Patient Threatens to go to Manager...

[nursechilespice, LPN]

So this is my second evening shift in a row working with the same assignment (on a CCC vented floor)

two of my three patients are in the same room (let’s call them patients A, B and C) I was about 40 minutes late to feed patient A, because patient C was throwing up excessively after suctioning.

i apologized to patient A, told him I was with alittle busy with patient C then patient A stated “you know what, I know you’re a nice person, but all weekend you’ve been a space cadet and I’m going to go to the manager because I don’t feel safe.” i asked him why he would say that, and his main points where:

1. Yesterday he said I gave his Advair (that he refused) at 2200 when it was supposed to be at 2000 (implying that I gave it late.) I told him his MAR is scheduled at 2200 but if he wants it earlier I could reschedule it- he was not pleased with my answer and didn’t believe me.

2. Patient B, patient A’s room mate, has g tube feedings- at lunch the day shift nurse is supposed to give patient B three salt packets that’s provided in the daily bags wit the feeds- I noticed yesterday AND today that there was three salt packets and asked patient B if the nurse gave him salt for lunch- patient B said he wasn’t sure, and patient A (from bed, with the curtain drawn, as always) yelled out at me that “he got his salt”- when I said that there was three salt packets from yesterday and another three today, patient A said “well, patient B’s mom was here so he must have got it.”

3. Yesterday when putting patient B back to bed I noticed a sign for the nurses to put a brown soaker for Bowel Routine on Saturday’s- yesterday was Saturday and when cleaning patient B he had a large BM- I asked for clarification if I should put a new brown soaker for patient B and patient B told me that that’s only for the morning shift to do- I didn’t need to. So that made patient A Upset that I had to ask.

4. Patient A was upset that he had to keep “looking out for his roommate” and didn’t like that I was so “unaware” of his Bowel Routine and didn’t like that I was asking questions to patient B- he stated that “you should just know.”

I think he just taking his anger out on me. He’s had a bad few weeks personally (family, ex gf, etc) yesterday he barely spoke to me because the morning shift nurse yesterday (new nurse- didn’t know his care) didn’t do things “as he liked” and he was in a horrible mood all evening yesterday- even today as well.

he seems more calm and talkative now after, but I’m 100% officially done with patients/ coworkers treating me like a punching bag- I’ve only been working for a year, and whenever things like this arises I turn the other cheek.

im not angry, or upset, but Im thinking, should I call his bluff and speak to the manager? Should I let it go since it’s (sorta/kinda) resolved between us?

im just concerned that he’ll paint a picture that I’m incompetent. I am not incompetent, but I should be treated with respect.

[amoLucia]

Go to your manager first, YOURSELF.

Calmly explain that he was angry & dissatisfied.

Better your manager hear it from you first, then to be broadsided by the pt.

And if you feel comfortable, ask to be NOT assigned again.

[Emergent, RN]

You need to develop detachment. This man is a manipulative bully. Be more businesslike. When you say "it's resolved between us", it sounds like you are in an (abusive) relationship.

[JKL33]

20 hours ago, nursechilespice said:

I noticed yesterday AND today that there was three salt packets and asked patient B if the nurse gave him salt for lunch- patient B said he wasn’t sure, and patient A (from bed, with the curtain drawn, as always) yelled out at me that “he got his salt”- when I said that there was three salt packets from yesterday and another three today, patient A said “well, patient B’s mom was here so he must have got it.”

20 hours ago, nursechilespice said:

I asked for clarification if I should put a new brown soaker for patient B and patient B told me that that’s only for the morning shift to do- I didn’t need to. So that made patient A Upset that I had to ask.

20 hours ago, nursechilespice said:

Patient A was upset that he had to keep “looking out for his roommate” and didn’t like that I was so “unaware” of his Bowel Routine and didn’t like that I was asking questions to patient B- he stated that “you should just know.”

Hear me out, this is going to decrease your difficulties:

You have to develop additional professionalism-related boundaries.

The portion I bolded above should have never happened - you should not be entertaining any off-hand conversation with A about what is going on with B. I don't care that he can overhear your convos with B; that doesn't excuse entertaining/inviting his input. Some of this borders on confidentiality issues to begin with, but beyond that it is not helping in your rapport with A himself, as he has now shown you.

Some of these issues I have to say that I would consult with my peers before getting into conversations with patients about what is supposed to be happening, for the very reason you are discovering--it can be difficult to establish and maintain a trusting rapport if you don't.

Patients do have their own difficulties and yes they absolutely can be abusive or just simply unpleasant. But you have the role and the ability to set professional boundaries within which to develop a good rapport.

Looking at it from A's perspective I can see how he might get the idea that things are just a little bit willy-nilly. Patients don't want that; there is already too much that feels out of control to them, they want to be able to trust us (for the most part). When they feel they can't, their sense of security becomes threatened.

I think this is a situation in which you can absolutely make positive gains that will make your life much easier.

Hope this makes sense, it is offered with helpful intent. LMK if you have questions~

[ComeTogether, LPN]

Yep you need to record his behavior. Not in the medical record (although you could write a very objective note, its usually hard to do without seeming subjective)

This guy needs to be educated by social services and shouldn't be getting involved in another patients care.

Your manager should know right away that his complaints are unfounded simply by their nature, but let her know anyway by telling her ahead of time.

[nursechilespice, LPN]

8 hours ago, JKL33 said:

Hear me out, this is going to decrease your difficulties:

You have to develop additional professionalism-related boundaries.

The portion I bolded above should have never happened - you should not be entertaining any off-hand conversation with A about what is going on with B. I don't care that he can overhear your convos with B; that doesn't excuse entertaining/inviting his input. Some of this borders on confidentiality issues to begin with, but beyond that it is not helping in your rapport with A himself, as he has now shown you.

Some of these issues I have to say that I would consult with my peers before getting into conversations with patients about what is supposed to be happening, for the very reason you are discovering--it can be difficult to establish and maintain a trusting rapport if you don't.

Patients do have their own difficulties and yes they absolutely can be abusive or just simply unpleasant. But you have the role and the ability to set professional boundaries within which to develop a good rapport.

Looking at it from A's perspective I can see how he might get the idea that things are just a little bit willy-nilly. Patients don't want that; there is already too much that feels out of control to them, they want to be able to trust us (for the most part). When they feel they can't, their sense of security becomes threatened.

I think this is a situation in which you can absolutely make positive gains that will make your life much easier.

Hope this makes sense, it is offered with helpful intent. LMK if you have questions~

Thanks! I sincerely appreciate the insight, When it comes to my personal life, I feel like I don’t have any issues setting boundaries etc.

But within my professional practice with dealing with patients, I tend to stop myself in the moment because I’m worried of “saying the wrong thing” in the heat of the moment (such as telling people off... which is what I DO NOT want to happen) I value having a good quality nurse/patient relationship, so I stopped myself and thought patient A was just trying to help- which was wrong, I know.

I definitely know this is something I need to work on, which is one of the points that I will be discussing with the manager.

Is there any resources you’d recommend to develop this skill?

[JKL33]

6 hours ago, nursechilespice said:

I tend to stop myself in the moment because I’m worried of “saying the wrong thing” in the heat of the moment (such as telling people off... which is what I DO NOT want to happen) I value having a good quality nurse/patient relationship, so I stopped myself and thought patient A was just trying to help- which was wrong, I know.

Well IMO you are definitely correct about not arguing/telling off patients. ?? Chastising them just rarely helps things but plenty of nurses insist on trying that route. It's good that you didn't do that.

I totally understand how these little conversations (for example the one about the salt packs) felt like just trying to keep your cool/keep things low-key and pleasant especially when A started butting in. Something like, "You have no business participating in this conversation!!!" would have been utterly ridiculous as well as rude and mean - I agree with you on that. He can't help it that he is in such close proximity. So the correct way with this guy is to decrease his "nosiness opportunities" to begin with. For now, if you have questions, consult a trusted peer. This will give him less to pick at you about (and is the more proper thing).

Secondly, imagine a bird's eye view of scenes you are involved in. Try to do this silently in real time. This is a useful exercise to help guide your interactions with people--everyone from doctors to patients to your LOs. You're leaving some kind of impression every time you interact with anyone (we all are). It helps to have an objective/neutral view of the scene so that you can deliver the kind of impression you wish to deliver.

Don't let "A" shake you. Stay calm. Use good body posture, pleasant tone of voice; convey confidence/sense of purpose. Next time you are to care for him, greet him pleasantly and be prepared to make a bit of pleasant small-talk. If you come upon a question about his care or care plan, consult peer/computer/chart, etc. Only ask him questions related to his personal preferences or questions r/t your assessment. Do the same with B when you are over on his side.

If "A" butts in, either don't respond to him--it is not required and it is not rude to just let his comments hang out there without a response; he is actually butting in and does not rightfully belong in the conversation even though we don't need to rudely tell him that. Occasionally you may choose to reply, "okay" or "thanks for letting us know that" - but again, the more you entertain his input, the more of it you will get and the more he will be able to claim that it is necessary for him to be his roommate's keeper because you are somehow incompetent.

I'm sorry I do not have a particular resource for you...just the results of my own trials/errors/successes. ? Some of our nursing communication techniques are very useful...but in general it is a matter of taking our own feelings out of the situation so that we can read other people correctly in order to respond appropriately.

GL~

[Wuzzie]

No help from me but what in the holy heck is a "brown soaker"? I couldn't even find it on Google.

[JKL33]

My guess was some kind of soaker pad (commonly green, pink or blue)? Quilted fabric on one side, moisture barrier fabric on the other?

I guess the brown one is for #2? ?

[amoLucia]

7 hours ago, JKL33 said:

My guess was some kind of soaker pad (commonly green, pink or blue)? Quilted fabric on one side, moisture barrier fabric on the other?

I guess the brown one is for #2? ?

Blue ones are also known as 'puppy pads'. Never ever heard them called that before. They were always 'blue pads' or 'incontinence pads'. Good for urine or BM.

[nursechilespice, LPN]

9 hours ago, Wuzzie said:

No help from me but what in the holy heck is a "brown soaker"? I couldn't even find it on Google.

It’s a sliding sheet! Haha we call them that interchangeably here- it’s more dense so any loose BMs wouldn’t soak the entire bed.

[amoLucia]

Never heard of it being a 'sliding sheet'

5 minutes ago, nursechilespice said:

It’s a sliding sheet! Haha we call them that interchangeably here- it’s more dense so any loose BMs wouldn’t soak the entire bed.

Never heard of it being called that either (neither?). The blue plastic underliner is impermeable to whatever.