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When One Patient Affects the Care Other Patients Receive

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

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SilverBells, BSN

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

22 hours ago, Emergent said:

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.

Hmm, didn't really think about that.  I do know that the daughter lives across the country and the son, who lives closer by, wants almost nothing to do with the patient's care.   So the daughter is probably stressed about not receiving any help from her brother and has no way to travel so she can be closer. 

Emergent, RN

Specializes in ER. Has 28 years experience.

9 minutes ago, SilverBells said:

Hmm, didn't really think about that.  I do know that the daughter lives across the country and the son, who lives closer by, wants almost nothing to do with the patient's care.   So the daughter is probably stressed about not receiving any help from her brother and has no way to travel so she can be closer. 

Hopefully, the daughter will do the more sensible thing which is to move her mother closer to her.

That really makes it easier for her to develop relationships with staff, develop some trust, and be able to visit her mother.

 

amoLucia

Specializes in LTC.

20 hours ago, Emergent said:

Hopefully, the daughter will do the more sensible thing which is to move her mother closer to her.

That really makes it easier for her to develop relationships with staff, develop some trust, and be able to visit her mother.

That option ain't likely to happen! The fact that the son is so 'reserved & distant (ie emotionally) says to me that there are prob some SERIOUS underlying issues. Like Momma wasn't such a nice Mom?!?!?!?

I'll bet Dtr is dealing with a really bad case of the 'guilties' - so her behaviors are the only way she can deal with her guilt by 'bullying' staff to do what she can't (or WON'T) do. Makes her feel like 'she's in control' as 'boss'. And woe to anyone who crosses her!

So even if Mom were to be local, dtr would most prob still be a royal PIA.

Emergent - am differing from your view, but take this from a retired RN, mostly all SNF/NH/LTC. This COB has pretty much BTDT and seen it all. And had to deal with those 'guilty' families waaaay much too often. If she were more tolerant, it would be a decent option.

Emergent, RN

Specializes in ER. Has 28 years experience.

@amoLucia

I totally agree, I mentioned exactly the guilt factor earlier in this thread.

I have a cousin who lives in New Mexico. She is a trophy wife, and last year her mother died. She talked me into intervening a couple times, talking to the nurses, and she is definitely one of these demanding people. She's very elitist and pretty obnoxious.

I made it pretty clear to the nurses that I totally sympathized with them, and it was apparent that my cousin had been quite demanding. She is quite a prima donna. So I know very much about that side of the equation.

Davey Do

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

On 2/13/2021 at 6:45 PM, Davey Do said:

I would go as far as to make certain patients persona non grata

I've also said this to high maintenance patients:

1623460152_havetogotoER.png.0a1b904d1011f84389ee19cfc9886e4f.png

Closed Account 12345

Has 14 years experience.

This situation definitely needs boundaries and prioritization skills.

It's concerning that several other patients were sent to the hospital for medical decline that could've possibly been avoided.  Getting someone a Diet Pepsi or listening to someone vent should never come before ensuring that all assigned patients are medically stable.  "Your comfort matters to me, and I'd like to hear your concerns, but first I need to assess the rest of my patients to make sure everyone is stable.  I'll be back to check on you in an hour."  An hour later, make sure all basic needs are met, and then excuse yourself.  If you're still in there 5 minutes later while someone angrily rants at you, say "Excuse me.  I need to go give a medication, but I'll be back to check on you in an hour."  Repeat.  Don't let anyone bulldoze you.  Even if you turn into Florence Nightingale, this patient is giving you a crappy patient satisfaction review, so don't scramble to win points.

Now that there's been a threat to report nurses to the Board, document as though there'll be an investigation.  Let your charting show that this patient was not neglected nor treated poorly - comfort measures, safety measures, interdisciplinary communication, assistance offered, etc.  Failing to run to the fridge when a diabetic requests a soda isn't neglect. If all staff members consistently document difficult interactions with this patient in objective/non-judgmental terms and provide professional, competent care, any threatened Board investigation would be short lived. 

0800: Blood glucose 370.  Patient states she ate a Snickers bar and small bag of chips 30 minutes ago.  Standing orders initiated; see MAR.  Patient re-educated on diabetic diet, and states "I already know all of that but am not giving up my snacks."  < Nothing to pin on the nurse, shows non-compliance from patient

(Meanwhile, a legitimate Board investigation could stem from the lack of assessment and response to your other medically declining patients while this lady holds you hostage with her threats.)

Edited by Closed Account 12345

SilverBells, BSN

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

16 hours ago, Closed Account 12345 said:

This situation definitely needs boundaries and prioritization skills.

It's concerning that several other patients were sent to the hospital for medical decline that could've possibly been avoided.  Getting someone a Diet Pepsi or listening to someone vent should never come before ensuring that all assigned patients are medically stable.  "Your comfort matters to me, and I'd like to hear your concerns, but first I need to assess the rest of my patients to make sure everyone is stable.  I'll be back to check on you in an hour."  An hour later, make sure all basic needs are met, and then excuse yourself.  If you're still in there 5 minutes later while someone angrily rants at you, say "Excuse me.  I need to go give a medication, but I'll be back to check on you in an hour."  Repeat.  Don't let anyone bulldoze you.  Even if you turn into Florence Nightingale, this patient is giving you a crappy patient satisfaction review, so don't scramble to win points.

Now that there's been a threat to report nurses to the Board, document as though there'll be an investigation.  Let your charting show that this patient was not neglected nor treated poorly - comfort measures, safety measures, interdisciplinary communication, assistance offered, etc.  Failing to run to the fridge when a diabetic requests a soda isn't neglect. If all staff members consistently document difficult interactions with this patient in objective/non-judgmental terms and provide professional, competent care, any threatened Board investigation would be short lived.  (Meanwhile, a legitimate Board investigation could stem from the lack of assessment and response to your other medically declining patients while this lady holds you hostage with her threats.)

I agree.  Thinking back, I'm not 100% sure that any of the patients who were sent to the hospital could have been kept in the facility, but I would have felt better about my decision to send them in if I could have checked in on them sooner or had more time to spend with them prior to making the decision (along with the provider) to call for EMS.  Theoretically, the suggestions as to what to say this patient are great, but are likely to be taken out of context by this individual.  She might express understanding initially, but she is the type of person who would immediately call her daughter right away, crying that "someone spoke to her in the wrong tone" or "someone was unwilling to help her."  Her daughter would side with her, and then would either call myself, the DON or the Social Worker immediately to discuss this "unacceptable behavior." 

As far as documentation goes, I have been documenting all interactions with her and I have urged other nurses to do the same.  I have also recommended two staff go in whenever someone needs to interact with her whenever possible because she cannot be trusted.   It's my job to look out for patients, but I also need to look out for staff members who may be wrongly accused.   It would be disappointing to lose good staff based on one patient's behavior, and several people have already called out sick in order to avoid working with this person.  

I also have to look out for the 29 patients who are not receiving my attention when I am spending 2+ hours with this one individual.  I actually stayed late every day making sure nothing was getting missed with someone else, but staying late routinely isn't sustainable in the long run.   I also worry for the consequences that could result from other patients not receiving the attention they need.    

vintagegal, BSN, RN

Specializes in Geriatrics. Has 2 years experience.

I have put out many fires with family and staff alike by mentioning casually that regulatory bodies are a good thing, a tool to help any situation. It really takes the wind out of their sails when you tell them that you are more than willing to cooperate and team up with state, the ombudsman, APS, etc. to have the needs of the patient met. After all, we all have one goal, and that’s to take care of mom! Wink wink

Best patient I ever had gave his whiny, demanding, and unbearable roommate a message that I wish I could say. Sadly he said it while being discharged. He spared no words. It started with a STFU, and went on from there.  All the while I'm silently saying in my head "YES! YES! You tell him"

The annoying patient was quiet for a while that day.

Been there,done that, ASN, RN

Has 33 years experience.

You have a Borderline Personality on your hands. Learn from this, there are many out there. Setting firm boundaries , may or may not work. A staff meeting to discuss this issue, along with how to handle her may help. Sounds like she is transitioning out. Call a meeting with administration. get her persona non grata.. so she can't come back to do it all again.

We had a time when we had several patients with severe behaviors all ar the same time.  Screaming, stripping, demanding to be toileted every 20-30 minutes.  Naturally, this made the nursing staff looked really bad. Management didn’t care.  If a staff member called out, we couldn’t get coverage because CNAs would rather tighten their belt and live on ramen noodles than come in to work only to be tormented and overwhelmed.

It finally got resolved because somebody called the State inspectors on us and management was able to magically be able to afford more staff.

I used to work in a LTC facility awhile ago. The usual here, too many patients and too little time and one person is giving you an issue can really mess up a shift. We had a guy that screamed, yelled, demanded all the time and then he would call his daughter who would call and cuss out the nurses. Was management helpful? Of course not. Anyway, I figured out if you have 30 patients in a 12 hour shift, and sometimes I worked 8s, you have 24 minutes per patient. That includes your lunch, med pass, treatments, charting and anything else that comes your way. I gave up when I got called in the office after a shift where I had 54 patients, a doctor that wanted me to write down orders, the aforementioned patient's daughter calling and screaming at me, no cenas to be found, phone ringing off the hook, and was told I had bad time management skills. Their solution was that I carry the portable phone and field calls while I did my med pass. That didn't seem safe so I walked. It was a beautiful looking facility but I'm telling you the people that had good "time management" skills were charting they did the work when they didn't. Glad I left that circus.

Edited by Wlaurie

Excellent feedback from various responders. I'm only going to add/encourage that you should consider leaving LTC, especially considering that you have a BSN. Career-wise and overall growth, few good things come from LTC in the long run. I wasted 2 years in LTC as a new nurse and it is the most regretful part of my career. 

On 2/15/2021 at 5:41 PM, Davey Do said:

I've also said this to high maintenance patients:

1623460152_havetogotoER.png.0a1b904d1011f84389ee19cfc9886e4f.png

No ER for SOB, CP, or other less than imminent death matters?

Or, of course, asking what is wrong?

 

JK, DD.  I'm sure you would do a decent appraisal.

4 hours ago, cynical-RN said:

Excellent feedback from various responders. I'm only going to add/encourage that you should consider leaving LTC, especially considering that you have a BSN. Career-wise and overall growth, few good things come from LTC in the long run. I wasted 2 years in LTC as a new nurse and it is the most regretful part of my career. 

 

really a waste?

54 minutes ago, Kooky Korky said:

 

really a waste?

Yes, perhaps not total waste, but in the grand scheme of things, LTC was indeed a heap of rubbish in retrospect. I am one to look for learning opportunities and advancement of the self in all aspects of life. The ceiling for growth in LTC is very low. What is one supposed to aspire to become? DON? MDS coordinator? Granted, I was an LPN at the time and opportunities were generally limited. As such, I regrettably ended up doing SNF/LTC. I have since rectified that regret and moved on to loftier endeavors. Nonetheless, had I known what I know now, I would have gone straight to community college for ASN, then get the BSN and skip the LPN part.

I think LTC/SNF is an excellent setting for the marginalized LPNs and perhaps some unambitious or nearing-retirement ADNs. However, any credentials past that is an overqualification for the responsibilities within the LTC setting. Half of what you learn in school will in fact go to waste in LTC. I would dissuade any RN, especially with grad school aspirations to stay away from LTC. For most nurses, after 1 yr in LTC, they will have experienced >95% of what they will ever see in that setting. Contrast that with the acute setting, and the inherent opportunities for growth, career-wise and educationally, it is candles to chandeliers. I'm not knocking LTC, but the aforementioned facts are indubitably inarguable. 

Edited by cynical-RN

Tenebrae, BSN, RN

Specializes in Mental Health, Gerontology, Palliative. Has 9 years experience.

I had one of those the other day. Patient with acute pysch issues and lots pf physical comorbidities. Tells me at 1730 that they havent been able to pee properly all day, bladder scan showed 850mls. Long story short, after 2 failed catheter attempts the patient finally managed to have a decent pee and avoided the need to go to hospital. Of my entire shift I reckon I spent over half my time with this patient who at the end of it gave me the whole 'you all suck, no one cares about me.......'

At that point I chose to therapeutically disengage and hide in the office 

I was happy to do what I did, however I did not like the feeling I was neglecting my other patients

Given that this was the second or third time that the patient did wait until after business hours to drop this clanger, I did suggest that the morning staff make regular checks with the patient

Edited by Tenebrae