"Can I take one of your patients for this one?" "No! And I resent your asking!"

[Alnitak7]

Listen to this debate from one work place.

"I don't have any I feel like trading."

"I don't want to, "give up," any of them."

"She just asked you to do something really easy!"

"If I find out she had to take care of him, I will see to it that you get written up and sent to the DoNs office."

"Your assertiveness training does not prepare you to work in this setting."

On this site I have seen discussions about trade-offs. Some people seem to think that when you are assigned to a group of patients, they are all, "your resonsibility," so that if you are feeling threatened by one and ask to trade them they interpret this to be childish and unfair. Most times, the others don't even feel threatened by the same patient so this is completely fair to everyone involved.

There used to be a patient on my group who was sexually assaultive and I would get someone to help me with him and one day I was yelled at by the charge nurse who said, "There is no reason for more than one person to be in here!" There was another patient who was screaming at me and calling me obscene names and most of the others thought this man was nice, and would take him off my group. There were other people on the staff who would try to force me to work with him when they knew he had been abusing me. One girl even started lecturing at me like I was a screwed up ten-year-old and I absolutely did not want to argue with her. Not only did it make me nervous, but they should have thought about the rights and feelings of that patient, who they all liked more than I did.

Forcing anyone on someone who is abusing them or a threat to them is immoral and in some cases even illegal. This is why some people get restraining orders and why some abusers go to jail. If you think you should try to get a co-worker used to a patient they are afraid of, this shoud be done with extreme tact. In some cases, you should go in the room with them to show them how you work with them. I think if you can work with just anyone, this is a gift you have and you should not look down at people who haven't got it. It might be different working in an emergency setting, but not in regular settings.

[Boognish]

I am currently in nursing school, but I have seen the same thing in the assisted living facility where I work. In one instance that I know of, "switching" residents has led to confusion between the two caregivers on shift that resulted in one woman who was supposed to be on two-hour incontinence checks to be left in wet depends for an entire shift (both caregivers were let go). In that case, one caregiver had attempted to trade "floors" with the other CG on shift (a floor actually being 1 & 1/2 floors out of 3 total), and each CG thought the woman whose care was neglected was the responsibility of the other. Apparently the CG who requested the switch felt that her floor was the more difficult of the two, and she wanted the easier one because she was "tired," or something like that.

While it's true that some people are better than others at dealing with "difficult" clients, everybody working in a direct-care role needs to be prepared to suck it up and leave their own feelings at the door in order to deal with difficult situations and meet the needs of their clients. I understand that dealing with abusive behavior is not easy. I think that it indicates a need for further training when people feel wholly unequipped to deal with certain situations, and I believe that bringing in a second nurse/CNA/caregiver (depending on the setting) who has an easier time with a "difficult" client is an excellent way to provide such training. But this needs to be treated as a teaching situation- the nurse having a difficult time should come out of it feeling better prepared to go solo the next time he/she goes into that client's room. While some people might "have a gift" that makes it easier to deal with certain situations, it is something that anybody can learn who is prepared to do so, and learning to deal with people with difficult behaviors, abusiveness, sexual inappropriateness etc. is part of being a nurse. If a person feels they aren't capable of learning to deal with those behaviors, then they should probably consider working in a different setting where they won't have to deal with them, as pawning off tasks that you do not want to do onto coworkers is not acceptable behavior in any workplace.

I do not believe that it is appropriate to "trade" clients unless it is for the benefit of the client. For example, when a female patient is extremely uncomfortable having a male nurse provide catheter care or a bath (of course, if a male nurse is assigned to a client who is uncomfortable with them providing care, they should assess the situation to find out if there is something they can do to help them feel comfortable with having a man provide care before finding a female nurse to take over). That is an issue in the setting where I work, and it is the only time where switching resident assignments is allowed. In fact it's required, since some residents have "female only" peri-care and/or showers as part of their service-plans. However, when I work caregiving shifts and have to trade my female-only residents to my female coworkers, I make sure to take on the care of a resident of theirs with a similar or higher level of needs.

[Alnitak7]

As for the lady that was supposed to be checked every two hours, this would never have happened if the two

caregivers had communicated with each other like they should in every workplace.

As far as only trading for the good of the client or only if they ask, if there is one worker who likes them and

another who can't stand them, it is not good for them to have staff-members who are on such a rigid set of rules

or so indifferent to each other that they can't think about what makes the shift easier for the other.

As far as pawning off tasks onto co-workers, several of my co-workers have given me patients off their list

who they could not stand so that one day I took one of my favorite patients from a girl who couldn't tolerate him

and I gave her one she liked and we were both happy for the rest of the shift.

In cases where the entire staff has a hard time with a patient, you should work with them in pairs, either/or the whole staff should work together on them and this is great for training purposes as well as protecting the patient.

If I was the patient and I hear a nurse saying, "Will you take this one," I would be think taht I have less chances of being abused by someone who does not have the skills to work with me. If I try to get inside the patients' heads, I know I would feel safer when the nurses are all working together so I won't have a nurse who can hardly stand me and I would be glad she was honest enough to trade me off. However, I am all for protecting their feelings and saving their faces and so I choose not to be obvious about it if I can get around it.

To on lady who asked, "Where is the other one," I answered, "Well she's afraid of you."

Some of them will abuse only one staff member and be nice to all the rest. In this case, it constitutes

emotional and mental abuse on your coworkers when they are foced to work with a patient who has

abused them and to offer no compromises.

I am currently in nursing school, but I have seen the same thing in the assisted living facility where I work. In one instance that I know of, "switching" residents has led to confusion between the two caregivers on shift that resulted in one woman who was supposed to be on two-hour incontinence checks to be left in wet depends for an entire shift (both caregivers were let go). In that case, one caregiver had attempted to trade "floors" with the other CG on shift (a floor actually being 1 & 1/2 floors out of 3 total), and each CG thought the woman whose care was neglected was the responsibility of the other. Apparently the CG who requested the switch felt that her floor was the more difficult of the two, and she wanted the easier one because she was "tired," or something like that.

While it's true that some people are better than others at dealing with "difficult" clients, everybody working in a direct-care role needs to be prepared to suck it up and leave their own feelings at the door in order to deal with difficult situations and meet the needs of their clients. I understand that dealing with abusive behavior is not easy. I think that it indicates a need for further training when people feel wholly unequipped to deal with certain situations, and I believe that bringing in a second nurse/CNA/caregiver (depending on the setting) who has an easier time with a "difficult" client is an excellent way to provide such training. But this needs to be treated as a teaching situation- the nurse having a difficult time should come out of it feeling better prepared to go solo the next time he/she goes into that client's room. While some people might "have a gift" that makes it easier to deal with certain situations, it is something that anybody can learn who is prepared to do so, and learning to deal with people with difficult behaviors, abusiveness, sexual inappropriateness etc. is part of being a nurse. If a person feels they aren't capable of learning to deal with those behaviors, then they should probably consider working in a different setting where they won't have to deal with them, as pawning off tasks that you do not want to do onto coworkers is not acceptable behavior in any workplace.

I do not believe that it is appropriate to "trade" clients unless it is for the benefit of the client. For example, when a female patient is extremely uncomfortable having a male nurse provide catheter care or a bath (of course, if a male nurse is assigned to a client who is uncomfortable with them providing care, they should assess the situation to find out if there is something they can do to help them feel comfortable with having a man provide care before finding a female nurse to take over). That is an issue in the setting where I work, and it is the only time where switching resident assignments is allowed. In fact it's required, since some residents have "female only" peri-care and/or showers as part of their service-plans. However, when I work caregiving shifts and have to trade my female-only residents to my female coworkers, I make sure to take on the care of a resident of theirs with a similar or higher level of needs.

[Alnitak7]

In some cases I have decided that I am not going to see a co-worker humiliated by a patient who abuses them.

I take the patient from them or pair up with them to make it easier. In most of these cases, they are more nervous and afraid of them than I am.

[Alnitak7]

This is not about having all easy patients. This is about trading a difficult one you like and can handle for

a difficult one that you can't handle. This makes it easier on everyone including the patients, ie.

"Can you take L off my group?"

"I'll take her. She doesn't bother me."

"And which one of yours do you want to give me?"

Now everyone is happy for the rest of the shift.

Your post is extremely hard to read, FYI. Did you mean to break it up into stanzas, like a poem?

I dont have a problem with nurses switching a patient at the end of their shift, especially if the patient is really abusive. We all need to share those patients. BUT I do have a problem with nurses who REGULARY switch patients just because they are a PIA. News Flash: there are a lot of PIA's in the hospital! You have to learn how to deal with them, because its not fair to give one nurse all the nice/easy patients while giving another one all the difficult ones.

There is one nurse who asks everyone who isn't coming back the next day, who their easiest patients were, then she would sign up for those and the next day have it soo easy while we are going crazy! SOO annoying!

[Boognish]

As for the lady that was supposed to be checked every two hours, this would never have happened if the two

caregivers had communicated with each other like they should in every workplace.

As far as only trading for the good of the client or only if they ask, if there is one worker who likes them and

another who can't stand them, it is not good for them to have staff-members who are on such a rigid set of rules

or so indifferent to each other that they can't think about what makes the shift easier for the other.

As far as pawning off tasks onto co-workers, several of my co-workers have given me patients off their list

who they could not stand so that one day I took one of my favorite patients from a girl who couldn't tolerate him

and I gave her one she liked and we were both happy for the rest of the shift.

In cases where the entire staff has a hard time with a patient, you should work with them in pairs, either/or the whole staff should work together on them and this is great for training purposes as well as protecting the patient.

If I was the patient and I hear a nurse saying, "Will you take this one," I would be think taht I have less chances of being abused by someone who does not have the skills to work with me. If I try to get inside the patients' heads, I know I would feel safer when the nurses are all working together so I won't have a nurse who can hardly stand me and I would be glad she was honest enough to trade me off. However, I am all for protecting their feelings and saving their faces and so I choose not to be obvious about it if I can get around it.

To on lady who asked, "Where is the other one," I answered, "Well she's afraid of you."

Some of them will abuse only one staff member and be nice to all the rest. In this case, it constitutes

emotional and mental abuse on your coworkers when they are foced to work with a patient who has

abused them and to offer no compromises.

It's true that the resident's care would have never been dropped if the caregivers had communicated. I guess my point is that the communication didn't happen because one of the CGs was more focused on what they wanted to get out of work that day than they were on meeting the needs of the residents.

I will concede that I was taking an overly-rigid stance on switching. However, I still believe that any time a switch is made, it needs to be done with the best interest of the client foremost in mind, and not based on whether or not a person likes or dislikes the client they are supposed to care for. And I still believe that there is a significant problem that needs to be addressed if a nurse/CNA/caregiver feels unable to adequately care for a client because of personality and/or behavior issues. Switching residents avoids addressing that problem. If a person does not feel equipped to care for those with whom they do not get along, what happens when no one is available to switch, or nobody wants to switch? If the answer is that the client will receive inadequate care from someone "who does not have the skills" to work with them, then is that not a serious problem?

And if I was a patient and I heard the nurse who was assigned to me trying to get someone else to do the job, it would make me feel lousy. It would make me feel like providing care for me was a chore to be avoided. If it made me feel like I had "less of a chance of being abused," wouldn't that mean that I believed that the nurse who was trying to get someone else to take care of me was not good at her/his job? If I'm a client in a hospital, or a nursing home, or any other healthcare setting, I think it's a reasonable expectation that anybody employed there as a licensed healthcare professional should be capable of providing my care adequately at the very least without worrying that they are going to abuse or neglect me.

As for being "forced" to work with clients who verbally abuse you- that's part of doing your job. Your coworkers refusing to switch does not "constitute emotional and mental abuse." If a client is abusive towards only one staff member, then there is probably something that said staff member is doing to upset that client, however subtle. Rather than using a client who you don't get along with as an opportunity to find someone else who can do the job better than you, use it as an opportunity to improve your nursing skills and figure out how to alter your approach in a way that makes that client more comfortable with you. Almost every time that I've had a coworker complain that a resident gives them a harder time than they do other caregivers, or when I've observed a resident becoming resistive or combative with one of my coworkers to a degree that is beyond what I normally experience, I've been able to identify aspects of the coworker's approach to which the resident was reacting- with very few exceptions. So I'm always very suspicious when I hear anyone say "well, they just don't like me." However, I have seen occasional situations where a resident with Alzheimer's has reacted immediately and severely to one particular caregiver before that person has had the chance to do anything to upset them. Maybe the client is being reminded of someone from their past who they didn't like- I don't really know. But those situations have been very few and far between, in my experience. Even then, there are often creative ways to work through such situations.

I've worked with a lot of difficult clients over a total of almost 10 years- in assisted living, memory care, and in caring for children and teens with autism and other developmental disabilities- including those identified as having behavioral and emotional problems. I've been cursed at, personally insulted, hit, bit, spit on, urinated on, and had feces smeared on me. And I didn't deal with it very well when I first started. I remember one job from which I'd go home shaken to my core, and which I'd feel awful about returning to the next day. I quit working in a direct care roll for two years because I felt like I just couldn't do it any more.

But since then, I've learned how to cope with and learn from situations which would have had me at the end of my rope before. Rather than taking it personally, I try to determine the underlying cause of the behaviors and evaluate what I could be doing differently to diffuse or prevent them from arising. Most importantly I let go of my own emotional response, because if I hold onto the anger, fear, and self-doubt that those situations bring about in me- and I do experience all of those emotions any time I feel attacked verbally or physically- I will be completely incapable of doing my job. If I bring in someone else, it is so I can see what approach they take and how it plays out- or so I can have them hang back and observe my approach so they can give me some feedback on how I could do things differently to improve the outcome of the interaction.

[ShannonRN2010, BSN, RN]

As an LPN, I often worked the more...unpleasant pt. load. I just learned to deal with it *Shrug*

[knittingknurse]

I have a regular schedule of 3 nights in a row. Sometimes there are patients my coworkers and I call "one-shifters." If we take turns having the patient, we are able to maintain good nursing care even if unable to provide continuity. It can actually be better for the patient not to have a nurse whose nerves are intact at the beginning of the shift. In addition, we often help each other deal with "difficult" patients by taking turns answering the call bell and responding to bed alarms. I am lucky to work on a shift with good teamwork.

[Alnitak7]

Can nurses refuse to care for angry patient? - Nursing for Nurses

"Can a nurse refuse to care for an angry patient?"

Here is another thread. It's much different.

[Alnitak7]

Most times when someone asks me to take one of theirs, my first concern is about their feelings and making their shift easier and reducing the stress load for everyone.

Most times it's a patient who doesn't bother me.

It's usually better for the patient to have a caregiver who likes them with all but a few exceptions.

[Alnitak7]

Has anyone ever refused an assignment? - Nursing for Nurses

[Alnitak7]

Under what circumstances can a nurse LEGALLY refuse an assignment? - Nursing for Nurses

[Boognish]

Most times when someone asks me to take one of theirs, my first concern is about their feelings and making their shift easier and reducing the stress load for everyone.

Most times it's a patient who doesn't bother me.

It's usually better for the patient to have a caregiver who likes them with all but a few exceptions.

Spreading the workload around and sharing difficult patients is good teamwork, as has been mentioned numerous times in this thread. But if you feel like whether or not you like a patient has in impact of the quality of care that you are able to provide to them, as is implied in this post and in others, then I believe that is a problem.

But I think what really stuck in my craw and caused me to go off in numerous TLDR-style posts is the idea that sometimes a client "just doesn't like" a certain nurse. While that may seem true at times, using that as a rationale for switching puts all the blame for the conflict on the patient, and allows the nurse to avoid taking responsibility for resolving it.