Sunday, May 09, 2010

Dirty Little Secrets of Nursing, Part Two: Sometimes we hate your guts. And it's your fault.

Everybody bitches about patients. People who are sick can be unlikeable, difficult, whiny, and hard to tolerate. Sometimes, though, we hate your guts. We'll do anything in our power to keep from taking care of you two days in a row, or sometimes for an entire shift, if you're offensive enough. We'll deputize other nurses to deal with you as much as possible and beg the doctor to send you home early. And that, my friends, is entirely your fault. You are an unlikeable person.

If you're an open racist, it's fairly obvious that we're going to have trouble finding people to take care of you. If you throw things, same deal. If you're a sexist piglet, we'll put you with the biggest, ugliest male nurse we can find--or me.

There are some patients that set off warning alarms in a nurse's head. My two personal least-favorites, the people I really and truly dislike, are the Nuts and the Lawyered-Up.

Nuts are reasonably easy to spot. Everybody gets drug allergies, and people with chronic conditions, or who've been treated for cancer, tend to have a lot of them. Nuts, though, come in with four-page, single-spaced lists of things they can't tolerate or are allergic to--and those lists are often annotated with editorial comments about how a surgeon "nearly killed" the patient, or a doctor's mistake harmed them irreparably. Nuts tend to be allergic to everything from tomatoes to polyester, yet are able to eat their favorite foods without harm, even if those foods contain supposed allergens. These are the people who are allergic to oxygen.

Strangely, in all those allergies, two will never pop up: Dilaudid and Phenergan (or Stadol and Zofran). And, because the Nut has been in more hospitals than MRSA, his or her (usually her) tolerance for pain meds is huge.

The Lawyered-Up are a little different. I've had two in the last year. In the first instance, the patient was fine and dandy--it was the family who was Lawyered-Up to the hilt.

They wrote everything down. That does not bother me, actually, and I'll happily write stuff down *for* them--after all, health care is so screwy these days that it's smart to have another set of eyes or three on the patient. What bothered me was that they'd second-guess everything we or the doctors did, call family friends who were doctors in different fields for advice, and question my skills in a particularly insulting fashion.

When I came in to start an IV on the patient, one of his family members looked at me narrowly and asked, "Are you sure you know what you're doing?" A question that silly deserves the response I gave, which was, "Frankly, I haven't a clue." The patient laughed, the family member fumed, and I'm sure wasted more ink on that smartassed nurse.

The second Lawyered-Up patient was, as she announced to me, an auditor for a large national hospital accreditation board. "I" she announced proudly, "make nurses cry."

"Good thing I'm not a nurse, then" I shot back. "I just found this uniform in the Dumpster out back."

Every time I walked into the room, she would regale me with stories of how she's sued this nurse or another, or gotten some nurse's license revoked, or generally destroyed the career of somebody with whom she disagreed. I finally sat down in the chair next to her bed, looked her straight in the eye, and told her this:

"Telling me that you routinely sue people is counterproductive. I will chart more thoroughly than you can imagine, and as a result, I won't be able to be in here every hour, as I'm supposed to be. I won't want to spend the time with you that I should, because you're trying to freak me out. Furthermore, if you continue with this, I won't be your nurse tomorrow, and your continuity of care will suffer. So how 'bout you drop the badass act and let me do my job without attempts at intimidation?"

We got along fine for the rest of her stay in the CCU. I even got a TEAM playa card from her later.

Sometimes it's the patient's fault that they are unlikeable. Nurses are human, and there is only so much we can take in terms of abuse and bullying. It's our dirty little secret: we hate you because you're an asshole.


Lisa G said...

Great post!! In my world (SNF, 50% short term rehab/50% long-term care) our short term length of stay is so long (average 30 days) that when an asshole patient joins us, those nurses are stuck for the next 30 days. Considering our nurse/patient ratios are 1:20, the unit manager, social services, and sometimes, even me (DON) intervene to decompress the situation. On the other hand, sometimes nothing works. Those patients, we just look forward to the day they meet their goals and discharge and we chart are asses off.

RehabNurse said...


I need to post this at work...or maybe sneak into all the admission packets.

Word verification: in "what you rookinat, punk?" ;->

bobbie said...

And again... AMEN!!!

The Future Missy Prissy RN said...

I love it. The smart aleck responses! I am writing these down for sure!

Unknown said...

having spent a lot of time in the hospital over the past 6 years, i have learned that the nursing staff always has my best interests in mind. i always thank them, whether they are delivering my meds, starting an IV, drawing blood or just checking up on me.
and you know what? my stays have always been as enjoyable as possible considering the circumstances.
my family makes my bed, cleans me up and generally tries to make the workload of the hospital staff easier.
and you know what? the staff always welcomes my family and welcomes their questions.
and on more than one occasion, i've been told that when a nurse was asked to take overtime, she said as long as she got me as a patient she would.
so, to those angels of mercy who care for those of us who become ill, you have my unending appreciation and are in my prayers every day.

Nurse J said...

love it. you ooze sheer poetry man, poetry.

Anonymous said...

You know there are more many more types of patients we hate, but this is a good start....

Sue G said...

For some reason THIS post, but only the first few lines, shows up when I link you on Facebook, but the link does not lead to this post, so I had to Google it, found it and LOL'ed. I am the one who gets deputized all too often because I can fake patience better than some and difficult patients often like me. I enjoy the role--to a point.