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Discussion

Requesting to not have a certain patient

We have a certain patient on our floor at the moment who is very demanding. She's not especially sick, but definitely total care, and does have a lot of chronic, but stable issues going on. Her family members are the main problem, with constant pestering and extreme rudeness. They fill out a complaint slip about the staff member caring for the patient every shift. Without fail. I've now been assigned to this patient my last two shifts. I think I'll break if I have her a third shift in a row. I'm not saying I never expect to be assigned to her again, but I desperately need a break from her. Is this unreasonable to ask?

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Absolutely not! If you don't ask they are going to assume you're o.k. with her and you're going to have her every single time you work.

As a charge nurse, I expect my coworkers to tell me when they are burned out on a particular patient, especially since I make the assignment for the oncoming shift that I don't work with. I have no idea they are burned out unless they say something. I apreciate the feedback and certainly don't mind rotating difficult patients. It's only fair.

Speak up!

  • Experts

This is common where I work. If you have worked say, a few day shifts in a row and are tired of your people you can just ask for a different assignment. Especially when they come complete with an aggravating family.

On my unit, we occasionally get people that we consider "single shift" patients. It is understood that no nurse should have to have them day after day. Mostly they are repeat customers, so we know from the door that we need to alternate their nurses.

It is a reasonable thing to ask for, to share the burden of an especially demanding patient/family. Especially if you keep the rest of your assignment, as those patients will probably notice that they get a more equitable share of your attention on the day that you don't have the patient you gave away. That is what gets me most about the very demanding people... they usually aren't actually accomplishing anything extra for their loved one, but they are taking resources away from others by monopolizing the staff's time.

  • Guides

Not only do demanding patients and families hinder the care of other patients, I think they undermine their own care because staff is reluctant to work with them.

We want to do the best we can with all of our patients, but the demanding ones tend to drive us away.

I know that patient would have gotten some darn good care, but they have to give me a chance to prove it instead of assuming I won't and giving me a hard time so that I dread working with them.

It's frustrating because, in these people's eyes, you can do nothing right, so you just about throw in the towel and say, "screw it!".

We usually tend to just take turns dealing with the patient and their family through out the shift. It helps because instead of having to bear the full brunt of their garbage all shift, you then only deal with it in shorter bursts. The patient may not be "your assignment", but you take your share of the grief to help out your co-worker... and pray they will do the same for you when it's your turn (which they do, thank god!!!).

As for requesting not to have that patient at all that day... of course! Sometimes you know darn well you are not going to be "nice" or "effective" or whatever if you have to deal with them that day. I have never seen anyone not understand this and not step up to the plate to help a burnt-out co-worker. We've all been in their place and understand.

You do what you gotta do to give good care.

  • Experts

This is totally a reasonable request. If you need a break from that patient, just say so. Usually before I leave I let my charge nurse know to please pass along to whomever makes the assignment that a) I WOULD like all my pts back if possible; or 2) please for the love of God do NOT give me my same assignment back. Whether I ask for a completely different assignment or just a particular patient that I need a break from, that depends on the patient(s). Yes, definitely ask for a break if you need one.

Don't feel bad about making the request. We do it quite a bit on our very large antepartum unit. We have patients that we need to "take turns" with- both good and bad.

Usually, when the charge is making the assignment, she passes a paper around for us to make a list of rooms we would like to have. We list the room numbers we would like and put a circle with a slash trough it on the rooms we don't want. That way the request is kept kinda quiet and there is no gossipy talk about "why". Indeed, we have an unofficial 'no questions asked' attitude. Truth is, sometimes there are people you are just not sympatico with for whatever reason.

We had one pt several years ago that kept a large list of nurses not allowed in her room. She never realized we were at the desk drawing straws to see who would have to take her that day! I actually liked taking care of this one and volunteered often to do so.

Most often, our long termers keep a list of nurses they do want.

The request is more than reasonable. We always switch up the difficult patients/families where I work so everyone has them one shift and then we rotate them around so everyone gets a break. This is what should be done.

Certainly should be policy at most places. Continuity is one thing, but I can't give good care if I'm dreading being in the room. We have a policy, where we write down whoever we had/want next to the next day's staffing sheet...it's usually followed.

sometimes, you just don't click with a patient...could be no fault of your own, but sometimes we all just need to be human. If the patient discovers that you are on the floor, I usually just say something along the lines of..."oh, we had a lot of admits today so just about everyone had to reshuffle their assignment." And make small talk until you can get out. It happens to everyone...good luck!

Let your charge nurse know, I have only done it twice once in the middle of shift, the patient was cussing yelling at me in the hallway wanting to know why I was helping another pt before him-mind you this man was a CHFer, 90 years old and trying to walk to his bed. I had just had it with him-day 3 of his ****. She was aware of this difficult pt-who later asked me why I wasn't spending more time with him? WHAT??? She gave him a different nurse.

I do this from time to time as well. On my floor we often have patients with quite lengthy stays, so when they are difficult we quickly learn we have to rotate the nurses so that everyone gets a break from the tough ones.

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