How do you deal with demanding/unreasonable patients?

I am referring to patients such as your drug seekers, call bell pushers, the one- shifters. What have you said or done that is not disrespectful but firm and effective in putting such patients in line?
It is hard to be RESPECTFUL yet firm when the patient is a total jerk or needy. I tell them that I have other, sicker patients that I need to attend to, but that I always have time for them also. I remind them that myself or the PCT will round AT LEAST once per hour and that they need to wait at least 5 minutes after pushing the call light before they are alllowed to yell into the hallway for me, since the needy ones tend to wonder through the halls with their IV pumps to find me, or if non-ambulatory, they scream "NURSE!!!!" I say NOT to scream out for help unless they are hemorrhaging to death, or having chest pains/stroke symptoms. A cup of apple juice can wait until I round again. Sometimes I give them a pad of paper to write down their list of desires until I round again. We try to round more frequently on this type of patient and to switch nurses halfway through the shift because they are so exhausting. If those measures fail, I have a very staunch, stern and sassy charge nurse to "put them in line" the hard way. That way, I don't have to be the enemy.

What do you mean by one shifters? The drug seekers, all I can do is give them the meds they can have as ordered. What else could you do? The bell ringers GET UP out of bed and away from the call bell. If all they are going to do is ring they have to be removed from the vicinity of the bell. I have done it in the middle of the night. You gonna ring instead of sleep? Up you get.No choice is given.Or else they get a lecture, nice but firm.

Quote from empatheticRNI am referring to patients such as your drug seekers, call bell pushers, the one- shifters. What have you said or done that is not disrespectful but firm and effective in putting such patients in line?

All of the listed patients need to be handled in different ways. If you approach each annoying patient with the idea that they all need firm boundaries (or whatever), than all you are going to have at the end of the day is a headache.Drug seekers get all of the medications that I can give them. If they want more, I call the doctor. If the doctor says no, I tell the patient "sorry the doctor said no more, your next dose is due at X time." Call light patients get a quick run-down of their needs before I leave the room each time. Food, drink, pain, room temp, bathroom, all belongings within reach, comfortable position in bed. Check? Check. Patients who persist are often lonely or frightened. Spending a few minutes with them (if you can) can make a difference. Patients who are curt or rude -- I kill them with kindness. For a lot of these patients, it can be a lack of control issue. For paras, quads, chronically ill folks (or their parents), I immediately approach the situation with "how do you want me to do this? How would you do this at home?"Sometimes I give context when I cannot fulfill a request right away. "I can't do this now because I am in the middle of my medication pass but I can come back in one hour." Sometimes it's about showing empathy or compassion in the face of manipulation; hard to please, manipulative, or lying patients will make your life harder if they don't believe that you're on their side. A little tut-tutting about that awful doctor or a sympathetic ear while a patient sheds crocodile tears builds a friendly rapport that you can hopefully fall back on when you have to deny a request or limit their call button use.

I try to remember that I can't "fix" a personality that's been broken for years and years. The best I can do is contribute to getting their body better so they can move on to the next place. Until then, I feel out different types of interaction to see what the patient responds best to. I frequently ask for psych consults and PRNs for anxiety, too.

Quote from empatheticRNI am referring to patients such as your drug seekers, call bell pushers, the one- shifters. What have you said or done that is not disrespectful but firm and effective in putting such patients in line?

Lets just say I pass out a lot of AMA forms

Quote from loriangel14What do you mean by one shifters?

Quote from cheezwizz90 I give them a pad of paper to write down their list of desires until I round again.

Try to find out whats causing their aggro. Realise that while this patient might be an utter pain in the ass, they are dealing with the situation the best they can with the tools and resources they have avaliable to them and realise theres a very good chance their anger/annoyance is a direct result of how they are feeling about themselves. Get them involved in the process. Its well proven that if a patient understands why a particular treatment is ordered they are much more likely to calm down. Its amazing how that 'difficult' patient calms down when they've been allowed to have a damm good rant and had their feelings validated. It may not change the treatment plan at all.

Quote from empatheticRNI am referring to patients such as your drug seekers, call bell pushers, the one- shifters. What have you said or done that is not disrespectful but firm and effective in putting such patients in line?

For the call light ringers, usually a good, old fashioned listening session gets to the bottom of the matter. As above, if I have learned this is a needy person, I am going to address all possible needs prior to leaving the room, so that if they are on the call bell again as I am halfway out the door, I feel very justified in waiting to respond. Patients needing pain meds get pain meds. I write the drugs they can have and the next time they can have them on their white board. Each time I give a dose, I change the time appropriately to when they can have that drug again. Then I verbally go over with them, pointing at the board, what meds are due when. Every single time. As long as I get in there on time (I try to make it a point to, for MY sake as much as theirs), we do just fine. Lonely people, I will stand in their room and chart. Mean people, I listen listen listen and then do what I can to resolve/empathize/validate. Those with unreasonable expectations get educated on the kind of floor we are, what the plan of care is and what to expect for the shift. Then I discuss THEIR goals for the day and work that into the plan of care as well.