Patient Keeps Asking for Another Nurse

[purplegal]

So, about a week ago, a rather "interesting" patient was admitted. From calling the ambulance herself not once but three times to accusing the facility of giving her a UTI that was likely already present the day she was admitted, this patient has, from day one, expressed her dissatisfaction with the care she has been receiving.

I have been this patient's nurse every day that I'm working there, and while there haven't been any actual issues between us, almost every time she puts on her call light for a nurse and I go into her room, she asks for another nurse, even giving a specific name of a particular nurse she wants. This patient does allow me to give her medications, but whenever she has questions, she always requests to speak to this other nurse instead. Even during situations that she calls "emergent," whenever I ask if I can help, she says, "Oh, no, I'll just wait until so-and-so is available." She also frequently comes to the nurse's station, and even if I'm the one sitting there, she always asks to speak to this other nurse.

I'm not terribly offended, because it sounds like the nurse she keeps asking for is the only one in the facility that she likes. Other nurses have had similar issues, even worse issues (I would hate to be the nurse that she accused of giving her a UTI!). However, my thought is, it seems like this patient does not really want me as her nurse, for whatever reason, even though she has not specifically said "I do not want you for my nurse."

However, there are some options that I have been thinking about and wondering which may be the best:

1. Remind the patient that while I'm there for my shift, I'm her nurse, and that the nurse she is requesting is busy with other patients.

The main reason for this option is that it involves not bothering this other nurse with issues that I, as this patient's nurse, should be taking care of. However, doing so may also cause further resentment in this patient, and if there's someone that the patient finds more suitable, it may not be in anyone's best interest to force her to keep working with someone she is reluctant to work with. The only problem is, sometimes this specific nurse is not available, so at one time or another, she will have to work with a different nurse.

2. Continue to take this patient as part of my med-pass assignment, but whenever she has a question, find the other nurse.

With this option, I would be taking care of the medications for this patient, so the other nurse would not have to worry about that, but would also be accommodating this patient's request to work with someone she feels more comfortable with. At the same time, this may be unfair to the other nurse, who has her own patients to take care of.

3. Change assignments altogether. Since there are 20 patients that we split into two groups of 10, maybe, until this patient is discharged, I should take the group of patients that this one particular patient is not a part of.

This may be the best option so the patient can have the caregiver she provides and the other nurse would not be "bothered" since it would be her patient anyways. This may also relieve frustration on both of our ends. For the patient, it is frustrating when the nurse who seems to be able to answer her questions the best is not available. At the same time, the constant "rejection" is frustrating for me, and I feel guilty about passing on my work to this other nurse.

Honestly, I feel that this has more to do with this patient "connecting" more with this other nurse than it has to do with mine, or the other nurses', abilities to be a nurse. In the past nine months that I have worked at this job, this has been the only patient that has repeatedly asked for a different nurse, and there have been many times that I have been the preferred nurse.

However, I am just trying to figure out a way for this patient to receive the care she needs in the way that is most comfortable for her. If that means that I am not her nurse, I am willing to step back and let someone else do it. At the same time, this patient seems to have unrealistic expectations that this one nurse that she favors will always be there for her.

What are your thoughts?

[Amethya]

Can you tell her "Ma'am that nurse is busy, I am your nurse and I will continue to be your nurse, our main nurse has told me so. This is not a hotel where you get what you want by waving your hand, this is a hospital. As such you must let me do my job, which is you listening to what I have to say and do what I say." Of course I would say it as politely as possible and smiling at the same time, but in the nicest way. But I was wondering, if they refuse the treatment because of this, can they be fired as a patient and taken to another hospital?

[Jedrnurse, BSN, RN]

Yup. Borderline.

[TriciaJ, RN]

While this is true, the patient is engaging in something we call "staff splitting". It is not something to encourage. A patient refusing care because the nurse is his brother-in-law, ex-lover, part of her AA group or the identical twin brother of her rapist is one thing -- recreational staff splitting is something else again.

Exactly. There would be no staff splitting if staff didn't allow themselves to be split. By agreeing to jump in, Nurse Lovely is just undermining the OP. If she's really grooving on her favoured status, then she should just be assigned that patient. And still be accountable for her other patients. After she's been run ragged and gotten herself demoted to unfavoured nurse, maybe she'll develop a bit more sense and stop setting up her coworkers.

[purplegal]

So, last night, I tried switching up the assignment. The other nurse, who was a different nurse than the one I originally posted about, took the 10 patients I usually take, and I took the other 10 patients. While the patient mentioned in my original post didn't ask to speak to me, there was another patient that I usually have that basically insisted that I do everything for her. The nurse who was assigned to her tried to help her, but she wouldn't let him help her with her bandage or even give her medications. And while this patient is very friendly and cooperative with me, the other nurse came to me and told me that I would have to take over for this patient, because she was very upset and "acting bizarre."

My attempts to make it easier on everyone turned out to cause more issues than I thought they would. Go figure. Plus, I'm pretty sure this other nurse didn't enjoy this assignment last night, so I have a feeling I'll be taking those patients again...

[Nurse SMS, MSN, RN]

I have been "Nurse Lovely" in my time. These patients wear me out. I would usually refuse to take them two shifts in a row, as normally they are super demanding, persnickety, time intensive and less sick than most. I have even been moved to a different hall to lessen the likelihood of said manipulator knowing I was on shift that night. When it is a pleasant patient who just doesn't want to have to deal with new people I make a point of talking up my coworkers so they hopefully will be more trusting.

These types of patients definitely make for a long shift.

[TriciaJ, RN]

I have been "Nurse Lovely" in my time. These patients wear me out. I would usually refuse to take them two shifts in a row, as normally they are super demanding, persnickety, time intensive and less sick than most. I have even been moved to a different hall to lessen the likelihood of said manipulator knowing I was on shift that night. When it is a pleasant patient who just doesn't want to have to deal with new people I make a point of talking up my coworkers so they hopefully will be more trusting.

These types of patients definitely make for a long shift.

Yup. That's what they do. Management really needs to get involved in situations like this. They need to explain to the patient that their nurse preferences cannot always be accommodated. Then, if they want to refuse care it can be charted as refused and so be it.

Trying to accommodate patients who have no interest in being reasonable is just stupid. Sets a terrible precedent that negatively affects care of others and contributes to staff burnout. Time for some limit-setting and management needs to lead the way.

[ThePrincessBride, MSN, RN, NP]

As someone with bpd, I take offense to people who don't have a psych np or psychiatric MD after their name fillipantly diagnosing this woman as having bpd.

Assign the patient to the nurse she wants. Problem solved.

[Nipper48]

The patient is the definition of "Borderline Personality Disorder".... treat her professionally, do your job and carry on... if she got the other nurse, she would make a point of letting you how how much better she is - for about a shift, then she would be trashing her and demanding you back... use this a a learning experience with 'difficult patient's and it will become one of you 'what stories'.... this is the kind of situation you really grow from as a nurse....

[HarleyvQuinn, MSN, RN, NP]

On ‎2‎/‎9‎/‎2017 at 1:41 AM, ThePrincessBride said:

As someone with bpd, I take offense to people who don't have a psych np or psychiatric MD after their name fillipantly diagnosing this woman as having bpd.

Assign the patient to the nurse she wants. Problem solved.

I work inpatient psych. This is not problem solved. This type of manipulative staff splitting is problematic behavior. Contrary to the opinion of a few, the favored nurse is not always "asking for it" or enabling it, either. Sometimes just any kind of positive attention, such as being kind or taking time to listen to a patient, can pin you to the "favorite" position. Don't just assume your coworker is getting some sort of ego boost - working with patients engaging in this behavior is exhausting mentally and physically. The number of times I've been abandoned to deal with patients with borderline personality disorder or similar who are engaging in manipulative and staff splitting behaviors because "well, they wouldn't talk to anyone else" is ridiculous. That's the whole part of staff splitting - pitting you against each other by instilling ill will between you. No one wins. We've had to move nurses to other units when the behavior is bad enough.

Just assigning the "favored" nurse isn't going to fix matters. ALL of the staff need to be on the same page regarding this patient's treatment and her/his current behaviors. You need to set limits - this patient needs to work with their assigned nurse and requests to only speak/work with such-and-such nurse will not be honored as they are tied up working with their patients. Support each other. Don't let a patient drag your unit into chaos.

[Ruby Vee, BSN]

14 hours ago, HarleyvQuinn said:

I work inpatient psych. This is not problem solved. This type of manipulative staff splitting is problematic behavior. Contrary to the opinion of a few, the favored nurse is not always "asking for it" or enabling it, either. Sometimes just any kind of positive attention, such as being kind or taking time to listen to a patient, can pin you to the "favorite" position. Don't just assume your coworker is getting some sort of ego boost - working with patients engaging in this behavior is exhausting mentally and physically. The number of times I've been abandoned to deal with patients with borderline personality disorder or similar who are engaging in manipulative and staff splitting behaviors because "well, they wouldn't talk to anyone else" is ridiculous. That's the whole part of staff splitting - pitting you against each other by instilling ill will between you. No one wins. We've had to move nurses to other units when the behavior is bad enough.

Just assigning the "favored" nurse isn't going to fix matters. ALL of the staff need to be on the same page regarding this patient's treatment and her/his current behaviors. You need to set limits - this patient needs to work with their assigned nurse and requests to only speak/work with such-and-such nurse will not be honored as they are tied up working with their patients. Support each other. Don't let a patient drag your unit into chaos.

Thank you. It's really great to have psych nurse input on the situation.

[HarleyvQuinn, MSN, RN, NP]

15 hours ago, Ruby Vee said:

Thank you. It's really great to have psych nurse input on the situation.

No problem, Ruby Vee. This type of behavior wreaks havoc even in psychiatric facilities, especially amongst those who aren't yet adept at identifying it. As someone else mentioned - you're in trouble if this type of patient can make you feel like a terrible nurse, but in worse trouble if they make you feel like an awesome nurse. We should not be basing our professional evaluations of our skills off whether or not a patient prefers and/or "likes" us. We should always be kind, compassionate, and professional. That does not mean throwing an entire unit into chaos on the whims of one person who has a perfectly acceptable alternative solution available to them. Don't engage in their attempts to trash talk your coworkers, but also don't engage in their efforts to pit you against them by "favoring" one, either. Pro-tip: They will run their favorite to death if allowed. Be watchful over new grads especially in these situations.

To be fair, it's not just seen in Borderline personality disorder, although it is one of the characteristic traits associated with that Axis 2 diagnosis. One should also remember that personality disorders are not all or nothing - they exist on a spectrum of severity, with some coping much better and living functional lives in spite of them. Patients with Cluster B disorders, in general, that are not well managed tend to be time consuming and exhausting.