RUDE pt and spouse=everyone fired from care!

MarySunshine · May 28, 2006

Wow. If I worked there I couldn't get "fired" fast enough from working with that family. That's entirely unacceptable. I agree a multidisciplinary meeting is in order.

anonymurse · May 28, 2006

These people are a lot more than just tired and irritable. They're going through a grieving process right now,

People we assume to be in some state which to us implies a lack of control, when observed, can be seen to be very careful. You have seen that most people who are apparently out of control are exceedingly careful about exactly who they vent on, what objects they break, what lines of social convention they cross, what degree of harm they will visit on themselves. And very rarely will they inconvenience themselves.

Clients pick and choose according to our limit setting. Let's suppose the first time the patient tried to "fire" someone, let's assume by refusing a dressing change, the charge came up and said "I'm the charge nurse. I assigned this nurse to care for you. She's the only one available. Everyone else is assigned to and responsible for other patients, including me. So let me make sure of something. Are you refusing care? I'm asking in person because we have to document it and I want to be absolutely sure before writing this in your record. I have to document it because your refusal could cause you to get worse, possibly much worse. This nurse is completely competent to change this dressing. I made sure of it myself before assigning her to you. So yes or no, are you refusing the dressing change?"

Wouldn't that have been different? We can and should shift the patient's focus from the person to the relevant process. One of the things a charge does is take heat. So she would be redirecting the patient, making him understand he's not messing with this particular nurse, what he's really doing is challenging the judgment of the charge. By now the nurse he's picking on is totally out of the picture. He's messing with the big dogs now. And for what? So he can have increased risk for a longer stay with the bonus of something he imagines to be damning written in his chart?

The key is to document "refused care" every time the patient refuses care, because that's what it is. I mean, you can't chart "grieving" as a response that excuses you for failing to change that dressing. "Refused care," now that's something else. Unusual grieving problems, ask the pt. if they want a chaplain, and if they don't, they can refuse that care, too. I'd document it.

My 2 cents.

SharkLPN · May 28, 2006

If that were me, I'd sure work as hard as possible to be on the 'fired' list. If management wants to allow manipulative behavior, I'd rather be on the 'fired' end of that behavior.

Agreed. And I've done it, matter of fact. Grieving process or not, I'm burned out of caring for and arguing with manipulative, non-compliant patients. Does that make me a bad nurse? Dunno. But I can tell you I don't lose sleep over things like this.

Long Term Care Columnist / Guide · May 28, 2006

WOW.....(shakes head in disgust) :nono: .....I just got into this thread, and it sounds SO much like some of the garbage I've dealt with in recent years, both as a floor nurse and as a manager. (It's better being a manager in this situation---at least you can DO something about it.)

I haven't much to add to the excellent advice already posted here; only this: It will get worse if nurses don't fight. Somehow, our profession MUST unite around this issue and make a priority of re-educating the public about how we are---and are NOT---to be treated.

I'm actually sort of a new convert to this way of thinking, maybe because I too have been abused as a nurse, and now that I have some authority, I refuse to allow myself or my staff to be abused by anyone---not families, not visiting nurses, not residents. My stance doesn't always make me popular, but I've decided I'm not in this business to make friends, I'm in it to help people be the best they can be and attain optimal quality of life. I am nothing if not diplomatic; in fact, 99% of the time I can convince people to change their behavior with a few well-chosen sentences.

But when diplomacy fails, I will not stand there and allow someone to curse, bully, threaten, or scream at me just because they don't like the service/food/staff/medications/fill in the blank. Just a couple of weeks ago I 86'ed a family member who is notorious at my facility for her verbal assaults on the staff whenever they don't respond to Mom's call bell within 30 seconds (never mind that Mom herself is a total narcissist who can do most things for herself, but pulls her cord approximately 10 times an hour around the clock so staff can fluff her pillow and hand her the water glass that's six inches away).

She'd never done this within my earshot before, but she evidently didn't know I was in the building. She found out soon enough, because midway through her dining-room tirade, I appeared and told her she had to leave. NOW. I didn't ask her to calm down, or try to appease her, or request that she come to my office to discuss her concerns. I've done that a thousand times, and it never works with her. Nope, I told her that her behavior was unacceptable, it was time for her to go home, and that she would be welcome to return ONLY when she could keep herself under control.

I haven't heard a squeak out of this woman since. I've checked with my weekend staff as well---she used to come in on Sunday evenings and just bully the living hell out of anyone she could find---and they've reported nothing but good behavior. In fact, she and I have had several really good conversations recently, and I'm hopeful that we can continue to work together to provide her mother with the care she needs (not necessarily the care she wants).

Of course, it's not always quite that easy to make people straighten up. But believe me, if we wait for healthcare CEOs and administrators to stand up for our right to be free from abuse, it will never happen. This is something we have to take responsibility for, no matter what the cost; for far too long we've been under the gun of Press-Ganey and other 'customer-service' tools that have served mainly as notice to the public that it can get away with just about anything. It's time to put an end to that mentality so we can take our rightful places as professionals, not glorified cocktail waitresses or store clerks (who don't deserve to be abused either, for that matter).

OK, getting down off soapbox now.

leslie :-D · May 28, 2006

marla,

it's one thing to assert yourself and refuse to be anyone's doormat.

most of us wouldn't have any problem waving our zero-tolerance hats.

but it's the rare mgr who will support and have our backs.

i know, you acknowledged that.

so yeah, we can either choose to tolerate this abuse, or not.

if we choose not to, then we must quit.

that's the grim realiity.

leslie

prettypaws · May 28, 2006

What happens when all the staff on a shift is "fired"? If the patient is total care and only one staff member is allowed to care for the patient,what exactly does the pt/family suggest you do?

ZASHAGALKA, RN · May 28, 2006

What happens when all the staff on a shift is "fired"? If the patient is total care and only one staff member is allowed to care for the patient,what exactly does the pt/family suggest you do?

Float nurses from other units here to care for my husband, of course. It's a big hospital, there has to be more nurses, somewhere.

After all, I'm not being THAT unreasonable. . .

~faith,

Timothy.

bluesky, BSN, RN · May 28, 2006

SOmeone needs to lay down the law with that family. I have worked in places where "firing" nurses is allowed to happen and it never turns out well. One family in particular had fired numerous nurses. It took another family confronting them to stop it. It's bad for the staff and bad for patient care. If they feel the care is so bad, they can be offered the option of transfering elsewhere. Allowing one patient to create such chaos is stupid IMO.
BTW, I get that sometimes nice people just lose it and need control over something and act out, but some people were just jerks before they came in. Regardless of the reason, it has to stop.

This is soooo true. We once had a patient that lingered in the ICU for almost 8 months. Over time, the wife became increasingly controlling, unreasonable and despotic. While she had her reasons to be frustrated (among other things there was a an error in her husband's care by physicians that contributed to his poor outcome), there was no excuse for her abussive treatment of the nurses. It was a huge source of stress for the nurses, especially after he got sick requiring CVVH, blood products on the hour, etc. There was debate among us as to whether her experience justified her behavior. But in the end an interdisciplinary meeting was set up. She refused to attend and my manager was simply not willful enough to force the woman into a meeting. Soon thereafter, the poor man died so we never obtained complete closure on the subject. It is a sore subject to this day however. We all agree on one thing, though.... we all agree that we should have tried to have some kind of official intervention WAY earlier than we did.

Just my 2.