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."
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
Specializes in Psych (25 years), Medical (15 years).
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
Specializes in New Critical care NP, Critical care, Med-surg, LTC.
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!
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.
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.
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.
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.
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.
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.)
SilverBells, BSN
1,108 Posts
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