Patient Entitlement

[Joe V]

We've all seen them......the people who think they should always come first, no matter the circumstances. In the healthcare environment, we cannot always address the needs of patients in the order of occurrence. Contrary to popular belief, the squeaky wheel cannot always get fixed first. Share your stories about patients and their sense of entitlement.

[meanmaryjean, DNP, RN]

We had a patient in our ICU for months and months. Her well-educated parents made it a point to 'need' something during report every single day. We made it a point to ask them before starting report if there was anything they/ she needed. But sure enough, a couple minutes after seven, there one of them would come- 'she needs suctioned' 'diaper is wet' 'pain meds' (none of which would turn out to be valid/ unaddressed before report). We educated them on the importance of nurses having uninterrupted communication for hand off. No matter, they always found a reason to track you down and have you do something for them during report. Exhausting to say the least.

[intothecosmos]

I worked in a clinic once and there was a traffic accident in the parking lot that dumped 3 teenagers out of the bed of a pickup truck. Most of the employees ran outside to help so of course it stalled the people who had come to the clinic to be seen. One of the patients in the clinic was heard to have said, "Maybe I'll be seen faster if I go lay out on the sidewalk."

Some patients understand that others will need to go first and that is always appreciated. We had one woman come in who was having an allergic reaction to something and literally couldn't stop sneezing. One nurse asked the people ahead of her if they would mind letting the woman go first and no one cared. They saw the trouble the woman was in.

But it is annoying sometimes to work triage in an ER and constantly be harassed by parents as to why one patient went ahead of their child when they got here first. We always have to explain that some patients might go ahead based on the nature of their illness and it never seems to satisfy. In their eyes, their child is sicker than everyone else. We eventually had to separate the waiting rooms for those that were considered "green" care (colds, runny nose) and those that needed more immediate care "blue" (asthma attacks, abdominal pain) just to fight off those parents who were always keeping an eye on who came in when. In the green room, they went by time because everyone was at the same level (they also went to a different part of the hospital than the regular ER, seen by a NP or a physician). In the blue room, it mostly went by time, but we could upgrade people as we saw fit. No one really got upset because they didn't see others go ahead from the other waiting room. It was frustrating when the green section moved faster than the blue section though. Sometimes the colds got seen before the asthmas because of that.

I don't think there is any tried and true way of dealing with situations like that. We are trying something new again in our ER. Let's hope it works out better.

[anon456, BSN, RN]

I was giving a 54 kg total care patient, who was also on isolation precautions, a bed bath, weight, and linen change by myself. In the middle of the bath I was called to my other room, which had an airway kid. We were short staffed and everyone on the unit was very busy. Although we have it set up that any vital sign alarms will come through my communication device-- and I can also see my other patient's VS from whatever room I'm in-- and this was just a call light, I did not want to ignore my airway patient. I quickly wrapped my half-bathed total care patient in a bath blanket, stripped off my PPE, and ran to the room of my airway patient. The parent of this kid was standing there with his hand on his hip looking impatient that I had not come by the room by myself in the last 10 minutes that he had arrived. He felt I was not keeping a close enough eye on his child. And wanted to know if I could get him some juice. I reassured him that I got all important alarms on my communication device, and had just tucked his child in not 15 minutes earlier. And then I told him I would come back with his juice just as soon as I could. This is just the most recent story. I'm sure we can all tell thousands of stories just like this.

[anon456, BSN, RN]

ReOxyS said:

I think it all started in the retail setting

Absolutely!

[Watkinsrn10]

What I have the hardest time with is knowing what to say. I have been to Haiti where the people there would kill just for a drink of water let alone a doctor who would see them and treat their needs. Coming home from that to these selfish people is almost unbearable. If i hear "I'm starving, I haven't eaten all day.." One more time...all I want to say is "try going to Haiti and not eating for a week!!!!!"

[cardiacfreak, ADN]

Guttercat said:

Entitlement syndrome is probably what burns me out more than anything else.

But we've created this monster. We not only allow it, we encourage it--"patient satisfaction" is out of control.

I second that!

[tamycruz.salmon]

Most patients really don't think about the other person that may be suffering more than they are. They always think its a first come, first serve situation.... Well, it would be if everyone was just suffering from the common cold alone and other life threatening diseases didn't exist. But that is just human nature, its just reality!

[IChooseThisWhy]

I came onshift and had a new patient, an older man out of a SNF for acute treatment of wound infection. He'd been in hospital before, gotten fixed, discharged to his SNF, and then managed to be nasty enough to drive away those who were to change the bandages and give antibiotics, there. So- infection. And he was sent back to acute care to fix the side effects of his abrasive personal behavioral choices.

Its shift start report and I notice he isn't going to be deep breathing well with his infected wounds all elevated - too much pillowage. But, there's an incentive spirometer on the table. Pt teaching moment, right?

"They show you how to use this?"

"No"

"Well, you can keep your lungs healthy and feeling much better if you breath in on the mouthpiece part here every so often. Want to try?"

"No!" He turns his head away.

"You sure? It'll help keep you from getting pneumonia and its really easy to use". I offer it. He grabs it, all right. Then proceeds to throw it with all his strength directly at my face.

I side step without thinking and it misses, shattering on the wall behind my head. "Think we'll let you rest now, Mr X. Sorry if anything made you feel uncomfortable".

My charge nurse refuses to allow me to fire this patient. The guy lets lab draw him about 6 hours later. Hes refused virtually all care up to that point: "Don't open my door till 6!"

Now he wants to be put on the bedpan. Immediately. From that time he very sweetly insisted that he be cared for, instantly, whenever. Picking and choosing what he would and would not accept therapeutically.

He was totally A/O throughout.

1- I shouldn't have had to care for him after he tried to rearrange my face in the first place

2- My priorities should be to give my time first to a patient who is working very hard to get well, not one who is sticking to making choices that have no chance of a good outcome. But no.

Ick.

[TriciaJ, RN]

IChooseThisWhy said:

I came onshift and had a new patient, an older man out of a SNF for acute treatment of wound infection. He'd been in hospital before, gotten fixed, discharged to his SNF, and then managed to be nasty enough to drive away those who were to change the bandages and give antibiotics, there. So- infection. And he was sent back to acute care to fix the side effects of his abrasive personal behavioral choices.

Its shift start report and I notice he isn't going to be deep breathing well with his infected wounds all elevated - too much pillowage. But, there's an incentive spirometer on the table. Pt teaching moment, right?

"They show you how to use this?"

"No"

"Well, you can keep your lungs healthy and feeling much better if you breath in on the mouthpiece part here every so often. Want to try?"

"No!" He turns his head away.

"You sure? It'll help keep you from getting pneumonia and its really easy to use". I offer it. He grabs it, all right. Then proceeds to throw it with all his strength directly at my face.

I side step without thinking and it misses, shattering on the wall behind my head. "Think we'll let you rest now, Mr X. Sorry if anything made you feel uncomfortable".

My charge nurse refuses to allow me to fire this patient. The guy lets lab draw him about 6 hours later. Hes refused virtually all care up to that point: "Don't open my door till 6!"

Now he wants to be put on the bedpan. Immediately. From that time he very sweetly insisted that he be cared for, instantly, whenever. Picking and choosing what he would and would not accept therapeutically.

He was totally A/O throughout.

1- I shouldn't have had to care for him after he tried to rearrange my face in the first place

2- My priorities should be to give my time first to a patient who is working very hard to get well, not one who is sticking to making choices that have no chance of a good outcome. But no.

Ick.

My motto: Don't work harder for anyone than he's willing to work for himself. Offer everything once. No encouraging, no enticing. When he refuses, say "okay" and document his refusal. No more stressing about him. Equanimity can be a wonderful thing.

[Thimbalina]

CDC is now being called the ''Center for Denial and Confusion"

"Hospitals cannot control the spread of C diff and resistant strains of staph in the hospitals in this country. How can they be expected to be able to control the spread of Ebola?"

[lisabethanne]

I'm still just a prospective student, but I know how tough people can be. I'm just thankful that the one time I was at the ER the other people waiting let me go first.

I was having severe abdominal pain, and my mom (MD) diagnosed me with kidney stones on the way to the ER. She dropped me off at the door and went to park. I couldn't even walk the 5 steps to the ER doors without having to stop and double over with the pain. When I got to check in, there was an elderly woman waiting in front of me, and I was prepared to wait. I knew I wasn't dying. The nurses came for her, but then she pointed over at me and said "Let the girl go first."

She was a breath of fresh air in a world that really just isn't willing to wait.

[DatMurse]

I had a patient that was mad that the neurologist hasnt came to see him yet. I told them maybe there was a patient in ICU that needed help, Since he has been stable I know that other people would have been ahead of him if they are in very bad condition. They found out that the neurologist was sick and they felt really bad.