Patience for patients

[Zippy83]

In general I have a reputation for being very calm and patient, both at work and at home. But even home with a teenager on the most teenager-y day is a piece of cake compared to my days out in the field lately. I’ve been a field HH and Hospice nurse for 7 years, back in the field recently after taking a year office for an office/admin position in hospice. I wanted a break from rude and demanding patients/pcgs but I missed the positives of being in the field so I came back.

However, since I came back, the rude and demanding patients seem to have multiplied like bacteria on a potluck dish that been in the sun for 8 hours. To clarify, the vast majority of patients are great (or at the very least, manageable), but the 10-15% who are awful have turned the volume up to 11 on awfulness, to the point that I just feel drained all day and struggle not to bring that energy with me to the other visits or to the office or home. It’s hard to tell if I’ve used up all up my lifetime supply of patience, or if more people are getting the attitude that home health is a concierge service where a nurse just appears out of the sky whenever it’s convenient for you and you can verbally abuse them and/or threaten them with no consequences.

When I was a new nurse I definitely worked at some terrible agencies that did not back up their nurses or enforce policies consistently, but now I’m at agencies that I’m very happy with, and have great supervisors and mentors. I have plenty of seniority and a good reputation so I can have patients reassigned when necessary. However, I just dropped 2 patients this past week (from different agencies). In both cases I had attempted to resolve the situations first and set reasonable boundaries and expectations, but to no avail.

I’ve noticed that HH agencies seem more likely to discharge problem patients from care instead of accepting the liability, whereas hospice agencies will just keep assigning rookie nurses who won’t refuse assignments. There was one hospice patient who I requested to be taken off of the case, and the nurse who was assigned was having to go outside to cry 1-2 times per visit (this was known because it became part of the patient’s weekly call to the agency to complain and or/threaten to have them closed down). I doubt the agencies keep them out of compassion, I think it has more to do with the very competitive and lucrative nature of the industry.

What are some of your worst experiences (or best horror stories) with patients and families? What’s your boundary for what you will and won’t tolerate? Where do you draw the line and let the issue become the agency’s problem?

[Kaisu]

I enjoy amazing support from my agency. I am proud to say that we do not keep someone on service who is inappropriate for whatever reason.

To answer your question, some patients recently discharged/transferred:

Patient snorting his oxys. Oxys were D/C'd even though the patient threatened to find an agency that would give him oxys. He transferred with our blessings and a thorough, professional and compassionate transfer of care.

Patient caregiver that was furious that RN Case Manager answered her father's questions about his wife's status with honesty. Caregiver had insisted that CM lie to the father.

Nonadmit for alert, oriented but bedbound patient who's life partner forcefully (banging on a table forcefully) insisted on a Foley despite patient clear and consistent refusal. Partner refused to allow nurse to present pros and cons to the patient.

Alzheimer's patient in assisted living who did not meet the 7A criteria and did not show decline.

I could go on. It makes it easy to provide ethical, professional care when the agency supports case manager decision.