For the past year I have been taking care of a patient who is a paraplegic due to spinal stroke resulting from pain injections to the lower spine. To list all of the diagnoses she has would take more space in this forum than is possible. She is 59 years old and for the majority of her life she has been in and out of medical facilities for various ailments. She also has a history of alcohol abuse. The over arching issue with this patient is that she is highly manipulative and completely non-compliant with all of her care and medications. The PCP has even refused to issue any orders or changes to her med regimen (she frequently would request different meds be added to her regimen). They would tell me that she is a huge liability and needs to be removed from the facility. She has a wound vac, has been treated for C-diff 3 times in the last 6 months and sepsis d/t UTI twice in the last 6 months. She is a diabetic who refuses to eat on a regular schedule and supplements her meals with items she buys online such as candy, cookies, marshmallow peeps, peanut butter, etc. Her glucochecks were typically 400 to 600 every morning. She insists on drinking large amounts of cranberry juice ad orange juice. She self caths but frequently refuses to cath on a given shift and will wait until she produces over 1000cc's (usually 1500 plus) despite education re: autonomic dysreflexia. She also orders online OTC meds such as sudafed (she says to pick her up), Benadryl and Nasal sprays (for her deviated septum) Immodium to harden her stools, Fiber Laxative pills. She also orders cigarettes, E-cigarettes, chargers and has been caught numerous times smoking in the facility ( she is on a nicotine patch) Literally everyday for months I was responsible for searching her room for contraband and documenting all non-compliance. Everyday I had to argue with this patient over her request for Xanax when she had just awoken (usually at noon). I found myself becoming extremely frustrated. When she was confronted with the contraband found she would lie and we would find new"stashes" hidden in evermore insidious places (most recently the false bottom of a drawer that she kept her cath kits in) Yesterday, after I caught her for the 3rd time in two days smoking in her room (in front of her family who then lied to my face about it) she was issued a 24 hour emergency eviction notice. I am trying to deal with my emotions regarding this patient as I went from being extremely empathetic and caring to feeling extremely frustrated and angry over her manipulation attempts and lying. I know she has a mental disorder, Definitely an addictive personality ( I also suspect Narcissistic Sociopath tendencies). I also felt angry over the danger she frequently placed staff and other patients, in as well as the amount of time that she took from the other 29 patients I am responsible for with her demands on my time. And, of course, since I was the main person finding all of her contraband and reporting her she went so far as to tell my supervisor that she did not want me around her anymore. Fortunately, I am off today and she will be removed from the facility this afternoon. I feel emotionally and mentally beat up. Has anyone else had to deal with this type of situation? Am I wrong to feel angry and frustrated?
Looks like one of my "problem management" patients.
It is natural to feel frustrated, angry and a bad nurse in general while dealing with this sort of people, but the fact is that one can only take a horse to the river, not to make it drinking. These patients are not imprisoned, they retain their human and civil rights. So, if one of them wants to commit a suicide by eating a pound of candy a day, that's her business and her life.
It is difficult to came to realization that we cannot change some people (and, for that matter, nobody but ourselves) but as soon as you get it, life suddenly becomes easier. As long as the patient doesn't do anything illegal in terms of law (bying and eating candy by pounds is legal as long as she got money to pay), there are only two things you should do. One is just documenting your educational efforts, doc's/family/charge updates and patient being non-compliant. The second one can be a bit tricky in modern climate of "customer satisfaction" and you might need support of your Powers. I am speaking about clear and unequivocal explanation to patient and family of what is going on and what is gonna to happen, so they couldn't tell the judge that "no one ever told us that she could die just from sugar. Everybody around got sugar, so we figured it was all right and nobody told us...". The talk must be clear and with as little sugar-coating and political correctness as possible. Not "a bit of infection in her urine" but "sepsis, or severe infection which often causes death, which came from her bladder because it was not emptied as often as necessary". Do this talk with a witness and document painstakingly. It can save your and someone else's license on the long run.
After this, just remain correct and professional. If there are threats to safety like smoking, state the facility rules and follow them to the point (evicting her was a good move!) If you can only see her once in an hour, state that as a fact of life and do your part. If you will be busy for the next two hours, say that, ask her for the "last wish", then say goodbue for 120 minutes. Make daily schedule and keep it that way as much as possible. If there is only X drinks/ice creams/etc she can get, write it on a piece of paper and give her, marking every one given. If all nurses and CNAs follow these rules, many of these folks come back to (relative) normal with amazing speed, the rest at least mellow a bit.
P.S. I'd seen many such patients delaying self-caths till their bladders were about to burst, and really wanted to know the reason. Many of these poor souls were and are intelligent enough to get an idea that sepsis is not fun, and yet they continue to delay caths. After cautious talks two issues emerged: high cost of supplies (usually solved by a good case manager) and what some of them described as "pleasant" feeling while quickly emptying overfilled bladder. They just liked that feeling, that's it. I do not know if it might have something with sex (of which many of these patients are deprived forever) or some residual sensation anomaly but the fact was that they just wanted to do self-caths that way.
Nurses do not lose their licenses over noncompliant patients not following orders. Ever. This concerns me that nurses are still spewing this kind of language and threats to each other in our profession. We need to educate ourselves on proper expectations as professionals and leaders. Proper documentation and education with our patients are minimum standards in our everyday practices. Threats of "losing the license" and "saving your license" need to be saved for actual events that could cause one to lose their license. Your BON will decipher when such actions are necessary.
Specializes in Psych, Addictions, SOL (Student of Life).
These kind of patients don't bother me but I worked several years in Psych which may be the difference. I simply institute a non-compliant care plan and document, document, document.
Ugh! I had one of these in LTC! I felt like he was just trying to control what he could as a way of dealing with the loss of his valuable functions. But it was no excuse for making it hell for everyone around him. He would curse at other patients (elderly) and staff. I didn't feelbad at all when he was kicked out, I was relieved.
Many, many meetings and many, many care plans lol. And you are right...she continues with her manipulations at the new facility. Her PCP told me that she was telling all of the nursing staff in the new facility that she had no earthly idea why we transferred her there. The PCP spoke with the new administrator that very instant and advised that they would no longer treat this patient. It is sad because the facility that she went to is not as "concerned" with providing optimum quality care so she will be able to do as she pleases and most likely will decline to the point where she will never be able to go back home or even to the point of death. I was more concerned with my own thoughts and feelings regarding this patient. Not so much the legal ramifications as my supervisors removed me from the responsibility of searches. I documented everything I said and did with this resident. And I never searched her room without her being in it (gaining her permission first) and a witness being with me. I did manage to work out my stress and also alleviate my feelings of guilt. I just needed to stop trying to be superhuman! I am an excellent nurse and I will always go above and beyond to help those in my care whether they work with me or not.
Specializes in Infusion Nursing, Home Health Infusion.
And I am tired of nurses grizzling forever about their patients - I have kept the derogatory words and showed them to my staff - most are shocked.
You try getting spit at!
,You try getting told, "Just shut up and do your job" by two angry mean daughters who lashed out at staff members because their mother was dying and they could not cope so instead abused the staff
No one could get the IV so mom could get her dilaudid drip....but I did......don't thank me I don't care but don't make it more difficult than it already is!
You try getting kicked and hit for no reason other than you are trying to ease someone's suffering
You try patients making up lies about you or your coworkers to try and get you in trouble
You try coping when a patient tells you they are going to get their gun and shoot you
You try getting yelled at by a meth addict who wants nothing more than to get the hell out of the hospital because they need a fix
You try getting your finger twisted so hard because someone is upset (it hurt for days)
You try having urine thrown at you and splash your eye
You have an HIV+patient refuse to hold still for their IV start and could care less if you get stuck
You try dealing with the patient that refused to be discharged, She just wanted her Dilaudid, security had to be called to escort her and her family out. Security had to protect me as I deaccessed her port
Those are just a few...ask any nurse
Certain nursing jobs require that you encounter a great number of patients during any given shift. I have such a job. I get ALL the patients that no one else wants to stick because they are not only difficult but they are abusive, difficult to deal with and often uncooperative. I not only manage but I am highly respected for my extensive knowledge and talents. Of course, not every patient is dysfunctional and difficult. Many are cooperative, civil and are grateful to have good healthcare. In fact, I cannnot keep up wth all the homecare patients that request me since I have 2 employers but I do as many as I can. So please you have no idea what you are talking and just need to make yourself feel better, Be shocked all you want while I and the rest of the nurses deal with reality...that's what allows us to get the difficult work of dealing with the ill and infirm done !
What a rant! why are you still in nursing? the patients you quote are in the minority why not attempt to convey some positive outcomes between you and your patients? this is never mentioned on this site - it appears to have generated into a outlet for ugly feelings.
What a rant! why are you still in nursing? the patients you quote are in the minority why not attempt to convey some positive outcomes between you and your patients? this is never mentioned on this site - it appears to have generated into a outlet for ugly feelings.
What a rant! why are you still in nursing? the patients you quote are in the minority why not attempt to convey some positive outcomes between you and your patients? this is never mentioned on this site - it appears to have generated into a outlet for ugly feelings.
Well, if that's what you're looking for, that's what you'll find.
ETA: interesting thing - I'm not reading any positive posts from you, at least in this thread.
Sounds very familiar. Typical behavior for an addict/alcoholic. In a situation like that it is hard for them to get treatment for their underlying issues/ mental health. When i encounter younger patients dealing with drug addiction i hope and pray they get to rehab. What do you guys do typically when you encounter a drug addict/alcoholic? Checking into the er for a few days does no good and they are typically using right when they get out.
Specializes in Mental Health, Gerontology, Palliative.
What a rant! why are you still in nursing? the patients you quote are in the minority why not attempt to convey some positive outcomes between you and your patients? this is never mentioned on this site - it appears to have generated into a outlet for ugly feelings.
Are you even a nurse?
And in terms of being sick of reading negativity, let me offer you one of these
because I have some much negativity towards nurses coming from you in this thread
ms boogie, BSN, MSN
27 Posts
Nurses do not lose their licenses over noncompliant patients not following orders. Ever. This concerns me that nurses are still spewing this kind of language and threats to each other in our profession. We need to educate ourselves on proper expectations as professionals and leaders. Proper documentation and education with our patients are minimum standards in our everyday practices. Threats of "losing the license" and "saving your license" need to be saved for actual events that could cause one to lose their license. Your BON will decipher when such actions are necessary.