Or rather, residents. (I work in LTC) A fellow nurse accused me of "spoiling" my residents, and we had a spirited debate about it. She is an excellent nurse, but very much "by the book". The residents do NOT like her, and they let her know. What started the discussion was when one of the residents compared her to me, and said, "Why can't you be more like that other nurse?", and she got a bit miffed, and said they only like me because I spoil them.
Well, maybe I do, but I find that it makes everything go much more smoothly. For example, one resident is a very non-compliant diabetic, refuses fingersticks, insulin, won't eat the food, etc, so her sugars are always off, that is, when you CAN get the sugars at all. Their answer is to force her to go to the dining room for meals, so they can monitor her. But she HATES eating there, so she just makes snarky comments about the "jailhouse food", then goes back to her room and eats the crap she got out of the vending machine. Lord only knows what this does to her blood sugar, because she won't let the other nurses do her fingerstick to find out.
Well, I was heading out to a fast food place for my dinner, and brought her a burger and fries, which she scarfed down like she hadn't eaten in days, which she probably hadn't. Of course it sent her sugar up, but since she was in a good mood because I had gotten her what she considered a decent meal, she allowed me to do the fingerstick, and give her the coverage.
Miss "Book Nurse" said I shouldn't have gotten her the fast food, that she needed to eat her proper meal. Perhaps she is right, but I felt I got better results by doing what I did. After all, she DID eat, and she DID allow me to stick and cover her afterwards, which is a lot more than Book Nurse was ever able to do. This resident is NEVER going to be a compliant patient, and all the forcing does is **** her off and make her even MORE non-compliant.
In my opinion, sometimes you need to put the "book" away and deal with these folks on a more personal level, but they don't teach you that in nursing school.
This resident is manipulative and noncompliant. I don't reward or pander to that sort of behavior, so yes, I'm by the book. I politely explain consequences of refusals and document them in the pt.'s chart for the Dr., but no, I would not bend over backwards for a competent adult to get them to comply with their care. I make it easy for them to change their mind if they want to do the right thing, but by and large, they can either take responsibility and do their part, or they are welcome to continue with their choices and deal with consequences.
An A&O smoker who chooses to smoke is welcome to go to a smoking area if they ask. They are a free adult. However, I would not be getting them a pack of cigs or taking them outside (as was suggested to me once, by a staff member, in the middle of a busy shift) under ordinary circumstances.
While I understand your intent, I disagree with what you did. I think that you and your co-workers need to take a united front in how this resident is approached. It seems to me that this non-compliant resident is creating a triangulation between herself, you, and the evil nurse(s)/facility policies. The chaos she's creating in her body parallels the chaos she creates with her caregivers. I wonder if she has good relationships with her family? Comments like "Why can't you be more like that other nurse" are meant to be manipulative. She got you.
I absolutely support a resident's right to self determination. If she refuses blood sugar checks, medications, a proper diet, etc. So be it, that's her right. However, just as I would not buy cigarettes for a resident who chooses to smoke, I won't buy junk food for a non-compliant diabetic.
It's not a matter of spoiling a resident. I looooove to spoil my residents with quality care. For those residents who are non-compliant, I like to spend time figuring out how we can compromise. If they are A&O, I try to reason with them. Most times this fails, like with our resident who chooses to smoke. My conversation with him has been "Sir, I can't support your decision to smoke, but I do support your right to do so." His reply has been "I appreciate that, and the lack of lecture. Now excuse me while I go abuse myself for awhile."
Why does this resident have to eat in the dining room? Why can't she have a tray brought to her room? She can just as easily refuse it in her room, but at the same time she won't be forced into the dining area, no one has to try and convince her. Just quietly leave her tray in her room, and pick it up when she's done. No comments on either end.
I'm assuming the dietary department is trying to work with her preferences? What does she want to eat besides vending machine crap and fast food?
Or rather, residents. (I work in LTC) A fellow nurse accused me of "spoiling" my residents, and we had a spirited debate about it. She is an excellent nurse, but very much "by the book". The residents do NOT like her, and they let her know. What started the discussion was when one of the residents compared her to me, and said, "Why can't you be more like that other nurse?", and she got a bit miffed, and said they only like me because I spoil them.
Well, maybe I do, but I find that it makes everything go much more smoothly. For example, one resident is a very non-compliant diabetic, refuses fingersticks, insulin, won't eat the food, etc, so her sugars are always off, that is, when you CAN get the sugars at all. Their answer is to force her to go to the dining room for meals, so they can monitor her. But she HATES eating there, so she just makes snarky comments about the "jailhouse food", then goes back to her room and eats the crap she got out of the vending machine. Lord only knows what this does to her blood sugar, because she won't let the other nurses do her fingerstick to find out.
Well, I was heading out to a fast food place for my dinner, and brought her a burger and fries, which she scarfed down like she hadn't eaten in days, which she probably hadn't. Of course it sent her sugar up, but since she was in a good mood because I had gotten her what she considered a decent meal, she allowed me to do the fingerstick, and give her the coverage.
Miss "Book Nurse" said I shouldn't have gotten her the fast food, that she needed to eat her proper meal. Perhaps she is right, but I felt I got better results by doing what I did. After all, she DID eat, and she DID allow me to stick and cover her afterwards, which is a lot more than Book Nurse was ever able to do. This resident is NEVER going to be a compliant patient, and all the forcing does is **** her off and make her even MORE non-compliant.
In my opinion, sometimes you need to put the "book" away and deal with these folks on a more personal level, but they don't teach you that in nursing school.
>>I went through the very same situation as you accept I was that " Book nursing student" My patient was a diabetic that was very >>out of control and she refused to eat the food that okay for her to eat. So my instructor told me that I needed to call down to >>dietary to order the patient a cheese burger and fries since thats what she wanted. Because the patient was on a diabectic diet >>there was no way dietary would allow me to do this.So I had to go to the doctor and get an order for a nutritional consult just so >>this patient can get her cheese burger and fries. My instructor was not pleased until I had went through all lengths to get the >>patient her cheese burger
I find this very strange. Were you there to do your part to promote the Pt.'s health according to medical orders and nsg care plans or to waste all this time just so someone can have a cheeseburger that they do not need to be having right then and there? IMHO, your instructor's priorities were in the wrong place.
It's always nice to get along with your patients/residents. But at the end of the day I'm at work to do my best for my patients, not to win a popularity contest.
This may be one of the oldest tricks in the book. Resident sets nurse against nurse. Lifts one nurse up as the best nurse in the whole world because you will do what I want you to do. As your reward, I'll give you my finger and let you stick me. That mean nurse doesn't cave into me at all.
Then the kicker comes. You have to do everything she wants you to do. Believe me, she will forget your former kindnesses the minute you draw a line on what you will do to keep her happy and compliant. At some point, you are going to want to stop bribing her and get her to comply because it's the healthy thing for her to do. Once you do it, you are going to be moved into the "mean" nurse category, and another "nice" nurse is going to take your place for a while. It's pure manipulation and as long as it works, she'll continue to do it.
whatever you want to call it, it happens all the time. manipulative patients pit one nurse against the other. and we are the dorks that let it happen. i cant tell you how many times ive seen one nurse talking about another nurse because of something a manipulative patient said.
i've been known to spoil my patients. i love to spoil them! but in a situation like this, this is NOT spoiling her. this is enabling her manipulative behaviors and showing her that they work. the other posters are right. now what are you going to do when you have to bring her in fast food every day because she wont eat or let yall stick her finger unless you do.
talk about between a rock and a hard place!
you really should listent to missbooknurse, she could probably show you just how to spoil a patient properly. but allowing manipulative behavior with foods and meds is NOT the proper way.
sorry, but i predict you have yourself in a world of mess.
how do you think many of us know this? because many of us have made the same type mistake once or twice.
lighten up on missbooknurse and try to drop that chip on your shoulder and get down off that high horse and listen to what she was trying to say to you. you might learn something.
I find this very strange. Were you there to do your part to promote the Pt.'s health according to medical orders and nsg care plans or to waste all this time just so someone can have a cheeseburger that they do not need to be having right then and there? IMHO, your instructor's priorities were in the wrong place.
i think the instructor was spot on.
advocating for our pts, has to be a team approach, AND it has to be medically approved.
so getting the md to order a dietary consult, was appropriate and ultimately advantageous to this pt.
I'm going to echo the chorus here. While you may feel like such a clever nurse, that you have forged this special relationship with this difficult resident, you are in reality enabling her manipulative behavior.
Any time a patient compares me favorably to any of my other coworkers, whether it be nurse or MD, it sends up red flags, and I take a step back. They still get their basic needs met, and get good nursing care, but I watch my back, because these are folks that will happily say bad things about *me* to my coworkers should I be the one to displease them.
Sometimes it is a genuine compliment, and I will acknowledge it with a "Thank you, that is a nice thing to say." or something like that. But no, it does not result in any special treatment or bending of the rules.
Try to find things you can do, that the patient likes, that aren't going to be bad for him/her. It's even better if the doing of it makes the workload more convenient for the nurse. I liked the one poster's idea of just leaving her tray in the room without much comment. It doesn't hurt anyone to commiserate on how terrible the food is, if the resident wants to complain about the food. When you go by the book, you can still be nice about it.
This is definitely an admonishment that every well-intended nurse, especially new ones, need to learn. Part of what keeps us going as nurses is the praise we receive for doing nice things for patients, and we're taught to work with the patients to do what works for them. This also represents a very big problem with nursing that manifests itself in many situations. For every nurse who tries to put her foot down and establish limits, another nurse will rush to coddle/enable defeating the original purpose, with the enabling nurse often lecturing others on how they should be more compassionate, giving, warm, etc. When nurses want to demand better conditions and refuse to take impossible situations, there's always a nurse who chides them for "neglecting the patients and forgetting the calling." This is why nursing is not respected (if it's so respected, how come it's not automatically a felony to attack us and you'll find more security in a bank than most hospitals?). There's always some goody-two shoes who will step in and play the martyr/savior, allowing the manipulative patients and greedy administrators to pit people against each other. Some of these people are simply well intended and want to do a good job, not perceiving the consequences. Others base their identity and self-worth on being the good one, the one who does the jobs nobody else wants to do, the one who patients wish all nurses could be like. These people are opportunists who use the perceived poorer actions of others to bolster themselves.
I'm going to say something that will sound horrible and selfish, but it's true. When in a workplace, it's not good to be the one who always goes the extra mile. Not only will it become expected of you (the burger and fries for a fingerstick is a perfect example), but others will resent you for going soft on the limits. This is not about lazy people resenting a hard worker or mean nurses bullying a nurse who honestly cares. This is not about keeping expectations low so you can have an easy job. I speak from experience. Back when I was a new nurse, I was able to go extra miles because my patient loads were much lighter. I loved the praise of being such a caring nurse, and I thought that the other nurses' advice to keep to the objectives were a result of being jaded. I sometimes fell into the manipulation trap. However, when my training wheels were removed, I realized that I couldn't do it all. Some of my patients (it was LTAC) had grown accustomed to my treatment. I had to learn that I'm not Jesus Christ, and that people are going to have to wait unless they are in bad enough shape to be my first priority. As I grew seasoned, I saw bright eyed new grads doing the same as I had. It was destructive to hear the occasional line-toeing patient to have the complaints of, "Well so-and-so did this for me!" We nurses need to look out for each other rather than let manipulative patients and work-loading administrations pit us against each other with the "Why can't you be more like _________" game.
Your actions were well intended, but the fact that you caved to her manipulations and take pride in being more liked than the book nurse show that you are being played like a harp. Good luck learning to set limits and realize that you can't do everything perfectly.
learning08
53 Posts
This resident is manipulative and noncompliant. I don't reward or pander to that sort of behavior, so yes, I'm by the book. I politely explain consequences of refusals and document them in the pt.'s chart for the Dr., but no, I would not bend over backwards for a competent adult to get them to comply with their care. I make it easy for them to change their mind if they want to do the right thing, but by and large, they can either take responsibility and do their part, or they are welcome to continue with their choices and deal with consequences.
An A&O smoker who chooses to smoke is welcome to go to a smoking area if they ask. They are a free adult. However, I would not be getting them a pack of cigs or taking them outside (as was suggested to me once, by a staff member, in the middle of a busy shift) under ordinary circumstances.