Im beginning to dislike geriatrics

Virgo_RN, BSN, RN · Jun 12, 2009

Acute care is no picnic either. People can be just as demanding and self centered. I expect a certain amount of self-centeredness from people experiencing an acute health crisis, but there is a point where it becomes ridiculous, and people reach that point with amazing regularity.

Roy Fokker, BSN, RN · Jun 12, 2009

people reach that point with amazing regularity.

As I sit with my feet soaking in a tub of hot, salt water; sipping a mug of beer while listening to The Eagles and The Police... that description seems entirely accurate.

cheers,

chicookie, BSN, RN · Jun 12, 2009

I agree with you. I CANNOT work with the older population. Not because I don't like them its just that I am always thinking am I going to end up like that? Then I say someone please shoot me before I do. I could not do it.

I like to work with a younger population. I would LOVE to work with children.

But then again I don't think there is any place in nursing that is better then others. Depends on the person really.

Ruby Vee, BSN · Jun 12, 2009

the incident you describe is by no means unique to geriatrics. i've been in acute care for over three decades, and you run into it often. if this is the only time you've run into it, you're either extremely lucky or in the right specialty. (which isn't to say we don't all have days/weeks/months when we hate our jobs, our patients, our specialty . . . . )

we have a patient on our unit who has been with us, dying literally by inches, for months. his parents (he's in his 40s) camp out at the bedside all day every single day and angrily question every intervention you make -- or don't make. if you give his meds, you either pushed them too fast or not fast enough, you hung them through the wrong port, you didn't dilute them with enough sterile water before putting them down his peg tube, you brought them ten minutes late or two minutes early. all day. every day. nurses are starting to avoid this room, even when they're assigned to it. they go in, do what they have to and leave as quickly as possible. no more long chats with the family about their love for fishing, their four-wheeling, their bar. now the family is angry because the nurses aren't spending as much time with them as they'd like, and they've taken to "reporting" every nurse that crosses the threshold of that patient's room for "negligence." this behavior is extreme, but not all that uncommon.

i guess what i'm trying to say, with my usual lack of tact, is "it sucks. but suck it up, sweetheart, because it doesn't get any better on the other side of the fence."

but hey, you might find you like acute care better for other reasons.

truern · Jun 12, 2009

Nurses are starting to avoid this room, even when they're assigned to it. They go in, do what they have to and leave as quickly as possible. No more long chats with the family about their love for fishing, their four-wheeling, their bar. Now the family is angry because the nurses aren't spending as much time with them as they'd like, and they've taken to "reporting" every nurse that crosses the threshold of that patient's room for "negligence." This behavior is extreme, but not all that uncommon.

How sad that patients and families don't realize that they're shooting themselves in the foot acting like that.

I give them great nursing care...but I don't give them *truern* nursing care. And believe me, there's a difference.

CoffeeRTC, BSN, RN · Jun 12, 2009

Yep...it is everywhere. Ruby Vee..sounds like they are loosing their son and just can't control that so they are trying to control everything else that they can.

Same for the OP situation. Yeah, easy for me to say since I'm not actually in that situation, but I think we all have been before in one form or another.

OP...I would chart my butt off in this case. Don't leave any meds out unless you have an order for this (for some inhalers we write "may leave at bedside") The state would jump on this one. If the pt refuses to take it when offered and you come back to reoffer it and they refuse, then chart it. Get the rest of the staff on your team. Care plan med admin for this pt. I would even see if you can get some type of contract written up and have the pt sign it stating that you have an xyz window to give the meds. We've had a few OCD pts that insisted having certain things done at a certain time. For the most part it was just easier to drop everything and do it then to get into the complaints etc that followed. You or your facility can even contact the ombudsman and see what they suggest. Just make sure that you are documenting what you are trying to do to meet this pts needs.

I've been in LTC too long to let these type of residents get to me.

Ms.RN · Jun 12, 2009

what if you take her medicine 10 or 30 minutes earlier and she tells you to bring it exactly at 10 and you write down a big bold refused in mar? i think that will protect yourself. oh and tell this patient that you are going to write down in mar that she refused her med. this patient definitely have control issues and should not be allowed.

is she capable of taking medicine by herself? i think in some ltc places, patients are allowed to take their own medicine if they have a locked drawer and keep medicine in it.

DivaNurse2007 · Jun 13, 2009

what if you take her medicine 10 or 30 minutes earlier and she tells you to bring it exactly at 10 and you write down a big bold refused in mar? i think that will protect yourself. oh and tell this patient that you are going to write down in mar that she refused her med. this patient definitely have control issues and should not be allowed.
is she capable of taking medicine by herself? i think in some ltc places, patients are allowed to take their own medicine if they have a locked drawer and keep medicine in it.

i think she is allowed to take her own medication, but i might check that tomorrow when i go back to work. i told my don but she just encouraged me to set my alarm clock on my cell phone and give it to her at 10pm.but i was told you have 1 hour before and 1 hour after to give the medication.if they refuse it 3x then chart as refused.i think they are trying to meet her needs and dont want any problems(from obusman) other than to correct her behavior. she is suppose to be the resident counsel so she knows the laws..yada ya.i have to leave exactly at 11pm to pick up my daughter from daycare no buts about it, so at 10pm i do my charting and paperwork before i go home. i think my don has enough of the state coming in she doesnt want anymore problems, but this lady is a hemmoroid. i think i may have to chart when she refuses the medication and check with local obusman.

PostOpPrincess, BSN, RN · Jun 13, 2009

One word:

LEAVE.

Lovely_RN, MSN · Jun 13, 2009

I work in LTC/SNF and I feel your frustrations Divanurse. I don't know how else to deal with manipulative and abusive residents other than to emotionally distance myself from them and document meticulously to protect myself.

LEN-RN · Jun 13, 2009

You have a grace period, the law is on your side. But you are still suseptible to getting flack or drama. But to cya Write in the mar the exact time.

And chart on every interaction or contact with this patient. And I would take someone in the room with you as a witness, each time.(Most aides don't mind doing this when its a pain in the butt patient) And chart it so if there is ever a question it is right in the record. I have had to do that before and I made no bones about it. The patient knew what I was doing..

I would explain to the patient(I am sure you already have) that there are many patients that have medication due at 10p just like hers. That she is not the only one, and that your are doing your best.(I wonder if another nurse kisses her butt, which makes it hard on other nurses). But make a point of letting her know that everyones mar says the same time.

And Chart chart chart. Because if you ever need to go to court to defend your actions or words, its right there. If its not charted, it didn't happen.