Managing Impatient Patients

[AnxietyMaven, BSN, RN]

Not a new grad, but fairly new. 2 years experience and I still struggle to deal with the impatient patient. 

Little backstory: I work ER. We don't have rooms but rather we have bays that are separated by curtains. At least once a shift I have a patient that yells out for me when I'm not right at the bed side. Normally I can set expectations early on with something like "Sir/ma'am I can see and hear you. If you say something to me I will respond, however most times I'm not going to be able to come to you immediately, especially if I'm with another patient. I don't want to cause any frustration and I will respond once I am able." Last night was different.

My patient kept yelling/grunting constantly (at least at the time it felt like that). No acute distress... Just wanted to be handed a cell phone, repositioning, what's taking so long, once or twice was to pee, wanted water etc... If the patient saw or heard me, they were yelling for me,  saw me on the phone and yelled for me, I was with a different patient next to them and they yelled for me.... On and on it goes. I'd respond "I'll be with you in a moment" but they would talk to me while I was with the other patient. My tech helped with the toileting but it was always something. They were disturbing other patients and taking my attention away from others that needed me. I reiterated my spiel about responding when able multiple times. It's like constantly pushing on the call bell but instead of the "ding ding" it's "nurse!" If I wasn't immediately bedside they would continue to yell even after I acknowledged them.

How do I manage this behavior*** Can I say/do something different. Am I just being a crappy nurse because I'm frustrated by this behavior***

[NightNerd, MSN, RN]

That doesn't make you a crappy nurse! That's super obnoxious and frustrating to deal with for hours on end. You did the right thing by explaining in advance and being consistent in your response.

Was the patient alert and oriented, or was there some AMS going on? This affects my answer a little bit. If they're alert and oriented, they've registered my answer and response to their first bid for attention, so I wouldn't continue to respond until I finished the task at hand. (IDK if that's particularly therapeutic for the patient, but that's the only way I'd personally be able to concentrate on my current patient and tasks.) If you've already acknowledged them once, in my mind, no need to continue for each new grunt/call/whatever. If it's getting disruptive to other patients, it may help to get your charge nurse to stick their head in and also reinforce that you've heard them, and they need to be patient and wait for you.

If the patient was confused, especially if their behavior was impulsive and unsafe, maybe look into getting a sitter (I know, laughable these days with staffing). Or if family was available to sit with patient for some time, that may calm him down.

[AnxietyMaven, BSN, RN]

18 minutes ago, NightNerd said:

Was the patient alert and oriented, or was there some AMS going on?

Nope AOx4... Left AMA at another hospital because they weren't happy with the treatment received ? .... It didn't take long to figure out why. No family allowed in ER due to covid right now but... Sometimes doesn't family make it worse? ? 

I didn't even think to get the charge involved. We usually don't unless it's assaultive behavior because ER is just full of all sorts of characters. Maybe next time (and there will be a next time) I'll reach out to charge to see if that helps. Thanks for the ideas and support.

[JBMmom, MSN, NP]

5 hours ago, AnxietyMaven said:

Nope AOx4... Left AMA at another hospital because they weren't happy with the treatment received

Always love the hospital shoppers. We have another facility not far from us and some patients have arrived at our hospital still wearing a gown from the other one that was "making them wait too long". 

Sounds like you're doing your absolute best to set appropriate boundaries and expectations with your patients for what you can and cannot physically do. You're most definitely NOT a crappy nurse. You're never going to be able to please some people. If the patient is the one that escalates the complaints or negatively impacts other patients, I might involve a charge RN, but if they're just being annoying and you can handle the situation, which it sounds like you did as well as could be done, I wouldn't really bother. Some people think it's all about them and there's no amount of education of feedback that will change their behavior. 

[JKL33]

Do what you can, when it's their turn, to let them know they have your attention. Make good eye contact, be pleasant, etc. When it's time for you to leave that patient, give the standard spiel about how there are a lot of urgencies and emergencies in the ER right now and it'll be awhile before you're back and is there anything else they need before you go. When all that is done and  they're still talking/making random non-urgent requests across the curtain, ignore...because it's someone else's turn right now.

If the requests are not appropriate, don't provide reinforcement. IMO it's okay, after you have done all the above, to say something like, "I'm sorry, I am helping other patients right now" as you walk past--don't stop and entertain it. And make sure you don't look/sound bothered by it. Stay upbeat/pleasant.

Remember to communicate with your docs/providers. If it's appropriate to get the patient dispo'd, they might have a moment to take care of that. Problem solved.

 

[NightNerd, MSN, RN]

7 hours ago, AnxietyMaven said:

Nope AOx4... Left AMA at another hospital because they weren't happy with the treatment received ? .... It didn't take long to figure out why. No family allowed in ER due to covid right now but... Sometimes doesn't family make it worse? ? 

I didn't even think to get the charge involved. We usually don't unless it's assaultive behavior because ER is just full of all sorts of characters. Maybe next time (and there will be a next time) I'll reach out to charge to see if that helps. Thanks for the ideas and support.

LOL, *sometimes* family makes it worse, but in my experience, having familiar faces often reassures confused (or just super anxious!) patients and helps them stay calm and relaxed. It just depends on the dynamic. But yeah, I know COVID has changed a lot of visitors policies lately.

And of course you and the charge nurse have to prioritize, and it may be that there just isn't time to have someone tag-team with you on setting limits with the patient. Sometimes getting reinforcement from someone with a little extra authority can help in these situations.

But yeah, it sounds like you did everything you could!

[AnxietyMaven, BSN, RN]

9 hours ago, JKL33 said:

And make sure you don't look/sound bothered by it. Stay upbeat/pleasant

? That's the hard part. To be and look like the professional when they have worn you down all shift. Maybe it was me that just screamed "I'm exhausted" that had him more anxious. 

I'm grateful for all the tips y'all. Thank you!

 

[amoLucia]

I had a personal guiding 'modus operandi' when dealing with these needy type pts - 'they can be NEXT, but they can't be NOW'. As long as situation wasn't emergent and I was otherwise importantly engaged, the needy one would be NEXT.

Now I never let them know my rationale, but it made my decision-making more acceptable to me.  It also helped some of my co-staff when they were experiencing similar frustration themselves. 

[gonzo1, ASN, RN]

I've had ER patients that told me they didn't care we were coding a patient in another room, they wanted their soda, or whatever.  I just firmly tell them everyone in the ER is working on a very emergent patient and they have to wait.  I usually say something like, "If you start to code, we'll be right in to try and save you."

[AnxietyMaven, BSN, RN]

5 hours ago, gonzo1 said:

I've had ER patients that told me they didn't care we were coding a patient in another room, they wanted their soda, or whatever.  I just firmly tell them everyone in the ER is working on a very emergent patient and they have to wait.  I usually say something like, "If you start to code, we'll be right in to try and save you."

Wow that's insane. I've yet to hear that thankfully. I had coworkers laugh and say I'm finally growing a backbone for telling a patient I can't help them find their phone.