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When One Patient Affects the Care Other Patients Receive

Updated | Posted

Specializes in Rehab/Nurse Manager. Has 6 years experience.

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Anyone ever have it where one patient's "needs" have impacted the care other patients have received? 

Let me explain.  We had a patient admit late last week who has done nothing but file grievances and complain to her daughter ever since her arrival.   While some of the complaints are valid (e.g. long call light waits in some instances), others are ridiculous.  For instance, this patient filed a grievance form because her TV remote was not fixed fast enough (it was repaired within 10-15 minutes) and that it took someone 20 minutes to bring her a new Diet Pepsi.  This patient and her daughter also demanded to know why the patient, who is a diabetic, had a blood sugar over 300 even though the patient admitted to having a couple of treats and why the doctor had not been called immediately.   They stated that the patient should be able to have treats/desserts without her blood sugars becoming "extremely elevated" and that we "should know how to manage her blood sugars better so she can have treats."   This is also a patient that will call her daughter weeping when nurses have brought her PRN pain medications 2 minutes late and complain that she has not been given a shower, even though she refused several times when offered, stating that "the timing isn't right."  They also have a list of staff members they do not wish to be involved in her care, even though all of them are competent.  Because of all of these grievances, I have had no choice but to dedicate 1.5 hours or more every day listening to them vent and addressing their complaints.    Yesterday, at least 3 hours was dedicated to this person alone.  This doesn't include the time involved with contacting providers, typing up an individualized medication list, and completing other "duties" they demanded.   

The thing is, this week I was covering for my co-manager, so there were almost 30 other patients that also needed some of my attention, and I barely knew what was going with any of them because a large majority of my time was spent accommodating this one individual, with the hopes that by doing so we won't get reported.  I understand that some patients are simply going to require more attention than others, but in my opinion, 1.5hours-3 hours every single day, when there are about 30 other patients who also require care, is excessive.   I can't help but feel that someone else, or multiple other individuals, were neglected because this one patient demanded so much of our attention.  

There were several patients that I sent to to the hospital over the past week, and part of me wonders if we could have kept at least some of them in the facility altogether if I would have had more time to focus on their needs.  Additionally, there are a couple of patients that I am concerned may decline over the weekend, but couldn't get further recommendations from the provider other than "to keep monitoring" and "send them to the ER if needed"  because by the time I was able to address concerns staff had about them it was very late on a Friday evening.  

Anyone else ever had an experience like this, where one patient's demands possibly impacted the care of other patients?  **Note:  Informing this patient that there are others who also need care isn't an option because they have already threatened to report staff members who have mentioned this to the board of nursing, stating that comments like that "are an unacceptable way to speak to a patient."  

SilverBells, BSN

Specializes in Rehab/Nurse Manager. Has 6 years experience.

This also reminds me of another patient who demanded that I listen to him vent for 45 minutes about the color of plastic spoons being provided by the facility.   He stated that he had asked for black spoons many times and there was "no excuse for continuing to provide white plastic spoons" or an hour listening to a patient complain wanting black compression stockings versus the beige ones we offered. 

Obviously, my time could have been better spent than listening to a patient complain about something that couldn't be resolved (our facility doesn't provide black spoons), but I run the risk of being reported and possibly losing my job if I don't attend to these grievances. 

Edited by SilverBells

Emergent, RN

Specializes in ER. Has 28 years experience.

It sounds to me like the facility needs to start setting some boundaries here. There have to be some limits, these people are abusing the situation. A behavior contract would be in order I think.

People do have a right to choose a different facility, if they can't abide by the rules. It's a big mistake catering to one person like this. It feeds the behavior which is bound to escalate.

 

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

I empathise with you, SilverBells because this brand of patient will such the soul right out of you. It's all we can do to tread and keep our heads above water.

One thing that the good staff I worked with on geriatric psych would do would be to tag-team the high maintenance patients.

Yours is a totally different situation. I would go as far as to make certain patients persona non grata, but you aren't allowed this luxury.

Once again, I feel for you.

SilverBells, BSN

Specializes in Rehab/Nurse Manager. Has 6 years experience.

2 hours ago, Emergent said:

It sounds to me like the facility needs to start setting some boundaries here. There have to be some limits, these people are abusing the situation. A behavior contract would be in order I think.

People do have a right to choose a different facility, if they can't abide by the rules. It's a big mistake catering to one person like this. It feeds the behavior which is bound to escalate.

 

I agree that boundaries should be set, but they probably need to come from administration, who typically tends to side with the patients, no matter how ridiculous they are.

With that said, after 5 days of incessant phone calls, I think even our social worker is a bit frustrated with the situations regarding the lady I described. And she has an endless amount of patience snd and empathy. 

As a side note, I will say that the more a patient states they are not trying to cause trouble, the less I believe them.  

I also wonder if these types of patients realize that the more they complain, the less staff want to help them.  It still wouldn't excuse neglect, but I can see how some people would not want to go out of their way to help them

Edited by SilverBells

SilverBells, BSN

Specializes in Rehab/Nurse Manager. Has 6 years experience.

2 hours ago, Davey Do said:

I empathise with you, SilverBells because this brand of patient will such the soul right out of you. It's all we can do to tread and keep our heads above water.

One thing that the good staff I worked with on geriatric psych would do would be to tag-team the high maintenance patients.

Yours is a totally different situation. I would go as far as to make certain patients persona non grata, but you aren't allowed this luxury.

Once again, I feel for you.

Thank you.  Dealing with the one patient this past week was both very physically and mentally exhausting.

While I'm not in a position to suggest to the  one patient she may want to see if another facility may be more suitable, I do wonder if our social worker or DON might be getting close to that point as I know they are also discouraged by the daily, lengthy complaints 

Edited by SilverBells

TheMoonisMyLantern, ADN, LPN, RN

Specializes in Mental health, substance abuse, geriatrics, PCU. Has 14 years experience.

Anyone can remind this patient that they have the right to choose another facility if they feel their needs aren't being met. Patients like this will test your ability to remain off the evening news, and they can be exhausting. I know you say that administration tends to side with the patient, but in this instance I don't think you have a choice but to get them involved, it is important that when you discuss her with them that you remain as objective as possible and provide the facts so that her behavior speaks for itself. Hopefully they will be supportive, they may not put a stop to her behavior but they may provide a certain degree of "immunity" to the people that are targets of her complaints.

I have a fellow who is very verbally abusive and nasty towards everyone. There is no dementia, no psych issues, he's just a manipulative jerk. Our management doesn't address his behavior, but the myriad amount of complaints he makes go nowhere with administration. That provides at least some assistance to staff so they don't fear for their jobs every time they enter the room.

As far as reporting things to the BON, etc. Let em! The BON, ombudsman, all these regulatory bodies receive frivolous complaints every day. Patients will threaten to report things in order to try to exert control over their situation and to manipulate staff at meet their demands and needs, if you refuse to show fear in what they say, eventually those threats will lessen. When I take phone calls from irate families I will allow them to say their peace, try address their concerns, but if we keep going round and round then I just end the conversation. I have also reminded families that they are welcome take their family member home if they feel they would receive better care, that typically gets them off the phone pretty quick.

I really hope your resident is just in a tizzy because she's trying to get settled in, I hope her behavior straightens up for all your sakes!

Remember, do NOT put a pillow over her head, just walk away instead! 

1 hour ago, SilverBells said:

I agree that boundaries should be set, but they probably need to come from administration, who typically tends to side with the patients, no matter how ridiculous they are.

With that said, after 5 days of incessant phone calls, I think even our social worker is a bit frustrated with the situations regarding the lady I described. And she has an endless amount of patience snd and empathy. 

As a side note, I will say that the more a patient states they are not trying to cause trouble, the less I believe them.  

I also wonder if these types of patients realize that the more they complain, the less staff want to help them.  It still wouldn't excuse neglect, but I can see how some people would not want to go out of their way to help them

Staff might not WANT to help them but they will, as proven by you spending all that extra time with them.  Yes, they need a behavior contract by admin or they need to leave.  Have you tested sitting down with them when you aren't called and explaining that this isn't home and they don't have a private duty nurse to cater to only her? They may not like it but maybe it needs to be said, probably in front of admin.  They're new so obviously they don't understand what your facility can and cannot do and you need to educate them. Edit: and if you think admin will side with them then perhaps a quick phone call to admin when they start with a problem can show admin exactly what they're like.  Of course admin will side with the patient, they're paying big bucks and they really, in most cases imo, don't care about staffing as long as they have a few people there.

Edited by Nunya

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

9 hours ago, TheMoonisMyLantern said:

Anyone can remind this patient that they have the right to choose another facility if they feel their needs aren't being met. Patients like this will test your ability to remain off the evening news, and they can be exhausting.

Your entire post was a joy to read, Moon.

Such wise opinions and perspectives filled with the reality of matters.

The moon is, truly, your lantern, and you do clearly see the way.

TheMoonisMyLantern, ADN, LPN, RN

Specializes in Mental health, substance abuse, geriatrics, PCU. Has 14 years experience.

19 minutes ago, Davey Do said:

Your entire post was a joy to read, Moon.

Such wise opinions and perspectives filled with the reality of matters.

The moon is, truly, your lantern, and you do clearly see the way.

Thank you so much Davey, I really appreciate this. 

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

10 hours ago, SilverBells said:

Thank you.  Dealing with the one patient this past week was both very physically and mentally exhausting.

While I'm not in a position to suggest to the  one patient she may want to see if another facility may be more suitable, I do wonder if our social worker or DON might be getting close to that point as I know they are also discouraged by the daily, lengthy complaints 

You're welcome SilverBells.

When there were things that were beyond my control in my job, I would deal with those feelings through my art.

Over 20 years ago, when I was going through Art Therapy, I apologized to the therapist for one of my drawings in my journal. The therapist said, "Never apologize for your art and never allow anyone to control your expressions".

I felt as though freedom of expression was given and went with it. Of course, all my art is not appropriate for public viewing, but the mere act of free expression is a feeling akin to that from taking some sort of anti-anxiety, pain relieving drug.

In the Summer of '19, we had a patient on geriatric psych who was a major PITA. In order to deal with my feeling of frustration, I made several comics with him as a character. This is one of them:

 

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When dealing with the patient, I would imitate an MC or DJ in order to to maintain.

We all need to be able to freely express ourselves in order to deal with our stressors.

 

Stillcrazyafteralltheseyears

Specializes in Mental health.

She sounds like she has borderline personality disorder.  And you can not win with this patient . Just  do your job and document. Involving the physician and patient advocate may help to get a handle on some of here negative behavior. I feel your pain, and wish for speedy discharge.

SilverBells, BSN

Specializes in Rehab/Nurse Manager. Has 6 years experience.

After reviewing my hours spent with tbis patient, I just realize I spent about 1/4 of my work week with her.  At least 25% of my work hours was dedicated to a person who was otherwise medically stable 

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

On 2/15/2021 at 11:59 AM, SilverBells said:

After reviewing my hours spent with this patient, I just realize I spent about 1/4 of my work week with her.  At least 25% of my work hours was dedicated to a person who was otherwise medically stable 

The Ole Squeaky Wheel, SilverBells.

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JBMmom, MSN

Specializes in Long term care; med-surg; critical care. Has 9 years experience.

I feel for you because these patients are exhausting for everyone involved. Because she is still so newly admitted, you have the benefit of a couple things. First, you can easily reach out to both the patient and the daughter to discuss how things are going, for all parties. With social work, nursing and maybe administration, an understanding related to care in the environment can be reach with everyone in attendance. The other benefit you have is maybe a little insight into why she's acting like she is.  I tried to always remember that for patients being admitted for long term care or short term rehab they are probably out of their home for the first time in many years. They were independent and able to make all of their own decisions only a short while ago. And now someone else tells them when to get up, when to go to bed, what they can eat, when they can do certain activities, etc. It's a great loss of control and whether she's conscious of it or not, she's grieving that loss and acting out to influence the only things that she can. Unfortunately right now, she can influence her environment by complaining and getting the attention that she is craving.

However, that doesn't make the behavior acceptable, nor can it continue because of the drain on resources. I think it's very reasonable, this early in her stay, to point out how you can work as a team to help her through this transition. It needs to come from a place of trying to understand her point of view. Trying to get her to understand that she's not the only patient isn't going to work, because in her mind she is. So make sure that her feelings are acknowledged and once she feels heard she's likely to reduce the amount of time she demands. Good luck!

Emergent, RN

Specializes in ER. Has 28 years experience.

Another thing regarding the daughter and the family of the patient, is that I have found that guilt can cause family members to become hyper demanding.

I remember when I worked long-term care, family members coming in from California who we never heard from otherwise, and rarely saw their mother. They then turned up the heat on the staff, nitpicking, criticizing Etc. It was a classic case of what I describe above.

Also remember, there are probably some long-standing familial dynamics that are never going to change. It could be that this woman has been a manipulative, demanding person her whole life.

LibraNurse27, BSN, RN

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 8 years experience.

Is she there for a short-term stay or is a permanent/long term resident? I hope the former!

SilverBells, BSN

Specializes in Rehab/Nurse Manager. Has 6 years experience.

36 minutes ago, LibraNurse27 said:

Is she there for a short-term stay or is a permanent/long term resident? I hope the former!

Short-term rehab for now.  Hopefully she transitions from an assist of 2 to assist of 1/independent soon.