16 Ice creams

[Birdy2]

I haven't been on here in a while, but today I just have to share the experience I have had as a nurse this week. I work on a med-surg floor at a small hospital with 29 patients on the floor. We usually have 5-6 nurses, but often have had 4 and even 3 occasionally.

We are the floor you dump all the miscellaneous crap on, which often includes your chf'ers, copd'ers, gib's, dialysis patients, surgery patients, Alzheimer's, and just about anything you can think of. Not to mention all the people who were brought from the local mental hospitals or rehab centers who are just absolutely nuts.

I was told when I was hired by the staff and my boss that it was a very challenging floor and that I would learn a lot, but be very stressed. Well she wasn't lying. It's practically like an ICU sometimes with how critical my patients are and I don't just have 2. I have 6 and that's being in charge on night shift. Anyways, let me tell you about the patient who has sucked the life right out of me within 12 hours of taking care of her. I had a better night the time my first patient died sudden and unexpectedly after s 55 minute code.

This is a 41 yo female who is a frequent flyer and usually comes in with abd pain, diarrhea, and N/V. She has been denied at 5 different hospitals for accusing male nurses of sexually assaulting her and reported at least 4 doctors for not giving her the pain medicine she demands and the diagnostic tests she believes she needs. She comes I with different names all the time. She states she has had cdiff for 5 years and treatment doesn't work. And she thinks she has SMA, but we're just not properly diagnosing her and not doing the right tests.

So my night started with a call that lasted 7 minutes. She first explained how unprofessional we were when answering the call light and stated that several people have hung up on her. Then she went on to say her scheduled pain meds were due 30 minutes ago, followed by requests for 5 ice creams and 3 apple juices, and many other questions about tests, pain meds, diet, how pretty much everyone has mistreated her. I was very polite, said I would definitely let her nurse know and the issues would be addressed. I was in charge that night. Her nurse was slammed like the rest of us, but managed to get her pain meds to her not late. She received a total of 16 ice creams within 7 hours and wanted more. She was told that we were out and that we could not take the other floors supplies when we use all of ours. Well, that was it. She wanted to speak with the charge nurse.

At the time I had a patient who was q1h bg, total care, agitated, no sitter, tube feeds, ativan q4 or she would climb out of bed and that would just be a whole other issue. Also, taking care of a women who demand dialaudid 2mg q4 on the dot and extremely sick with critical labs, admitted by nephrology. My third was a man who we got to know about a year ago when he came in and refused all care, but had nowhere to have dialysis because every place had kicked him out for being verbally abusive to staff and refusing assessments/care. Nephrology wouldn't discharge him because he was so sick. The man yells at everyone and demands everything he wants, meanwhile not taking any meds you have for him or cooperating with what the Drs want him to do. I guess he wasn't actually hard to take care of, until he started calling and yelling because he hasn't got his chocolate Icecream and coffee and then crapping all over the floor and refusing to let anyone clean it. We call him Mr. Personality. Patient #4 is not bad, but wants me to come at different times for her prn meds, like one at 9, then the other at 10, and so on. My other two were new admits. I got one at the beginning of my shift and another by 0300 even though the next one was supposed to go to someone else and it was my 6th patient. The other nurse is older and just refuses to take anymore. She was busy and if I had given the patient to her she would have complained so much that the rest of us might have gone crazy....or crazier. Anyways, my one admit came up on bipap with critical abgs, total care, >400 lbs and the one at 0300 was a GIB.

So that was my group. I had enough to do without this women demanding things and making everyone crazy. She wanted to speak to the charge nurse because they wouldn't give her anymore Icecream. She had had 16! When I went into her room I introduced myself and asked how I could help her. She started off by saying there's a real issue with the way we are answering her calls and hanging up on her without listening to her 25 complaints and that they weren't telling her nurse what she needed. Then that she needed Icecream because she could only have full liquids and she was being denied it. The next problem was not getting paid meds on time, not getting what she ordered for dinner (3 puddings, 3 soups, 4 ice creams), not getting a ct with contrast, which would diagnose her SMA. So far the ct w/o contrast hadn't shown a thing. She never really did shut up and just moved from one thing to the next. I had to interrupt to tell her that I would see to it that her nurse was being notified of all her needs and that I had witnessed her calls being answered and then the message given to the nurse. She argued with me and said that was not true and I explained that they may be listening to her need/complaint, saying they'll let her nurse know, and hanging up because they think she's done. Also told her that I had answered a call from her earlier that night and i was very polite but shocked at how rude she was. I listened and i told her nurse, but there is a list of callers waiting behind her that could be having trouble breathing or chest pain. I explained that we had to answer everyone's calls and could not spend 5 minutes on the call light. All of her needs can be addressed once the nurse knows to go down there and she did. Then I moved on to the issue about Icecream and this is where I got hot. I've never been nauseated by how mad I am, but I swear I almost threw up all over this lady. I told her we have 72 ice creams stocked at beginning of each week and that she had 16 already, so she could not have anymore and even apologized for heavens sakes. First of all she denied she had that many. I had seen them take at least that many down to her room. So I told her of every one had that many there would only be enough for 4 patients and we can't use all of our supplies and then go take another floors, unless it is a need and that is by no means a need. The women had breakfast, lunch, and dinner and snacks! She needed no more. I then asked her why she would want to eat that much if she was in pain and having diarrhea and nausea, plus a diabetic. She just redirected to another thing, such as getting s soft diet order. I explained that Drs do not allow people to eat when they are that nauseated and in pain and that if she was able to tolerate food that would mean she wasn't in pain or sick from it. It's common sense. She then said I was calling her a liar. Well yes I was. I told her I would be glad to page her dr and request a ct with contrast and a soft diet. She argued and said I wasn't listening to her and that that's not what the problem was and neither was the Icecream. I'm thinking well what the hell is the problem lady? I think IBS caused by a good ole case of crazy. Any ways, when she complained about meds being late I apologized and explained that if any meds are late it is because there is a patient that is in more critical condition who we must treat before treating her pain. If someone's having cp the nurse can't give her pain meds before taking care of the cp. she said I was making her problems out to be fake. She said she was told by a "nurse helper or whatever they're called" that her nurse wasn't busy and sitting down when her meds were due. I immediately asked which nurse she had and what tech. She backed out saying she didn't want anyone to get in trouble. I told her nobody would be in trouble, but that I had to go to each source to figure out at what point she misunderstood what the tech said because none of our techs would ever say a thing like that. First of all the nurses hardly ever sit and the techs are smarter than that and know her well. She then went on to say I know you guys get breaks, it's a law that you have to have a 30 minute break and youfe not allowed to work 24 hours. Oh I was getting so mad. I told her that I hadn't taken a lunch and had been up for 36 hours. Clearly we are all proof that what she was saying was ideal, but impossible sometimes. She asked if I was calling her a liar about that and what the tech said and I just said yes ma'am I am because you have now lied to me about at least 4 things that I have proof are not true. At that point I walked out and paged the dr who said no to the ct. I let her know and she said she was gonna report the dr and the hospital for not treating her and trying to find out what's wrong with her. I just apologized and advised her to do so if she felt hat was necessary and walked out. I told my boss when she got there the next morning and she was not surprised. Even she can't stand lady.

My concern with this is that this women is dangerous! She is going to get someone fired and nobody who I work with deserves that! I thought about that the whole way home. What if I actually got fired because of this women when I was working so so hard to make sure all of my patients were taken care of, dealing with everyone's issues as charge, putting out fires all night long, and not ever stopping to eat or pee. I had to stay until 10 to chart. And I continued to work during that time on/off, helping my patients who would come to the desk and catching up with patients I used to have, crying with ones who just break my heart with how amazingly positive and grateful they are even considering they're terrible situation. It just kills me to think I could lose my job over a women like that when I am a good nurse...I may not be perfect or held it together as much as I should have, but I survived hell. And I didn't deserve the way she was wasting time I needed for other patients who were critically ill. Neither did any other nurse or tech. I literally want to report this women to the police. Pretty sure she's got 4 or 5 different identities. Ugh. I guess I just need to get over it. It sure does help to get it off my chest though. I'm wondering if any of you have ever experienced something similar to this and did you get just as frustrated? What would you have done? Although there really is no advice that could help a person deal with this particular patient. Even the dr and nursing supervisor couldn't win with her. The dr was actually requesting someone go with her to see the patient so that she couldn't manipulate the rest of the staff and say things that weren't true or accuse one of them for mistreating her. Just a ridiculous situation. Anyways, thanks for letting me get this out there lol I realize not s lot of people will probably read this, but at least it's off my chest. You guys know how it is. Nobody cares about your nurse problems. They just don't understand. I wish everyone good patients and hope you never ever have to deal with a dreadful person such as this evil women I had the pleasure of taking care of. Thanks for listening.

[KatieMI, BSN, MSN, RN]

Well, ... hugs, to begin with

First of all, document as if your life depends on it, in real facts. Patient is lying? Write it down. Patient is accusing staff (with name or without)? Write it down. Patient is given 1 ice cream @2200, second 2300, etc? Write it down.

In cases like that, we just keep a pack of paper outside of the room, so everybody can use it. Everybody who enters the room, doesn't matter why and for how long, writes down time, date, what was the problem (if any), what was done, patient's reaction in her own words.

In most "acute" cases, two individuals always present when interacting with the patient, even when it is over the phone, so that there is always a witness.

Second, the most effective way to resolve the problem is to call up the chain of command and let THEM know that they can be sued at any moment. "They do not treat my SMA" cannot be blamed onto nursing staff. You heard patient's wish, you called the doc, the doc said "no", you let the patient know, educated, provided comfort, documented. That's everything you could do as a nurse. The "failure to treat" whatever under such scenario is about an MD and his employer. So, if you let know the doc and whoever employs him what ticking bomb they got upon themselves, they usually start to move around with discharge plans and (lo and behold) refusing future care.

Third, such patients benefit from setting rules once and forever. Just like "clockers" who are told that doctor ordered narc shot q4, that means 1200, 1600 and 2000, no further discussion. After they got their fix at 1200, 1600 and 2000 sharp, they early or later become a little more relaxed and trusting, and can be spoken with. Tell this lady that (no excuses, no mentioning of other people -such creatures do not get it) there is, say, 6 ice creams for every 12 hours for every patient. It is up to her how much of them to get at a time, but there will be 6. You just do not have more, kitchen is closed. Write it down, and make a mark every time she gets one. Same about everything else. Writing on the room white board helps.

It also GREATLY helps to make them busy and responsible for something, sort of. I once asked lady just like described to give me a favor and write down which number corresponds with which channel on TV. It kept her quiet for an hour, with following abundant thanks. They can watch beeping pumps for their roommates, keep an eye on a random piece of equipment. Ask volunteering department in your hospital, they may have more ideas.

Do not worry much about getting fired. Unless a nurse "under fire" already has target on her back, the patient needs to contact higher-ups and possibly a lawyer to make a noise. This is your primary responsibility in this case, as a charge, to make the said higher-ups aware of situation in all details, including the ones which are more dangerous for them than for you (like supposed "abandonment" for a whole 20 min.) They will be aware, and, if patient decides to speak with them, she will spew out more lies and hysterics, and they know for sure what they are really playing with. They want trouble no more than you, and they will start to move about "firing" the patient from the hospital service. Regarding lawyers, they usually do not work for free, and such patients are commonly big proponents of "I just want sumethin' for nuthin'" principle.

Hugs again :)

[TriciaJ, RN]

Whoa. You have many responsibilities in your job, but you are taking on responsibilities that are not yours.

1. It really is not your job to make people well in spite of themselves. Your goal is to follow your job description and perform assessments, provide meds and treatments and document them. If you can provide emotional support or little extras, more power to you.

2. To hell with Press-Ganey and the Culture of Appeasement. Stop making it your goal to make these people happy. They are enjoying their misery. If these people are already persona non grata at other hospitals, they should be happy they got in anywhere. But they aren't going to be and you can't make them. Trying to appease them just makes their behaviour worse. Learn not to feed the monster.

3. There is no law that says you have to take these idiots seriously or their behaviour personally. Just do your job as efficiently and politely as you can. You're not competing with the Hilton for their business; you're not even competing with other hospitals.

4. Just be the best nurse you can be, not the best flunky or whipping boy. Then let the chips fall. If management even thinks of taking this nonsense seriously, please invite them to strap on skates and shadow you for a shift. Remind them that they eat when you eat, and pee when you pee.

5. Off topic, but paragraphs are your friend. But not as good a friend as you need to be to yourself. Good luck.

[nursej22, MSN, RN]

Hugs, OP, it sounds like you went above and beyond on a floor very similar to the one I used to work on. We had a frequent flier who had somehow gotten the nursing supervisor number, and would call for lemon jello, stat. The docs luck out because they can use the nurses to run interference.

A behavioral contract can be useful for manipulative patients like this one, it can be drawn up by manager/ and or social worker, with patient's input. They agree to certain behaviors, (like 6 ice creams per 8 hours), and the staff agree to certain things: pain assessed and medicated on an agreed schedule. If patient doesn't hold up their end, then they get discharged, if stable.

And for the wanting an audience for the endless complaints, I hand them paper and pen ask them to write it all down and you will deliver it to the manager personally. People are rude when answering her light? What exactly did they say? That helper said the nurse was sitting? Need a name and exactly when it was said. After all, if it isn't documented, it didn't happen, right?

[Dranger]

Most hospitals have a cohort of people like this. As a staff nurse I wouldn't about my job being in jeopardy. After all a while, everyone knows these people are crazy and subsequently take every they say with a grain of salt.

Honestly, from a charge nurse perspective, I think you were a lot nicer than I would have been. From the get go I would have told her to write down everything she wants on a piece of paper and limit her calling to every 1-2 hours. Anything less than that time frame I would refuse to answer unless it was an emergency. Make it clear that YOU run the show and not her. Intimidation will not work. Normally we are patient focused but with a crazy person like this we are just tolerating their presence, it isn't a matter of healing anymore.

Her threats to report/complain are empty and everyone including her knows it. Once you are labeled like that, no one takes you seriously anymore despite the huge focus on satisfaction scores.

[CelticGoddess, BSN, RN]

I second the behavioral contract. We have a long termer with Narcissistic personality disorder. Manager had to draw up the contract because she became such a problem. It doesn't end the behaviors completely but the patient understand that there are consequences to all actions. The only thing, the contract has to be enforced across the board. If anyone doesn't follow the contract (staff wise), then it becomes more difficult to enforce.

I am sorry you are going through this.

[ponymom]

16 ice creams? oh for freaking crying out loud. Don't be so apologetic and kicked-in with pigs like this. You run the show. Some good ideas here. I really like the one about having her make a list. Make sure your higher-ups see it. And also, make sure you give her the higher-ups phone numbers. She can contact them while you're running around taking care of the other patients.

And document every last little bitty thing.

[NuGuyNurse2b]

I really thought this was about ice cream...

OP I got a headache reading your post. why I continued to do so? cause I'm bored.

Anyway, we have a few patients like yours and we ended up just passing the patient advocate # to them. Our PA knows when the complaints are unreal and deals with it accordingly. I don't know exactly what goes on, but I imagine they just address their grievance, then let it die. point is, we all have roles to play. you can't be everything to everyone. it's impossible and it takes away time from other people who need you. find the right person to whom you can hot potato it.

[ProgressiveActivist, BSN, RN]

what is SMA?

[Birdy2]

Lol I had a headache writing the post and tears in my eyes that were much needed after al long 3 nights at work. I wasn't exactly trying to make it pretty, just trying to get it all out before I lost any details.

Thanks to everyone for the advice. I will definitely be trying these things next time I come across this type of patient. I have only been a nurse for a year and was working with even less experienced nurses. I'm not exactly as confident as I'd like to be and was unsure of what I was allowed to limit the patient to. I let her get the best of me and really have to learn not to do that. I was just so frustrated that because of her some of my other patients important care and meds were late .

[Birdy2]

I had no idea we were allowed to limit number of calls haha that's brilliant.

And I think I forgot to mention the patient was found to be recording many of the nurses in and out of the room, so it's a good possibility she recorded me calling her rude and her requests ridiculous. I was polite, but blunt.

[canoehead, BSN, RN]

Looking at you assignment that night, it would be reasonable to tell her you can't address her issues because other patients are acutely ill. Leave a note for the manager to take some time to talk to the patient, and maybe set limits. You did an exceptional job that night.