putting the squeeze on the nursing staff

[adrienurse, LPN]

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[traumaRUs, MSN, APRN]

Yikes! A family conference seems in order. Maybe this resident needs a higher level of care?

[JentheRN05, RN]

I totally agree - you need to suggest to the nurse manager a family conference - possibly a move to an alzheimers unit.

[barbie90210]

i totally sympathize. i have had my share of family members who write everything down, call you to turn the patient every hour, and look at you as if you are a criminal, lazy or trying to get out of work. their needs come first. they don't care that another patient you are caring for may be critical or even that there are other people in the world for that matter. however, i also sympathize with some of the patients because they have gotten a raw deal. they are in the hospital, not getting better, and spending all that money. it isn't a good situation for anyone in many cases. this is another example of a nursing manager sacrificing her staff to keep her own butt out of trouble. instead of talking to this family member and setting limits with her she is protecting her own hide. i've seen it many times. might i suggest a condom cath? it is not invasive and it can't be good for the skin if the patient is that incontinent. :blushkiss

[romie]

You better hope that any Alzheimer's unit that has to recieve this patient is properly staffed to accept this patient, otherwise you are just shifting your problems to another unit. As an Alzheimer's Unit director I have to ensure that each resident meets our unit admission criteria and not to accept patients because the staff on another floor are annoyed by a patient.

My facilty would definitley have a wellness meeting with the family and explain that while our facilty provides 24 hour care, we do not and cannot provide 1:1 care that this resident may need and that the family seems to want. The family would have to provide their own private caregiver. Sometimes the families will actually pay for a sitter or private caregiver or they back off once they see how much it is going to cost them.

[noc4senuf]

THere are a couple things to look at. 1. Has he been evaluated by a urologist? 2. He may need medication adjustments. 3. An Alzheimer's unit. 4. If left like this, there is bound to be issues with the surveyors during survey time.

[snowfreeze, BSN, RN]

I think unit managers need to have management training. When you understand the communication that allows things to work for both sides and the middle you do a better job. You also need rules, guidelines and someone willing to enforce them. This patient needs a different care level than this unit can provide. The family needs to be spoken to about the care level needs of the patient and themselves. This should not be dumped back on staff, the manager can contact the physician, social services, administration, DON, psych and clergy if she/he does not want to be the confronter. With some help in sifting through the information it really does not seem all that out of control. On the staffs end of this, documentation is the key, everyone must document the outragious demands of the family (professionally of course) and the above and beyond needs of the patient. Hourly notes of incontinence for 2 days after a urinalysis shows no infection should trigger further testing. Not everything needs to be documented in the patient chart, some issues of blatant disregard and verbal abuse of family members toward staff needs to be written in an incident report. This incident report should include a written signed and dated statement by the staff involved, the abused, the witnessed and the nurse in charge at the time. This should also be followed up by admininstration within 72 hours or less.

[Antikigirl, ASN, RN]

uhggggg been there had this probelm before! please read..this really works!

what we wound up doing is to have a check off list of items that seem to be out of control...like how many times a day the resident has to be changed, how many times the bed had to be changed, refusals of incontenence products, how many showers were needed to clean resident a day and so on!

then once we did that for a month, we submitted it to our care co-ordinator so that she could tally it. our facility allows for said amount of times for total change of clothes, showers and what not in the rent...but not extra times..hello this is a business too! so those were subtracted from the alloted times and the patient was charged for the extra time!

it was the only way we could get some of these demanding pt/family to be realistic! money talks, and it got to the point it had to be done because the other residents who pay their rent too were suffering!

so i would suggest a check list for the room, sign and date for items done. then in the mar have a prn section for how many times incont. products were offered, and have the caregivers/nurses circle it, and write on the back declined and a quote!

then when a care plan meeting occurs..they can use this as proof of how often this occurs, and either warn or charge the pt!

it works!!!!!! trust me!

[TrudyRN]

Lots of good suggestions already made.

You guys should definitely keep track of how often you change him, how much linen is used, how much time is spent on him.

Make sure he has no infection. Maybe he needs a prostate resection.

I don't really know how to get your manager's attention but probably focusing on $$$ will do it - faster than focusing on staff's workload or the rights and needs of other residents, that is.

And a conference is definitely needed. I think the family needs to hire a private duty for at least part of the 24 hours of each day, at least 5 days per week. Maybe noon to 8:30 p.m., which will cover most of the time he is probably up.

I wonder if his refusal to wear incontinence products might be due to shame or discomfort. Have different products been tried? Are the diapers big enough? Is his hair being pulled?

You should probably keep him slathered in zinc oxide or petroleum jelly or other skin protectant.

Maybe he'd accept a towel, at least, between him and his clothing.

Was he like this at his last living place? Maybe the dtr has no real comprehension of how frequently he pees.

Changing the sheets daily is the least of your problems. Go ahead and change them, I'd say, if you have sheets available. Of course, that cost adds up, too, but not very much. But I think the dtr needs to stay with him for several hours and see just how often he wets himself and how his refusals of proper protective gear are making a big problem.

[teeituptom, BSN, RN]

Why dont you do what the majority of LTCs do, send the pt to the ER for an Eval of something even a Social Eval. We get even that all the time from LTCs. Ive seen LTCs send 90 yo dementia pts in for a psych eval because the pt was swinging at them.

[adrienurse, LPN]

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[adrienurse, LPN]

:banghead: