Patience is a virtue

[Pinknurse12]

Hi Everyone,

This is my first time to express my concerns and ask for your expertise. I am new in nursing, less than 6 months experience. I would say so far I am really enjoying with what I am doing.

The floor where I am working is busy and heavy but rewarding for me when the patients appreciate what you do for them. I am casual but almost working full time. So far so good for a newbie. I am getting the hang of it and keeping up.

One day, I came to work I had a bariatric pt who has spinal stenosis, who can't walk and can't do anything for herself. But that is so okay, As nurses we are here to support and help them. I normally go the extra mile for my patients. I always put myself in their shoe, I always ponder. What if its my mom? my grandmother? my loved ones? I want them to receive best nursing care. Who doesn't want the best, right?

But, this patient of ours, really pushed my patience button. I tried so hard to please her. Oh my Gosh! She really did. When I transferred from her chair to the bed. She specifically wanted not to remove her shirt, she wanted it later when she is already in bed. ( okay, that is fine though she is really big) that is what she wants.

She wanted to 2 incontinence brief but you have to rip off the sides because it might cause some blisters that is according to her.

It gets better when she was already in bed. She wanted a specific fold for her liners. her towels should be hang on her chair, her pillows should be placed exactly on her thighs, you have to keep on adjusting it. In other words, to put her on her chair it would take you 40mins to an hour with all the special things she wants you to do.

okay, I told myself that is fine. If I will have her again tomorrow. I will just do her last. She started to get into my nerves when i tried to give her meds at 2200, This is exactly what she said " I take my pills at 2300 with toast butter and tea". This patient needed a private nurse.

Inhale... exhale! That is doable, I told myself. I have 2 legs and 2 hands. I can walk. I am privilege. Nursing is a caring profession. She needs my help. I gave what she wanted. I waited at 2300 with her toast and tea.

The pills were narcotic, I did my 2 patient identifier and guess what. She doesn't want to take her pills. She wants to finish her toast and tea first. The exact words she used " I always have these narcotics at home" I don't know why you want to watch me take it. I explained to her why I needed to see that she takes it. We were good after.

At 0030 she called me and she wanted to void. I gave her female urinal (its a big help especially if you have a huge patient) BUT then and again, she wants you to remove the pillows from her thighs, she wanted you to put her on trendelenburg, she wanted two towels, she has a special ritual how you out the freaking urinal in her peri area. I am going nuts! Oh my! it was worst when you have to take her off the urinal. I felt I am her slave. wipe me like this, you have to do this, you have to make sure my fold is dry, you have to put pressure when you wipe me! I almost lost it! She is a pain in the butt!!!!

I don't know how to deal with her anymore. Do you have any tips on how to handle this kind of patient. Our floor is so busy and we normally have 6 to 7 patients and at night 10 patients. I felt so sad, we are nurses but I guess some of these patients treats us like their slave. Thanks.. I am just venting out.

[Sunflowerinsc, ADN, RN]

I tried to read. It's very hard in this format. Could you put in paragraphs?

[huskernurse]

You are doing your best. Do you have a nursing assistant? Now that you kind of know what you are in for I usually grab my nursing assistant before I go in to a patients room who is like this because it helps you save time having 2 people to get it all done. Unfortunately you will encounter people like this, learning to set boundaries with people is the hardest thing I think you will have to learn as a nurse. Good luck.

[Hollybobs]

Hey Pink, you sound like you are doing really well and like you are already doing A LOT to try to be kind and patient and help this lady!

I've had lots of these kind of patients. So, for what it's worth...this is what i do! I re-frame the situation in my head. I tell myself that it is good to have the type of patient who will tell what she wants in detail because it saves me having to guess. I tell myself that it is great that she can tell me what she needs rather than little old "Edna" in room "16" who will stay in pain all night as she won't ask for pain relief despite prompting. I don't do this in a pollyanna way, I make myself remember that I do believe that. Anything you personally believe in, basically.

I will remember and check back with her in a semi-soothing but not patronising way EXACTLY how she wants all the meds, butt-wiping etcetera etcetera done. Obviously you will be doing that but it is a good opportunity to decrease her anxiety by slowing speech and lowering tone. There will be a finite number of routines, once you have them down pat you are halfway there. The end result is that you will have a calmer, happier patient. She will ask for less, sleep better, wee better and be in less pain. Win-win. If she is well (i.e. not acutely delirious), I do encourage patients not to be rude whilst I am learning their routines.

"So how do I have time to do all this fantastic, patient nursing when I have 6-7 patients, an even newer nurse to support and maybe some relatives ringing constantly overnight?"- I hear you ask. Cluster your cares for this patient. If she needs something before you are ready but it isn't urgent then you can say you will come and do it thoroughly at a specific time. Arrange it so that other urgent cares for other patients are done before this time. When you go in, do EVERYTHING you possibly can and make sure all her little bits and bobs are within reach etc etc. Chat about her life whilst delivering cares, do all the good nurse stuff, show her you don't really think she is a nuisance and a burden. Then go.

If she won't let you cluster her cares as she constantly calls then she is just lonely and that one is tough. She needs to know you want to look after her well, you can't always be there as you have other urgent demands and you really care about her welfare. Without directly saying that if possible. You'll gain her trust and slowly she will let you have more control of her care. Look her in the eyes, we avoid people's eyes when we don't like them or are finding them difficult. You're going to be busy either way :).

Check back in with her if you have a spare minute unprompted, give her a smile. If you are struggling to be patient with her and you are trying there will be plenty of nurses who when under pressure (as you are in med-surg) will not be so patient. So a smile and approaching her voluntarily should relax her a bit.

If all else fails, FORCE yourself to seem as patient as you can whilst screaming in your head. Then go and scream in the linen cupboard. If I am having a trying day I will speak with a very trusted co-worker and have a mini vent. Then I go back out there. This is part of the skill of our job, one of the reasons why non-nurses say "your job is so hard...i could never do your job". If you are really, really at the end of your tether after 8 hours you can swap a favour with a pal and arrange for them to go in a couple of times while you do a job for them or whatnot

We should get good at this or at least fake it well, I think it is part of the skill set and also takes our stress levels down. When you mentor your own students they will be in awe at how calm and compassionate you appear in the face of provocation. I've gone on a bit but I think it's really interesting topic.