Why is it always the patient with the worst situation? geez

[gloryfied]

Why is it always the patient with a chronic disease, stage 4 of some cancer, or some autoimmune, self deteriorating condition that passes judgement initially, or wants to be picky about their care?

For eg, a pt who was homeless, he passed out walking 30 miles in the heat to a shelter after his landlord kicked him out, stage 3 cancer, continues to smoke, he smelled really bad because he had been at the hospital with the same clothes he came in.

He refused EVERYTHING, his telemetry, assessments, vitals ... and the nerve to not want an African American nurse at some point during his care here. Goes out to smoke, against rules.

I just thought, dude, you are at your worst, and you have the nerve to be reckless to people and make our hob harder.

Pt I have tonight, has cancer, maybe it might be my fault at reading people, but I went in to say hello, you can sense his annoyance. His wife was pretty nice. I assessed him, said "call if you need anything". He goes "uh huh, yea, have a good day (although its the night shift).

Maybe he's passive in life in general, idk. but I will not be rude or reckless to the person who was taking care of me. Like how you shouldn't scream at the waiter serving your food - they'll spit in it sorta thing.

I hope to continue to look at these people as just overstressed with their condition, and that this might not be who they are on a daily basis. wow.

[chevyv, BSN, RN]

Wow! Reading this seems really off. I'm sorry but I see very little compassion from the OP. If you go into a room, introduce yourself, and the pt seems upset, why did you not inquire? Reads like he may have been there more than a day or two and has had some difficult days/staff. We have so much to do at work, but our pts sit in a room, have people wake them when they finally get to sleep, poke them repeatedly, wait for everything, take meds that may make them feel awful, battle illnesses that many have no hope of winning, and you wonder why they are unappreciative and out of sorts? How dare they not think of you! Really!?!

[AweSmiles]

I agree with Aurora77. The most appreciative and respectful patients have been those with a chronic disease or those who are terminally ill. I always say it doesn't seem to make sense to me. And the patients with the least amount of medical need end up being the most picky, demanding, and least appreciative. It always baffles me.

[Anna Flaxis, BSN, RN]

OP, I haven't noticed a correlation between severity/chronicity of illness and the type of behavior you describe. As human beings, we all respond to loss and grief in some pretty predictable ways, and yet there is also a great deal of variation from person to person; it's a paradox. Sometimes people lash out because they're not at their best; they're sick, they hurt, they're scared, they've lost control of their life, and/or they're grieving their impending death and all that entails. It is not about you, it is about them, and you cannot take it personally. It's their diagnosis, their life, their situation. They get to feel however they want to feel about it.

[Been there,done that, ASN, RN]

Thank you for offering your insight on this. I try really hard not to say "I understand" or anything of that sort, even as a former chronic pain type person I DON'T understand exactly how they feel.

The only place where I'm with the OP is the people who come in and refuse everything, or want to make up their own rules, etc. and tell me how many "rights" they've got. Dude, you also have the right to WALK OUT OF HERE. I didn't ask you to come here! I actually told one COPD lady, who was very angry on admission, telling me all the things she had the right to refuse, "Then maybe you need to have a talk with your family or write up some documents that tell them to stop picking you up off the floor and bringing you in here when they find you, because all we can do once you're here is our job, which is to make you feel better." That shut her up. I mean, sometimes they act like we went to their house and dragged them to the hospital ourselves to make money or something.

Well... jolly for you. You TOLD the patient that YOU were in control of their care.And you "shut them up".

Run THAT attitude by administration.... and report back .

[student987]

.......

It was NEVER the high tech stuff that I remember while undergoing my many surgeries, but rather is that was the kind nurse who took my hand and said "you will get through this and it will be OK".

The 2 things I remember most from all my surgeries (at this point it is 22 or 23 i have lost count). The nurse who told me she would be there with me the whole time and held my hand while I was going to sleep years ago. and just 1.5 weeks ago the nurse who stopped what she was doing and told me what her job to do was hold my hand. those are seriously the things I remember most. Patients need compassion. not judgement.

While waking up from my surgeries. I am agitated and mean. I flail and hit. I have made contact with nurses before hitting them. this last surgery I was crying in post op because I truely hate that I do that but am unable to control it (know what is going on, know it is not the right thing to be doing but for some reason can not stop) my nurse was trying to tell me it was ok but i had trouble forgiving myself....the person i hurt was saying it was ok and i could not forgive myself.

as i already said patients need compassion not judgement

[Lynx25, LPN]

I see the opposite. It's the guy with the sniffles that wants to yell and scream and threaten and file complaints, while my little man with stage four jaw cancer is just the most freaking adorable, wonderful person I've ever met.

[coupb8222]

Just because the patient is in the hospital does not mean that because they don't feel like doing something doesn't mean nursing staff should be their slave and do it all for them. It's all about knowing your boundaries. Just because I can do xyz; does not mean I will do xyz for you!

I have no problem telling a patient NO I won't be able to do that; who is being rude to me "commanding" me to do things for them; that they can do for themselves.

They can get mad at me; I'm not a mean nurse --- I am promoting self care; it's called tough love!; they are manipulative and I won't for the sake of 'compassion' be trampled on and do things just because they don't want to when they are ABLE.

I also have no problem doing cares for a patient who is being rude and swearing at me that really is UNable to complete self care. Or a patient who is feeling ill that really can't do something. I gladly do whatever request they may have; or whatever order they bark at me. If you are UNable by all means that's what i'm here for! But i'm not your slave.

For example the person who is completely independent at home and goes to the bathroom on their own, brings their own hand to their mouth when eating, can put lotion on their own legs, can wash their own groin...and suddenly believes they are on vacation from performing self care and demand that you complete xyz task when they are only admitted for like a venous stasis ulcer or something. I believe in tough love and stretching people; questioning what is different about the hospital than at home? why do I need to do this for you? We want you to be independent here, and will help facilitate that. Your perceiving that I don't want to help you at all; I want to help you to help yourself! I usually have a rule; I do for others what they CAN NOT do for themselves. I don't contribute to your laziness by doing everything for you - and continuing this co-dependency. I can be the nurse that you don't like or request not to return; but I know what my job is; and it's not being your mother; and your not an infant! (so that is what I think in my head about those patients)

No your arms work; you can put the water to your mouth to drink your pills. No you are here for cellulitis of the leg --- how does that translate that I will wash your groin when you are fully continent with no neurological problem preventing you to do so? and when you do it for yourself at home? You hold your urinal and set it there; this is where i will measure it; leave it there and I will flush it down the toilet after I get your output. I refuse to do for others what they can do for themselves. Maybe I am a witch. I won't let those lazy patients turn me into their slave. And I will pull the "it's not in my job description to be your mother card".

Patients can be a jerk to me and I will still give them compassionate care and do tasks that are relevant to their hospitalization even if they were cussing me out while I did it. However feel free to cuss and kick me out of your room because I won't wash your genitals when your hands work or refuse to put the water to your mouth when you are fully able.

Another analogy is a mother, college student and laundry.

1. College student comes home for break and is at library all day studying focusing on their upcoming finals. Mom does laundry while student is gone; to help college student be more successful for finals.

2. College student comes home for break twiddling their thumbs and watching TV all day bumming around then to top it off gets aggressive towards mom starts ; "I do my laundry all the time at school - I need you to do it for me; and your going to do it!" Mom says excuse me but you are fully able to do your laundry honey - you can wash it during commercials etc. is there enough soap for you? Want me to help sort it for you? Student says to mom; "screw you; you never want to help me do anything; just get out of here i'll wash my own damn laundry then!"

3. College student comes home for break twiddling their thumbs and watching TV all day bumming around then to top it off gets aggressive towards mom starts ; "I do my laundry all the time at school - I need you to do it for me; and your going to do it!" Mom says would you like it ironed too, can i fold it for you too. Oh you need a soda, i'll bring it right to you, oh you want the remote and it's only 1 inch from your hand....here i'll pass it to you. Oh! let me give you a bath tonight; just because your home!

4. College student comes home for break and is at library all day, when he comes home to spend time with family he watches TV and washes his laundry in between commercials. Mom helps student while he is home, cooking meals, allowing him a place to stay, accommodating to the needs of the student.

What type of mother are you?? I'm 1. 2. and 4. Who else agrees in tough love?

[tokebi]

Alas, providing compassionate care with absolutely no expectation of acknowledgment or reward is a tricky thing to do.

[redhead_NURSE98!, ADN, BSN]

Well... jolly for you. You TOLD the patient that YOU were in control of their care.And you "shut them up".

Run THAT attitude by administration.... and report back .

Yep, exactly, I don't let people refuse O2, sorry. She needed to know that if she wanted to be left on the floor in her living room she needs to communicate that to the people that keep bringing her to our place.

[redhead_NURSE98!, ADN, BSN]

Just because the patient is in the hospital does not mean that because they don't feel like doing something doesn't mean nursing staff should be their slave and do it all for them. It's all about knowing your boundaries. Just because I can do xyz; does not mean I will do xyz for you!

I have no problem telling a patient NO I won't be able to do that; who is being rude to me "commanding" me to do things for them; that they can do for themselves.

They can get mad at me; I'm not a mean nurse --- I am promoting self care; it's called tough love!; they are manipulative and I won't for the sake of 'compassion' be trampled on and do things just because they don't want to when they are ABLE.

They told me a story at my first job about a blind patient who was nearly independent at home, and after being in the hospital having people hand him everything, feed him pills etc. just so the nurse could hurry it along and get her job done etc. he left in way worse condition ADL-wise than when he came in. That story left a big impression on me about holding cups for people to drink out of just because they look frail, are taking too long with it, look like they're going to spill it etc. If they don't use it they'll lose it.

[Been there,done that, ASN, RN]

Yep, exactly, I don't let people refuse O2, sorry. She needed to know that if she wanted to be left on the floor in her living room she needs to communicate that to the people that keep bringing her to our place.

As you are also a doctor of jurisprudence you must also be aware that the administration of oxygen is a treatment... and the patient has the legal right to to refuse any treatment.

[redhead_NURSE98!, ADN, BSN]

As you are also a doctor of jurisprudence you must also be aware that the administration of oxygen is a treatment... and the patient has the legal right to to refuse any treatment.

And you are always free to explain to administration and to the family of a person with COPD exacerbation that you chose to WITHHOLD OXYGEN from someone with sats in the 80's, since confusion and depression are quite the common symptoms of hypoxia. Surely as a Registered Nurse YOU are aware of THAT? She's free to come back and remove her O2 when she's back in the 90's, then bee-bop on out of here and have a nice discussion with her family about leaving her on the floor next time, and don't involve me. It's oxygen, not a kidney.

I'll take the bet on "tearful confused hypoxic patient NOT suing me for giving her oxygen once she feels better" over "helpless family members suing me for not giving their mother oxygen because she said not to in a state of hypoxia" ANY. DAY. But you know, if you think killing people in the name of patient rights is a good idea you go right ahead.

LOL why would a law degree tell me that "administration of oxygen is a treatment?" It's funny, no one else dwells on my law degree but you, and it usually has little to do with the subject at hand.