Not allowed to say "I was busy w/ another pt"

[General E. Speaking, RN]

I work Tele. I was recently told by my manager (after a patient complained) that I cannot tell patient's that I am busy with another. Where does this leave me? What should I say? "I'm sorry I am an incompetent nurse who cannot time manage very well 'cause I didn't know that my nap and eating those bon bon's in the break room would take so long?"

Seriously, I came straight out of report and went to see my first patient (turned out to be unstable). Older gent on a bipap that he pulled off, he was hypoxic (60%), restless, pulling at his IV lines, etc...Managed to get the bipap back on but he was slow to oxygenate up. I was at his bedside continuously, then his SBP was running 180-190, DBP 100's. Called the MD, lots of new orders. FULL CODE btw. Call from lab: another patient with a critical K+ of 2.9- needed riders. I quickly go down to assess her IV site which is red as hell and infiltrated. She was crying about getting more K+ thru her IV so I had to call and get a Lidocaine order for Pharmacy to mix in the bag. No veins, of course. Charge nurse managed to get another line in her for me. Another patient going for surgery, etc...on and on- I was running! Charge nurse was helping (thankfully)

I know this patient well who complained about me. She is a frequent flyer who is a frequent complainer. I did manage to go in and make sure she was breathing and no acute distress. She kept calling for nonessential things during my busy time (see above). I sent the tech in and the charge went in a couple of times. When I finally got my other patients somewhat stable and settled (although I had a dry mouth and a full bladder) I went in to see her (her light was on AGAIN- no surprise) She started complaining that we weren't paying attention to her needs, etc. It just came out. I said, "I am sorry but I was busy with an unstable patient. I am here for you now. What can I do for you?"

When the chaplain did his "customer service" rounds, she complained that my nurse said she was busy with another and didn't have time for me, blah blah He immediately went to my supervisor. They gave her a balloon as an apology!:angryfire

In the end, my supervisor and others shrugged off her complaints (as she is well-known for never being satisfied) but I am still struggling with the whole 'I can't tell patient's I am busy'. Is it just word play? Am I getting unraveled for nothing?

What do you think?

[leemacaz]

I doubt if my family or myself would need to be tazered...I can't imagine a better reason for a nurse to be unable to answer a call button than if the nurse was with another patient....It always satisfied my family.. we know our family member is not the only patient around....and we have always known if the nurse was being truthfull...and that being with another patient may not be the only reason for not answering a call....but since it is usually the truth big time..I can not see why it would offend anyone. Better than the making up of some fake reason (You want me to not trust you..and maybe become harder to get to do what you want?) But then I really never asked why a call was taking so long to be answered unless there was a real emergency going on... just assumed that another patient also needed the nurse. Most nurses just say sorry it took so long and leave out any reason...most of the time we never felt a nurse needed to explain or justify herself.. only saw one slacker two years ago...and I noticed she seemed to disappear from the floor within a few weeks..

As to the "dying swans" and other assorted cranks...most of the time the other patients learn about them real fast..through observation and the decent folk feel bad for the nurse and other staff....and know without your saying a word .

[Hospice RNCM]

I doubt if my family or myself would need to be tazered...I can't imagine a better reason for a nurse to be unable to answer a call button than if the nurse was with another patient....It always satisfied my family.. we know our family member is not the only patient around....and we have always known if the nurse was being truthfull...and that being with another patient may not be the only reason for not answering a call....but since it is usually the truth big time..I can not see why it would offend anyone.

Oh if only EVERY family member wer like you........unfortunately the vast number I have dealt with are not. At the nursing home I used to work at, I had to deal one night with an angry family member who demanded, right in the middle of me trying to deal with another patient with a seizure, that I get righht in there and insure that her mama was changed RIGHT NOW because she had just BM'ed, and "I'll be damned if I allow you to let her just sit in her poop" I endeavored to explain that I had an emergency, but she didn't want to hear it. "NOPE, NOPE, I DON'T CARE, I want my mama taken care of a dnI want it NOW, not later!" Of course, I left her standing there and tended to my real emergency. When my CNA's and myself were finally free, and the emergency was over, I told them to go take care of the lady who needed changing. One came back and told me that the daughter was taking pictures; I went in and was told by the daughter that she was going to file a formal complaint that I was unresponsive and didn't care that her mother needed assistance, and had allowed her mother to sit for over 20 minutes in poop and pee, even after I had been told by her that her mother needed assistance, and just "Blew her right off." She said I was the worst nurse she had ever seen, and she was going to have the state close us down and have me fired. The upshot was that I documented EVERYTHING, including the fact that I had a legitimate emergency, that this had been explained to her, that we had told her we would get right on her mother once we were finished, the nature of the seizure emergency documented in the patient's file, and the fact that the lady was taking pictures, which is specifically prohibited in our facility. The next day, a representative from the State came in to investigate, interviewed me, my CNA's, read our incident reports, read the documentation from the patients' files, and asked to see the patient who had needed changing. Her skin was clear, there was no rash which would be present if she had lain for hours in poop and pee. There was ample evidence that we were doing a very good job of taking care of her. The State rep also noted that ther was previous documentation in bother her mother's chart and in incident reports of her daughter making trouble for us. The upshot was that the state told the daughter that she had no case, the administrator told her that one more incident like that of her interfering with the duties of staff, and she would be told to take her mother to another facility.

The moral of this story is that documentation is essential, and it also helps having an administrator who is willing to side with the staff when the staff is in the right, instead of trying to kiss up to difficult family members for the sake of keeping their business.

[leemacaz]

I understand that there are those folks who do not care how sick someone else may be...they want attention Right Now...yeah, I have seen that...really felt badly for the nurses...save a life or pander to self-centered inconsiderate boobs...I am so glad you had the documentation and in the end it ws good the state came in...now the Royal Pains in the #@$! are exposed. I don't know how I could then ask a nurse for any favor for myself or family member if I did something like that...

I bet if other patients had family memebers there, they would have really been offended by the jerks...and except not wanting to go to jail they might even want give the tazer treatment to the miscreants themselves.

[inava]

When I worked a post-op floor in Galveston, we had private (insured) and staff (uninsured) patients. While it was a regular floor (no ICU glass walls where not only do you have a constant visual of your patient but conversely their families and sometimes the patients have a constant visual of you) I found that the least demanding patients were the staff patients, even though at times they had the higher acuity. Therefore I made it my business to make more frequent rounds on them since otherwise I might not know that they needed pain meds or ADL assistance. Over all there were no overly demanding patients but there were some tricky situations I would not have caught in time had I not been in constant surveillance. I have to say that I found working in an environment where I did not have my patients in my line of sight not my preferred work setting. This was 20 some years ago. My more recent experience as a nurse manager revealed more demanding and short tempered patients and families. It makes me wonder what has happened to our country's psyche?

[twistedpupchaser]

It makes me wonder what has happened to our country's psyche?

I think it is a universal problem, not just one country/region. I think there is an international psychosis of believing that one is the "Centre of the Universe" I just wish there was a drug to treat it.

[emnicams]

I had a patient call on the call light for saltine crackers to go with her salad. I went to get them when I realized my patient a few doors down - my confused, Alzheimer's and paranoid schizophrenic patient - had woken up and was ranting and raving, had crawled over her siderails and had her Foley stretched to the max. I dealt with the situation and got her calmed down and back in bed.

It was a 15 minute delay in getting the crackers to pt #1. I apologized for the delay but didn't give her any excuses. She didn't say anything rude to me, but I heard heard loudly complaining to the respiratory therapist a few minutes later. It just really made my blood boil - I mean, I am NOT a waitress!!

I was in her room later on and Confused Woman started ranting and raving again - you could hear it all over the floor. My pt said "Sounds like someone is having some trouble." I couldn't resist and said sweetly.. "I guess you can see why it took me so long to bring your crackers earlier." She actually looked embarrassed.

[TLCinCICU]

It's all in semantics. I usually say something to the effect of "I'm sorry for the delay. I have another patient who has been requiring much of my time. But at the moment, you have my undivided attention. What can I do for you?" The tension level usually drops quickly. If the coworkers on my pod work well together, it's not so much of an issue. Many of us will answer a call light that isn't our own assigned patient, if it has been on for a longer time than usual. We can then go to the assigned RN and ask what he/she would want us to do if it's a med need.

[IrisheyesTag]

Is this not amazing??--what healthcare is coming to? Not only is our care directed and managed by insurance companies, but are our motives are now further insulted by "customer service." Customer service is for department stores with 9-5 hours and holidays and weekends off, where the only brain activity required is to know what button to push and how to count small change (unfortunately--this is what most of these workers get paid--I know I've been there). I find it utterly insulting when someone--particularly someone in management with a bachelor's degree in "management" with a blazer and a fake smile--has to take time away from my patients to tell me that I need to improve the "customer satisfaction scores" by giving the patient the "disney experience" during their hospital stay. :argue: HELLO? Last time I checked goofy and cinderella weren't on their feet for 8-14 hours straight with nothing to eat and a full bladder (now I'm gonna get an e-mail from someone who works for disney).

Bottom line, I wouldn't have gone into this profession if I was an emotional moron. I know what it's like being in the hospital. I know that, in general, most of the patients who act with a sense of entitlement are usually the frequent flyers or the ones who don't want to be in the hospital anyway. But, they can't control that, they can control who goes and gets them a sprite and when. I accept that. I understand that. But, I will not condone it. Patient satisfaction and customer service will come a lot quicker if management practices this ethic towards their staff FIRST!! Until then, we nurses will take the load--just like we have with everything else. We will smile at the next patient we see, or perform CPR without hesitation, or clean someone after they've soiled themselves or put our arm around the wife who's just lost her husband and she has no one else to cry to. We will do it in 12 hours and go home, knowing that our day was more meaningfull than listening to the noise of the scanner at the checkout counter at walmart. That's my comfort.

[ayla2004, ASN, RN]

i'm currenlty a student but in 6 weeks i should qualify and have already been offered a post as a staff nurse.

I have said to pt i was busy with another patients, we still nurse most patients in bays so that they have 1-6 room mates at times they can see if a fellow patient is poorly due to the amount of staff around the bed. I do prefer to stay close to my bay or patients, and they like this close attention and comment if they haven't seen anyone for a while we don't round on patients as noramaly we are in and out carring for the various patients in the bay.

I have however have witnessed a very distressed patient following a nurse informing her that didn't she understand that due to a another patient being critical that is why no one had been in to see them.

The afternoon nurse had rectify this and explained that it unfair to the patient to make them guilty for wanting care as the patient who was critical was not the morning nurses patient.

When i interviewed i was asked what did i think a patient considered the most important aspect of nursing care, to which i said they value good competent technical care but patient want to be teated as equals . Some patients and their famillys are understanding and see that if that you are busy and will get to them as soon as possible. Others even when they can see you still interrupt you to ask for stuff whilst with another patient with the curtain drawn doing morning care or a drug round.

[flygirl43]

Lol.............

[twistedpupchaser]

I had a Pt last week who is an RN and had spent several shifts telling us how to do our jobs. The usual I-know-everything-there-is-to-know-about-nursing types. She, (knowing full well the time) demanded a cup of tea in the midle of the 0600 drug round. While she didn't get the cup of tea until later, it was pointed out that she hadn't worked the wards for a number of years if she couldn't figure out why we were busy.

She stopped telling us how to do our job after that. How quickly some people forget.

[correctlywrong]

"I was busy with another patient just then, but I am here now to help you. I will give you the same respect and take care of your need before I go on to help someone else."

"Yes, I do have other patients. I have eight patients on my assignment today, and you are right that is a lot. But you are one of the people that I am here to take care of and I do have time to take care of you. Please don't hesitate to ask me for things that you need, since helping you is what I am here to do today."

It is all in how you phrase it. It is important to not only convey that you are busy and do have other patients, but that the person you are currently speaking with can count on you to be as devoted to them as to the other people on your assignment. When you put it that way, people understand and respect it. They appreciate it when you let them know what they can honestly expect from you.

If you really *cannot* meet their needs/wishes, for instance, because they actually do want you to be their 1:1 private nurse, then setting limits in a professional manner will allow them to problem solve a little on their own. Maybe they can reassess what they really do need from you, or maybe they can find someone else, perhaps a family member, to assist them with low priority tasks.

Any manager or facility that attempted to prevent me from communicating honestly with my patients would quickly be down by one nurse.