Last night on our med/surg unit, we had an elderly woman who was in wiht consitpation. Very stable patient, vitals within normal limits, fairly negative past medical history, no home meds, independent with ADLs...again, a very stable patient. No BM for 8 days...came in to ER via private vehicle with complaints of abdominal pain.
We are a small rural hospital, average patient census of 10. Last night we had nine patients. This woman decided that she did not want any LPNs or CNAs in her room. OK...we try to accomodate such requests, but on nights like this, we have one RN on med/surg and one in ER. ER was pretty busy, so the ER nurse did not have time to come to the floor to help. Other than the charge RN, we had two LPNs and one CNA...staffing well above what we normally have. Certainly, the RN had time to care for this patient, but this woman didn't even want the CNA or one of the LPNs to do the simple things like taking her vital signs, refilling her water pitcher, or emptying her commode. So...the RN not only was charge over 9 patients, but had to do all cares for this patient, simply because she did not want anyone but an RN.
I agree 100% that there should be an RN available for all patients, but not all patients require an RN as their primary nurse. In a small rural area like this one, sometimes you have to take an LPN, especially if you are stable and have a predictable outcome. Had we been busier or had an unstable patient, would we have been out of line to explain to this patient that there was an RN available if anything unexpected happened, but that due to staffing reasons, her assigned nurse would be an LPN? This happens every now and then and usually we are able to accomodate the requests of RNs only, but what about when we just can't do it?
But...you just about have to give in to the manipulations. How do you think this patient would have reacted if she had fallen with an LPN helping her? It would have been the hospital's fault because she knew she "needed an RN."
We once had a patient who was in the hospital for 112 days...after about ten days, she had picked out her favorite nurses and demanded that only a certain few be allowed to care for her...for the most part, the charge nurses tried to assign her only to the nurses she had requested (occasionally she had to take a nurse who was not on her "list" but it was rare)...on day 112 the one who "favorite" was on was sick of her and requested that she be assigned to another nurse...the patient fell, hit her head, and died...her son filed a lawsuit because he felt that the nurse caring for her was not familiar enough with her to know her habits, etc. The patient, who had never in 112 days made an attempt to walk to the bathroom without help, got out of bed without calling before she fell.
So...was anyone at fault? Not really, but the patient died...the family is obviously pretty angry. The nurse who was totally burned out on this patient feels guilty, the nurse who was assigned to the patient is angry...not only at the situation, but at the family, at the nurse who asked not to be assigned to the patient and at the charge nurse who made the assignment. Could the incident have been prevented had the patient had her choice of nurses? Maybe...perhaps had she not been angry, she would have called for help...she was angry and bitter that day...maybe she got out of bed without help out of spite...maybe her condition was just declining and she forgot...maybe she thought that she was getting better and could do it without help...
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Well no easy solutions here. Unless you are backed up, you have no grounds and will continue to get types like this able to play your system. I wish I knew the magic bullet. There is none if admin won't back up its nurses. The patient who died, is this the same as in your OP or a different case? Just curious. I am sorry either way this happened. Awful for her, the family and that nurse.
In general, I think requests should be accomodated whenever possible. I once had a patient tell me I was too short to be a nurse, I switched assignements with the tallest nurse on the floor...somewhat because the patient was rude and his comments honestly made me mad, somewhat because I thought he might sincerely be uncomfortable with someone as short as me helping him, and somewhat because we were being silly that night and it sounded like a good idea at the time. However, had I been the only nurse available, we both would have had to accept the assignment...:)
Well no easy solutions here. Unless you are backed up, you have no grounds and will continue to get types like this able to play your system. I wish I knew the magic bullet. There is none if admin won't back up its nurses. The patient who died, is this the same as in your OP or a different case? Just curious. I am sorry either way this happened. Awful for her, the family and that nurse.
Specializes in LTC,Hospice/palliative care,acute care.
If I were very ill, I would want an RN....can't deny that. However...I would have no problem with anyone from the MD to a CNA or anyone in between helping me to the commode or emptying my bedpan. The patient in question would get angry any time an LPN or CNA even came into her room...she would put on the call light and when someone went in to answer it, the first words out of her mouth were, "Are you a registered nurse?" If you were not, you were told to leave. I think it would have been appropriate for the RN to explain to her that LPNs and CNAs are quite competent at things like emptying commodes...and that while the RN would try to provide all of her cares, do assessments, etc, that she would have to either allow the LPNs and CNAs to empty her commode or she would have to put up with the smell until the RN could ge there. As it ended up, the RN went in every time the light went on...she was late to report, she had to interrupt rounds with a doctor, and one of the LPNs had to resolve a staffing issue because the RN was not available. Not a huge deal, but it did interrupt care for others and upset some staff members when an LPN was scrambling to make patient assigments for the next shift because the RN did not have time.
BTW...yesterday, the RN was helping the patient up to the commode and she (the patient) fell...broke her hip, sprained her wrist, dislocated her elbow. When she was transferred to a the nearest hospital to see the ortho doctor, she told the paramedics that she fell because was so upset because only RNs would come into her room and RNs don't know enough about moving patients...
"Borderline" personality disorder is an under-utilized dx IMHO-these people thrive on disrupting routine everywhere they go-any kind of attention they receive- negative or positive -is their fuel...and to top it off I can't imagine how horrible it must have been for an LPN to have to handle a staffing issue and upset the staff....Rough shift all around
"Borderline" personality disorder is an under-utilized dx IMHO-these people thrive on disrupting routine everywhere they go-any kind of attention they receive- negative or positive -is their fuel...and to top it off I can't imagine how horrible it must have been for an LPN to have to handle a staffing issue and upset the staff....Rough shift all around
Borderline Personality Disorder is where they clump folks that choose to be rude, crude and socially unacceptable because it is easier than assimilation into the mainstream. I don't believe in any Borderline Pshych Dx.
Go ahead and flame me... I'm ready for my opinion to get blasted, but I will hold firm to it.
Specializes in LTC,Hospice/palliative care,acute care.
borderline personality disorder is where they clump folks that choose to be rude, crude and socially unacceptable because it is easier than assimilation into the mainstream. i don't believe in any borderline pshych dx. go ahead and flame me... i'm ready for my opinion to get blasted, but i will hold firm to it.
by diagnosing this behavior disorder you can care plan it and staff can present a united front thus minimizing the up-roar to the unit and helping to insure that everyone gets the care they need... this behavior goes way beyond that of an ordinary jackass borderlinesare difficult to live with and even worse to work with...and no-one is flaming you-just voicing an opinion that differs from your own-thick skin helps with that on boards like this....that and loosing the need to have the last word..that will bring down a good thread fast and it's a shame when a good dialogue is going on to have it shut down.. this might help -----[ borderline personality: persons with this personality disorder--predominantly women--are unstable in their self-image, mood, behavior, and interpersonal relationships. this personality disorder becomes evident in early adult years, but it tends to become milder or to stabilize with age. such persons believe they were deprived of adequate care during their childhood and consequently feel empty, angry, and entitled to nurturance. as a result, they are relentless seekers of care. this personality disorder is by far the most common type seen in psychiatric and all other types of health care services.
when persons with a borderline personality feel cared for, they appear like lonely waifs, who seek help for depression, substance abuse, eating disorders, and past mistreatments. however, when they fear the loss of the caring person, their mood shifts dramatically and is frequently expressed as inappropriate and intense anger. the shift in mood is accompanied by extreme changes in their view of the world, themselves, and others--from black to white, from hated to loved, or vice versa (see splitting in table 191-1). their view is never neutral. when they feel abandoned (ie, all alone), they dissociate or become desperately impulsive. at times, their concept of reality is so poor that they have brief episodes of psychotic thinking, such as paranoid ideas and hallucinations.
such persons have far more dramatic and intense interpersonal relationships than those with cluster a personality disorders. their thought processes are disturbed more than those of persons with an antisocial personality, and aggression is more often turned against the self. they are more angry, more impulsive, and more confused about identity than those with a histrionic personality. they tend to evoke intense, initially nurturant responses in caretakers. but after repeated crises, vague unfounded complaints, and failures to comply with therapeutic recommendations, caretakers--including the physician--often become very frustrated with them and view them as help-rejecting complainers. splitting, acting out, hypochondriasis, and projection are common coping mechanisms ------
that is from the merck manual-lots of info on the web if you are interested...i,too have come to this board with lots of conviction but have learned to be open to learning from others-i have taken alot away from the people that post here-i hope others do also...... ps-i am certainly not claiming to be a psychologist here,either......just thowing out some ideas....
Borderline Personality Disorder is where they clump folks that choose to be rude, crude and socially unacceptable because it is easier than assimilation into the mainstream. I don't believe in any Borderline Pshych Dx.
Go ahead and flame me... I'm ready for my opinion to get blasted, but I will hold firm to it.
While I might agree that some folks indiscriminately use "Borderline" to define anyone with slight neuroses, 'Borderline Personality Disorder' IS an Axis II condition and is defined in DSM-IV.
Specializes in Happily semi-retired; excited for the whole whammy.
While I might agree that some folks indiscriminately use "Borderline" to define anyone with slight neuroses, 'Borderline Personality Disorder' IS an Axis II condition and is defined in DSM-IV.
I agree. I also think that it is dangerous to not "believe" in diagnoses that are defined and accepted by the DSM-IV, since it might mean we don't end up making appropriate referrals that could get our patients the help that they need.
flashpoint
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But...you just about have to give in to the manipulations. How do you think this patient would have reacted if she had fallen with an LPN helping her? It would have been the hospital's fault because she knew she "needed an RN."
We once had a patient who was in the hospital for 112 days...after about ten days, she had picked out her favorite nurses and demanded that only a certain few be allowed to care for her...for the most part, the charge nurses tried to assign her only to the nurses she had requested (occasionally she had to take a nurse who was not on her "list" but it was rare)...on day 112 the one who "favorite" was on was sick of her and requested that she be assigned to another nurse...the patient fell, hit her head, and died...her son filed a lawsuit because he felt that the nurse caring for her was not familiar enough with her to know her habits, etc. The patient, who had never in 112 days made an attempt to walk to the bathroom without help, got out of bed without calling before she fell.
So...was anyone at fault? Not really, but the patient died...the family is obviously pretty angry. The nurse who was totally burned out on this patient feels guilty, the nurse who was assigned to the patient is angry...not only at the situation, but at the family, at the nurse who asked not to be assigned to the patient and at the charge nurse who made the assignment. Could the incident have been prevented had the patient had her choice of nurses? Maybe...perhaps had she not been angry, she would have called for help...she was angry and bitter that day...maybe she got out of bed without help out of spite...maybe her condition was just declining and she forgot...maybe she thought that she was getting better and could do it without help...