How do you deal with these types of patients?

[dudette10]

The chronically dissatisfied patient, getting better for admitting diagnosis, but with uncontrolled, officially diagnosed psych issues that cause them to call you to the bedside every 30 minutes--keeping you at the bedside with demands for 15 minutes--despite your best attempts at clustering care and setting time parameters.I've had one of them for each of three shifts in a row, and I'm at a loss as to how to handle them, except to just plain ignore them for a little while.

[tnbutterfly - Mary, BSN]

Moved to Nurse Colleague / Patient Relations.

[tewdles, RN]

Interesting thread...

[JZ_RN]

Very interesting. As much as I agree that consistency will help these patients, they know better than to cry wolf all the time. I know it sounds un-nurse-like and mean but they know you're busy as heck and they know they're making you run around more for silly requests and they know they're being rude. No one short of a person with a an intellectual disability diagnosis would not figure out that they're being a complete pain to the nurses and stop it. I don't blame the nurses for rotating. We already work long hours, understaffed, not enough supplies, too many patients, and to top it all off with one of the patients who has needs every 5 minutes? We're only human, too.

[joanna73, BSN, RN]

I had a resident who was bipolar and had BPD. Drove everyone nuts with the constant splitting of staff, complaints, and constant demands. However, she quickly learned who she could manipulate and who she couldn't. I was friendly, respectful, and firm at all times. Boundaries need to be set with these patients early and consistently. When I'd go to her room, I'd take everything I knew she would request, including pain meds without her having to ask. I would fluff up her pillow, say hello, get in, get out....but before leaving I let her know I would return later, which made her feel secure. Whenever she tried to keep me longer with her stories, etc...I'd listen for a few moments, politely interrupt and say, "I have others to see now. I need to go. Good night." And be out the door. Also, you need to ensure the other staff are on the same page, and document, document, document! In a nutshell, be nice, but get in and get out, or they will suck your energy and your time.

[joanna73, BSN, RN]

We do not have this capability where I work.

Re: rotating patients. We also do not have this option where I work. Sometimes the same nurse has to deal with the same patients all week. One nurse to 35 where I work. In order to save my own sanity, I have no problem saying no and setting limits because I will have to deal with the same patients for four to five 12 hour shifts in a week.

[JZ_RN]

I used to work in a place with one of these patients and was the only nurse on the unit. (S)He may have been part of the deciding factor in my quitting. Always there, never easier to deal with.

[iluvivt, BSN, RN]

In addition to identifying and taking care of their needs I liked to use distraction techniques. I woud find out if they liked music or movies. We have a mobile cart with movies to play for pts. We also can play music for them and that is very calming if you select the right type of music. One patient like that can ruin your entire shift and suck the life right out of you.

[RNJill]

I think that in theory it makes sense for this type of pt to have the same nurse as often as possible-BUT in practice I think this sometimes may be unsuccessful. While it may be disruptive for the pt to have a different nurse all the time, if they are totally butting heads with their current nurse I think it could just escalate the situation for them to continue to have that nurse. When I'm charge nurse and have heard in report that certain pts. are this "type" of patient (for lack of better description) I try to check with their nurse for the day to see how things are going. If they are going well/pt is not completely sapping the RN's psychological energy (ha) I'll give them that pt tomorrow if they are there. Otherwise, no, or it just ends with an angry nurse and possibly a pt refusing that nurse.

When I have a pt like this who clearly has some un-dx'd psych issues, sometimes I just end up winging it (or hoping they go to a procedure for a looooong time-LOL). Just keeping it real by saying this! Also, truthfully, sometimes I find it works well to just somehow carve out a few minutes in the day to give them a little extra time/attention/etc. The form that this takes is very dependent on what is going on with the pt, but I think doing this lets them know that you are trying to see them as a person and not just the nuisance in x room.

[86toronado, BSN, RN]

I am so glad to be out of the ER, because I think this type of patient made up 50% or more of our patient and family member mix.

And maybe it is un "nurse-like" but as another poster stated, no one short of someone who has an IQ less than 80 can be completely unaware of how much time they are taking away from other patients with their frequent requests of "can you move my tissue box four inches to the right?" The only way to deal with this is to set limits, stick with them, and make sure all of the staff on the unit does as well.

[dudette10, MSN, RN]

I agree they probably intellectually know the demands they are placing, but I really think they can't stop doing so due to their anxiety.

[JZ_RN]

I understand the anxiety as well but you know that most of the staff will avoid that patient as much as possible because they are such time wasters and the patient has to catch on at some point too. I would feel more secure to have 1 minute with a staff member who wasn't just seeking an exit strategy then to ramble on with pointless stories and requests and keep someone there for longer and longer who didn't want to be there. I do not mind almost any request (within reason, and sometimes even sorta ridiculous ones) so long as they are not constant or used as a ploy or I am not being treated poorly by the patient. I've made sandwiches for homeless patients, scratched backs, trimmed beards, changed socks, brought snacks, made phone calls for patients, and just sat and held hands with someone who was scared. But not because they were being pests and begging for attention, because they asked for my time and were respectful of it. That is all the difference. I am there to care for others but not to be someone's whipping boy.