Unprofessional to mention you have other patients?

cjcsoon2bnp, MSN, RN, NP · Jun 3, 2017

I think that it has to be said very carefully with the right tone, choice of words and context. Saying somethign to the effect of "well I have other patients too" or "I have 4 other patients besides you that I need to take care of" is completely inapproapraite and out of line. But I think that there are subtle, professional ways of reminding patients and families that you have multiple people to care for and you want to make sure that everyone gets the best quality of care.

However, I have said to patients before "Now that we have gotten you some pain medication let's see if that helps you to feel more comfortable. I'm just going to check on a few of my other patients to make sure that we don't have any emergencies going on but I will be back to check on you. If there is anything that you need before I get back please press your call bell and one of the staff will be right in ASAP."

I find that usually is usually sufficient for most people but if someone requires a lot of assistance or is requesting frequent updates on what is going on then I might change the script a little bit.... In the ED a lot of patients and families want to know the result of every single test exactly as it comes in (and we all know that many of the labs or diagnostic imaging tests result at different times) so what I tend to say is this

"Right now we are waiting on the results of a few of your tests. I'm going to step out to round on all of my patients to make sure that everyone is doing ok at the moment and there aren't any emergencies that need my attention. Once all of your test results have come back or we have an update in your plan of care for today then I will come back and we can talk about it. If you need me for any reason before that time please hit your call light and one of us will be right in to help you."

!Chris :specs:

yourefirstllc · Jun 3, 2017

I have a question Most people agree that the costs are out of control. What can be done about that?

NuGuyNurse2b · Jun 3, 2017

I have a question Most people agree that the costs are out of control. What can be done about that?

You mean like the cost of their hospital stay? I refer them to billing. From what I was told, we sometimes actually lose money based on some new payment scheme. Our hospital doesn't do itemized billing anymore. Depending on what your diagnosis is, they charge you that flat fee. Somewhere someone figured out how much the average costs were for each diagnosis and that's the way they do billing now. So if you run over that amount, we kinda absorb the cost. Again this was what I've been told by upper management, not really sure about its validity. I feel like they're managing to make up that loss somewhere else. One area is in the supplies...noticeably cheaper gloves that tear easily, cheaper plastics used on urinals or bed pans. And annual review metrics that seem impossible to meet, hence a lower raise.

gemmi999 · Jun 3, 2017

ER is a bit different from floor nursing, but I do try to manage expectations. I will routinely tell patient's that the MD has to handle emergent cases first, and that they will be seen and have their needs addressed, but they might need to be patient. If I know I'm about to get a critical run, I'll tell my patient's flat out that I will be busy for the next 30 - 45 minutes settling a critical patient, but they are on the monitor and I (and other nurses) will keep an eye on their vital signs/needs during this time. It helps that the ER I work in has "float" or "resource" nurses who you can ask to do things if you know you'll be tied for for awhile.

I firmly believe everything is about teamwork. If I know another nurse is busy but her patient needs to use the restroom/pain medication/has a change in condition I will definitely help out because that's what nursing is all about. That and time management. If I know it'll take me 40ish minutes to settle a patient/monitor/foley/IV/medicate/med rec, etc, I will round on my other patient's first and take care of basic needs.

Plus, I try to be honest. On my last shift I told a patient who asked about lab results that honestly, I'd been busy with another situation and I hadn't had time to look, but I would look as soon as I could and let them know what to expect/call the lab/etc. They thanked me for being honest because it had been 2+ hours since their blood work but we'd had two respiratory distresses and one code sepsis during that time. The patient's abdominal pain was back burner.

FolksBtrippin, BSN, RN · Jun 3, 2017

I don't think it's "unprofessional" to tell your patients that you have other patients, but I hate that word.

I think that telling your patients that you have other patients is not an effective way to encourage their patience and understanding. So, I don't do it. I am often tempted to do it. Because I literally have other patients and I constantly have to prioritize.

When I am tempted to say that, it means I probably need to delegate, or I need to give an estimate of how long it will take me to attend to that request, and then add a few minutes because it is always better when I am early.

RescueNinjaKy · Jun 3, 2017

It certainly isn't unprofessional. It's all about providing education. As nurses we are taught to prioritize our patients and care and that is exactly what I tell my patients. If I'm busy with something If my patient wants to ambulate now and I need to do something more urgent for my other patient like starting an amiodarone drip or whatever, I tell them that I have another patient that needs my attention at this time but I will either find another person to ambulate with him or I will be back after.

Heck now that I'm in the cath lab when I bump my patient in the holding area for a stemi, I explain to my patient that we have an emergency case that just came in and that he remains next on the list barring any other emergencies.

For the rare patients that don't give a damn and the family members that say that they don't care about my other patients, I tell them that I care about my other patients and this is what I'm working with. Then I direct them to patient relations if they remain angry.

After all it is what it is and if they want my undivided attention then they can either talk to patient relations to get nursing staff ratio of 1:1 (ha) or be sick enough in an icu to actually be 1:1.

LovingLife123 · Jun 3, 2017

No. Not unprofessional at all. If you make the patient believe they are the only patient you have, then they expect you to be on all of their stuff all the time. And truly if it was 1:1, you should be. You have to set the expectations appropriately.

Otherwise, when you don't answer that call light right away you do look like you don't care. It's that simple. It's worse, in my opinion, to make it look like they are your only one.

I'm always very up front with my patients. I'll be in to do this at this time. Or I apologize, I was in my other patients room, what can I do for you, and then I do it. To me, lying to your patients, and giving them unrealistic expections is completely unprofessional. You are setting yourself up for failure, and going to get the family and patient angry with you because they will think you are out playing on your phone somewhere. When in reality, you may be saving a life.

Nurse_ · Jun 3, 2017

I don't think it is.

I usually say at that to my patient/patient's family in the beginning. I'll tell them that I'll be outside their room, and if they need something and I'm not there, I could be in my other patient's room and there's always someone in the nurse's station to help them. And if there really isn't anyone in the floor, that I'll be back in 45 to an hour to check on them.

Its important to tell them that there's also someone else you are responsible for. I believe that by knowing that they'll be more cognizant with their care and demands.

cyc0sys · Jun 3, 2017

I not only tell them that I have others patients, I tell them they are 1 of my 28 patients. Most of the time, people better understand the situation when you give them sound and timely information. However, I did have one older lady say, " I don't care, my husband is the most important person to me and he needs his medication right now." To which I replied, "So the person I'm tending to right now, in respiratory distress, can wait. After all, oxygen isn't important unless you're not getting any and he's not someone else's husband, father or grand father". She apologized when I give her husband his medication 15 minutes later.

These patient ratios will never change unless we make people aware of them. I encourage people to call CMS and their congress critter about these numbers.

Kooky Korky, BSN, RN · Jun 4, 2017

People usually are understanding, but it can also backfire on you. I had a family member point blank said "I don't care about the other people." ...

To be frank, that's how I feel when my loved ones are in need of nursing care. I truly do not give a good _________ about anyone else. I know that's awful but that's how I feel.

Why should I care about anyone else? I'm not totally in my right mind when my loved ones are seriously ill, so don't expect me to be fully rational or courteous.

When someone I love is in danger, I am afraid. And knowing how terribly wrong a situation can quickly go, knowing that signs are often missed, knowing that errors can and do occur, well, I just care about nothing but the well-being of my loved ones.

If you are honest (you = anyone reading this), you might acknowledge the fear and the terror and the lack of concern for anything or anyone but your loved ones.

It might be different if I knew and trusted the nurse/staff involved. Even those with whom I am more comfortable because it's not the first contact with them can and do flub up sometimes. But it's very hard to automatically trust upon first meeting them that they will give excellent or even just adequate care. And being helpless to intervene makes it all that much worse.

So for me, just tell me "OK, no problem. It will be about 20 minutes. Or I can show you where the kitchen/linen room/supply closet is located if you want it sooner".

And I would be happy to get it myself if I can.

But no I don't think I would like to hear that you have other patients, especially if that is stated in an exasperated or complaining kind of way. I know you have other patients and I don't care.

jaderook01, BSN, RN · Jun 4, 2017

If I was told that they don't care about other people, I'm afraid I would have to respond that I don't have that luxury and thus have to prioritize who needs me the most at any given time.

NuGuyNurse2b · Jun 4, 2017

If I was told that they don't care about other people, I'm afraid I would have to respond that I don't have that luxury and thus have to prioritize who needs me the most at any given time.

If I could, i would "like" this comment x infinity.