The Needy Patient

[Nurse Pompom]

So I have a hard time with needy, sometimes manipulative patients. I have zero patience for it. I am not referring to the patients who need medical attention, of course.

It drives me banana when a pt is needy and just wants attention.. I am talking about the patient that for instance goes... can I have icy water? I bring water to my pt and pt goes.... can I have a boost.. get another nurse and boost pt... pt then goes... what time is it? I point to the clock in the room and give time, tell them the date since I'm at it.. I leave.. light goes off again for various futile reasons... secretary chases me down because she keeps having to answer light... I have ton to do.. it doesn't matter how many times I answer the call light, it will go off again.

I can tell this kind of patient isn't happy when I ask if there anything else I can do for them or if they have any other questions. I explained to them that there are not my only pt. They acknowledge and everything is good.. 2 min later light goes off.. AMG!

What kind of strategy do you have in place? Any tricks and tips to set boundaries?

[Sour Lemon]

I give them a LOT of attention when I first come on shift, then I let them know that I will be rotating from patient to patient and might not be able to respond to every request immediately. I add any requests to a list, usually in front of them, and I encourage them to make their own list if they're capable.

If the patient calls immediately after I leave, I do not get what they're asking for right away. I simply add it to their list, remind them that it's their "neighbor's" turn, and let them know that I'll bring it back by when it's their turn again.

I do have patients who will strategically develop chest pain or trouble breathing. In those instances, I will assess the urgent issue, but when they mention applesauce, it goes right to the list and I let them know how many people are in line ahead of them.

I've had only limited success with this strategy, but I haven't found anything drug-free that works better. Realistically, it's not a problem that can be solved during a short stay.

[Nurse Pompom]

On 4/13/2021 at 11:04 AM, Sour Lemon said:

I've had only limited success with this strategy, but I haven't found anything drug-free that works better. Realistically, it's not a problem that can be solved during a short stay.

I mean it doesn't seem like a good strategy then. And if you give them a ton of attention, you get them hooked asking for more. I was thinking about giving them a pen and piece of paper to write down their non urgent questions. 

I do agree that it's not something that gets solved during short stays though, that's why I was wondering if anybody had found tricks or had tips to deal with it during the short stay.

[BagelBomber, ASN, BSN, RN]

I had two of these individuals on my shift last night, and I was hoping to find some tips and tricks here, too- because right now, I just grit my teeth through my shift and give the oncoming nurse a "warning" during report. I've tried explaining that it's easier for both them and myself if we tackle multiple questions and requests at once to no avail. I do like the list idea, though. 

[Sour Lemon]

1 hour ago, Nurse Pompom said:

 And if you give them a ton of attention, you get them hooked asking for more.

I've found the opposite, actually. Showing that you're happy to engage when you have the time makes them less desperate for your attention. People are more likely to believe and accept your limitations when they like you and they feel liked by you.

If anyone has found a better way to deal with these patients, I'd like to hear about it too! I've experimented a LOT over the years, and limited success has been my best accomplishment.

[JadedCPN, BSN, RN]

I agree with SourLemon. I work pediatrics but encounter similar issues with the teen patients and often times the parents at the bedside.

I've found that telling them directly that I’m going to go finish whatever (med pass, assessments, etc) on my other patients when I am done with them will leave me tied up for X amount of time, so tell me everything you need now and I will grab it but then won’t be available until I’m done with everything else. I of course go out of my way to mention that they can always use their call light or the emergency buttons for any emergencies.

And I have no problems directly telling them, but softly in a tough love type of way, when they press their call light for that extra juice after I just dropped off water that “I was just in here, now why didn’t you tell me when I was here?!” and they get the point some without being offended. 

If they are repeat offenders and call out for something non urgent, such as a snack or ice refill or something they can do themselves like turn on/off a light when I’m busy, I will make a point to finish everything else I am doing which takes a while; when I finally bring that thing in, I will say something like “sorry that took a while, I got caught up with another patient, next time if I take to long feel free to use the family lounge which has an ice and water machine.” 

It isn’t fool proof, but it gives me peace of mind that I’ve set that boundary. And I agree that giving them that time and attention in the beginning let’s them know that you do want to provide the best care for them, but there are times where it may take a while if it’s not urgent.

[Nurse Pompom]

On 4/13/2021 at 7:48 PM, Sour Lemon said:

I've found the opposite, actually. Showing that you're happy to engage when you have the time makes them less desperate for your attention. People are more likely to believe and accept your limitations when they like you and they feel liked by you.

That's funny, because the exact opposite happened and that is why I am asking the original question. No matter the amount of attention/effort, these patients don't stop.

[NightNerd, MSN, RN]

1 hour ago, Nurse Pompom said:

That's funny, because the exact opposite happened and that is why I am asking the original question. No matter the amount of attention/effort, these patients don't stop.

They sure don't! There is honestly not much else to be done, unfortunately. In these situations, my goal is to be a good nurse to all my patients, including the needy ones, and also to retain some sanity by the end of the shift. This is more realistic than finding the ultimate boundary-setting strategy, which we're all looking for but probably won't ever find. It's really the ultimate exercise in prioritizing.

Clustering care, the list idea, and reminding them to ask for everything they need at once really are the best strategies. Afterward, all you can do is what you said you would do, which is return to their room when you're available. If you need to go silently scream in the breakroom for a minute first, well, do what you have to do. I've found sometimes that even when my patients start getting grumpy about the lack of constant attention, their calls slow down a little after some repetition. I can live with that, as long as I know I've responded the best I could and kept them safe.

Now, if anyone has a solid script for what to do when a patient gets manipulative - as in, "Uh-oh, NightNerd's upset with me for hitting the call bell/getting thirsty as soon as she left the room/asking to be repositioned for the third time in an hour" - that would be helpful! It's all I can do sometimes to keep from being like, "Damn right I'm upset with you!"

[hppygr8ful, ASN, RN, EMT-I]

From a psych perspective, I always ask my self what is the secondary gain the patient gets through this behavior. Understand that they don't just act like this while hospitalized. This is a learned behavior and most people in the 50+ age range have been doing this with  their families for years. Setting boundaries is important even though this type of patient is used to smashing through the boundary being set. 

One pf the things I do is set up a behvaior contract with them or their family members and then hold to it. The only issue with doing this in as chaotic and dynamic situation is making sure you keep your commitment. It has mostly worked for me although no two patients are alike  and we have to remember this. 

Hppy

[anewsns]

On 4/13/2021 at 11:04 AM, Sour Lemon said:

I give them a LOT of attention when I first come on shift, then I let them know that I will be rotating from patient to patient and might not be able to respond to every request immediately. I add any requests to a list, usually in front of them, and I encourage them to make their own list if they're capable.

If the patient calls immediately after I leave, I do not get what they're asking for right away. I simply add it to their list, remind them that it's their "neighbor's" turn, and let them know that I'll bring it back by when it's their turn again.

I do have patients who will strategically develop chest pain or trouble breathing. In those instances, I will assess the urgent issue, but when they mention applesauce, it goes right to the list and I let them know how many people are in line ahead of them.

I've had only limited success with this strategy, but I haven't found anything drug-free that works better. Realistically, it's not a problem that can be solved during a short stay.

EXACTLY my method. The ultra proactive, friendly approach. It works best honestly. I also always use the word "neighbor" too. "I will be in with your neighbor for a while/ (or) "I gotta work on a busy admission next door for a while!" and if I don't hear from you, I will round in an hour to make sure you are OK. You got your news paper, you got your applesauce. You got the ice chips. You got the Eagles going. Your daughter should be up with the chicken nuggets shortly. Doctor should round within the next couple hours. Want the lights off? Alright friend! See you later on!" It sounds very excessive but they usually leave me alone for a bit.

[LibraNurse27, BSN, RN]

I tried to spend some "quality time" with these pts at beginning of shift, introduce myself, explain plan for the shift, ask if anything they want to accomplish, if any questions, anything you need before I round on my other pts. Then I'd answer the lights asap the first few calls. Sometimes if they feel like you will answer if they call they calm down, if the excessive calling is anxiety related. I would let them know I may not be available for a while so to let me know if there is anything they need, and to push the call light for an emergency. 

If none of this worked, behavior contract with management. We had a behavior response nurse from psych who would come talk to difficult pts. They were so helpful! One pt stayed on our unit for 2 years. She called incessantly. One day a nurse accidentally said "Did you really call again or is your finger stuck to the call button?" Pt got offended and said she didn't call a lot. The nurse kept a tally and showed the pt she had called 53 times in 2 hrs. I only used that strategy once w/ a pt who claimed no one ever came to his room. I put tallies on the board all shift and at the end of the day showed him staff members had been in his room 81 times in 8 hours between me, other nurses, CNA, MD, RT, PT, OT, specialists... wow. 

[Red Shirt 6, CNA]

Depending on location, type of patient this has worked for me. 

I will take an extra set of vitals making sure they know their numbers, this includes asking them if they want to be weighed. If yes then I get their weight. If needed set the patient up with a shower if it does not interfere with scheduled showers.