My patient fired me!

rn/writer, RN · Jul 22, 2005

It sounds like you really needed to feel liked by this patient, as if you had certain expectations of her based on your relationship of the night before and were hurt when she didn't meet your expectations. This may sound harsh, but that was about her meeting your needs. Wishing your charge had explained your side was all about you, too. If it was about her you would have been concerned that the charge had reassured her that her needs would be met. And it's great that you are inventorying your behavior toward her to see if you did anything wrong, but someone who blows you in for not emtying a Foley as she ordered you to and leaving her with a "floppy IV" is acting out her stuff. She did what she needed to get her needs met, as strange and unreasonable as they may have been. Most of our patients are polite as they get their needs met, but that's a courtesy they extend to us. You can't expect it. And of course we get surprised when people do off the wall things, like this, but for our practice's sake it's a good idea not to make it about us.
I dunno, I'm not going to say don't take it personally, but I will say that we need to be careful about getting our needs met through our patients response to us.

I was thinking something along these lines. You (the OP) talked about being hurt by the pt.'s reaction and that, to me, raised a flag on the play. When you mentioned wanting the charge nurse to explain your side of things, I reacted to that as well. As Katillac stated, it's good to do an inventory of your actions--you don't want to dismiss a complaint without first examining it for merit--but if you don't find anything amiss on your end and no one on staff gives you a hard time, that should be the end of it.

The other posters who told you not to take this personally gave you positive advice, but I'd like to encourage you to go a step further. This might be a good time to take an inventory, not of your actions (which you already did) but of how emotionally vulnerable you might be on the job. We caregivers tend to be a needy bunch from time to time and a great many of us fall into the role of people-pleaser. Giving care and concern to a patient and their family members is a necessary part of the job. The occupational hazard is what Katillac mentioned--looking to get your strokes in return. Don't get me wrong. Having a patient appreciate what you've done is a great feeling and it's wonderful when you are able to establish a good connection. But the nature of the therapeutic relationship is that the patient does not have to take care of you.

A simple form of not taking things personally can mean picking the barbs out of your flesh and making yourself walk away. A stronger (and less defensive and consequently less wearing) form develops as you see your boundaries more clearly and alter your expectations so that, while you may be surprised by a bad reaction now and again, you are not crushed, shocked, or even terribly disappointed because you are secure in your skills and identity and you don't need your patient's understanding or approval.

I hope that doesn't sound cold. It's actually a great relief to learn how to live with being misunderstood (when further efforts won't accomplish anything beneficial).

I wish you well.

Miranda

HuggyPuglet · Jul 22, 2005

Oh yes, I remember we had a patient like that! She was in a VIP room and would stay up all night, night after night, and keep us all hopping over the smallest things even during the busiest of times - most of it more like "maid duty" rather than for legitimate health concerns. We tried speaking with her, and her family, regarding her behavior, but all fell on deaf ears. They all seemed to think that the nursing staff was there to give her exclusive care and they didn't (or wouldn't) recognize there were 35 other patients on the floor.

After one extremely hectic evening - and two codes - the charge nurse came up with the ideal solution. Fortunately, the doctor was also sympathetic to our plight (my guess is his staff was run crazy by the same people). The next day she addressed the patient and family and indicated that since she required "so much care" that arrangements would be made, with the doctor's blessing, to hire a private duty nurse to stay with her 24/7. Of course, the costs would be borne by the patient and her family.

There was a flurry (or should I say storm) of activity in her room that day. She signed out AMA and went home. Last I knew she had run through at least 7 or 8 private duty nurses in short order - and likely was running out of options.

I guess you just can't let this get to you...

Reminds me of a time many moons ago, when I was working as an aide on the night shift on an extremely busy medical floor. We were literally busting our butts, and this patient who was housed in one of the VIP rooms sat on her call light ALL night long. Finally, at 5AM, the Charge Nurse stormed down to her room, yanked the call light cord out of the wall (I'm not kidding!), brought it back to the nurses' station and threw it in a corner of the desk, as I and the rest of the staff looked on, with our mouths hanging open.
I don't remember if anything happened to that nurse, but that patient packed her bags and walked out AMA before the day shift came on, refusing to sign anything. I guess she fired ALL of us after that! :sofahider

broke1 · Jul 22, 2005

These things happen, espeically when the patient feels you arent "tending" to their needs. I completely understand that when you are busy something like emptying a foley isnt high on the list, but patients dont care that you have 6 others.
Sometimes its best to just do the simple things, take a couple extra minutes to meet what they feel are their needs and then move on. Unless you have someone ready to code on you, or another emergency like a patient on the floor, the patient in front of you has to feel like they are your priority.
Dont sweat it, sometimes you cant satisfy some patients no matter what you do for them.

I agree completely. The amount of time spent explaining why you couldn't do it could have been spent doing it. That is our hospital's policy. Unfortunately, NA's and nurses still point fingers at each other instead of just doing the job, which is patient care.

As for being fired, I was told just that by a patient, because I'm male.

Nesher, BSN, RN · Jul 22, 2005

Lesson - what doesn't seem important to "US" the nurses, is not on the same level of importance to the patient. Our priorities aren't the same. Clearly this woman had a need, perhaps for a bit of attention beyond delivering pain meds on time. It's a human thing.

nursemike, ASN, RN · Jul 22, 2005

We refer to that type of person as one who has "used up her nurse cards" say too early!

Thanks for the chuckle. Not meaning to hijack the thread, but what discourages me (just a little) is that I was feeling so good about managing a different needy patient the night before. She wanted constant handholding and/or more ativan r/t anxiety. I knew three hours was too soon for more ativan, but we got by with intermittent hand-holding and assurances that I would be back soon. Within an hour, she was sleeping, and I felt both caring and competent (well, getting more competent.)

The Monday patient was on Q1H neuro checks, so there was no escaping spending a lot of time with him, but he wanted even more attention. My other pt was Q2. (God bless my preceptor for not letting me take our third pt, who was trach'ed and on a vent. I'm sure I would have been lying on the floor, weeping, before the night was over.)

Anyway, this is a very instructional thread, for me. I do like to please people, and I do understand the need to prioritize. In a way, it's reassuring that more experienced nurses have to deal with these issues, too. In another way, it would be nice to believe that it would become automatic in a few months.

I wonder if it's too late to learn to drive big rigs.

chadash · Jul 22, 2005

Thanks for the chuckle. Not meaning to hijack the thread, but what discourages me (just a little) is that I was feeling so good about managing a different needy patient the night before. She wanted constant handholding and/or more ativan r/t anxiety. I knew three hours was too soon for more ativan, but we got by with intermittent hand-holding and assurances that I would be back soon. Within an hour, she was sleeping, and I felt both caring and competent (well, getting more competent.)
The Monday patient was on Q1H neuro checks, so there was no escaping spending a lot of time with him, but he wanted even more attention. My other pt was Q2. (God bless my preceptor for not letting me take our third pt, who was trach'ed and on a vent. I'm sure I would have been lying on the floor, weeping, before the night was over.)
Anyway, this is a very instructional thread, for me. I do like to please people, and I do understand the need to prioritize. In a way, it's reassuring that more experienced nurses have to deal with these issues, too. In another way, it would be nice to believe that it would become automatic in a few months.
I wonder if it's too late to learn to drive big rigs.

Dont drive those big rigs!

There will be great nights and there will be times no one is pleased: YOU ARE NOT THERE TO PLEASE THEM but to give them great compassionate care!

There is a verse in proverbs that states 'the fear of man is a snare'...be fearless!

From a formerly scaredalot CNA

Dalzac, LPN, LVN, RN · Jul 22, 2005

Don't take everything a patient feels about you to heart. I was fired once by a patient who felt I was too fat to take proper care of her. (I am overweight but not that much) She actually told the charge nurse that if I had to run into her room for an emergency that she would probably die before I got there. I never took it personally. she had a bias against fat people.

And I know that this fat nurse can run like the wind to get to a patient if they were in an emergent situation. My fellow nurses say I can create quite a wind to get there. I just don't lose sleep over a patients opinion of me it is just not worth it.

ZASHAGALKA, RN · Jul 22, 2005

As a general rule, complainers are like people that eat Lays chips: they can't stop at one.

And once you complain about 3-4 people, you not only used up your nurse cards, you used up your credibility. Patients are people and just like people, some are rude, some are obnoxious and some are pot-stirrers.

There are just some patients that staff have to take turns handling. If 1 shift was too many, then next night, it's somebody else's turn. From that point of view, I've 'fired' more patients than have 'fired' me.

But, the flip side: I can't tell you how many times I've been told in report that so-and-so is a complete jerk, call button hog, etc. only to go in the room with my best smile and demeaner and have a great night.

If one nurse has a bad interaction and relays that, the expectations of the next nurse can sometimes provide the same result. That's why I never listen to complaints about patients in report and I rarely pass on complaints - if a patient is a jerk, I'm gonna find out soon enough.

As for call button hogs, some people, especially LOL (little old ladies), want the security to know you are going to arrive when called, or if not, they want to call so that, IF they need to go to the bathroom in 30 minutes, then you are there by then.

I've found that when I'm told that a patient is a call button hog, If I arrive johnny on the spot the first time they call, they'll call again in the next 20 min, and again, normally 1 more time. If I'm there for each bogus call, they realize that I'll be there if they ACTUALLY need me, and they won't call again unless they do. Many times, after those original 2-3 calls, I don't get called again the rest of the night. It's a test - and I try to pass that test because it's much easier in the long run - and because my pt's peace of mind is actually therapeutic.

~faith,

Timothy.

broke1 · Jul 23, 2005

Dont drive those big rigs!
There will be great nights and there will be times no one is pleased: YOU ARE NOT THERE TO PLEASE THEM but to give them great compassionate care!
There is a verse in proverbs that states 'the fear of man is a snare'...be fearless!
From a formerly scaredalot CNA

I agree that there are great nights ahead, but in this world of competative healthcare, a big part of our job is to PLEASE THE CUSTOMER. How many times have you seen cards from patients on the bulletin board saying how wonderfull and caring the satff was? Our boards are full of them. When's the last time your Nurse manager or DON congratulated you for getting a compliment? If we didn't read the cards, we would rarely know anyone said anything good. How much more attention do complaints bring? Complaint letters are the things staff meetings are made of.

A great, compassionate and caring nurse that consistantly fails to make patients happy will soon be standing in the cheese line.

rn/writer, RN · Jul 23, 2005

I agree that there are great nights ahead, but in this world of competative healthcare, a big part of our job is to PLEASE THE CUSTOMER. How many times have you seen cards from patients on the bulletin board saying how wonderfull and caring the satff was? Our boards are full of them. When's the last time your Nurse manager or DON congratulated you for getting a compliment? If we didn't read the cards, we would rarely know anyone said anything good. How much more attention do complaints bring? Complaint letters are the things staff meetings are made of.
A great, compassionate and caring nurse that consistantly fails to make patients happy will soon be standing in the cheese line.

There is a big diffrerence between pleasing the patient for his or her own sake (and because it's the latest buzzword) and pleasing them because we need emotional validation and approval. Trying to be accommodating and caring for the patient's sake only makes sense. But we can set ourselves up to believe that reciprocity is due and that's a mistake. It's nice when there is give and take. It sucks when there isn't. And sometimes limits have to be set on what will be tolerated. But a therapeutic relationship is not one between peers. It is by definition, one in which a great deal more is expected of the professional than of the patient. I think that sometimes working with really nice patients makes that distinction easy to forget.

I'm not saying the OP shouldn't have been bothered. I'm only saying we should all remember to get our own emotional needs met away from the job.

Miranda

DG5 · Jul 23, 2005

I haven't read all the posts here, but my feeling is why didn't the charge nurse support and back up the OP instead of taking the patient's words verbatim and just taking over her care instead? Was that maybe the easier way to deal with this instead of the right way? Yes, the customer comes first, but, aren't we enabling the patient to continue to attention-seek inappropriately?

chadash · Jul 23, 2005

There is a big diffrerence between pleasing the patient for his or her own sake (and because it's the latest buzzword) and pleasing them because we need emotional validation and approval. Trying to be accommodating and caring for the patient's sake only makes sense. But we can set ourselves up to believe that reciprocity is due and that's a mistake. It's nice when there is give and take. It sucks when there isn't. And sometimes limits have to be set on what will be tolerated. But a therapeutic relationship is not one between peers. It is by definition, one in which a great deal more is expected of the professional than of the patient. I think that sometimes working with really nice patients makes that distinction easy to forget.
I'm not saying the OP shouldn't have been bothered. I'm only saying we should all remember to get our own emotional needs met away from the job.
Miranda

I appreciate your reply, and agree.

I am a CNA and have worked in LTC facilities and home health. I really like people, and that has resulted in alot of happy customers! people know if you really like them! I guess, though, that I want to really communicate one thing that I have learned in my old age and years of doing this, to save you all alot of heartache. Never and I mean NEVER do what you do to please any one. Love people and do your best. Go home at night with the peace of knowing that is what you did. If you ever depend on what people think, you are screwed from the start! God bless, and take this as the ramblings of a grandma:)