Yelled at a patient

[KalipsoRed]

So I need some advice on damage control here. I've been a nurse for 2 years all of which have been on a telemetry/cardiac step down unit in a non-profit hospital in a poor metropolitan area. It's not huge hospital (500 beds), but it is big enough for CABGs/Caths/Cardio-Pulm stuff. My floor has about 16 to 20 nurses on the schedule for both nights and days and a 5 to 1 ratio on both nights and days. I've worked both shifts for a year minimum and can tell you that nights are a piece of cake compaired to days. Recently, like in the last 3 weeks, we lost our awesome manager, the best floor supervisor ever, a great night charge, and like 4 other decent-great nurses. Now there are only like 3 of us on day shift that have worked here more than a year....actually there are only 3 of us who have been nurses for more than a year and only 1 who has been a nurse for more than 5. I guess what I'm saying is that the circumstances are poopy and the reason we lost so many to begin with was because the circustances have been poopy since I've started there.

Anyhow I get a patient from the ER that comes in with chest pain. She's aggrivated on arrival because "no one has told me why I have to be admitted. I've had chest pain before, if the tests are negative they should let me go!" Well I end up going and getting her chart and pulling my computer in the room to do a little PR so that maybe she'll be satisfied and I can take care of my actually sick patients. I go over her labs and what they mean, the EKG, the doctors orders and why he probably wrote them, AND I told her about the fact that I didn't know when the doctor would be in but he would be there sometime before I left. She seemed satisfied and happy so I left and didn't go to her room for a while. I finally went to check on her and she was in a frenzy about her insurance and worried that if we didn't get precertification that she'd have to pay for her admission. Well I'm not all that great with insurance and I can understand her worry so I take the time (45 + minutes) to call registration and then the preceritfication department to make sure that they have the right insurance card and that they actually called and got approval. I went back to tell the pt and she was on the phone. I started to talk and she told me, "Don't be rude I'll talk to you when I'm off the phone." I bit my tounge and waited and then told her what I'd done. She did not seem completely satisfied because whe wanted the precertification department to call her and verify what they had done to her. At that point I was starting to get tired of her so I just told her again it was taken care of and I'd be back. About 1600 I notice that the MD hasn't made it by. I haven't been to her room but since I noticed I decide to call the doctors office to make sure they know about the consult because eventhough the ER and my secretary both say the consult has be done I just felt the need to make sure. Well low and behold the patient had called the MD's office 6 times since 10am and had been told repeatedly that the doctor was at another hospital but he knew she was waiting to be seen and that he would not finish his evening until he saw her. So I went to tell the patient that I'd also called and checked up on the situation and low and behold the butt pimple was on the phone with her MD's office AGAIN telling them that no one had explained to her why she was here, what was going on, or doing ANYTHING to care for her. Something in me just snapped. I'd spent so much time trying to make sure she had what she needed and for her to go and say something like that just sent me through the roof. Thus I ended up yelling at her and telling her point blank that she was a waste of my time and that I would no longer be caring for her. I then marched up to my charge nurse and handed her the chart and told her that I was done with her and I refused to take care of her anymore. My charge RN precedes to go into the patient's room to reconsile the issue by joking with the patient about how I need to go get a psych evaluation.:sstrs:

I feel bad. I feel bad about the fact that I don't feel bad that I yelled at a patient...and I'm ****** at my charge RN. While I know that she needed to reconsile the issue I don't feel that it was appropriate to do it by makeing a joke of my mental health. Furthermore I feel even more aggrivated because I had put in my notice for June 15th but then agreed (after lots of begging from this particular charge RN and the director of my floor) to stay, at least part time, until October to help them out because they are so short.

I don't even want to step foot into the place tomorrow.

[pielęgniarka, RN]

If I was in your place, I would take back your original last day notice of June 15th!!!! Sounds like a stressful place and a break might do some good. PRN they are going to be calling you every day.

[SWS RN, ASN, RN]

WOW, my first instinct is to stand up and applaud you. However, I am sure that is not the "politically correct" anwer.

So, knowing the correct "textbook answer/advice"...I will not comment on it...I will simply say...Bravo!

You did what I have been tempted to do many times in 18 years but was too chicken to do.

(ok, before I get flamed for having this attitude by all of the nurse "wannabees", I know this was not the appropriate action...but it happens)

and I don't want to hear that "what if this was your mother" thing, or "the patient was just stressed"...my mother or any prudent person would not act in that manner....and being stressed is not excuse for boorish, poor behavior.

This woman was unreasonable and it sounds like she has been in this situation before if she used the "if my tests and labs were normal why did they admit me defense"...at the very least she is a narcissist, control freak and master manipulator.

As to your charge nurse, the psych eval statement was inappropriate and just plain WRONG! SHe is just as screwed up as this patient.

I ,for one, hope you do not get into trouble. You went beyond the call of duty. I work in case management doing precertification for insurance companies and it was NOT your responsibility to call and see if this was pre certed...that is for admitting or billing to do...so what was a favor came back to bite you in the butt...no good deed goes unpunished!

Good Luck,

A very jaded SWS

ps, if this does come back at you, don't even wait until June 15...run for the door now and don't look back.

[NC Girl BSN]

Wow! While I think its was wrong to yell at the patient, I can untotally understand your frustration. I wanted to do it a few times myself. Please leave the job on decent terms. I would not want the job or that incedent to come back and later haunt your professional career. Do you think the patient got mad and reported you or will the charge nurse go to a higher authority?

[cmdrbnd007]

Sounds like a terrible place to work, put in your two weeks and take your license somewhere else. I think we've all had patient's like that, the ones that drive you crazy and are always on the call light. I'm not going to say that yelling at the patient was the smartest course but if I had been in your shoes I'm not sure I would have done anything differently. That's why I do work nights, lol, so much less stress and most of the patients are sleeping for most of the shift. Keep your chin up and continue doing a good job.

[Kymmi]

Ok Im agreeing along the same lines as SWS RN. Ive been in nursing for a long time so I would not have even done as much for this woman as you did. I would have explained to her once that the MD would be in to see her and at that time the MD would go over her test results. I would have informed her ONCE from a nursing standpoint what I was going to do as far as her plan of care was concerned. It is not within your scope to discuss test results with the patient...that is for the MD to explain and diagnosis with. If she continued to express that she doesnt understand why she has to be there or voice that no one will let her go I'd politely (of course) explain that she is not a prisoner and that no one is forcing her to be there. If she feels there is no reason to be there than she can sign the AMA papers and go on about her merry way. I'd of course ask her why she came to the hospital in the first place if she thought there was nothing wrong with her that required treatment. I would NOT give in to her attention seeking martry behavior. I wouldnt have called the insurance either. I would have told her to make the phone call...she apparently was capable of making phone calls and who knows that might have tied up her time with the insurance company and the doctors office would have gotten less phone calls from her. :)

I know there are a lot of sick people that require our attention and care and I would never deprive anyone of that however I also will not force my care onto you. If you want to leave AMA or just cant understand why were "forcing" you to be here then leave but spare me the drama because I can better use my time to save someone's life.

Just as there are very ill people there are also those people that seem to think they are dying constantly and really just like the drama and attention that goes along with being in the hospital.

[SWS RN, ASN, RN]

Great points...I forgot about the leaving AMA card...Love it!

THe loudest most obnoxious patients almost always shut up when they are informed that they certainly do not need to stay with such "terrible care"...

especially if it is suggested that they do go..

.

SHe has been there and done this behavior before and is getting some sort of sick gratification out of it...especially by denigrating the OP...the statement regarding the phone call should have been enough...over the top!

Go, please GO...and I'm sure after all of those calls, the Doctor or at least his staff would have agreed!

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

I agree with most of the previous replies. This patient was out of control. That's undesireable in a cardiac patient. I'd have cornered any doc, resident, or standing order I could get my hands on and push for maybe Morphine, Ativan, Geodon!! or SOMETHING to get her emotions in a state conducive to cardiac care. I think Ericson covered this in his hierarchy of needs.

I would have yelled at her too, but I'd have chosen differant words. I'd reflect back to her that she was her own worst enemy cardiac wise, that she was getting more care than maybe 3 or 4 other patients combined, and that she was rude, inconsiderate and alienating to all the people trying to help her.

After that verbal slap in the face, the drugs should be kicking in. Tell her specifically what will be happening and why. Tell her how to help herself (hint; you catch more flies with honey than vinegar) hopefully by now you can establish a raport with her and she'll be singing your praises to your charge nurse. She feels out of control, and who wouldn't? Show her you're in control and she should back off.

I'm a big fan of disarming patients with dry or inappropriate humor. I won't comment on the charge nurse's comment because I wasn't there. However, I'll go to my grave beleiving nurses should be allowed to write a nursing order for a "retroactive abortion" for impossible patients.

Now you've got a lot of good advice from experienced nurses for dealing with an impossible patient. Fortunatley if she complains, she's the type to make herself look bad and impossible to please. If you're called on the carpet, begin by telling whomever your talking to that they must have noticed that about her. It'll give you the high ground in the discussion. If there's any doubt, they can call the pt's doctor's office for confirmation. You've handled an impossible situation pretty good. Is doing the impossible in your job description?

And if all else fails to comfort you, remember you were looking for a job when they hired you anyway. And if you hear any wisdom in my reply, it's because I've learned from my (many) mistakes. Good luck. Paul

[SWS RN, ASN, RN]

Loved what you said, especially about the retro abortion...

word...I think it's Maslows Hierarchy of needs...either way this manipulative nutjobs needs could never have been met!

s

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

The AMA form is sooo tempting at times, but think about this. In Maine a competent patient signed out AMA in the middle of a winter night a few years ago. His frozen body was found in a snow drift by a dayshift worker coming in. He'd gone less than a hundred feet (still on hospital grounds).

Every hospital I've ever worked at has had the same unwritten rule. If the excrement hits the rotary oscilator, the first thing you do is fire a nurse. You don't need to do anything wrong to be fired. Just be a convenient sacrificial lamb sometimes. Sucks, huh?

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

SWS

Awe nuts! Ericson, Maslow, Freud, Dilbert, Charlie Brown. I can never keep all the great minds of the world strait. Thanks for the correction. Next time I go off on a rant like that I'll check with you because, like I said, I can never remeber them all.

Speaking of memory, when do you want to finish that conversation you started? Remember? You were saying you thought you had Alzheimers?

Paul

[SWS RN, ASN, RN]

Paul,

OK, it's late, so I will give you that....but You had me spitting my iced tea all over the computer screen.

Good One...

Out of those choices I pick Charlie Brown...but remember, Lucy was actually the psychiatrist..."the doctor is in"

and I thought we finished that conversation while we were hiding our Easter eggs......

s :redpinkhe