So TIRED OF IT

[ThePrincessBride]

I'm so over it. I'm so over dealing with ahole patients who are so entitled and disrespectful to staff and think that they are in some damn hotel with room service. I'm so over management choosing to side WITH these patients and not backing up staff. I am tired of the ridiculous pay, the crazy assignments, over-the-top patients, the cliques, and how hospital-based care is now some big business and how I am a glorified pill-pushing waitress. I'm tired of patients cursing at me, lying, manipulating and everything.

I'm tired of not feeling supported by management. I don't feel like I can talk to my manager. I am no-nonsense and I don't tolerate absolute disrespect or cursing from completely alert and oriented young people. Yet the manager thinks *I* am the problem and states I should take a class in how to deal with difficult patients....but seems to forget that these patients have a tendency to fire MULTIPLE nurses and even entire hospitals/nursing homes.

No. Nurses aren't the problem. PATIENTS and SOCIETY are the problem. Don't get me wrong. Not every patient or their family is bad...but the ones who are rotten ruin everything. And they are becoming more frequent.

Am I the only one who thinks nurses shouldn't have to put up with nonsense? We should be allowed to say that being cursed out or told to shut up by "with it" patients is unacceptable. Would you go over your manager's head to the Director of Nursing to have this addressed?

I am ready to escape the bedside. I am done with adult med/surg (which I do on a contingent basis). Any other contingent jobs out there that are decent paying and not at the bedside? I am done with acute care for adults...it keeps getting worse and worse.

[Cheyenne RN,BSHS]

Of course patients and families are afraid. Of receiving incompetent care by uncaring, immature, arrogant, unprofessional staff; of what is going to happen to them; of medical and nursing errors (which have been shown to happen quite frequently). But really and truly, as nurses, although some of us like to aggrandize our role, as part of taking care of patients and providing good quality nursing care we are also responsible for providing good customer service to our patients. The HCAHPS survey should have brought that to your attention. It's really not smart to fight against this in my opinion; patients and/or their insurance companies are paying the bill and that is why you have your job. Without patients there wouldn't be any money coming in to pay your wages.

This is exactly why the belief "nurses eat their young" and "there is too much horizontal bullying" continues in nursing IMO.

[hppygr8ful, ASN, RN, EMT-I]

I've been dealing with my own health issues the past month so have delayed responding to the thread, but I have thought about it several times and really wanted to respond not only as a nurse but as a patient.

Let me start by saying that I was trained to believe that healthcare is a customer service industry. Cusomers pay insurance premiums often in excess of 10K a year in order to assure that they will receive quality care should they need it. Example I pay car insurance - if I get in a wreck I expect timely competant service from my insurance company. The same is true for my medical care. If I need to be seen in ER or admitted as an in-patient I expect to get what I paid for. This does not give me license to act like an orifice but I should not have to wait more than 15 minutes for someone to acknowledge a call bell (even if it's just to say I'll be there in a minute). I am an extremely easy person to care for but the times I have been hospitalized have been serious.

On one occasion I had an infected draining wound that came through the dressing and exudate was seeping into my perineum and through the blankets and bedcloths. It took so long for a nurse to acknowledge a call bell that I actually had excoriation from the body fluids. When the nurse did finally arrive she was unpleasant, rude and acted extremely put out to have to do a dressing change. Which is in fact the job of the nurse. On another shift a nurse was pleasant acknowledged how uncomfortable I was changed my dressing and asked if I needed pain medication. Do you see the difference.

During another hospital stay My Iv started to feel really uncomfortable and when the nurse responded to a call bell an hour later it had infiltrated - if it had been addressed sooner I could have avoided that pain.

Because I was not supposed to move around much I could not sit up, fluff my own pillow or take myself to the bathroom. Could I do these things for myself I would have, but I needed assistance and it was not unreasonable for me to expect it in a timely, professional manner.

As a nurse for many years I have rarely had problems with patients or their families because I always acknowledge them with respect and sensitivity. If a pillow needs fluffing I fluff it. If a patient needs water I get it. If they have pain or another medical complaint I try to address it quickly and keep the patient updated about what is happening. I set firm boundaries with family members from the start and usually do not have issues with them.

Nurses are busy we work hard but trust me very few people want to be hospitalized and their perception is that we nurses get paid to do a job. If they are not satisfied with the quality of care they receive they have a right to voice their complaint and have it acknowledged. By addresses problems quickly they can often be resolved.

In the past month I have been in either the ER or hospitalized three times. Fortunately my insurance company owns it's hospitals so customer service is looked at as a goal of care. When patients understand their care and their concerns are met they have better outcomes. Sure I have met lots of patients who just can't be satisfied. I kill those with kindness and move on.

Hppy

[guest52816]

Of course patients and families are afraid. Of receiving incompetent care by uncaring, immature, arrogant, unprofessional staff; of what is going to happen to them; of medical and nursing errors (which have been shown to happen quite frequently). But really and truly, as nurses, although some of us like to aggrandize our role, as part of taking care of patients and providing good quality nursing care we are also responsible for providing good customer service to our patients. The HCAHPS survey should have brought that to your attention. It's really not smart to fight against this in my opinion; patients and/or their insurance companies are paying the bill and that is why you have your job. Without patients there wouldn't be any money coming in to pay your wages.

To state the obvious, there will always be patients.

Whether insurance pays the bill, the patient or the state, there will always be patients.

Too many folks like to smoke, drink and drive, abuse drugs, beat their kids and eat crap on a daily basis.

Never will be a shortage of patients.

I have no idea why you can't acknowledge there are nasty patients. There are nasty nurses. There are facilities that are understaffed.

Most of try and do the best we can, under not the best working conditions.

So, if I am busting my butt to care for eight patients, and one complains because she wanted her meds at 2000, not 2200, and she is the least sick of my patients, do I care?

No.

[eg1014, MSN, APRN, NP]

The moment patients and their families became "clients".. that's where it all went downhill. I love taking care of people, but I don't get paid to be cussed at, spit on, bitten, strangled by my stethoscope, or sexually assaulted by a patient or their family member.

I miss being in critical care, but I don't miss the BS of that hospital life.

[eg1014, MSN, APRN, NP]

Er, no.

A family member of mine was in the ED fairly recently. Her nurse was getting slammed that night (I happened to know the nurse ... and she was closing in on tears as she was getting another trauma on top of the already full load she had). This family member was stable; she was looking to be d/c.

My dad stalked the poor nurse throughout the ED because "they needed to go, damn it ... they've been waiting in this place for TWO WHOLE HOURS." Two hours TOTAL, at a busy metro ED. I happened to catch him at it and gave him hell.

This isn't my dad's typical behavior.

So why act this way?

People do not seem to act their baseline while receiving care. Or maybe they are and we are just seeing them at their very basic selves ... their poorly behaved, egotistic selves.

The selves that feel it's ok to stalk a 22 year-old nurse.

The selves that feel it's ok to spit on the nurse that didn't get your pain medications "in a timely manner."

The selves that feel it's fine to raise their voices at the nurse who can't figure out the TV remote.

I don't raise my voice at my CPA.

I don't spit on the cashier at Target when my coupon doesn't go through.

These behaviors are NOT to be a NORM.

And this "timely manner" you speak of? I'm not even going into that ...

OP - vent away.

AMEN. That is all.

[Susie2310]

The moment patients and their families became "clients".. that's where it all went downhill.

Your bio says that you have been a nurse for three years; patients have been considered clients (by some in the health care industry) for a lot longer than that. And patients didn't choose this. However, patients do have the right to expect to receive what they are paying for; and often they are paying a lot of money, many thousands of dollars a year in premiums alone, and/or their insurance company is paying a lot of money, with the expectation that the patient will receive respectful, competent, timely, high quality, medical and nursing care. Why should they expect less?

[Susie2310]

This is exactly why the belief "nurses eat their young" and "there is too much horizontal bullying" continues in nursing IMO.

Please show me the bullying. Straight talk is not bullying. Some nurses need to look at how their own behavior affects their relationships with patients instead of projecting the unsatisfactory results onto patients. If you want to have good relationships with patients first of all you need to be sure you are behaving in a way that will earn their trust. We need to look at our own conduct first. It always starts with us.

[Susie2310]

Sometimes that abnormal behavior is easily traced to fear, helplessness and worst of all-guilt. The overbearing family member that's "gonna take care of... (whatever)" by over the top reactions, accusing staff of not taking adequate care, etc can be seen as an attempt to control the situation. The posturing helps them to restore their feeling of being in control. Or to cover those latent guilty feelings they've neglected their loved one and are going to swan around making a big show. Those people are easy to deal with. It's the ones that you can just see are dripping with self centered egos, those are the ones that make you wish you'd gone for the MBA instead.

Given that this is professional nursing forum, I personally find this comment very unprofessional and immature. Have you read the Nurses Code of Ethics? Do you know that your role is to be an advocate for your patient? There are many who would love to replace nurses with unlicensed workers, and in my opinion posts such as this provide plenty of ammunition. The nurse-patient-family member relationship is built on trust; without trust there is no relationship, nothing. That is what is happening now. Patients expect to be cared for by competent, caring, knowledgeable nurses who are their advocates, and their family members expect this also; they certainly don't expect to have to defend themselves when they are very sick from the very nurses who are caring from them, but that is the dynamic I see taking place now.

[guest52816]

Given that this is professional nursing forum, I personally find this comment very unprofessional and immature. Have you read the Nurses Code of Ethics? Do you know that your role is to be an advocate for your patient? There are many who would love to replace nurses with unlicensed workers, and in my opinion posts such as this provide plenty of ammunition. The nurse-patient-family member relationship is built on trust; without trust there is no relationship, nothing. That is what is happening now. Patients expect to be cared for by competent, caring, knowledgeable nurses who are their advocates, and their family members expect this also; they certainly don't expect to have to defend themselves when they are very sick from the very nurses who are caring from them, but that is the dynamic I see taking place now.

Oh, c'mon!

I dare say, everyone on this thread understands the nurse/patient dynamic, and how trust is earned, on a daily basis.

Three weeks ago, a nurse I work with was accused of sexual assault on a competent, adult patient, by a FAMILY member, who wasn't in the room at the time.

An investigation was launched, and the nurse placed on leave.

This patient had been a problem, her entire stay. Nobody wanted to take care of her.

After the sexual assault claim, nobody could go into the room alone. We all had to enter as pairs.

The sexual assault claim turned out to be bogus, and thankfully, the patient was quickly discharged after that.

Some patients are just jerks.

I took care of that patient for one night, when all entering room were part of a pair.

Trust? That patient burned that bridge!

I did what I had to do in that room, and got out fast.

It made me feel sick to go in that room, knowing the hell she was putting a good, an innocent nurse through.

[guest52816]

Your bio says that you have been a nurse for three years; patients have been considered clients (by some in the health care industry) for a lot longer than that. And patients didn't choose this. However, patients do have the right to expect to receive what they are paying for; and often they are paying a lot of money, many thousands of dollars a year in premiums alone, and/or their insurance company is paying a lot of money, with the expectation that the patient will receive respectful, competent, timely, high quality, medical and nursing care. Why should they expect less?

You are absolutely right.

But your beef should be with facilities who understaff and don't provide basic things, such as enough vital signs machines on individual units.

Call bells can't be answered in a timely manner if there isn't sufficient staffing to do so.

Patient wishes for additional, unordered medications can't be granted unless an MD grants the wish.

Closed kitchens, can't simply be reopened by the wave of a magic wand to open and produce food that isn't on the menu, but is more palatable to the patient.

And I could go on, but won't.

[Susie2310]

Er, no.

A family member of mine was in the ED fairly recently. Her nurse was getting slammed that night (I happened to know the nurse ... and she was closing in on tears as she was getting another trauma on top of the already full load she had). This family member was stable; she was looking to be d/c.

My dad stalked the poor nurse throughout the ED because "they needed to go, damn it ... they've been waiting in this place for TWO WHOLE HOURS." Two hours TOTAL, at a busy metro ED. I happened to catch him at it and gave him hell.

This isn't my dad's typical behavior.

So why act this way?

People do not seem to act their baseline while receiving care. Or maybe they are and we are just seeing them at their very basic selves ... their poorly behaved, egotistic selves.

The selves that feel it's ok to stalk a 22 year-old nurse.

The selves that feel it's ok to spit on the nurse that didn't get your pain medications "in a timely manner."

The selves that feel it's fine to raise their voices at the nurse who can't figure out the TV remote.

I don't raise my voice at my CPA.

I don't spit on the cashier at Target when my coupon doesn't go through.

These behaviors are NOT to be a NORM.

And this "timely manner" you speak of? I'm not even going into that ...

OP - vent away.

You sound as though you are struggling for insight into patients' behavior. You ask why your father behaved uncharacteristically; I'll offer a suggestion - he was suddenly in a situation that was very stressful for him. I already explained in my earlier post that you reacted to some of the stressors that patients and family members experience. As nurses we are expected to make allowances for patients/family members behavior. You are offended that a patient/family member raises their voice; ask yourself what they are experiencing at that moment; delays in diagnosis and treatment are common stressors and can mean the difference between life and death or serious permanent injury for a patient.

No, when people are stressed receiving medical/nursing care of course they don't behave as calmly and reasonably as they would otherwise. I am very surprised that this seems to be a foreign concept to you, but there are numerous continuing education courses available that could help you to further your understanding on this subject that may also increase your compassion towards your patients and their families. Without the ability to feel empathy it is really difficult to form good relationships with patients/family members.

I'll give another example; I was recently in the ED with a family member who was receiving care. From the very beginning, from triage, the nurses made poor eye contact with both of us. Body language is very important. You have to look at people when you are talking to them if you want to communicate well with them; you are not delivering a monologue; and if you do this, don't be surprised when patients/family members don't respond well to this and find you to be rude and unapproachable and become defensive.

Now, just to clarify, no-one is suggesting that abusive behavior from patients/family members is acceptable, but the great majority of patient/family member behavior is not abusive, and usually there is enough time for an observant nurse to recognize when a situation is escalating and to take steps to de-escalate it. Again, one of the ways to de-escalate patients/family members becoming upset/angry is to listen to their concerns, acknowledge them, look at them when they are talking to you, don't cross your arms when they are speaking, and show them by your actions that you are doing your best to help them.

[Susie2310]

Oh, c'mon!

I dare say, everyone on this thread understands the nurse/patient dynamic, and how trust is earned, on a daily basis.

No, what is being written here shows evidence of the opposite.