Patients declining certain staff to take care of them

[dialysisnurseLC]

Have you all ever had a patient decline your care?

I have recently and it is bothering me.

First of all the patient cramps nearly every tx due to the usual reasons of high fluid gains. Also I transferred to the clinic and was a new face to him and he would not allow me to canulate him (that didn't bother me, I would just ask a tech to cannulate him after I cleaned his access). One day during his treatment he tells me that his pressure can't drop below 90 systolic (it usually does every treatment) because he has heart problems, and I tell him that we always watch his pressure and I would intervene if need be. So he starts cramping during my change over (he is the last patient off the machine so it would be a while before I ended his treatment) and I ask him if he wants fluid , he declines and I document. He asks to put his feet down and I instruct him to lean into his calves to relieve the cramping and I document. I go back to my other patient that is off the machine to finish her up. I then go back to the cramping patient and he is still cramping. I tell him I am going to give him fluid to see if it helps (he is always against getting saline) and I give him 200ml BP is in the 90's btw, call over the charge nurse and document what's going on after also turning the UFR off. She talks to him while I am putting on another patient. While putting on another patient i asked how he is doing etc and document. After putting on the other patient I go over to the guy that was cramping and he still has not had any relief so he wants to end to early. So I rinse him back and his blood pressure dumps to the 80's on my ending treatment line so I rinsed back with 400 or saline and I told him I was going to have him recline in the chair and I told the charge nurse what I was doing. Long story short everything I did was documented and we were communicating positively. The next time he came back to treatment he tells my administrator that he does not want me taking care of him because he is concerned for his safety in my care and he filled out a grievance report. My administrator tells me and says I can't take care of him and she knows what happened because everything was documented and she doesn't believe I put him in danger but I can't take care of him. Fast forward to now... I was placed in his section and he looks in the window from the lobby to see who is his tech/nurse and he sees its me and he gets all upset in the lobby and the charge nurse goes to talk to him and another tech takes him. I honestly thought everything had blown over because he would speak to me I would push his heparin and do his assessments so I thought he had a change of heart. The techs also told me he was considering talking to a lawyer about me...I really don't get it and my administrator has told me some patients are like that and don't take it personal... But I honestly am because in my 5 years of nursing no one has ever questioned the safety of my care. Patients have gotten upset with me but we generally talk it out and it's usually something minor. But the whole time I had him he didn't get upset with me or raise his voice etc.

Any suggestions or has anyone experienced this?

[jdub6]

I don't do dialysis bUT see this all the time. If your mgr says you did everything right, just let it go. No pt or family is going to like everyone. Personalities clash. You may look like his ex. Who knows. If it's a pattern that's different but one pt? Especially a dia lysis pt (already a rough situation for him) who sounds like he has a lot of discomfort with his tx (even worse). It's the perfect setup for a frustrated man looking for a scapegoat.

I do believe it's usually good for staff to try to fix things with pts when possible, confront the situation directly and try to move past it with them. Sometimes this can work, especially if say the pt misinterpreted something and got offended. Other times its best to just steer clear. In this case you did everything right, I would just not let it bother me and move on. He obviously is taking oUT his frustration on you irrationally, but you can't change that. It happens to everyone eventually.

[dialysisnurseLC]

Thanks! You are right! I will keep treating him with respect and kindness...

[nutella, MSN, RN]

Be happy that you do not have to run his tx anymore.

Some dialysis patients will just get hung up on a bad tx and blame the nurse for whatever is going on. Also, it is true that some patients always end up with not enough fluid off because of cramping or low BP with chest pain. High fluid gain between tx is a problem and needs to be addressed but that is nothing that you can do for that patient.

Just relax and when you are in his section and see him coming in make sure to tell him that somebody else will run his tx.

If he has serious other issues like cardiac stuff and cramping he will have that with anybody over time.

It is always hard when you are the new person in a chronic unit...

[verdeacres]

I agree with Nutella too. We have many pts at our clinic who do not want a certain tech to stick them or treat them. Sometimes they have no choice as there is somewhat of a high turnover and the schedule cannot be changed. Hang in there and continue to do what you have done.

[Chisca, RN]

The probable answer to his cramping is longer treatment times or an extra treatment or three but instead he blames you. I think it's called denial.

[Erikadawn RN]

Don't be upset by it, I have been in dialysis for 5 years . I have a pt now that tells everyone I wasn't watching him and he had to go to hospital for a high BP. I did send him to the ER but he conveniently forgets , that it was his "favorite " nurse that left early and when I took over that section I discovered his BP was elevated for the past 2 hours. Smh

[dialysisnurseLC]

Smh...it does bother me that a patient complains about his safety of the care he receives from me... Especially when he mentions lawyers all the time.

[Erikadawn RN]

There are pts in every dialysis unit like this, just leave him alone and stay away from him. I believe the majority of dialysis pts are so bitter that they are on dialysis, so they hate us, the caregiver. I have also taken care of some that I love to see every day and talk too. Just chalk it up and move on, don't stress about it, it's not worth it

[dialysisnurseLC]

I agree. I do stay away from him. I speak and keep it moving.