What's a "difficult pt" to you?

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What does everyone consider to be a "difficult pt" and what unit/area do you work in? Curious what everyone thinks!

The ones that sleep late or don't sleep or get sick.

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Specializes in Cardiology, Cardiothoracic Surgical.

The patients that are medically complicated, almost total cares who require a higher level of care than where they currently are and the staff can reasonably handle.

We don't seem to have too many verbally abusive cardiac patients- we have some physically intimidating midlevel providers on those floors well known for "keeping it real" with the patients.

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Specializes in SICU, trauma, neuro.

We had one recently who was on the call light literally q 1 minute. We ALL took turns answering it, and each of us were in there q 5 min. She had a brain tumor which had caused seizures, but she was A&O. We'd ask several times if she needed anything else, and she'd say "I think I'm good now, and I'll try not to bother you for a while" One minute later she'd be on the light again. At one point, one of us told her that this cannot continue--that we had critical pts to take care of and can't keep coming in q 1 minute. When that didn't work, the same RN said that we're going to take the call light away--with the promise that we'd be in to check on her q half hour. That backfired when she started calling "Yoo hoo!" in lieu of the call light. :facepalm: That was difficult b/c as I said, she was A&O. Not some LOL with dementia who didn't remember that she'd been on the call light like white on rice for the past two hours.

Once when working LTACH I had this pt who was in for Fournier's gangrene but also had a fluid restriction for electrolytes (he had schizophrenia and would drink constantly if we'd let him). Incessantly yelling my name out into the hallway, asking for more water, more ice. Doing wound care was a nightmare b/c he'd yell that I was being too rough but then yell that I needed to hurry up. I had premedicated him, and honestly I am as gentle as I can w/ wound care. I don't like torturing people! I told him, "Well I *can* go faster, but then it's going to be rougher. I'm trying to be gentle, but that means that I also need to be careful and take my time. Which is more important to you: fast or gentle?" He yelled "Do it fast AND gentle!"

More generally speaking, whining grates on my nerves. That and ordering staff around...I'd say like servants, but "servants" don't deserve disrespect either. And of course the families that are always up in your face (or sitting back taking notes), treating you like an adversary and not as someone who is trying their best to make their loved one well.

I work in the SICU of a Level 1 trauma center; our SICU includes neuro--surgical and medical--as well.

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Specializes in Cardiac.

CHF exacerbation patients who refuse to make necessary lifestyle changes and are constantly in the hospital with the same complaints of edema and SOB. They call every hr wanting ice or something to drink...Yet when I remind them of their fluid restriction & the importance of sticking to it... I get cussed out.

Pts scheduled for heart caths the next morning (I work nights) who constantly go out to smoke, but want their morphine for chest pain every 2 hrs. When I tell them they cannot leave the floor if I give morphine, I get cussed out & told it's their right and I can't hold them here.

Pts with overbearing family members who are detrimental to their loved ones care. Example - LOL with dementia & CHF exacerbation, daughter is POA - refused coreg, IV lasix, and norvasc. Also Ativan for the pts extreme restless & pulling off her venti mask every other minute with sats dropping to the 70s. Like why did you even bring her in???

Pretty much what I consider a difficult pt is any who hinders me giving exceptional care to my others pts by wasting my time calling for food, blankets, pillow fluffing, "turn my light off", ect. And pts/family members who don't want to participate in their own or their loved ones care and then are mad when they aren't getting any better. It's sad and frustrating..

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Pt.'s w/ placement issues due to lack of insurance or illegal alien status. It's demoralizing for the patients to be stuck in a hospital for months and even upwards of a year. Frustrating for me to want to do more for them and knowing that they could be progressing much faster if they were only in the appropriate setting.

Language barrier issues.

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Specializes in Emergency Nursing.

Emergency Department:

Patients who "know" they need an MRI or other expensive test for chronic condition. I love when the doctors shut them down with statements like "Since this is a chronic condition, it is technically out of my expertise. You need to see an XYZ specialist."

Helicopter parents of children of any age, especially of grown adult children. How are you not embarrassed that your mother "has to" argue on your behalf?

The drunks that repeatedly come in wasted and say they are suicidal, then sober up, deny suicidal ideation, and become nightmares. "I hate this place!!!". Well, great. Then stop telling the ambulance to come here.

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Specializes in Public Health.

I've been told I have the patience of a saint but sometimes I have to be firm and set limits. I always tell my difficult pts that they are free to leave at anytime but good luck dealing with your insurance company if you go with AMA. I work in my pts best interest always.

Some people just want to have their cake and eat it too. Smh

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For me the difficult patient is one that can not move, so are dead weight, can not communicate well, so you really don't know they are uncomfortable in positoning until they have a pained look about them, and having to figure out how to position them so that they are at least comfortable and their skin is intact. They are frightened, helpless, and rightfully so.

Breaks my heart.

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Specializes in NICU, ICU, PICU, Academia.

My 'difficult patient' is the toddler with multiple lines/ intubated or (Heaven help me) and EVD. Who is used to sleeping prone.

Longest. Night. Ever.

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LOL on diuretics who has to void very 15 minutes, but it takes 15 minutes just to get them to the BSC for a 1 minute void, and can't be left there because she's a fall risk. I wouldn't mind if I didn't have bunches of other things going on!

Patients who can't communicate.

Recently the daughter who wants to refuse treatment for mom because of something her psychic told her...how can THAT be reasoned with??!

CHF exacerbaters who refuse to be compliant, refuse teaching and refuse meds, but they're mad because we can't fix them!

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Non-compliant and then complaining because there is no change. If you did what was suggested it would be better.

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Your schizophrenic patient reminds me of one I had in LTC. She would yell the name of whoever she saw pass by (and she knew everybody's name) over and over again. When you want it to see what she wanted she'd always say "It's nothing" or "I don't need nothing" or simply say "nothing." All at the top of her lungs of course.

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