What is up with these Sickle Cell Patients?!

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Hi everyone,

So just a little background...just like the name says, I am a brand new nurse. Where I went to school and did my clinicals was a part of the country that didn't have much diversity, so I never ran into patients with Sickle Cell. Where I work now is a very busy, inner city teaching hospital with an abundance of patients with this diagnosis.

So anyway, after getting report for my sickle cell patients, I asked the reporting nurse and my preceptor for any tips or words of wisdom on how to provide the best care for my sickle cell patients. Their answers were, "Oh, you'll see. You'll learn quick..." They weren't kidding. I am not trying to categorize sickle cell patients, but the ones I've had are by far the worst, rudest, and ill-natured people I have ever run into in the health care setting.

For example, we have patient X who is an addict. This patient has a high dosage IV Dilaudid ordered PRN for pain every 3 hours and she has an alarm going off telling him/her when he/she is due. Patient is so rude to the nurses and aides. She gets her meds on time every time but complains about every thing and tries to get the staff pitted against each other with manipulation and lies. Patient X also keeps messing with her central line and being non-compliant with the plan of care. Patient Z is the same exact way, just add more cursing and attitude. Mind you, these patients are constantly on their phone and computers showing no outward signs of pain, no change in VS to signal pain, no anxiety, normal labs (minus what is expected for sickle cell). Patient Z goes as far as messing with her IV pump and changing drip settings and trying to be slick by stealing syringes and needles if he/she thinks the nurse is not watching him/her like a hawk. Both these patients are suspected of doing something with their central lines because they both have problems with them. If you ask any of the nurses, they all say the same thing. I feel terrible that the sickle patients are under this predetermined category in this setting, but they all seem to put themselves there.....rude, drug-seeking, addicts, manipulators, non-compliant, liars. The ones I have had will not hear you out no matter what angle you use. It's like their dx gives them an excuse to be horrible human beings...

What has your experience been? I know these patients are sick and in pain, but why act like nightmare people or nightmare patients?

It's probably more of a cultural problem than a sickle cell problem. Rude people.

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Specializes in critical care, ER,ICU, CVSURG, CCU.

I have even had Sickle cell patients tell me , "thank you for being on duty". (InER) My trick, and I really meant it, I would say, I know it's rough, but I will get you feeling some better in a sec. Or so.....and preceded with our protocols.....

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I agree with what everyone else said about SC pts being in constant pain and you are not the nicest person when you are hurting but it doesn't give u the right to be rude to people.

On the other hand maybe they are mad at the world because they have SC. I would be. It could have all been avoided if there parents would have taken the time to just ask if they have that gene. I'm an African American female and when dating I always ask if it runs in the family.

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It's probably more of a cultural problem than a sickle cell problem. Rude people.

Because people without sickle cell aren't rude?

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I agree with what everyone else said about SC pts being in constant pain and you are not the nicest person when you are hurting but it doesn't give u the right to be rude to people.

On the other hand maybe they are mad at the world because they have SC. I would be. It could have all been avoided if there parents would have taken the time to just ask if they have that gene. I'm an African American female and when dating I always ask if it runs in the family.

Very true, but it's not always that simple. When I was tested for sickle cell trait I was told I did not carry it. My daughter was diagnosed at 14 days old with sickle cell disease.

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Very true, but it's not always that simple. When I was tested for sickle cell trait I was told I did not carry it. My daughter was diagnosed at 14 days old with sickle cell disease.

Did she have the anemia or just the disease? I was told there is a difference.

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It's probably more of a cultural problem than a sickle cell problem. Rude people.

We all know it's primarily in the African American culture. So are you saying AA's are rude?

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Specializes in Hospice.

In my opinion, it's neither cultural nor limited to people with sickle cell. It's about being in constant pain with a life-limiting disease and the endless power struggle with providers to get some kind of relief, any kind of relief -- even if it's limited to lashing out at caregivers that have issues with "drug-seeking" and cross-cultural communication.

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Did she have the anemia or just the disease? I was told there is a difference.

She has type SD. It is a variant form of Sickle Cell Disease. There are several different hemoglobin variants,however they all receive the diagnosis of Sickle Cell Disease and the majority of them consist of anemia. My daughter does have the chronic anemia, her baseline hgb is 8 but has gotten as low as 3. With many of the variants you will see that some of them have more immune system issues. Sickle Cell Disease is also more severe in people with asthma.

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She has type SD. It is a variant form of Sickle Cell Disease. There are several different hemoglobin variants,however they all receive the diagnosis of Sickle Cell Disease and the majority of them consist of anemia. My daughter does have the chronic anemia, her baseline hgb is 8 but has gotten as low as 3. With many of the variants you will see that some of them have more immune system issues. Sickle Cell Disease is also more severe in people with asthma.

SC is so interesting to me. I would love to be a research nurse and research it.

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Specializes in Corrections, neurology, dialysis.

We currently have a sickle cell patient we are dealing with and, as the OP said, she is the worst, meanest, ugliest, most belligerent, most manipulative patient I've ever dealt with. We cringe when we see her name on the census because we know that she will raise constant mess the whole time she is here. She complains to administration about something at least once a day. She has fired all her doctors and yet she keeps coming to this hospital.

Currently I always end up taking care of her because she has reported everyone else for something or other. I know it's just a matter of time before she does it to me. For now she is my best bud, she smiles and laughs when I'm with her.. We talk and she's actually very smart and funny. But then she will go down the path of speeing her hatred of this hospital and everyone in it, and they better do what she says OR ELSE! I thought renal patients were the worst. She has all of them beat by a country mile. She calls the unit and screams and curses and demands to be out on PD right now, and if we don't she calls the house supervisor. She says she was guaranteed by some nebulous unnamed person that she will be put on PD between the hours of X and Y, which is a complete lie. We don't guarantee anyone a specific treatment time. Triage and acuity is what drives our schedule.

Yes i I have compassion for her situation. Yes we all treat her with the same respect we treat all our patients. Does it make it okay for her to be a complete jerk and wreak havoc the whole time she's here?

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We currently have a sickle cell patient we are dealing with and, as the OP said, she is the worst, meanest, ugliest, most belligerent, most manipulative patient I've ever dealt with. We cringe when we see her name on the census because we know that she will raise constant mess the whole time she is here. She complains to administration about something at least once a day. She has fired all her doctors and yet she keeps coming to this hospital.

Currently I always end up taking care of her because she has reported everyone else for something or other. I know it's just a matter of time before she does it to me. For now she is my best bud, she smiles and laughs when I'm with her.. We talk and she's actually very smart and funny. But then she will go down the path of speeing her hatred of this hospital and everyone in it, and they better do what she says OR ELSE! I thought renal patients were the worst. She has all of them beat by a country mile. She calls the unit and screams and curses and demands to be out on PD right now, and if we don't she calls the house supervisor. She says she was guaranteed by some nebulous unnamed person that she will be put on PD between the hours of X and Y, which is a complete lie. We don't guarantee anyone a specific treatment time. Triage and acuity is what drives our schedule.

Yes i I have compassion for her situation. Yes we all treat her with the same respect we treat all our patients. Does it make it okay for her to be a complete jerk and wreak havoc the whole time she's here?

Normally I'd say that chronic pain can make a person bitter and demanding, but this one sounds like she may have a personality disorder on top of everything else. You have my sympathies.

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