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PATIENTS BECOMING MORE ABUSIVE?? anyone agree?

Posted

Specializes in LTC, PACU, Psych, OB/GYN, ED. Has 5 years experience.

So I spend a good amount of time as a triage nurse outside of D.C. Since moving to this area, I've noticed patients are becoming more & more irrational, demanding & downright nasty. They argue about coming in for follow ups (sorry but you cannot have your statin when it has been 8 mos since your last CMP/Lipid Panel/LFTS') & state they "don't care" if this medication un-monitored can put them into renal failure. All they want is the quick fix - to break the nurse down until she refills that standing order. Is anyone else experiencing this? Despite the fact that nurses are more & more recognized as leaders in healthcare, there seems to the less and less respect on the forefront.

I have previously worked as an in-patient psychiatric nurse, and those patients at times were more reasonable then my patients now!

So nurses out there...and I alone in this?!?!

0.adamantite

Specializes in Acute Care - Adult, Med Surg, Neuro. Has 3 years experience.

I feel too young to be saying this, especially as a part of the dreaded "millennial" which have a bad rap for being selfish. But I believe society as a whole is getting more entitled. The Burger King "Have it your way." Nobody wants to hear the word NO. Well N-O. NO. "No" is a complete sentence.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

Do you have kids? Sometimes it's like dealing w/ kids. If you give in, you are rewarding their bad behavior and teaching them that if they just throw enough of a fit, they'll get their way.

DO NOT reward their bad behavior. :up:

dream'n, BSN, RN

Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych. Has 28 years experience.

There are rude, entitled, hateful, lying, manipulative people in this world. Nursing because of the nature of our profession, comes into contact with maybe more than the average.

Gooselady, BSN, RN

Has 23 years experience.

I think the corporate focus on patient satisfaction creates a sense of entitlement that hasn't always existed (at least in this degree). All corporations do this, it's better for business, and healthcare is a business in the US. It's not a bad thing altogether, we have patients who are more informed and better prepared to participate in their care, rather than our grandparent's generation that lay there passively, afraid to ask. It's just that everything has a downside as well as an upside.

Nursing has had to adjust to this. Remember the old stereotype of the bossy nurse cum nun shaking her finger at you for getting out of bed? Patients are no longer 'children', they are consumers and the old fashioned nurse mind set where the nurse calls all the shots (where she's authorized to) just won't hang anymore.

If patients are better prepared and educated, and thus at times more obnoxious and demanding, nurses have to adjust. I'm not saying it's no big deal, it's a total pain in the butt to not have that old fashioned "I'm a nurse, you shut up and take your medicine" kind of authority anymore :D . Nurses are dealing with more empowered patients these days, and must accommodate the reality. Rather than blame the patients and wring our hands, let's step up our game and meet entitlement and demands with assertiveness. Let's repeat; I am the nurse, you are the patient. That is still true! Whatever the patient thinks. They can't MAKE you do anything. And if such a complaint were to reach your manager and you get crap for it, I'd reconsider my employment options. Your problem there is not the patient, your problem is your management.

Anyhow, my 0.02

What is the reason they give for not wanting to come in for follow ups? Are appointments available at times convenient for patients? I have found since the economic downturn, quite a few patients had difficulty securing jobs and they do not want to jepordize their jobs by attending medical appointments, especially if it is for a prescription refill.

You need to flip this in the correct direction. "your choice is A) or B)" "Those won't work for me". "Well I will have the provider contact you, then, as I can not authorize a refill unless you ______________. Shall I schedule you for _______________ or would you prefer to have discussion with the provider?" Make sure you DOCUMENT everything.

Don't ever get into a corner where you are refilling medications due to patient convenience. If something were to occur untoward, then you can bet that the patient would say "nurse red refilled my prescription no problem. I had NO IDEA I had to ___________"

Keep track of those patients. Keep the provider in the loop. Should someone decide not to refill and go without, contact them again, per your office policy and DOCUMENT. "The MD needs to see you to check on and discuss BP control. When can I schedule you to come in?"

If these policies are not in place, they need to be. And something you should bring up to your boss for a policy. Never, ever take it upon yourself to refill medications that require monitoring.

SubSippi

Has 2 years experience.

The really aggravating part, is that if patients like this DO end up suffering from a health issue due to the lack of monitoring, they will not hesitate to blame their providers.

Patients seem to want complete control over everything, but do not want to take any personal responsibility over their health.

LadyFree28, BSN, RN

Specializes in Pediatrics, Rehab, Trauma. Has 10 years experience.

Patients seem to want complete control over everything, but do not want to take any personal responsibility over their health.

^That's the main issue; many people feel out of control when acute and chronic illnesses arise; I see this more in pediatric nursing with the parents. :yes:

So many issues and choices and lack of mindfulness are the maladies of mere mortals; sometimes we all make the missteps of life; some missteps find a trail as long as the yellow brick road.

I think you have been give pretty good advice by Gooselady and jadelpn; keep it in the reason and rationale phase, document, and communicate with the providers; try to find solutions to this, whether it be having pts the ability to access the lab only, then the provider contacting them, other strategies that may help increase access for pts who may not have access to healthcare.

Seek to understand the community you work in. For example, I just started a position where it has the highest rate of poverty in the nation, highest rate of food insecurity, as we as 5 times the rate of HIV in the community; to add the access to healthcare is atrocious and the only access they have is the ER; having an understanding of "what you are working with," helps one understand the rationale in order to provide the population choice and emphasis on empowerment, whether their choices are less than ideal, you still maintain the purpose as a nurse is to promote advocacy and autonomy.

I agree with what is being said, but have you ever thought that patients are finally speaking up? Being their own advocate? There are a variety of articles and other sources telling the patients to ask questions, speak up, take charge, etc. Granted, there are those patients who complain, but there are patients where it sounds as if they are complaining, but maybe they are just passionate about something and when they speak up and give their opinion, it comes across as complaining. There are those patients who google and read up on their conditions, medications, procedures, etc. and will have a list of questions. I take care of my health, go in every 3 months for labs and then a few days laters for the results and to go over concerns with my doctor. However, I will speak up and will say no. I was raised to respect doctors, nurses, etc. and I do, but about 20 years ago when I was mistreated by a physician (not sexually) and with another doctor pressuring me into something; that's when I started speaking up and taking charge of my health. Example - just because it's easier for a patient to be put to sleep than an epidural, doesn't mean that the patient doesn't have a choice. However, some medical professionals will take that as a patient complaining. Or a patient might be bringing mistakes to the physician in regards to his staff. I'm sure it could sound like complaining, but the physicians need to know. I find it refreshing that patients are standing up for themselves and even though it might sound like a complaint. Granted there are those patients who are very nasty and rude, who might spit and hit ... I would not tolerate them, but those who are voicing their opinion (which might sound like a complaint) - look at it from the side of the patient.

I haven't experienced a change, yet. I'm sure much of that has to do with the majority of my patients being on Medicare.

No Stars In My Eyes

Specializes in Med nurse in med-surg., float, HH, and PDN. Has 43 years experience.

My husband is one of those who feels the medical community, and particularly doctors, only want these repeated visits to get some more $$ out of the patient. I hear it all the time at home, the vituperate blaming.

I've learned to listen and say "hmmmm" and "huh". I do not feel obliged to try to explain every rationale to him because then I would be frustrated all the time, as it would be him arguing with me over something I have no control over.

I say, "Why don't you ask the doctor." It isn't my job or responsibility to break down his aversion to the process. At home, I am a wife, not a nurse.

I say he is a grown man and knows what he knows, even if he doesn't want to believe it.

i don't nag, because then I wouldn't have a very happy marriage. He is the way he is. While I don't actually support his attitude, I allow and accept his feelings. So he gets to squawk and I don't have to answer to every point he brings up.

Then, by the time he goes into the office for his appointment, he is much calmer and more reasonable (your welcome!) and he is able to discuss his displeasure or ask his "why" questions in a more non-confrontary manner.

brandy1017, ASN, RN

Specializes in Critical Care.

This situation probably comes down to money. More and more people have been forced into high deductible insurance where they have to pay for the office visit. Even if they have regular insurance they still have to come up with copays. Again labs cost money and that may be why they are reluctant to come in. I myself am in a high deductible plan not by preference, and I too think twice about seeing a Dr because of the cost. What is so frustrating is the medical inflation built into every bill and the fact that you don't even know what you are going to be charged till after the fact! My employer self insures and contracts with an outside servicer. I can't tell you how many times I've had to argue with them to get them to pay their share of the bill. Time after time they try to push more of the bill onto us than is right. I've always won in the end, but it is not fun to have to fight just to get the insurance to pay the bills. I always wonder how many others just don't bother fighting and end up overpaying more than there fair share! I'm sure not everyone is as determined as I am.

I have only been doing this for half a decade. I can't observe a trend. Just do whatever the patient wants as long as policy and laws of practice will cover it.

My husband is one of those who feels the medical community, and particularly doctors, only want these repeated visits to get some more $$ out of the patient. I hear it all the time at home, the vituperate blaming.

I've learned to listen and say "hmmmm" and "huh". I do not feel obliged to try to explain every rationale to him because then I would be frustrated all the time, as it would be him arguing with me over something I have no control over.

I say, "Why don't you ask the doctor." It isn't my job or responsibility to break down his aversion to the process. At home, I am a wife, not a nurse.

I say he is a grown man and knows what he knows, even if he doesn't want to believe it.

i don't nag, because then I wouldn't have a very happy marriage. He is the way he is. While I don't actually support his attitude, I allow and accept his feelings. So he gets to squawk and I don't have to answer to every point he brings up.

Then, by the time he goes into the office for his appointment, he is much calmer and more reasonable (your welcome!) and he is able to discuss his displeasure or ask his "why" questions in a more non-confrontary manner.

You are a very wise wife.

brownbook

Has 36 years experience.

I guess maybe patients are more rude and demanding. I think it has to do with computers. You can get immediate access/answers to everything. It is hard to suddenly be told.....no I can't do that when the patient knows you are looking at all their health care information on a computer screen.

I don't understand your example. Are you a triage nurse in an ER? I have only heard of triage nurses working in ER's. If patients are coming into ER's to get meds refilled that is way beyond rude, that is stupid? Your ER needs a huge sign saying we do not do routine med refills.

If you are working in a Dr's office then I can understand the patients frustration. I almost ran out of my BP pills. (I know stupid mistake, they do happen.) I would probably get rude if the nurse in my Dr's office said....no you can't get a refill until you see the Dr.....our next appt is in two weeks. Yeah...I would get rude.There is going by the policy, and there is common sense!

Farawyn

Has 25 years experience.

They are more non compliant, and also more rude. They do know the healthcare "business" more and ask more questions and such.

Abusive? No. Not in my experience. My worst patient who threw a phone at me (a real phone, which he ripped out of the wall, not a cell phone) and cursed me out was over 10 years ago.

No, you are absolutely not alone. People can be very unreasonable and think that their lack of a medical degree does not mean anything, meaning they think they know everything. One of my pet peeves is when it is a patient's adult child making ridiculous medical decisions that could potentially harm the patient, for example when I had this patient who's daughter didn't want the patient to have any insulin for a blood sugar over 300 because she thought the patient's blood sugar would drop too much. Mind you the patient was eating jello packed full with SUGAR. It drives me crazy how people with no medical background think they know everything. Also, there was no pleasing this adult child and everything the medical staff did was wrong; the doctors weren't taking good enough care of her mother, the nurses weren't compassionate enough. I think people in general can be too ridiculous sometimes, not everyone but a good amount.