Why is it that it only takes one patient (and usually not the sickest one on your list) to absolutely eat you alive?
Lady was 4 days post-op, had been on PCA Morphine, was confused, combative, disoriented. They took the PCA away, started PO opiates, she starts to clear up. I'm told in report that she's oriented and appropriate now, expected to go home.
Upon walking into the room to do my assessment I'm told she is going to "write the nurses and doctors up" because of her adverse drug reaction. Then she does a 180 and tells me what a great nurse I am (I've been in the room less than a minute.) Then she wants her bed up. No... too much down a bit. No, on second thought she wants to be flat. When will breakfast come. Food has been just awful here. When am I going to bring her a pain pill. She is going a mile a minute, with what I call a "sticky dialogue" meaning a rambling conversation without real information or questions, designed to hold the listener there.
So... I'm off to do my other assessments. CNA comes to me and tells me the patient has her own little stash of pills in her purse and has been taking one from a bottle labeled "diazepam". Cool. I asked the pt. directly and she said she was just rummaging through her purse for her check-book and there was this one pill sitting there by itself in the bottom of her bag... so she took it. Yeah. Documented this up the whahzoo.
MD comes by says he's going to put her on a fentanyl patch and when we're sure it's working well for her, she can go home. She tells me she wants to go. I tell her the onset of action of the patch is many hours, we won't know how she'll respond to it for quite a while and to not expect to go home immediately. Thus began a day long harassment about her discharge. I'm given minute by minute updates on when her husband is coming, told to get her a raised toilet seat, reaching device, shower chair, and walker so she can take them home. ("What do you mean my insurance won't pay for that!!!) We order her a walker any way. Now she's nesting at the nursing station demanding the walker, demanding copies of her chart, demanding to be allowed to walk to the pharmacy (in another building) to get her scripts filled yadda, yadda, yadda. ("Yes, ma'am, I can't stop you from goint to the pharmacy, but you'll be leaving against medical advice.") She's getting herself all worked up. She's oooozing righteous indignation.
Finally, I get her walker, get her discharge orders, get her paperwork printed off, am going through discharge instructions and... OR calls to get my pt. with the acute belly... I have to do final check lists, v/s, get her to void, and get her chart ready to go. I have to do that NOW. I excuse myself and go to the room across the hall.
This virago of a patient actually FOLLOWED me into the other patient's room! ("Now my husband's an hour late for work. We're just going to leave. We have a long drive to make to get home.)
OK... I lost it. I slammed a chart onto the bedside stand, wheeled around, pointed at her with my index finger and said "I am getting someone ready for surgery. I'll be with you when I can. Get out."
I don't know if that was bad. I know I was menacing... I meant to be. But I didn't raise my voice.
Looking for validation here. Should I have continued to be sweetness and light? I think I know where my last nerve is now. I'll probably ask colleagues to run interference for me if such a situation arose again. What would you have done?
The big thing that is gnawing at me re: your handling of this PITA was you putting your finger in her face. This gesture is often perceived as a threat and I think it was out of line. She most definitely needed limits set and if what you verbalized to her was ineffective, you should have brought in back-up. Hit your pt's call light and call out for help. Someone else can escort her out of the room and back where (in the hospital, that is:devil: ) the heck she belongs. I also think her inappropriate behavior should have been addressed long before it escalated. You can usually tell someone is going to be a pain long before they get to that point.
The big thing that is gnawing at me re: your handling of this PITA was you putting your finger in her face. This gesture is often perceived as a threat and I think it was out of line. She most definitely needed limits set and if what you verbalized to her was ineffective, you should have brought in back-up. Hit your pt's call light and call out for help. Someone else can escort her out of the room and back where (in the hospital, that is:devil: ) the heck she belongs. I also think her inappropriate behavior should have been addressed long before it escalated. You can usually tell someone is going to be a pain long before they get to that point.
I think you and Daytonite are right. I thought I almost had her out of there, just moments before sending her off, only seconds from getting her signature on her discharge papers... and then this urgent issue arose in the other room. I was absolutely shocked when she came in behind me. It was the first time (in a way long time) I'd ever just reacted. I bit my tongue right after I told her to get out. I almost followed it up with something worse. But it was at that moment I realized I was in reflex mode. Not good.
The finger wasn't in her face, truely. She was maybe four feet away and my hand was in front of my body. But I was, indeed, trying to convey to the loon the seriousness of my dissatisfaction with her actions. I was horribly offended personally, but also because of this poor patient. (Non-Enlish speaking, scared poopless woman who wanted to be annointed before she went down to OR and we couldn't find the priest. Family all asking me what the implications of a leaky appendix were. Translating back and forth in Spanish, everyone was tense...It was a mess.) I was so focused on the belly patient, I wasn't prepared for what happened.
It seemed to just happen so fast. I should have seen something bad with this gal coming. I should have called in the super earlier (and we have some good ones, seriously.)
I don't regret what I did... but I want to avoid it in the future. I learn something every time I go to work, and this is just another example.
Well, I certainly don't feel that you need to feel regret over this. Perhaps getting your charge or someone from administration to assist would have been a good idea....BUT...hindsight is always 20/20, isn't it? I applaud your enduring patience; you held out FAR longer than I would have!
Specializes in LTC, assisted living, med-surg, psych.
I feel your pain..........I have three ladies like your patient in my assisted living facility (try dealing with it every single day ........) and while none of them has ever gone so far as to follow me or one of the caregivers into another resident's room, they can be completely narcissistic, calling 10x/hr for NOTHING and then getting mad when they aren't accommodated five minutes ago. I keep telling our administrator we need to charge extra for what I call "PITA points", when residents who are perfectly capable of doing for themselves abuse the call system and the care staff for 'bend-my-straw' requests every two minutes.:angryfire
Oh, and did I tell you she wanted my full name and home phone number???? Yeah, "just in case I forget something about my hospitalization."
I noticed this thread is a year old. Oh well.
It's a good thing she didn't get your name and phone number. She sounds like one of those people that would call you in the middle of the night. That's one obnoxious lady.
........) and while none of them has ever gone so far as to follow me or one of the caregivers into another resident's room, they can be completely narcissistic, calling 10x/hr for NOTHING and then getting mad when they aren't accommodated five minutes ago.
I keep telling our administrator we need to charge extra for what I call "PITA points", when residents who are perfectly capable of doing for themselves abuse the call system and the care staff for 'bend-my-straw' requests every two minutes.:angryfire
NurseyBaby'05, BSN, RN
1,110 Posts
The big thing that is gnawing at me re: your handling of this PITA was you putting your finger in her face. This gesture is often perceived as a threat and I think it was out of line. She most definitely needed limits set and if what you verbalized to her was ineffective, you should have brought in back-up. Hit your pt's call light and call out for help. Someone else can escort her out of the room and back where (in the hospital, that is:devil: ) the heck she belongs. I also think her inappropriate behavior should have been addressed long before it escalated. You can usually tell someone is going to be a pain long before they get to that point.