several minutes. Later that night, I went to the room for some reason, and he asked for another massage. He already had me in the room, so I felt bad just leaving, so there I was giving him another long neck and head massage. He wouldn't ask anyone else for massages, just me. I was really creeped out by then and tried to avoid walking by that room.
--My patient wanted me to hand her her purse so she could get something out of it. I gave it to her and asked if there was anything else I could do for her before leaving. She wanted me to stay in the room and wait while she looked through her purse. So I stood there while she went through everything till she finally found what she wanted. I didn't see the point of this since it's not like she wanted me to put her purse away when she was done. She just wanted me to stand there. She did this several times throughout the night. I grew more and more frustrated and eventually asked if there was something she needed help finding. Nope...no reason for me to stand there as she looked through her purse. But didn't really know how to say "Yeeeah I've got stuff to do. Bye."
All of these were young, capable people.
Yeah yeah, I need a backbone. So, how do y'all handle similar situations at work?
It's all about following policy, setting limits, and being firm but polite when people become a little overly demanding. I would have told the lights lady that maintenance would have to come in and approve those decorations (which in most hospitals, is usually the policy). And if she was making snide comments while I was helping I would have said, "well you seem to have a better idea of what you want, so I think it would be better if you placed them" and left the room saying "I'll check back in later." As for the massage guy...I would have said I am not licensed to give massages and if I hurt him or made him worse (which can happen if you massage incorrectly) I could be liable. Then I would offer pain medication, heating pad, or to reposition him. As for the purse, I would have been upfront and just explained that I had other patients to round on and would check back in. It's hard to say no at first...when I first started I thought if I said no it would make me a bad nurse or I would somehow get written up. It's important to set limits though because some patients do think you are there to SERVE them. I have actually had a patient's daughter tell on me because I would not stay in the room and give a foot massage to their mom, I put venous flow foot pumps on her instead. The daughter complained because 15 minutes later she came out to the nurse's station and saw me "playing on the computer", when in reality I was trying to chart. My supervisor came to my rescue and told her that with 9 patients she was surprised I managed to put the foot pumps on her so fast. And then she asked the daughter why she could not do a foot massage for HER mother if she was going to stay the night...that shut her up!
It's all about following policy, setting limits, and being firm but polite when people become a little overly demanding. I would have told the lights lady that maintenance would have to come in and approve those decorations (which in most hospitals, is usually the policy). And if she was making snide comments while I was helping I would have said, "well you seem to have a better idea of what you want, so I think it would be better if you placed them" and left the room saying "I'll check back in later." As for the massage guy...I would have said I am not licensed to give massages and if I hurt him or made him worse (which can happen if you massage incorrectly) I could be liable. Then I would offer pain medication, heating pad, or to reposition him. As for the purse, I would have been upfront and just explained that I had other patients to round on and would check back in. It's hard to say no at first...when I first started I thought if I said no it would make me a bad nurse or I would somehow get written up. It's important to set limits though because some patients do think you are there to SERVE them. I have actually had a patient's daughter tell on me because I would not stay in the room and give a foot massage to their mom, I put venous flow foot pumps on her instead. The daughter complained because 15 minutes later she came out to the nurse's station and saw me "playing on the computer", when in reality I was trying to chart. My supervisor came to my rescue and told her that with 9 patients she was surprised I managed to put the foot pumps on her so fast. And then she asked the daughter why she could not do a foot massage for HER mother if she was going to stay the night...that shut her up!
"I'm sorry, I cannot accomodate that request at this time. I have other medical priorities to attend to".
It's cold and robot-like but saved for the really demanding.
To the run of the mill ME-type - Just say with a smile:
"I'm sorry, I can't do that at this time, I'm very busy and have to see my other 5 patients. Is there anything medically necessary that you need at this time? If not, I'll check back on you with my regular rounds".
It's true that it is all about boundaries. It can be hard to set them early in your career but it is imperative that you learn to do it. It's not mean to tell them you have other patients to care for. That's the truth. Don't feel bad for prioritizing and doing your job. While it might be fun to decorate a tree that isn't your job or priority with other patients in need.
"I'd love to but other patients need care right now. I'll be back in a bit."
Specializes in Psychiatry, corrections, long-term care..
As for the massage guy...I would have said I am not licensed to give massages and if I hurt him or made him worse (which can happen if you massage incorrectly) I could be liable.
I've said that before and essentially have been told I'm full of **** by patients and coworkers. I honestly believe that I'm not licensed though and I don't want to be liable for anything outside of my scope of practice. Anybody else dealt with this before?
I've said that before and essentially have been told I'm full of **** by patients and coworkers. I honestly believe that I'm not licensed though and I don't want to be liable for anything outside of my scope of practice. Anybody else dealt with this before?
Um... rubbing a patient's back used to be part of what we called AM and PM care, and it was expected that nurses would do it. (Different era. Hell, different century!) But it is not out of your scope of practice. You were being ironic, right?
When a patient or a family is being that manipulative, there is a reason for it. It is a symptom. Believe it or not, this is part of your assessment. You have to formulate a hypothesis about why this is going on, understand how it works against the patient, set your nursing goal... a realistic re-formation of some part of the behavior... and put together a nursing plan and implement it.
Your professionalism requires that you don't get sucked in to maladaptive, manipulative behavior, but do your professional best to "fix" it to the degree that you can. (And collaborate with other nurses to develop and carry out your plan.)
This is not about getting out of a room or avoiding unpleasant contacts with demanding patients. It's a bout thinking and acting like a nurse. See it in that light and stop feeling guilty.
um... rubbing a patient's back used to be part of what we called am and pm care, and it was expected that nurses would do it. (different era. hell, different century!) but it is not out of your scope of practice. you were being ironic, right?
[/b]to me, big difference betw offering massage as am/pm care, vs a male pt requesting it...in continued form.
and, not only is it "different era and different century", often it comes down to different intentions, i.e., typically male pt requesting it, r/t plain, old horniness...
contrasted with nurse giving it to relax pt.
and it doesn't matter, creepy is creepy whether i'm a nurse or not.[/b]
when a patient or a family is being that manipulative, there is a reason for it. it is a symptom. believe it or not, this is part of your assessment. you have to formulate a hypothesis about why this is going on, understand how it works against the patient, set your nursing goal... a realistic re-formation of some part of the behavior... and put together a nursing plan and implement it.
i'll agree with that...in this case i suspect this lady wanted her to standby in event she couldn't find what she needed in her purse.
that way, pt could further direct nurse to look where pt directed.
but yeah, many pt requests have underlying and unspoken fears, anxieties, etc.
your professionalism requires that you don't get sucked in to maladaptive, manipulative behavior, but do your professional best to "fix" it to the degree that you can. (and collaborate with other nurses to develop and carry out your plan.)
yes...which takes progressive experience and confidence.
this is not about getting out of a room or avoiding unpleasant contacts with demanding patients. it's about thinking and acting like a nurse. see it in that light and stop feeling guilty.
this is where we differ, i think.
being 'me' vs being a 'nurse', are not oppositional or unique.
it is me (meaning, it's me, who is a nurse) who is scheming to avoid discord.
they are not separate.
thinking like a 'nurse', would pretty much mean identifying pt's underlying needs and planning accordingly...
which is very similar to what you posted about, "when a pt or a family is being manipulative...".
which, as i stated, takes experience and confidence.
and even then, the most experienced among us, still gets the urge to run or avoid.
re topic at hand, if i get a frivolous request, i'll respond to effect...
"oh my gosh, i would so love to, but time constraints and critically sick pts don't allow me...
however, i'll put it on my christmas list this year.
iow, i feign enthusiasm and regret simultaneously...it works for me.
(of course, i'm responding to a dying pt, so i'll always honor their requests...just not at that moment.
Specializes in Cardiac care/Ortho/LTC/Education/Psych.
Just give a quick "Sorry but I have to get a patient off the bedpan". Works every time.
Try to avoid what I recently did when a patient asked for a massage. I couldn't help it ,I burst out laughing.
I will ask the question we should never ask " but why"?Massage is part of our care, yes, we can not give it all time , and yes, we are busy but massage is GOOD!!
I am not saying that having boundaries (and I DO HAVE after years of working) is bad, seeing massage request as funny makes me sad. It is a human touch that calms babies, it is a human touch that calms us.
Specializes in Psychiatry, corrections, long-term care..
Um... rubbing a patient's back used to be part of what we called AM and PM care, and it was expected that nurses would do it. (Different era. Hell, different century!) But it is not out of your scope of practice. You were being ironic, right?
I work in a very busy facility (on the glorified psych unit, no less) and I rarely have time to have an adequate break, let alone give someone a massage. And with the way some families seem to be these days, I don't feel comfortable having that kind of contact with a patient because there have been incidents at my facility where spouses have gotten upset at the notion of their loved one receiving a massage from an aide or nurse.
So, no, I wasn't being ironic. I'm not trained as a massage therapist (though we have one that families pay to come in and see the residents, which is wonderful), neither I nor some families feel comfortable with the notion, and I simply do not have the uninterrupted time to do so. I'd rather all my patients be well taken care of, than just have a few be "extra" taken care of with a massage and the others just "so-so".
Call me cold or uncaring, but that's just the way things are in this day and age (as you noted).
When I'm turning pts who are incontinent or who for whatever reason have compromised skin integrity, I rub their backs with lotion just enough to rub in the lotion… that's as far as it goes, unless I see fit otherwise.
I've said that before and essentially have been told I'm full of **** by patients and coworkers. I honestly believe that I'm not licensed though and I don't want to be liable for anything outside of my scope of practice. Anybody else dealt with this before?
Yes & I could care less what the patients or co-workers say when it comes to massage. The days of randomly rubbing people are over, its not a greed factor but massage is a separate discipline with an endless amount of modules within itself. It is indeed outside of our scope of practice massage if we are LPNs or RNs unless we have taken additional courses. I know for sure because my mother is an LMT. There are nurse massage therapists but I'm not one of them. If you were to massage someone with uncontrollabe HTN or a hx of blood clots you could could indeed be held lible if something went wrong or they threw a PE because you dislodged a clot with a little foot rub. I know for a fact that the place my mom works at does not accept walk-ins, if the person isn' referred by a physician who has given medical clearance they won't work on them. Even then the patients are distributed to different LMTs based on their physical ailments. A fibromyalgia patient would not be able to tolerate a therapist who was trained in Trager or Swedish deep tissue.
Specializes in Psychiatry, corrections, long-term care..
Yes & I could care less what the patients or co-workers say when it comes to massage. The days of randomly rubbing people are over, its not a greed factor but massage is a separate discipline with an endless amount of modules within itself. It is indeed outside of our scope of practice massage if we are LPNs or RNs unless we have taken additional courses. I know for sure because my mother is an LMT. There are nurse massage therapists but I'm not one of them. If you were to massage someone with uncontrollabe HTN or a hx of blood clots you could could indeed be held lible if something went wrong or they threw a PE because you dislodged a clot with a little foot rub. I know for a fact that the place my mom works at does not accept walk-ins, if the person isn' referred by a physician who has given medical clearance they won't work on them. Even then the patients are distributed to different LMTs based on their physical ailments. A fibromyalgia patient would not be able to tolerate a therapist who was trained in Trager or Swedish deep tissue.
Which was exactly my thinking on the subject! I work in a subacute facility and we have patients with multiple problems that I am not yet capable of understanding fully. If I did something to harm them unintentionally, not only would I feel bad, but boy oh boy would I have a hell of a time finding another job of the same quality here.
) Hang those decorations on the tree but make sure they are spaced out well...No, no, that's no good, do it like this/like that." I felt like just walking out of the room and getting to my truly important tasks. Of course, I didn't... 
GARN912
16 Posts
It's all about following policy, setting limits, and being firm but polite when people become a little overly demanding. I would have told the lights lady that maintenance would have to come in and approve those decorations (which in most hospitals, is usually the policy). And if she was making snide comments while I was helping I would have said, "well you seem to have a better idea of what you want, so I think it would be better if you placed them" and left the room saying "I'll check back in later." As for the massage guy...I would have said I am not licensed to give massages and if I hurt him or made him worse (which can happen if you massage incorrectly) I could be liable. Then I would offer pain medication, heating pad, or to reposition him. As for the purse, I would have been upfront and just explained that I had other patients to round on and would check back in. It's hard to say no at first...when I first started I thought if I said no it would make me a bad nurse or I would somehow get written up. It's important to set limits though because some patients do think you are there to SERVE them. I have actually had a patient's daughter tell on me because I would not stay in the room and give a foot massage to their mom, I put venous flow foot pumps on her instead. The daughter complained because 15 minutes later she came out to the nurse's station and saw me "playing on the computer", when in reality I was trying to chart. My supervisor came to my rescue and told her that with 9 patients she was surprised I managed to put the foot pumps on her so fast. And then she asked the daughter why she could not do a foot massage for HER mother if she was going to stay the night...that shut her up!