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."
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.
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.
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.
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.
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.
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.
Specializes in Mental Health, Gerontology, Palliative.
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
SilverBells, BSN
1,108 Posts
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.