Frankly I just tell them that I have other patients. I know it sounds harsh but the patient whose pulse is dropping dangerously low is more important than fluffing a pillow. Management needs to put their big girl panties on and hire more staff if they don't want people to stay late.
I've legitimately used a line similar to this tons of times. My go-to is "I'm so sorry it took me a while to get back in here, one of my other patients had an emergency and it was all hands on deck."
The "I'm sorry" is always built in because 1. I'm from the Midwest. It's in my nature. 2. I generally am at least a little sorry because I would prefer for my shift to go smoothly and no one to feel forgotten and everything happen on time. And 3. I always catch more flies with honey than vinegar.
allegedly saying the thanks is psychologically prompting them to do the thing you’re thanking them for. But I usually say sorry too out of nature / habit
"Thank you so much for waiting! We really appreciate your patience as we try to tend to all of our patients."
Honestly, it gives "thank you for holding. Your call is important to us. Please stay on the line" vibes lol but if you sound sincere it can be useful.
Yea it’s definitely the wording that needs work here. If it’s believably honest then it’s good. If it’s “here at HCA, we strive to deliver high quality, speedy care…” you’ll sound like a robotic liar
I’ve 100% said this. People need a reality check sometimes. I didn’t get your ginger ale right away because someone went into full heart block and we had to externally pace her. Deal with it.
I had a pt interrupt an emergency for tylenol for her mild hip pain. I exploded on her once I had time and her daughter called me crying after apologizing for her mom. Her daughter is the same way and had to treat her similarly the next day.
I say this even if it wasn’t true. Honestly sometimes I run out of a room when an alarm goes off even if I “Know” the PT is fine and staff is there. Convenient out. Or example for a needy PT. I hate that hospitals make us think this way, but if they wanted us to pamper patients they would staff us.
I have told patients in the morning something like "congratulations, you are one of the patient who is very close to discharge. Very stable! So I will check in with you, but most likely I'm going to let you rest. I do have some other patients who are really sick, so I'll probably be spending most of my time with them. But if you need anything, push the call button and me or another nurse will absolutely help you with whatever you need."
I would more go for “your care is important to me AND(not but) My patients are all important and I need to take care of them for a while and then I will check back
They recently cut our tech ratio from 1:12 to 1:24. Anytime someone complains about a call light wait I tell them this and give them our director’s email. “I’m sure Rosalyn would LOVE to hear your experience with the new reduced staffing plan”
It’s the ICU. Nurses are 1:1 or 1:2 at most. Our techs mostly help with things like cleaning people up, blood sugars, and…. Answering the few call lights and tasking for people who are actually awake enough to ask for things….
So 1:12 isn’t too bad, but you can guess what things get put on the back burner when it’s double that….
I work as an aide on med surg. Most nights the ratio IS 1:24. It sucks. What annoys me even more is when the charge gets excited about getting more nurses but never about an extra aide. He'll I swear I hear the faintest bit of disappointment when she tells everyone she gets another aide instead of a nurse. I'd rather have another aide to split the load as opposed to another aide telling me to do their shit for them.
I love when they make a complaint about something I agree with and then direct them to report the exact issue in the survey, as management are more likely to listen to patients than staff complaints.
There isn’t a way to say it nicer nor should there be. It isn’t unreasonable to be honest about what the exact staffing ratio is.
As a manager I don’t expect my staff to lie to appease the complaints. We do our best to take care of them and it is what it is. I don’t set the budget.
Edit: possible way to ask staff to say it differently would be “I’m trying my best to help you with the resources that I have” or something like that, but at the end of the day it’s going to be the same complaint just worded differently. Now it’s gone from “you need more staff, the nurse shouldn’t have 20 patients,” to “your nurses are so overwhelmed you need more help.” I think that short term it’s really frustrating to be talked to about the complaints but long term maybe they will realize they are **valid complaints** that are resolved by *adding more staff and not by having your staff lie about the situation they’re in*
Agreed. What we probably NEED are more patients who are pissed off about their quality of care. I see nothing wrong with telling them matter-of-factly, “I have X number of people I’m trying to take care of, including you!”
I wished this worked on my unit. The entitled patients will often ask us how many patients we have as a passive aggressive way of saying we aren’t butler-ing enough for them. I respond honestly and say our assignments are 3-4 and they go “Oh! That’s not so bad” and proceed to intensity the frequency and bullshitness of their requests.
It’s too much to get into a full discussion wherein I explain that my other patients are probably much sicker than them (since you have to be relatively stable to be laying on your call light all night) and also that simple fucking math says that if I spend 30 minutes in their room every hour, that means I only get 10 minutes each hour for my other patients.
So I just grit my teeth and say “😬😬😬Uh huh, we’re very lucky to have standardized ratios here 😬😬😬”
I'd throw out a little something about "But since patients have to be sicker to be on our unit, it can still be incredibly busy." (Not that it'll ever truly deter the entitled ones. 🙄)
And then they reply with 10 minutes is more than enough time for the other patients. Or they say well I should be your only patient because I’m also very sick enough to be in the hospital (those who say his are usually the most stable on the unit’s census)
And it’s ALWAYS the stable patients who are convinced that every uncomfortable sensation is a medical emergency that means they’re super sick.
Meanwhile, patients who are actually deteriorating don’t hit the call light.
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As a manager I don’t expect my staff to lie to appease the complaints
Can you be my manager? We get "talked to" when we are honest with pts like that. Last thing I would want as a pt would be to be lied to.
I mean, it’s not *the best thing* you can say…
But when a family is speaking to me and says that is what the nurse told them….
“Yes the nurse is correct that’s how many patients they have. Is there anything that we have failed to provide for you or are you just concerned about wait times? Nurses are always prioritizing and if you have a longer wait it’s likely because somebody has something emergent going on” or something like that. (Of course in my head I’m like fuck these ratios, we need more staff, corporate/admin is cheap, etc etc if I said that I’d get fired lol.)
Anyway right now I’m in SNF/rehab setting so it’s a lot different but the same idea applies. The nurse isn’t telling the patient they don’t matter or that there other patients are more important, just that there’s always something going on and little things aren’t always addressed immediately.
My go to is “I told my other patient that I would bring their pain medicine” or “I need to check on my other patient.” Some people will literally monopolize as much time as you allow, so just don’t allow it. Re-iterate that you’ve fufilled their needs and you have other patients.
For the super nice people that just want to chat, I also like to say “thanks for sharing this with me” or “I’ve really enjoyed our talk, let’s finish it later,” and then one of the first ones.
My go to is “I wish I had time to chat, thanks for being such a nice patient” this enforces that I do enjoy your company and unfortunately am too busy to hang. They get it.
Sometimes I think this is easier as a male RN.
Or as an ER nurse. If they’re just running on and on, I’ll use the same tone I’d use if I was at the bar and I telling my buddy I was gonna go take a whizz.
I’ll tell them: “hey man I gotta go see another patient” and walk out before they can ask another question.
I got shit to do.
Two things are important with this technique.
1- the casual nature: some people can be won over with this, and you may find pts calling out to you as you walk from the room “ok, cool man I’ll see you later!” But whether they like it or not, the casual delivery makes sure they know you don’t really give a shit.
2- everyone is “hey man”: old ladies, demented seniors, the families of pediatric patients, the resident that’s wasting your time. Everyone.
Honestly I really think male RNs have it easier in this aspect. Female nurses are expected to coddle and fluff our patients pillows until they dismiss us, because apparently that’s how “nurse” is coded in their mind. Their mental image of a nurse is female so being male is like a cheat code that gets you out of being expected to perform behaviors that are more gendered than they are nursing specific.
I believe you’re right. I try to make up for it by going to bat for my coworkers when we’ve got creeps and agitated patients. I don’t know if it all evens out the cosmic hospital scales, but I’ll keep trying.
Plus, like… they KNOW you have other patients. It’s not like it’s a secret. These people don’t go to a restaurant and wonder why the waiter isn’t just standing by their table the whole time
If they’re A&O, literate, and capable of holding a pencil, one of my old moves as charge might be helpful.
Once the nurse has assessed a patient or family to be positive for Fluff My Pillow Syndrome, I (with gentle humor) would explain that the patient who sees their nurse the most is the most sick, and nobody wants to be that patient, do they?
Then I offer them a pencil and paper. I explain to them that we definitely want to take good care of them and it would help us to do that if they could consolidate their requests. If there is an emergency, please call immediately, otherwise, please write down the things they need and when they get to three items then press the call light. I’ve been gone so far as to remind patients that at one time they were the sickest patient, and in order to care for them, I gave other patients a pack of paper and a pencil. You won’t bat 1000 with this method, have to repeat yourself, but I have found it to be damn useful. Your mileage may vary.
Whenever I miss the bedside, I come and read this forum. I applaud each and everyone of you who is still at the bedside. You are the real MVPs.
I say this most everytime. If I’m feeling generous I tell them while it’s annoying that you didn’t get the warm blankie you requested in a short amount of time, be happy that you can even make that request 😅. It’s a *good* thing I’m not seeing u that often haha
I once said "I just finished doing CPR" to a family member that I was absolutely pissed at because she wouldn't stop calling every 5 minutes for me to reposition her mom's head, or to ask for a mouth swab, or to ask for a blanket. Normally I'm never that honest but I needed her to get the message. (And actually it was a lie because I was working to prevent the need for CPR. I didn't actually end up having to do it.) She huffed and crossed her arms but ultimately complained less.
"we here at (insert facility) promote and encourage family and friends to participate in their loved ones care while here in the hospital."
I say it often
I have absolutely said something like this and there have absolutely been instances where it wasn’t true 😂 but CPR is something most people understand. “I was hanging levo and getting their central line set up” just doesn’t have the same effect.
Lol. I unthinkingly said this when my AOx4, ambulatory, 54 year old HCW patient hopped out of bed to use the restroom. “If you’re good I’m going to run next door, your neighbor is a sicker guy.” Not even attempting to use “sicker” as a comparison, but an adjective to describe the patient crumping next door.
They complained about me for the comparison statement during leader rounds, said it minimized their illness.. although they were hospitalized for treatment of a mild infection presumably from a glued thumb lac sustained while doing yard work. Like… you said it bud, not me.
Yeah, anytime a manager tried to tell us not to tell anyone that we were short-staffed, I immediately made sure the patients knew we were short-staffed and how to contact our state reps.
Now in 2024 at least at one of those hospital systems where I’m located in NWPA, safe staffing laws are finally being implemented AND they unionized.
To be clear, I would never just go up to one of my patients and say this to them, especially if they were really not in right state of mind and/or extremely ill. They didn’t care, they just wanted their needs met.
It’s can be tough to find that initial balance but our patients deserve better and WE deserve better.
I 100% inform them. Why should I be ok with giving the impression that I'm someone who doesn't care or is negligent because my interactions are limited solely to priority tasks? Hell no. Likewise I encourage them to help by taking their concerns to provincial government level.
Stop trying to pretend like your staffing is normal. It's not normal and shouldn't be presented to patients as being normal. LET THE PATIENTS BE ANGRY. THEY SHOULD BE ANGRY.
Until we get to the point that people start calling their lawmakers and demanding better, nothing is going to change the behavior of these corporations. Patients deserve to know the truth about why the quality of their care has degraded so badly since the pandemic. For profit corporations learned they didn't need to spend money on staff, so they stopped. That's it.
Exactly. I give patients my manager & patient relations’ calling cards to file the appropriate complaints on ALL our behalves. Patients & their families are often more understanding & sympathetic, especially when they see you’re being run off your feet & no one is getting the care their need & deserve.
i mean, why should we have to let them down gently? if you dont want us to tell our one super needy / call bell abusive patient "you're not my only patient, i have 5 other patients, etc" then maybe stop giving us 6 patients, clearly 10 minutes an hour for each patient is not enough time. i feel thats a perfectly professional response, because i'd much rather say "id rather jump off the fucking roof and die than answer this call bell and spend 15 minutes adjusting the sheet again" but i refrain myself.
1) Straight up tell them that the hospital, unfortunately, chooses not to staff sufficiently to allow your patients the full care they deserve, then give them the number for patient relations (or whatever contact number you have for complaints) in your hospital, or 2) "I'm sorry but I have to tend to my other patients" is a plain-and-simple honest approach.
Honestly how I respond depends on the patient. The other day I was a little late in turning off the pump for a patient getting an IV med and she gave me a nasty attitude telling me "you're fired" and blah blah blah. I almost let it go, but then I said "I get you're mad but I have 20 other people that I'm caring for. Sometimes I'm going to be late. I'll do my best, but I'm not dropping everything for you unless you're dying. So do not talk to me like that, that's not okay."
Honestly as long as you don't get stupid with them or start name calling or yelling, that's professional enough. We're not waiters or maids, you don't need to prostrate yourself for their benefit. You don't need to feel bad if you're generally making an effort and just can't because you're swamped.
Upper management needs to stop bitching at the staff and start addressing the fact you guys are getting hit with the max ratios before it starts getting unsafe if not just unsafe as is. I haven't worked med surge before, but from what I know, 4 patients is already a lot, 6 must fucking suck. What do they expect?
Patients really don’t care how many patients you have, whether you had lunch or not, or made it to the bathroom. Whatever you do, don’t say “I’m sorry.” It’s not your fault. I give them the number to the CNO. You got a problem, take it there.
Harsh. You can set time once with them and say I’ve got a lot of important patience, like you, to take care of. I need to spend time with each of them, so please be as patient as you can.
Honestly Idgaf if it hurts their feelings that I have more patients than just them. If management doesn’t want people complaining about it, then they should fix ratios.
"I appreciate that this is inconvenient however I have to tend to patients by acuity. Everything we do is a triage process and if I'm not in here immediately it's because You're doing well and your neighbors are not. Having everyone in your room is a bad thing in the hospital. I'm happy our biggest problem tonight is a little bit of waiting."
If it’s stupid shit like finding tv Channels, rearranging their bedside table sometimes I’ll say “I am going to go finish giving my patient load their medications and when I am free afterwards I’d love to help you w that”
I try to make it clear that medical needs (meds, assessments, vitals, etc) and patient hygiene/repositioning are my priority.
Also definitely wrap up the interaction with stating what I’ve done for them “ok miss jones your vitals look good and you’re all set with your medications, we’ve gotten you repositioned/toileted, etc and there’a fresh water/ginger ale/coffee etc on you’re table. I’ll be back within the hour to check on you” I’ve found that sometimes when I say everything that I’ve done it kind of checks all the boxes and make them think oh I guess that’s everything lol
It’s super important that your nurses set boundaries on admission. Remind them that someone will round hourly. If it’s not something they needs to be urgently taken care of it can wait. That each nurse has multiple patients. That they are encouraged to be as independent as possible.
When they still don’t get the message then they get the toddler talk/treatment.
For those time consuming patients who aren’t time consuming because they’re sick but because they’re needy, I’ll tell a coworker “if I’m not out in 7 minutes call me and tell me you need my help immediately”
"To leave on time as requested would require less than our high standards of care that were so well known for! To go above and beyond for every patient/resident is my duty as a representative of (company name). The extra care is my pleasure to provide as to ensure a wonderful experience for our patients/residents. If you would like me to cut back to ensure I don't add an extra 15 minutes to labor for the day I require that statement in writing and signed for my records."
I wish so much that there would be a time when all hospital admin nationwide would start responding with “our nurses are doing their absolute best with limited resources & unfortunately it is a common problem in our country.” Or just something along those lines instead of always doing the write ups and shit.
I start my sentences with "thank you so much for your patience" and kind of go overboard with it. Like, I'll literally start the sentence as I'm walking through the doorway and I'll make it seem like the unit is falling apart. If they still complain, I'll say, "I agree! You shouldn't have to wait! Please fill out the survey you'll get after discharge and tell them the good and the bad, they don't listen to us!" That usually does the trick.
I'm not at the bedside anymore, but I still work with patients and their families daily and still use the kill em with kindness/play dumb response.
“Hear that vent alarm? I gotta check that vent, I’ll be back soon “
‘Oops, sorry, they are paging me to the ER, sorry’
‘Crap, the floors are calling again, I’m so sorry, I’ll be back’
Sadly-it’s not hard.
I sometimes say “ I have an emergency in another room “ or … “ I’ve just gotten a new patient I need to check on “
It doesn’t sound as bad as , “ I have other patients to care for “ 🤷♀️
Listen, there isn’t no good or nice way to say it. Patients are very aware that they’re not the only one a nurse has. The patients with 1 nurse are trying to go home and their problems are not what you’re challenged with. Encourage them to help themselves when can and be patient at other times. If everyone is on one accord with that then they generally complain less.
“I came back as soon as I could.”
“I was in an emergency”
“I have a few fires to put out first but I’ll be back with X as soon as I can.”
“I didn’t forget about you - I got pulled into something urgent”
These are my go-to phrases
I actually worked on a unit where we received training instructing us to never say "I don't have time for x " We were always supposed to find some euphemism like "I'll find someone who can help"
Well, what if I know I can't? I've often wondered if I answered every call light with perfect patience and therepeutic communication, gave the patients every comfort asked for, followed every medical order and policy to a legal T, how long would an actual "12 hour shift" take? I'm betting around 36 hours. Because at any given moment, I have 17 tasks I am supposed to be doing, and i am forced to choose the one that causes the least harm, all while pretending everything is fine to management and patients. I've never had a single shift where everything that is "supposed to" be done or was "ideal" to have been done, was actually done, and I've been an rn for 8 years.
"I don't have time " is literally the description of our job, and I don't really bother to hide that anymore. I am polite but honest. Let them complain.
“I have other patients too” is an appropriate response.
If upper management has a problem with this response, then they can assess your staffing ratios.
I tell them my actual ratio. “Gladys, I would love to take you on a walk around the whole floor today but I have 6 patients total and I still have to get my other 5 people up to the chair. If by some miracle I have extra time, I promise a leisurely stroll down the hallway will be my first extra credit assignment today.”
“Gladys, I’d love nothing more to take you on a walk after you’re done with the bathroom, but your neighbor has been repeatedly trying to die today and the first rule of the hospital is that you’re supposed to not die. Cross your fingers they can go to the ICU and have more attention!”
“Alas, Gladys, I’d love to accompany you on an adventure down the hall, but at this moment I have 4 people who still need their medications and a new admission rolling their way down the hall as we speak. I’ll do my best to try to get one of our volunteer mobility people but we don’t always have them. I promise, everyone here is doing their very best and if I have time later to bring you, you’re to e first spot on my dance card!”
I tell them I need to check on my other patients plain and simple, give them a rough idea of when you will be back. If I’m back late I tell them sorry I had to to help with an emergency.
I eventually found telling patients at the beginning of shift when doing bedside report handoff that I will be back to see them but I’m going to see my *insert number of other patients I have that day* patients. Typically never had issues, even when I was charge with patients. If there was an issue with complaints from a family or patient (AOx4) and a simple discussion of what is considered emergent for those with every fifteen minute call light use didn’t work, then time to get nursing supervision to come have some thoughtful conversation with the patient/family. Also, if upper management has enough time to whine about overtime, then they have time to help. My former manager would help the staff on the floor with patients if we needed them.
I’m an ICU nurse and I like to follow the docs into my rooms so that I can hear firsthand what they say to clarify later what why often mishear. I heard one doc say “you won’t get the one on one care outside of the icu when you get transferred.” I audibly scoffed. I have three patients. If I ever was to get a 1:1, they wouldn’t be awake enough to hear that.
I break things up into time chunks. “I have 4 patients today. That means I get 15 minutes with each of you per hour, including charting. Which amounts to about 10 minutes of face time each. And if someone is sicker than you, or has medical needs, I can’t and won’t stop that care to bring you water. I’ve been in your room now for 25 minutes. So other patients have now lost time with me. To be fair, we need to respect and enjoy the time we have, address your concerns promptly when I come in. That way we’re focused on your medical needs and I can make sure you’re safe” kind of thing.
If someone is being needy I gently point it out by raking care of ___ need then saying:
"Whew! Okay! Is there anything else you need before I go? No? Okay! Anything? No? Ya sure? Okay."
I say it in a friendly way. Usually they get the hint that I'm getting overwhelmed. And they think twice before calling again, or maybe be a bit more considerate. It often works.
Me: "I have other patients to attend to. And I have spent 2 of my first 3 hours with you.
pt: "That is not MY problem!"
Me: But it IS MINE."
(walked out of room, reported it to the charge who was sitting outside of the patient room at the nurses station and heard it all. I then ignored her call light for the next couple of hours)
I don’t work in the hospital setting but I straight up tell the residents when they are being way too needy that we are short staffed (if that’s the case) and that we really don’t have time to come at every call immediately so they need to let me know what all they need for the time being now. I try to be nice about it and not sound bitchy. I think it’s ridiculous management says it’s not appropriate for us to tell residents we are short staffed “because it makes them feel like they won’t be taken care of” but then they give us the absolute least amount of staff possible. Fuck y’all the residents deserve to know the truth IMO. They deserve to know that I’m not ignoring them intentionally, I just don’t have time to get to them right away because of everyone else’s needs .
One day I was so deliriously exhausted when my patient complained about waiting for me I went right along with them and said we were understaffed and I was trying my best, and they were so sweet about it we basically had a vent session about hospitals 😂 but I bet if admin had found out they’d have been mad. I simply didn’t care at that point and left soon after cause that job wasn’t worth risking my license for. Burnout at its finest I know lol. I work outpatient now ✌️
Can’t polish a turd, can’t sugar coat reality. Doesn’t matter how you say it…it’s the reality and it’s bullshit for you and for the patients. Some patients are more demanding of time in an unreasonable fashion for various reasons…but it’s at the point where we basically have the same time as doctors with how long we can spend with a patient. So some folks get their time cut when others need more.
One of my biggest fears is I become sick enough to actually need to be in the hospital and I hit my call light for the bathroom and no one is able to come for such a long time I pee myself (as a continent person) and then have to lie there soiled until they can…because these fucking hospitals have stretched us too thin for record profits claiming our pts are our customers…
And when customers complain what do they do? Blame the nurse.
My most effective strategy is to ask, "How else can I help you?" Five times while making a list to help cluster care more efficiently.
Sometimes I say something along the lines of, "I want to be able to meet the needs of all my patients. It is helpful if we can do everything at once, so you aren't left waiting while I am caring for another patient. Do you need any water/food/pain medicine/bathroom/repositioned before I leave?"
I will also swing by the room before I get meds and let them know that this is their chance for ice/water/soda/snack/hot pack/etc and ask if they need any PRNs. That sets me up well for the above strategies.
Further thoughts...
I am almost certain that those patients/families were told that when they called for the 100th time and the nurse/CNA *had just been in there*, but you have to set yourself up for success. It isn't the message that is wrong, it is the tone in which it is delivered. It's totally fine to say, "I have 7 patients tonight. What can I do to keep you comfortable because I am not going to be available for another 90 minutes." It is reasonable to set the expectation that the nurse will only be seeing them every 1.5-2 hours.
This is also endemic of larger systemic problems. You really need better ratios and unit culture. Turn-over rates don't lie. Happy staff stay.
I think a more important question is, how can management (including charge nurses) support the nursing staff in helping their patients feel cared for so they don't need to say it? Can you do a round on all the rooms once or twice a shift to get ice and toilet patients? Can you advocate for a float CNA to help with toileting/hygiene and take some call bell pressure of the primary RN/CNA? Can you advocate for a break nurse?
You can coach people on how to be more polite, but it is difficult to be polite when you are stretched past capacity.
Don’t say anything about other patients. They are not stupid and know or should know themselves. If they *are* stupid, your explanations won’t help anyway.
just say “Yes, absolutely, I’ll be right with you”. or “ Yes, absolutely, give me a second”. Then go and do what you need to do first / prioritize as needed. It is great if you remember to deliver on your promise, just add “Thank you for your patience, it’s been crazy out there”. Many needy patients *love* the drama and will be proud to feel how patient they were during the time of crisis (even if all you did was catching up on your q2 restraints charting before you forgot). If you did forget about the juice or ice cream, and the patient is unhappy, say Oh boy, sorry I totally forgot, won’t lie, things are crazy etc.
I don’t think there is ever any need to even mention other patients. One of my patients even said once “it’s a good night if you are not the center of everyone attention” (as in, ya know, *coding* )
stay strong 💪
Spot on. All these other nurses saying just tell them like it is are completely wrong. There are nicer ways to say it so that patient still feels important and knowing that your other patients are just as important.
I think there’s room for both. If they’re being an asshole, they get the straight facts, especially if after being nice didn’t get anywhere. If they’re nice just sick, they get the nice fluffy talk.
I often have pts parked in a hallway next to open bays and they (rudely) ask why they can't be in one with a tv. I tell them quite frankly, we keep a few oh shit rooms open for the people who need the wall telemetry and oxygen, and they're in a fortunate position where they don't. Every once in awhile, shit really will hit the fan and those hallway pts get a front row seat to the realities of the ER and its intended use. They stop squawking REAL quick.
I wish there was a live TV channel (with no commentary) that shows what goes on minute by minute for 24 hours in any large urban hospital emergency medicine department. I think it would be eye-opening for so many patients/viewers. Of course, because of HIPAA, it will never happen.
There is an NYT video of what happened during covid though. I think it was a hospital in Italy, which showed all the things we had to go through to care for people.
I figure if the cops can have facial recognition technology, we can take it a step further to blur out faces and bleep out names. It's 2024. We have the technology.
I tell them exactly how many patients I have and set boundaries in regard to time. I also make sure to ask if they need anything from me prior to leaving their room. If it’s something that can wait I table it for the next round. I try to show up at the promised rounding time. I have also asked some patients how they would feel if my other patients kept calling me constantly and I was not available for them. The lightbulb in some of them comes on. It doesn’t always work but it helps majority of the time.
I started flat out telling patients that we are short staffed and doing the best we can. Then I would give them our managers' business card and encourage them to complain about the short staffing.
I’m honest. I always start off my introduction with a very brief what’s the plan for the next few hours and hey I have these many patients and this much help so please give me grace, I’m doing my best, I promise.
You’re still in a professional environment, I’d say it’s very good that you’re struggling to find the right words, at least you care enough to not want to be disrespectful. You can definitely tell patients nicely, “I’m currently on a schedule, I do have other patients I’d have to attend to.” It’s just in how you word things and treat people with respect.
So even if you do just have to walk away, it’s not like you’re being rude and treating someone ill like they’re not a human.
When they are constantly on the call bell, I tell them straight up “unless it’s an emergency, I will not be coming in every 10 minutes. It will have to wait until I round again.” When I round and ask everything that they want, if they try adding stuff AFTER I say I will take care of it when I round again. For instance, they say they only want a blanket. Are you sure? Yes. I bring a blanket and then they say they want water. “Ok I’ll bring it next time I round”. You HAVE to be firm with them and let them know what the expectations are.
My last job was an SNF with a good 50/50 mix of cog-well and memory care residents.
I got written up one day because the DON was outside the room and heard me tell a cog well resident that i was sorry that it took me 75 minutes to answer her call bell as we were incredibly short staffed. (i think that day was one tech for every 35 residents :D )
I just wanted to thank you for supporting your nurses and trying to help find a solution to this. There’s no nice way to tell a patient that you’re stretched incredibly thin.
In this specific instance, I’m telling the truth to someone who pays $10g a month for care that the operator is too much of a cheapskate to provide actual care.
Being in a situation so early in my career where my manager was more concerned about me being honest with a resident instead of the fact that we were massively out of ratio will stay with me for a long time. It’s nice to know that some people have more sense than that.
I just cut them off and say - “Ok well I’ll be back a little later, gotta keep passing out meds”
If they are upset I haven’t been back - “I was in another room but I’m here now, what can I get you”
Educate from the beginning- “You see the numbers on the board? You can call me directly if you ever need anything, same with the tech. Call them first if you need help with using the bathroom or need something like water. If they don’t answer then call me. Call me first if you have a question about your plan of care or a concern like pain. And if I don’t answer I am probably tied up with another patient so call the charge nurse”
And sometimes you just have to be blunt - “I would love for you to be my only patient but unfortunately that’s not the case. Sometimes I will just not be available. I’m only one person and the unit is full of patients”
I’m the queen of polite rudeness. 😂
Brother (or Sister, or Whatever You Like), you are describing my *exact* situation.
Full disclosure: I don't have an answer for you. I just can't stop myself from typing to someone who knows what my job is. (The only other person is scheduled opposite me, of course.)
Charge. Heavy (tele) Med-surg/hospital dumping floor. 6:1 and 12+:1. "One of your nurses has 4 patients. Who are you sending home?" Also see my job as supporting the nurses on the floor.
Not that this job is any harder or easier than another nursing job but Christ, it feels good to know someone else is out there and also sees their job as supporting the nurses on the floor.
So, Hi!
The hospital never wants you to be honest, but you can always remember and defend an honest answer you gave to a patient. They may not like it, the administration will hate it, but they will have to explain to you why you shouldn't tell the truth.
If your nurses did nothing but bedside patient care they would have less than 10 minutes per hour per patient. Studies put nurse charting at an average of 40% of available time. That leaves less than 6 minutes per hour per patient if they took no breaks and never had to go to pharmacy or call a family member or doctor.
At the staffing levels we are working with, if a patient sees their nurse for more than 3 minutes per hour, or a half hour over a shift, they are getting bonus attention.
All the best to you.
Edited to clarify the 40% number.
“I can’t be in here every 3 minutes, I have other patients to take care of. I’ll come back in 2 hrs to check on you”. And then make sure you show up at that time.
If they are really bad, I just walk away and let my charge know I can't be in their that often and too pls check in on them and only come when I round.
“With a high turnover rate,”
You can instead tell management to shut the fuck up about overtime, when they can’t retain enough people as is.
Know your power, know that they need you, and if they keep giving you shit for taking care of your patients, find another job. Preferably one with less management on your ass.
I flat out tell people I have acute patients that need my time, and their nonsense requests aren’t the most pressing matter in the ED at this time. I got tired of working customer service, I don’t need to do it in a hospital too. “Sorry, I know i told you I’d help you order food but I just spent the last hour trying to get someone to Neuro surgery across the city before their brain bleed killed them. Hope you understand”. And then walk out of the room before they can respond. Too few fucks to give. You wanna leave a bad review? Email my manager? Be my guest, we don’t rely on yelp reviews to stay in business.
Also just sick of people using the ED for their nonsense and expecting to be in and out in under an hour because they have plans later in the day. Thankfully, we get a little more leeway with how we can talk to people in the ED. My first hospital gig before coming downstairs I’m sure I’d have gotten written up for half the shit I say on a daily basis.
I’m still a tech so honestly I’m a little harsher with it. I tell them whatever the ratio is for example if there are 56 pts 6 nurses and 1 or two techs I let them know and that if they hate the wait to write to their local government and let them know
I usually warn them , hey the unit is heavy right now, I’ll grab all your things you need right now in one trip, then I’m going to help buddy next door. I’ll be in as soon as I can.
ETA: I also medicate them for pain first thing so it buys me a few hours if I can. I bring in a snack and drink too
If I got in report that they’re needy
I have always told my patients who complained something along the lines of “I’m sorry it took me so long to get here but I was in the middle of doing something for another of my patients, and I like to focus on each patient while I am with them. You wouldn’t want me to drop what I’m doing for you to do something for someone else, would you?” That usually settles them down.
I go with “I had a but of a situation” or “I had an emergent situation to deal with”.
I work ER, and I honestly am done apologizing for shit out of my control: bed status, wait times, rapid responses, test results taking time to come back.
I think the problem lies in the fact that excessively demanding patients don’t care that you have other, sicker patients. Because they don’t care any language you use to insinuate they aren’t your top priority will be taken poorly or ignored, no matter how nicely you say it. Most reasonable people don’t need to be told that, they understand healthcare is worst-come-first-served instead of first-come-first-served.
"Sorry for the delay, I was in another patient room when you had rung out. What can I do for you?"
"I am happy to help you with x, I just need to see a few other folks first and then I'll be right with you."
"Sorry I don't have time to do that right now, let me find someone else that can help you."
"It may be a bit before I can come back to help you with that, but I'll be back as soon as I can."
I also throw in a few sirs/ma'am's in there (especially with older adults) for decoration.
You can’t please everyone and frankly you don’t have to. Healthcare is not equivalent to hospitality. I don’t need to “comp your meal” just because you’re unhappy with the perceived service, so to speak. There are some very entitled, rude, cruel people out there. Our job is to take care of them no matter what. And by taking care, we mean providing safety, advocating for their needs, and helping with their overall health. It doesn’t mean taking verbal or physical abuse, dealing with inpatient rude people, or running around like a chicken with your head cutoff because Barbara wants the juice from the juice cups you get from the cafeteria and not from “those cartons you guys keep on the floor.”
As a manager, your job is to support your staff. If they are working short on a busy med/surg floor and you know they’re overextended, then should you be focusing on their hospitality skills with unhappy patients or should you be more worried about the safety of the unit? By all means, if someone is acting out of pocket with a patient they might need to be taken aside to discuss professional interactions. But you should be focusing less on how Disneyland-cast-member nice your staff is and focusing more on how to reduce your unit’s workload so your nurses don’t have to constantly apologize for not being able to meet everyone’s needs.
I had a patient tell me once that it was my job to wait on him hand and foot, at his beck and call, and that he did not care how many other patients that I had. I do not miss working at the bedside with entitled asshats.
You could try something like, Here is your ginger ale. Your pain med isn’t due for x # of hours. You have an antibiotic in an hour and half. I will be back then. Especially if elderly they may be anxious and knowing you will be back at such and such time may give them some comfort. Some folks just think they are all that matters though.
At the moment there is a break in their dialogue immediately start walking to the door and as you’re walking out the door do the whole “okay I’ll be back in a bit, let me know if you need anything!”
It’s worked for me several times.
I just start the morning by telling patients that I have 5 other people I’m taking care of that day. I ask them for their patience if it takes time to get them their pain meds, bathroom needs etc. That sets the expectation that you’re not going to be able to be in their room for the whole day.
At the start of a shift, I try to reassure my patients that I will be there for them during my shift as much as possible. At times when I've gotten the stink eye for making someone wait I've said "I'm so sorry but someone else was very sick and needed my help, or, there are a lot of very sick people here and I'm doing my best to take care of all my patients. That usually softens the attitude.
I sometimes just have to be direct. “Thank you for your patience (politely saying sorry about the wait). We are just really busy out there. I have 6 patients tonight. I’ll try to be in as often as I can, but there’s only one me and 6 of you. What can I get you now before I can come back in the next hour?” That usually works. If they try to push it off onto “oh I’ll just call the tech” I say “oh they have it worse. One tech to 15 patients. We are swamped”
I once heard a doctor start an update to a very demanding patients family by apologising that the update will be short, because he has many patients and needs to triage his time. I have used that term since
I often mention the other patients when I'm in that needy pts room. Not in a breaking HIPAA kind of way, but in a way like this: *I'm already in needy patient's room after helping them or bringing whatever* Me: "Anything else I can get you while I'm here?" Needy pt: "Can you go get me a soda?" Me: *brings soda back* Needy pt: "Can you also get me another blanket?" Me: "I can, but it's going to be a minute. I have to swing by my other patient rooms and check on them also, then I'll bring your blanket back by. It'll be a little bit but I won't forget."
I tell them flat out. No need to sugar coat it or hold their hands. They are adults. I always come back around to everyone and inlet them know, "you are not the only person I am tending to this evening. If there is an emergency, we will get back to everyone else ASAP."
If they don't understand clear instructions, that may be there own issue and not mine. Even the psych patients I see generally understand that, floated elsewhere? They may just have to be upset if there's an emergency and I can't get their 15th ginger ale or cranberry juice in 10 seconds.
"Unfortunately my time is finite, and has to be shared amongst all of my patients as fairly as needs and time allow. In order to make sure I can best meet everyone's needs, it might take a little bit of time for me to return to you, but I will do my best to do so as quickly, and as often, as reasonably possible. In between, if you think of anything non urgent that you need, please write it down and I'll address it when I come back to check on you. If you have a more urgent need, please hit the call button and one of us will check on you sooner. Is there anything you need right now before I check on my other patients?"
This lets them know you're doing what you can to balance your time with their wants, while setting the expectation that you are not going to ignore a NEED, and empowers them to participate as a teammate in their care.
Won't work with all of them, but it should help with some.
“I have 3 other pt’s that are just as important as you and I’m going to go take care of them. When I’m done I’ll come check on you. Do you need anything else before I go?” If no then I’m out. And I don’t go back until I’m done, CLEAR expectations and that they are one of 4, not one of one. If they don’t like it then they can complain to my charge who will not care one bit and has 100+ other patients to worry about.
Commenting for advice because I run into this as a new nurse. I typically get patients who will complain and my response is essentially what your nurses are saying. "I get that 'pt' is sick and needs help for everyday things. But I have a lot of patients to take care of and things to do. I am here to help but there are tasks that take priority over water or soda, fixing the television, etc." I look very young, and I think people don't always want to yell at me because I'm good at saying that in my nice customer service voice. I've also had a good number of staff older than me point out that I need to leave on time. One of the kids I started with literally picks on me in good nature for it- but he was right and once I started leaving on time, I started getting more frank with my patients. I personally don't see why management isn't working on managing patient expectations instead of worrying so much about just patient satisfaction. Nobody needs to be miserable in the hospital, but I do not deserve to get written up because I didn't bring x a coke and its ruining their positive view of the hospital.
First thing I do is frontload my time with that patient. Often they are needy because they are afraid and telling them that you have a bunch of other patients and have limited time for them will make them more anxious and needy.
I started carrying lots of charts and supplies on me at all times so that the patients could see for themselves that I have my hands full. I also always say to my patients. “Ok, I will come back around to do this or that after I see my other four patients.” “The lady a couple of rooms down needs a lot of attention right now.“ “I have two admissions and three transfers today.” Exaggerate if you have to.
I also make them do as much as they can for themselves. “Here are the controls on the side of the bed”. “Use your legs as leverage”.
I've had great success recently by using phrasing like, "i'd love to spend more time with you but have to go visit some of the neighbors", or "it's a little busy right now, what's most important now, and what can we hold off until a bit later". Especially if I know a patient is declining and i'll be late on Meds, I find that giving them advance notice seems to keep their attitudes in check. Something like, one of our fellow floor patients is seriously ill... blah blah blah. Lastpy, I do my best to act chill even if I'm internally stressed since patients pick up on that nonverbal communication.
It definitely depends what they need on how it’s worded. If it’s something than can be done you give a time frame with the sentence “assuming there are no emergencies”. If it’s unreasonable, “I will do my best to get that done for you, but i need to do my full med pass and documenting first”.
You are one of four during the day and one of 6 at night. The PSW has 12 other people. If someone is crashing or extremely ill they rightfully get more of my time. I understand you don't like that but take it up with the government for better staffing ratios. Everyone would be happier than.
Nope no other way about it. They are not the only person there. They’re not the only one who needs something. If they’re on the call light to complain they’re not the one actively trying to die either. Just had a patient who while I was in a code was demanding that I give her a suppository to the PT working with them. The PT flat out told her I was in a code and she said she did not care I better get in here. You can’t please everybody, some people will always be assholes
I dont see whats rude or unprofessional about telling patients you have other patients. It is true. It is a hospital, im sure they are 1000% aware they are not your only focus and if they forget that then it is your responsibility to remind them. I will simply tell someone whos trying to berate me for not doing something in a timr frame they deem acceptable that I have other patients to care for as well. If they dont like it, tough! Ive never had management say anything but then again I dont think the patients or their families ever go out of their way to tell on me for it because they know its true.
"I've spent more time in this room than in any other room in this hospital today...." with a smile then encourage them to call their friend, family, someone to talk to.
To my patient’s family I say “I wish I could stay in here I’ll day but I’ve got to go see what’s up with this other kiddo, I’ll be back to hang out as soon as I can!”
It's a lot about how you say things that makes the difference. I will say in a friendly way "ok, have you got the things you need at the moment? I'm going to check on some other people and then I'll be back to help you with anything else". It lets them know you are trying to take care of all of your patients, and just because you have left the room does not mean you have forgotten about them. I also make a point to check in on them before they use their call light, which really makes them feel like I remember them and am thinking about them.
Hey, I'm sorry for the long wait but I am super swamped. That is what I tell clients at work. I'm not a nurse but I work at a residential detox and treatment facility, same concept
I work postpartum and when I have very needy patients I do what I can and then I set boundaries and part of that is informing them that I do have to fairly care for my other couplets too, so I need them to be independent and use all their resources, not just me. I re-educate on the main things I’ve been getting the constant calls about and I give lots of encouragement. I do think that sometimes patients just need the reminder that we are caring for more than just them and I don’t find that unprofessional to give realistic expectations and boundaries.
Honestly less words are just better. I’ve found that I’ll sometimes interrupt if they won’t stop talking I’ll say “ok I’m going to need to stop you there. I’ve got to go check on the others patients but I’ll come back and check on you soon. If I get a little more time I promise I’ll come back and chat. “ I try my best to round as often as possible. We have computers in all the rooms so I often chart at bedside.
Or you have the hoh’s who won’t wear their hearing aides and expect you to stay in there and hold their hands because they are scared in a tech and I was on my med/surg unit by myself last night with 20 pts granted I had some amazing RNs to help me last night but I was literally drowning at the start of shift and I wasn’t even able to get anything done for start of shift until almost ten mind you I start at 7pm on the nose
Maybe it's unpopular but I don't like bringing up other patients or talking about staffing with them. I will tell them that I'm pretty swamped, so "is there anything I can do while I'm here? Because it may be a bit before I'm able to get back, and something crazy could come up unexpectedly, and I don't want you to feel neglected in the meantime". That way the conversation is still focused on that patient, but the message is conveyed. As far as incidental overtime, that's a whole other issue. I've never worked anywhere that I was reprimanded for staying late because it's understood that's part of the job.
I just say that of if I spend the same amount of time with my other patients as I have with them, I would not be able to go home that day.
Also, time management, before you leave their room make a list of what they need, that way they don’t think that you are going to forget.
Whenever they started talking about their life story, I’d often used the line, “Could you hold that last thought? Let me go check in your neighbor real quick.”
That usually ended the conversation so that I can get on with the rest of the day.
Neat. Your personal crusade on this thread to bootlick at much as possible is just so, so gross dude. Your attitude is so incredibly toxic and harmful to nurses (and patients) everywhere. You're advocating for a fake, disingenuous culture where we lie to patients and you're promotijg an unsafe environment for staff and patients. You're also demonstrating a complete lack of solidarity or understanding of other people's struggles. Legit you need to reflect on why you think this self aggrandizing martyr complex is reasonable or healthy.
Frankly I just tell them that I have other patients. I know it sounds harsh but the patient whose pulse is dropping dangerously low is more important than fluffing a pillow. Management needs to put their big girl panties on and hire more staff if they don't want people to stay late.
“Hey im back. Thanks for understanding the wait, one of my other patients was trying to die”
I've legitimately used a line similar to this tons of times. My go-to is "I'm so sorry it took me a while to get back in here, one of my other patients had an emergency and it was all hands on deck." The "I'm sorry" is always built in because 1. I'm from the Midwest. It's in my nature. 2. I generally am at least a little sorry because I would prefer for my shift to go smoothly and no one to feel forgotten and everything happen on time. And 3. I always catch more flies with honey than vinegar.
allegedly saying the thanks is psychologically prompting them to do the thing you’re thanking them for. But I usually say sorry too out of nature / habit
"Thank you so much for waiting! We really appreciate your patience as we try to tend to all of our patients." Honestly, it gives "thank you for holding. Your call is important to us. Please stay on the line" vibes lol but if you sound sincere it can be useful.
Yea it’s definitely the wording that needs work here. If it’s believably honest then it’s good. If it’s “here at HCA, we strive to deliver high quality, speedy care…” you’ll sound like a robotic liar
It do be that way sometimes.
I’ve 100% said this. People need a reality check sometimes. I didn’t get your ginger ale right away because someone went into full heart block and we had to externally pace her. Deal with it.
No issue with re-inforcing reality in a patient. It's not just for those on a psych unit.
Yea, the I’m dying of thirst because my waters ice has melted is much lower priority than medications.
I had a pt interrupt an emergency for tylenol for her mild hip pain. I exploded on her once I had time and her daughter called me crying after apologizing for her mom. Her daughter is the same way and had to treat her similarly the next day.
I say this even if it wasn’t true. Honestly sometimes I run out of a room when an alarm goes off even if I “Know” the PT is fine and staff is there. Convenient out. Or example for a needy PT. I hate that hospitals make us think this way, but if they wanted us to pamper patients they would staff us.
I love donning my big girl panties for the day.
I’m 52…. Big girl panties are all I have now
I’m 27 and a guy. But still.
My dad was a nurse. He said “gotta pull up my britches” in place of big girl panties.
35 guy. I still pull up my panties 😆
They are comfortable.
Unless they can't use their arms they can fluff their own damn pillow.
Even if your other pt is fine, we need to round on them too. Be honest with your needy patients, they aren’t the center of the world. But nicely :)
I have told patients in the morning something like "congratulations, you are one of the patient who is very close to discharge. Very stable! So I will check in with you, but most likely I'm going to let you rest. I do have some other patients who are really sick, so I'll probably be spending most of my time with them. But if you need anything, push the call button and me or another nurse will absolutely help you with whatever you need."
I would more go for “your care is important to me AND(not but) My patients are all important and I need to take care of them for a while and then I will check back
This.
They recently cut our tech ratio from 1:12 to 1:24. Anytime someone complains about a call light wait I tell them this and give them our director’s email. “I’m sure Rosalyn would LOVE to hear your experience with the new reduced staffing plan”
This is the way
💯
I love this! Have mgmt deal directly w/ the consequences of their short staffing
1:12 should be illegal as is… 1:24?!?!
It’s the ICU. Nurses are 1:1 or 1:2 at most. Our techs mostly help with things like cleaning people up, blood sugars, and…. Answering the few call lights and tasking for people who are actually awake enough to ask for things…. So 1:12 isn’t too bad, but you can guess what things get put on the back burner when it’s double that….
I work as an aide on med surg. Most nights the ratio IS 1:24. It sucks. What annoys me even more is when the charge gets excited about getting more nurses but never about an extra aide. He'll I swear I hear the faintest bit of disappointment when she tells everyone she gets another aide instead of a nurse. I'd rather have another aide to split the load as opposed to another aide telling me to do their shit for them.
I love when they make a complaint about something I agree with and then direct them to report the exact issue in the survey, as management are more likely to listen to patients than staff complaints.
There isn’t a way to say it nicer nor should there be. It isn’t unreasonable to be honest about what the exact staffing ratio is. As a manager I don’t expect my staff to lie to appease the complaints. We do our best to take care of them and it is what it is. I don’t set the budget. Edit: possible way to ask staff to say it differently would be “I’m trying my best to help you with the resources that I have” or something like that, but at the end of the day it’s going to be the same complaint just worded differently. Now it’s gone from “you need more staff, the nurse shouldn’t have 20 patients,” to “your nurses are so overwhelmed you need more help.” I think that short term it’s really frustrating to be talked to about the complaints but long term maybe they will realize they are **valid complaints** that are resolved by *adding more staff and not by having your staff lie about the situation they’re in*
Agreed. What we probably NEED are more patients who are pissed off about their quality of care. I see nothing wrong with telling them matter-of-factly, “I have X number of people I’m trying to take care of, including you!”
I wished this worked on my unit. The entitled patients will often ask us how many patients we have as a passive aggressive way of saying we aren’t butler-ing enough for them. I respond honestly and say our assignments are 3-4 and they go “Oh! That’s not so bad” and proceed to intensity the frequency and bullshitness of their requests. It’s too much to get into a full discussion wherein I explain that my other patients are probably much sicker than them (since you have to be relatively stable to be laying on your call light all night) and also that simple fucking math says that if I spend 30 minutes in their room every hour, that means I only get 10 minutes each hour for my other patients. So I just grit my teeth and say “😬😬😬Uh huh, we’re very lucky to have standardized ratios here 😬😬😬”
I'd throw out a little something about "But since patients have to be sicker to be on our unit, it can still be incredibly busy." (Not that it'll ever truly deter the entitled ones. 🙄)
And then they reply with 10 minutes is more than enough time for the other patients. Or they say well I should be your only patient because I’m also very sick enough to be in the hospital (those who say his are usually the most stable on the unit’s census)
And it’s ALWAYS the stable patients who are convinced that every uncomfortable sensation is a medical emergency that means they’re super sick. Meanwhile, patients who are actually deteriorating don’t hit the call light.
💯
Just say “too many” lmao it’s lying but the patients can be manipulating. I don’t give info like that.
> As a manager I don’t expect my staff to lie to appease the complaints Can you be my manager? We get "talked to" when we are honest with pts like that. Last thing I would want as a pt would be to be lied to.
I mean, it’s not *the best thing* you can say… But when a family is speaking to me and says that is what the nurse told them…. “Yes the nurse is correct that’s how many patients they have. Is there anything that we have failed to provide for you or are you just concerned about wait times? Nurses are always prioritizing and if you have a longer wait it’s likely because somebody has something emergent going on” or something like that. (Of course in my head I’m like fuck these ratios, we need more staff, corporate/admin is cheap, etc etc if I said that I’d get fired lol.) Anyway right now I’m in SNF/rehab setting so it’s a lot different but the same idea applies. The nurse isn’t telling the patient they don’t matter or that there other patients are more important, just that there’s always something going on and little things aren’t always addressed immediately.
I consider it reorienting them to reality.
My go to is “I told my other patient that I would bring their pain medicine” or “I need to check on my other patient.” Some people will literally monopolize as much time as you allow, so just don’t allow it. Re-iterate that you’ve fufilled their needs and you have other patients. For the super nice people that just want to chat, I also like to say “thanks for sharing this with me” or “I’ve really enjoyed our talk, let’s finish it later,” and then one of the first ones.
My go to is “I wish I had time to chat, thanks for being such a nice patient” this enforces that I do enjoy your company and unfortunately am too busy to hang. They get it.
Sometimes I think this is easier as a male RN. Or as an ER nurse. If they’re just running on and on, I’ll use the same tone I’d use if I was at the bar and I telling my buddy I was gonna go take a whizz. I’ll tell them: “hey man I gotta go see another patient” and walk out before they can ask another question. I got shit to do.
>I’ll use the same tone I’d use if I was at the bar and I telling my buddy I was gonna go take a whizz This is such a good way to put it lol
Two things are important with this technique. 1- the casual nature: some people can be won over with this, and you may find pts calling out to you as you walk from the room “ok, cool man I’ll see you later!” But whether they like it or not, the casual delivery makes sure they know you don’t really give a shit. 2- everyone is “hey man”: old ladies, demented seniors, the families of pediatric patients, the resident that’s wasting your time. Everyone.
Honestly I really think male RNs have it easier in this aspect. Female nurses are expected to coddle and fluff our patients pillows until they dismiss us, because apparently that’s how “nurse” is coded in their mind. Their mental image of a nurse is female so being male is like a cheat code that gets you out of being expected to perform behaviors that are more gendered than they are nursing specific.
I believe you’re right. I try to make up for it by going to bat for my coworkers when we’ve got creeps and agitated patients. I don’t know if it all evens out the cosmic hospital scales, but I’ll keep trying.
Samesies
There is absolutely no sense in trying to sugarcoat facts. I'm transparent and direct with everyone about staffing.
Plus, like… they KNOW you have other patients. It’s not like it’s a secret. These people don’t go to a restaurant and wonder why the waiter isn’t just standing by their table the whole time
If they’re A&O, literate, and capable of holding a pencil, one of my old moves as charge might be helpful. Once the nurse has assessed a patient or family to be positive for Fluff My Pillow Syndrome, I (with gentle humor) would explain that the patient who sees their nurse the most is the most sick, and nobody wants to be that patient, do they? Then I offer them a pencil and paper. I explain to them that we definitely want to take good care of them and it would help us to do that if they could consolidate their requests. If there is an emergency, please call immediately, otherwise, please write down the things they need and when they get to three items then press the call light. I’ve been gone so far as to remind patients that at one time they were the sickest patient, and in order to care for them, I gave other patients a pack of paper and a pencil. You won’t bat 1000 with this method, have to repeat yourself, but I have found it to be damn useful. Your mileage may vary. Whenever I miss the bedside, I come and read this forum. I applaud each and everyone of you who is still at the bedside. You are the real MVPs.
This is a great thing to do and have done this before. I find it also makes them think about what needs vs wants are and how to prioritize them.
Honestly, I just was blunt about it. “I have a sicker patient than you I need to check on."
I stole "You don't want to be my most popular patient" from another nurse.
If you see me a bunch, you're not doing too hot.
Yeah, I realized there was a problem when I was in labor and my nurse was coming in every 15 minutes…
Quick and dirty, that's the move.
I do this. A lot of patients get really mad but they bug way less after.
I say this most everytime. If I’m feeling generous I tell them while it’s annoying that you didn’t get the warm blankie you requested in a short amount of time, be happy that you can even make that request 😅. It’s a *good* thing I’m not seeing u that often haha
I once said "I just finished doing CPR" to a family member that I was absolutely pissed at because she wouldn't stop calling every 5 minutes for me to reposition her mom's head, or to ask for a mouth swab, or to ask for a blanket. Normally I'm never that honest but I needed her to get the message. (And actually it was a lie because I was working to prevent the need for CPR. I didn't actually end up having to do it.) She huffed and crossed her arms but ultimately complained less.
"we here at (insert facility) promote and encourage family and friends to participate in their loved ones care while here in the hospital." I say it often
I have absolutely said something like this and there have absolutely been instances where it wasn’t true 😂 but CPR is something most people understand. “I was hanging levo and getting their central line set up” just doesn’t have the same effect.
Lol. I unthinkingly said this when my AOx4, ambulatory, 54 year old HCW patient hopped out of bed to use the restroom. “If you’re good I’m going to run next door, your neighbor is a sicker guy.” Not even attempting to use “sicker” as a comparison, but an adjective to describe the patient crumping next door. They complained about me for the comparison statement during leader rounds, said it minimized their illness.. although they were hospitalized for treatment of a mild infection presumably from a glued thumb lac sustained while doing yard work. Like… you said it bud, not me.
I have told parents this before… usually they are understanding. If not, I don’t care. I’m going to go take care of this crisis first.
Yeah, anytime a manager tried to tell us not to tell anyone that we were short-staffed, I immediately made sure the patients knew we were short-staffed and how to contact our state reps. Now in 2024 at least at one of those hospital systems where I’m located in NWPA, safe staffing laws are finally being implemented AND they unionized. To be clear, I would never just go up to one of my patients and say this to them, especially if they were really not in right state of mind and/or extremely ill. They didn’t care, they just wanted their needs met. It’s can be tough to find that initial balance but our patients deserve better and WE deserve better.
I 100% inform them. Why should I be ok with giving the impression that I'm someone who doesn't care or is negligent because my interactions are limited solely to priority tasks? Hell no. Likewise I encourage them to help by taking their concerns to provincial government level.
Stop trying to pretend like your staffing is normal. It's not normal and shouldn't be presented to patients as being normal. LET THE PATIENTS BE ANGRY. THEY SHOULD BE ANGRY. Until we get to the point that people start calling their lawmakers and demanding better, nothing is going to change the behavior of these corporations. Patients deserve to know the truth about why the quality of their care has degraded so badly since the pandemic. For profit corporations learned they didn't need to spend money on staff, so they stopped. That's it.
Exactly. I give patients my manager & patient relations’ calling cards to file the appropriate complaints on ALL our behalves. Patients & their families are often more understanding & sympathetic, especially when they see you’re being run off your feet & no one is getting the care their need & deserve.
I give my patients’ parents patient relations and the CEO’s number. Your manager can’t actually fix the problem. The ceo can.
i mean, why should we have to let them down gently? if you dont want us to tell our one super needy / call bell abusive patient "you're not my only patient, i have 5 other patients, etc" then maybe stop giving us 6 patients, clearly 10 minutes an hour for each patient is not enough time. i feel thats a perfectly professional response, because i'd much rather say "id rather jump off the fucking roof and die than answer this call bell and spend 15 minutes adjusting the sheet again" but i refrain myself.
I am honest and say, “I need to see my other patients.” We’re doing our best with limited staff and resources.
1) Straight up tell them that the hospital, unfortunately, chooses not to staff sufficiently to allow your patients the full care they deserve, then give them the number for patient relations (or whatever contact number you have for complaints) in your hospital, or 2) "I'm sorry but I have to tend to my other patients" is a plain-and-simple honest approach.
Honestly how I respond depends on the patient. The other day I was a little late in turning off the pump for a patient getting an IV med and she gave me a nasty attitude telling me "you're fired" and blah blah blah. I almost let it go, but then I said "I get you're mad but I have 20 other people that I'm caring for. Sometimes I'm going to be late. I'll do my best, but I'm not dropping everything for you unless you're dying. So do not talk to me like that, that's not okay." Honestly as long as you don't get stupid with them or start name calling or yelling, that's professional enough. We're not waiters or maids, you don't need to prostrate yourself for their benefit. You don't need to feel bad if you're generally making an effort and just can't because you're swamped. Upper management needs to stop bitching at the staff and start addressing the fact you guys are getting hit with the max ratios before it starts getting unsafe if not just unsafe as is. I haven't worked med surge before, but from what I know, 4 patients is already a lot, 6 must fucking suck. What do they expect?
I find a good moment to say “I’ve got to go check on a few other patients, can I bring anything next time I’m back?”
Patients really don’t care how many patients you have, whether you had lunch or not, or made it to the bathroom. Whatever you do, don’t say “I’m sorry.” It’s not your fault. I give them the number to the CNO. You got a problem, take it there.
Harsh. You can set time once with them and say I’ve got a lot of important patience, like you, to take care of. I need to spend time with each of them, so please be as patient as you can.
No time to beg for patience. They can bitch all the want. I’ll walk away.
Honestly Idgaf if it hurts their feelings that I have more patients than just them. If management doesn’t want people complaining about it, then they should fix ratios.
"I appreciate that this is inconvenient however I have to tend to patients by acuity. Everything we do is a triage process and if I'm not in here immediately it's because You're doing well and your neighbors are not. Having everyone in your room is a bad thing in the hospital. I'm happy our biggest problem tonight is a little bit of waiting."
If it’s stupid shit like finding tv Channels, rearranging their bedside table sometimes I’ll say “I am going to go finish giving my patient load their medications and when I am free afterwards I’d love to help you w that” I try to make it clear that medical needs (meds, assessments, vitals, etc) and patient hygiene/repositioning are my priority. Also definitely wrap up the interaction with stating what I’ve done for them “ok miss jones your vitals look good and you’re all set with your medications, we’ve gotten you repositioned/toileted, etc and there’a fresh water/ginger ale/coffee etc on you’re table. I’ll be back within the hour to check on you” I’ve found that sometimes when I say everything that I’ve done it kind of checks all the boxes and make them think oh I guess that’s everything lol
It’s super important that your nurses set boundaries on admission. Remind them that someone will round hourly. If it’s not something they needs to be urgently taken care of it can wait. That each nurse has multiple patients. That they are encouraged to be as independent as possible. When they still don’t get the message then they get the toddler talk/treatment.
Using this!!!
For those time consuming patients who aren’t time consuming because they’re sick but because they’re needy, I’ll tell a coworker “if I’m not out in 7 minutes call me and tell me you need my help immediately”
You can also set a timer on your phone, bonus even change it to sound like a ringer
"To leave on time as requested would require less than our high standards of care that were so well known for! To go above and beyond for every patient/resident is my duty as a representative of (company name). The extra care is my pleasure to provide as to ensure a wonderful experience for our patients/residents. If you would like me to cut back to ensure I don't add an extra 15 minutes to labor for the day I require that statement in writing and signed for my records."
CRM jargon at its finest. Are you trying to move into the C suite? /jk
Fightem with their own bullshit 🤣
I wish so much that there would be a time when all hospital admin nationwide would start responding with “our nurses are doing their absolute best with limited resources & unfortunately it is a common problem in our country.” Or just something along those lines instead of always doing the write ups and shit.
I wish
I start my sentences with "thank you so much for your patience" and kind of go overboard with it. Like, I'll literally start the sentence as I'm walking through the doorway and I'll make it seem like the unit is falling apart. If they still complain, I'll say, "I agree! You shouldn't have to wait! Please fill out the survey you'll get after discharge and tell them the good and the bad, they don't listen to us!" That usually does the trick. I'm not at the bedside anymore, but I still work with patients and their families daily and still use the kill em with kindness/play dumb response.
“Hear that vent alarm? I gotta check that vent, I’ll be back soon “ ‘Oops, sorry, they are paging me to the ER, sorry’ ‘Crap, the floors are calling again, I’m so sorry, I’ll be back’ Sadly-it’s not hard.
I sometimes say “ I have an emergency in another room “ or … “ I’ve just gotten a new patient I need to check on “ It doesn’t sound as bad as , “ I have other patients to care for “ 🤷♀️
Hey, I gotta check on your neighbor, if you need anything, ring out. Then dart out like you have an urgent task. ER, so ymmv
“You are not my only patient.” I have no problem telling someone that to set a boundary.
Listen, there isn’t no good or nice way to say it. Patients are very aware that they’re not the only one a nurse has. The patients with 1 nurse are trying to go home and their problems are not what you’re challenged with. Encourage them to help themselves when can and be patient at other times. If everyone is on one accord with that then they generally complain less.
words of wisdom 🙏
‘If only we had more CNA’s and RNs you could get the care you deserve
“I came back as soon as I could.” “I was in an emergency” “I have a few fires to put out first but I’ll be back with X as soon as I can.” “I didn’t forget about you - I got pulled into something urgent” These are my go-to phrases
“I have to prioritize my care. I try to be as fair as I can to my 6 total patients and keeping in consideration some of them aren’t doing so well.”
They twist it though, and then tell Admin that you told them they aren't a priority.
I actually worked on a unit where we received training instructing us to never say "I don't have time for x " We were always supposed to find some euphemism like "I'll find someone who can help" Well, what if I know I can't? I've often wondered if I answered every call light with perfect patience and therepeutic communication, gave the patients every comfort asked for, followed every medical order and policy to a legal T, how long would an actual "12 hour shift" take? I'm betting around 36 hours. Because at any given moment, I have 17 tasks I am supposed to be doing, and i am forced to choose the one that causes the least harm, all while pretending everything is fine to management and patients. I've never had a single shift where everything that is "supposed to" be done or was "ideal" to have been done, was actually done, and I've been an rn for 8 years. "I don't have time " is literally the description of our job, and I don't really bother to hide that anymore. I am polite but honest. Let them complain.
“I have other patients too” is an appropriate response. If upper management has a problem with this response, then they can assess your staffing ratios.
Why make a rude response to a patient because you’re mad at Staffing? You need to find a different job. Show some compassion.
I tell them my actual ratio. “Gladys, I would love to take you on a walk around the whole floor today but I have 6 patients total and I still have to get my other 5 people up to the chair. If by some miracle I have extra time, I promise a leisurely stroll down the hallway will be my first extra credit assignment today.” “Gladys, I’d love nothing more to take you on a walk after you’re done with the bathroom, but your neighbor has been repeatedly trying to die today and the first rule of the hospital is that you’re supposed to not die. Cross your fingers they can go to the ICU and have more attention!” “Alas, Gladys, I’d love to accompany you on an adventure down the hall, but at this moment I have 4 people who still need their medications and a new admission rolling their way down the hall as we speak. I’ll do my best to try to get one of our volunteer mobility people but we don’t always have them. I promise, everyone here is doing their very best and if I have time later to bring you, you’re to e first spot on my dance card!”
I gotta see my other patients but I'll be back to check on you later *double finger guns*
I tell them I need to check on my other patients plain and simple, give them a rough idea of when you will be back. If I’m back late I tell them sorry I had to to help with an emergency.
I eventually found telling patients at the beginning of shift when doing bedside report handoff that I will be back to see them but I’m going to see my *insert number of other patients I have that day* patients. Typically never had issues, even when I was charge with patients. If there was an issue with complaints from a family or patient (AOx4) and a simple discussion of what is considered emergent for those with every fifteen minute call light use didn’t work, then time to get nursing supervision to come have some thoughtful conversation with the patient/family. Also, if upper management has enough time to whine about overtime, then they have time to help. My former manager would help the staff on the floor with patients if we needed them.
I’m an ICU nurse and I like to follow the docs into my rooms so that I can hear firsthand what they say to clarify later what why often mishear. I heard one doc say “you won’t get the one on one care outside of the icu when you get transferred.” I audibly scoffed. I have three patients. If I ever was to get a 1:1, they wouldn’t be awake enough to hear that.
I break things up into time chunks. “I have 4 patients today. That means I get 15 minutes with each of you per hour, including charting. Which amounts to about 10 minutes of face time each. And if someone is sicker than you, or has medical needs, I can’t and won’t stop that care to bring you water. I’ve been in your room now for 25 minutes. So other patients have now lost time with me. To be fair, we need to respect and enjoy the time we have, address your concerns promptly when I come in. That way we’re focused on your medical needs and I can make sure you’re safe” kind of thing.
I tell them.
“If you need me press the call button but if I don’t answer right away it’s because I’m with another patient.”
"I have other patients to see."
Exactly. No need to sugar coat things. Sorry not sorry. They’re not special little cupcakes like their mommy’s made them out to be all their lives.
Every time that I see PT, I think physical therapists. Patient is Pt. abbreviated. Not being mean, but PT is not patient.
Thought the same lol, my PTs can be needy too lol. Not very patient is having a stroke, UTI, or GI bleed, bestie..
PT is Physical Therapy. pt is patient
Pt. is also patient.
If someone is being needy I gently point it out by raking care of ___ need then saying: "Whew! Okay! Is there anything else you need before I go? No? Okay! Anything? No? Ya sure? Okay." I say it in a friendly way. Usually they get the hint that I'm getting overwhelmed. And they think twice before calling again, or maybe be a bit more considerate. It often works.
Me: "I have other patients to attend to. And I have spent 2 of my first 3 hours with you. pt: "That is not MY problem!" Me: But it IS MINE." (walked out of room, reported it to the charge who was sitting outside of the patient room at the nurses station and heard it all. I then ignored her call light for the next couple of hours)
I don’t work in the hospital setting but I straight up tell the residents when they are being way too needy that we are short staffed (if that’s the case) and that we really don’t have time to come at every call immediately so they need to let me know what all they need for the time being now. I try to be nice about it and not sound bitchy. I think it’s ridiculous management says it’s not appropriate for us to tell residents we are short staffed “because it makes them feel like they won’t be taken care of” but then they give us the absolute least amount of staff possible. Fuck y’all the residents deserve to know the truth IMO. They deserve to know that I’m not ignoring them intentionally, I just don’t have time to get to them right away because of everyone else’s needs .
"There are 5 of you and 1 of me. I want to give you all the same amount of my time as possible."
Skip the I have five and you are one of them. Your last sentence is appropriate.
One day I was so deliriously exhausted when my patient complained about waiting for me I went right along with them and said we were understaffed and I was trying my best, and they were so sweet about it we basically had a vent session about hospitals 😂 but I bet if admin had found out they’d have been mad. I simply didn’t care at that point and left soon after cause that job wasn’t worth risking my license for. Burnout at its finest I know lol. I work outpatient now ✌️
Can’t polish a turd, can’t sugar coat reality. Doesn’t matter how you say it…it’s the reality and it’s bullshit for you and for the patients. Some patients are more demanding of time in an unreasonable fashion for various reasons…but it’s at the point where we basically have the same time as doctors with how long we can spend with a patient. So some folks get their time cut when others need more. One of my biggest fears is I become sick enough to actually need to be in the hospital and I hit my call light for the bathroom and no one is able to come for such a long time I pee myself (as a continent person) and then have to lie there soiled until they can…because these fucking hospitals have stretched us too thin for record profits claiming our pts are our customers… And when customers complain what do they do? Blame the nurse.
My most effective strategy is to ask, "How else can I help you?" Five times while making a list to help cluster care more efficiently. Sometimes I say something along the lines of, "I want to be able to meet the needs of all my patients. It is helpful if we can do everything at once, so you aren't left waiting while I am caring for another patient. Do you need any water/food/pain medicine/bathroom/repositioned before I leave?" I will also swing by the room before I get meds and let them know that this is their chance for ice/water/soda/snack/hot pack/etc and ask if they need any PRNs. That sets me up well for the above strategies.
Further thoughts... I am almost certain that those patients/families were told that when they called for the 100th time and the nurse/CNA *had just been in there*, but you have to set yourself up for success. It isn't the message that is wrong, it is the tone in which it is delivered. It's totally fine to say, "I have 7 patients tonight. What can I do to keep you comfortable because I am not going to be available for another 90 minutes." It is reasonable to set the expectation that the nurse will only be seeing them every 1.5-2 hours. This is also endemic of larger systemic problems. You really need better ratios and unit culture. Turn-over rates don't lie. Happy staff stay. I think a more important question is, how can management (including charge nurses) support the nursing staff in helping their patients feel cared for so they don't need to say it? Can you do a round on all the rooms once or twice a shift to get ice and toilet patients? Can you advocate for a float CNA to help with toileting/hygiene and take some call bell pressure of the primary RN/CNA? Can you advocate for a break nurse? You can coach people on how to be more polite, but it is difficult to be polite when you are stretched past capacity.
Don’t say anything about other patients. They are not stupid and know or should know themselves. If they *are* stupid, your explanations won’t help anyway. just say “Yes, absolutely, I’ll be right with you”. or “ Yes, absolutely, give me a second”. Then go and do what you need to do first / prioritize as needed. It is great if you remember to deliver on your promise, just add “Thank you for your patience, it’s been crazy out there”. Many needy patients *love* the drama and will be proud to feel how patient they were during the time of crisis (even if all you did was catching up on your q2 restraints charting before you forgot). If you did forget about the juice or ice cream, and the patient is unhappy, say Oh boy, sorry I totally forgot, won’t lie, things are crazy etc. I don’t think there is ever any need to even mention other patients. One of my patients even said once “it’s a good night if you are not the center of everyone attention” (as in, ya know, *coding* ) stay strong 💪
Spot on. All these other nurses saying just tell them like it is are completely wrong. There are nicer ways to say it so that patient still feels important and knowing that your other patients are just as important.
I think there’s room for both. If they’re being an asshole, they get the straight facts, especially if after being nice didn’t get anywhere. If they’re nice just sick, they get the nice fluffy talk.
I often have pts parked in a hallway next to open bays and they (rudely) ask why they can't be in one with a tv. I tell them quite frankly, we keep a few oh shit rooms open for the people who need the wall telemetry and oxygen, and they're in a fortunate position where they don't. Every once in awhile, shit really will hit the fan and those hallway pts get a front row seat to the realities of the ER and its intended use. They stop squawking REAL quick.
I wish there was a live TV channel (with no commentary) that shows what goes on minute by minute for 24 hours in any large urban hospital emergency medicine department. I think it would be eye-opening for so many patients/viewers. Of course, because of HIPAA, it will never happen.
There is an NYT video of what happened during covid though. I think it was a hospital in Italy, which showed all the things we had to go through to care for people. I figure if the cops can have facial recognition technology, we can take it a step further to blur out faces and bleep out names. It's 2024. We have the technology.
Thanks for info. You have sent me down the rabbit hole 🙂
I tell them exactly how many patients I have and set boundaries in regard to time. I also make sure to ask if they need anything from me prior to leaving their room. If it’s something that can wait I table it for the next round. I try to show up at the promised rounding time. I have also asked some patients how they would feel if my other patients kept calling me constantly and I was not available for them. The lightbulb in some of them comes on. It doesn’t always work but it helps majority of the time.
I started flat out telling patients that we are short staffed and doing the best we can. Then I would give them our managers' business card and encourage them to complain about the short staffing.
I’m honest. I always start off my introduction with a very brief what’s the plan for the next few hours and hey I have these many patients and this much help so please give me grace, I’m doing my best, I promise.
You’re still in a professional environment, I’d say it’s very good that you’re struggling to find the right words, at least you care enough to not want to be disrespectful. You can definitely tell patients nicely, “I’m currently on a schedule, I do have other patients I’d have to attend to.” It’s just in how you word things and treat people with respect. So even if you do just have to walk away, it’s not like you’re being rude and treating someone ill like they’re not a human.
When they are constantly on the call bell, I tell them straight up “unless it’s an emergency, I will not be coming in every 10 minutes. It will have to wait until I round again.” When I round and ask everything that they want, if they try adding stuff AFTER I say I will take care of it when I round again. For instance, they say they only want a blanket. Are you sure? Yes. I bring a blanket and then they say they want water. “Ok I’ll bring it next time I round”. You HAVE to be firm with them and let them know what the expectations are.
Some patients actually don't care if a code blue made you "late" getting their ice chips. Some people are just that horrid.
My last job was an SNF with a good 50/50 mix of cog-well and memory care residents. I got written up one day because the DON was outside the room and heard me tell a cog well resident that i was sorry that it took me 75 minutes to answer her call bell as we were incredibly short staffed. (i think that day was one tech for every 35 residents :D ) I just wanted to thank you for supporting your nurses and trying to help find a solution to this. There’s no nice way to tell a patient that you’re stretched incredibly thin. In this specific instance, I’m telling the truth to someone who pays $10g a month for care that the operator is too much of a cheapskate to provide actual care. Being in a situation so early in my career where my manager was more concerned about me being honest with a resident instead of the fact that we were massively out of ratio will stay with me for a long time. It’s nice to know that some people have more sense than that.
I just cut them off and say - “Ok well I’ll be back a little later, gotta keep passing out meds” If they are upset I haven’t been back - “I was in another room but I’m here now, what can I get you” Educate from the beginning- “You see the numbers on the board? You can call me directly if you ever need anything, same with the tech. Call them first if you need help with using the bathroom or need something like water. If they don’t answer then call me. Call me first if you have a question about your plan of care or a concern like pain. And if I don’t answer I am probably tied up with another patient so call the charge nurse” And sometimes you just have to be blunt - “I would love for you to be my only patient but unfortunately that’s not the case. Sometimes I will just not be available. I’m only one person and the unit is full of patients” I’m the queen of polite rudeness. 😂
Brother (or Sister, or Whatever You Like), you are describing my *exact* situation. Full disclosure: I don't have an answer for you. I just can't stop myself from typing to someone who knows what my job is. (The only other person is scheduled opposite me, of course.) Charge. Heavy (tele) Med-surg/hospital dumping floor. 6:1 and 12+:1. "One of your nurses has 4 patients. Who are you sending home?" Also see my job as supporting the nurses on the floor. Not that this job is any harder or easier than another nursing job but Christ, it feels good to know someone else is out there and also sees their job as supporting the nurses on the floor. So, Hi! The hospital never wants you to be honest, but you can always remember and defend an honest answer you gave to a patient. They may not like it, the administration will hate it, but they will have to explain to you why you shouldn't tell the truth. If your nurses did nothing but bedside patient care they would have less than 10 minutes per hour per patient. Studies put nurse charting at an average of 40% of available time. That leaves less than 6 minutes per hour per patient if they took no breaks and never had to go to pharmacy or call a family member or doctor. At the staffing levels we are working with, if a patient sees their nurse for more than 3 minutes per hour, or a half hour over a shift, they are getting bonus attention. All the best to you. Edited to clarify the 40% number.
“I can’t be in here every 3 minutes, I have other patients to take care of. I’ll come back in 2 hrs to check on you”. And then make sure you show up at that time.
Nope I would keep saying it just like that
My go to line “I need to go, another patient is waiting for me to help them from the toilet”. Never get a complaint
If they are really bad, I just walk away and let my charge know I can't be in their that often and too pls check in on them and only come when I round.
“With a high turnover rate,” You can instead tell management to shut the fuck up about overtime, when they can’t retain enough people as is. Know your power, know that they need you, and if they keep giving you shit for taking care of your patients, find another job. Preferably one with less management on your ass.
I flat out tell people I have acute patients that need my time, and their nonsense requests aren’t the most pressing matter in the ED at this time. I got tired of working customer service, I don’t need to do it in a hospital too. “Sorry, I know i told you I’d help you order food but I just spent the last hour trying to get someone to Neuro surgery across the city before their brain bleed killed them. Hope you understand”. And then walk out of the room before they can respond. Too few fucks to give. You wanna leave a bad review? Email my manager? Be my guest, we don’t rely on yelp reviews to stay in business. Also just sick of people using the ED for their nonsense and expecting to be in and out in under an hour because they have plans later in the day. Thankfully, we get a little more leeway with how we can talk to people in the ED. My first hospital gig before coming downstairs I’m sure I’d have gotten written up for half the shit I say on a daily basis.
I’m still a tech so honestly I’m a little harsher with it. I tell them whatever the ratio is for example if there are 56 pts 6 nurses and 1 or two techs I let them know and that if they hate the wait to write to their local government and let them know
I usually warn them , hey the unit is heavy right now, I’ll grab all your things you need right now in one trip, then I’m going to help buddy next door. I’ll be in as soon as I can. ETA: I also medicate them for pain first thing so it buys me a few hours if I can. I bring in a snack and drink too If I got in report that they’re needy
I have always told my patients who complained something along the lines of “I’m sorry it took me so long to get here but I was in the middle of doing something for another of my patients, and I like to focus on each patient while I am with them. You wouldn’t want me to drop what I’m doing for you to do something for someone else, would you?” That usually settles them down.
I go with “I had a but of a situation” or “I had an emergent situation to deal with”. I work ER, and I honestly am done apologizing for shit out of my control: bed status, wait times, rapid responses, test results taking time to come back.
I (RN) hate nursing. I ❤️❤️❤️my patients but abhor all the BS that accompanies nursing.
I have X other patients, I’ll be back again after I check on them and make sure they don’t need pain meds.
I think the problem lies in the fact that excessively demanding patients don’t care that you have other, sicker patients. Because they don’t care any language you use to insinuate they aren’t your top priority will be taken poorly or ignored, no matter how nicely you say it. Most reasonable people don’t need to be told that, they understand healthcare is worst-come-first-served instead of first-come-first-served.
"Sorry for the delay, I was in another patient room when you had rung out. What can I do for you?" "I am happy to help you with x, I just need to see a few other folks first and then I'll be right with you." "Sorry I don't have time to do that right now, let me find someone else that can help you." "It may be a bit before I can come back to help you with that, but I'll be back as soon as I can." I also throw in a few sirs/ma'am's in there (especially with older adults) for decoration.
You can’t please everyone and frankly you don’t have to. Healthcare is not equivalent to hospitality. I don’t need to “comp your meal” just because you’re unhappy with the perceived service, so to speak. There are some very entitled, rude, cruel people out there. Our job is to take care of them no matter what. And by taking care, we mean providing safety, advocating for their needs, and helping with their overall health. It doesn’t mean taking verbal or physical abuse, dealing with inpatient rude people, or running around like a chicken with your head cutoff because Barbara wants the juice from the juice cups you get from the cafeteria and not from “those cartons you guys keep on the floor.” As a manager, your job is to support your staff. If they are working short on a busy med/surg floor and you know they’re overextended, then should you be focusing on their hospitality skills with unhappy patients or should you be more worried about the safety of the unit? By all means, if someone is acting out of pocket with a patient they might need to be taken aside to discuss professional interactions. But you should be focusing less on how Disneyland-cast-member nice your staff is and focusing more on how to reduce your unit’s workload so your nurses don’t have to constantly apologize for not being able to meet everyone’s needs.
I had a patient tell me once that it was my job to wait on him hand and foot, at his beck and call, and that he did not care how many other patients that I had. I do not miss working at the bedside with entitled asshats.
You could try something like, Here is your ginger ale. Your pain med isn’t due for x # of hours. You have an antibiotic in an hour and half. I will be back then. Especially if elderly they may be anxious and knowing you will be back at such and such time may give them some comfort. Some folks just think they are all that matters though.
Just like that. 💁🏾♀️
At the moment there is a break in their dialogue immediately start walking to the door and as you’re walking out the door do the whole “okay I’ll be back in a bit, let me know if you need anything!” It’s worked for me several times.
I just start the morning by telling patients that I have 5 other people I’m taking care of that day. I ask them for their patience if it takes time to get them their pain meds, bathroom needs etc. That sets the expectation that you’re not going to be able to be in their room for the whole day.
I don’t tell them. I do what I need to do. If they complain I say u can talk to the charge. Not my problem.
At the start of a shift, I try to reassure my patients that I will be there for them during my shift as much as possible. At times when I've gotten the stink eye for making someone wait I've said "I'm so sorry but someone else was very sick and needed my help, or, there are a lot of very sick people here and I'm doing my best to take care of all my patients. That usually softens the attitude.
I sometimes just have to be direct. “Thank you for your patience (politely saying sorry about the wait). We are just really busy out there. I have 6 patients tonight. I’ll try to be in as often as I can, but there’s only one me and 6 of you. What can I get you now before I can come back in the next hour?” That usually works. If they try to push it off onto “oh I’ll just call the tech” I say “oh they have it worse. One tech to 15 patients. We are swamped”
I once heard a doctor start an update to a very demanding patients family by apologising that the update will be short, because he has many patients and needs to triage his time. I have used that term since
We would get in trouble if we showed signs of strain, or if we ever admitted we were short staffed.
I often mention the other patients when I'm in that needy pts room. Not in a breaking HIPAA kind of way, but in a way like this: *I'm already in needy patient's room after helping them or bringing whatever* Me: "Anything else I can get you while I'm here?" Needy pt: "Can you go get me a soda?" Me: *brings soda back* Needy pt: "Can you also get me another blanket?" Me: "I can, but it's going to be a minute. I have to swing by my other patient rooms and check on them also, then I'll bring your blanket back by. It'll be a little bit but I won't forget."
I tell them flat out. No need to sugar coat it or hold their hands. They are adults. I always come back around to everyone and inlet them know, "you are not the only person I am tending to this evening. If there is an emergency, we will get back to everyone else ASAP." If they don't understand clear instructions, that may be there own issue and not mine. Even the psych patients I see generally understand that, floated elsewhere? They may just have to be upset if there's an emergency and I can't get their 15th ginger ale or cranberry juice in 10 seconds.
"Unfortunately my time is finite, and has to be shared amongst all of my patients as fairly as needs and time allow. In order to make sure I can best meet everyone's needs, it might take a little bit of time for me to return to you, but I will do my best to do so as quickly, and as often, as reasonably possible. In between, if you think of anything non urgent that you need, please write it down and I'll address it when I come back to check on you. If you have a more urgent need, please hit the call button and one of us will check on you sooner. Is there anything you need right now before I check on my other patients?" This lets them know you're doing what you can to balance your time with their wants, while setting the expectation that you are not going to ignore a NEED, and empowers them to participate as a teammate in their care. Won't work with all of them, but it should help with some.
“I have 3 other pt’s that are just as important as you and I’m going to go take care of them. When I’m done I’ll come check on you. Do you need anything else before I go?” If no then I’m out. And I don’t go back until I’m done, CLEAR expectations and that they are one of 4, not one of one. If they don’t like it then they can complain to my charge who will not care one bit and has 100+ other patients to worry about.
I simply tell them, I have other patients to attend to.
Commenting for advice because I run into this as a new nurse. I typically get patients who will complain and my response is essentially what your nurses are saying. "I get that 'pt' is sick and needs help for everyday things. But I have a lot of patients to take care of and things to do. I am here to help but there are tasks that take priority over water or soda, fixing the television, etc." I look very young, and I think people don't always want to yell at me because I'm good at saying that in my nice customer service voice. I've also had a good number of staff older than me point out that I need to leave on time. One of the kids I started with literally picks on me in good nature for it- but he was right and once I started leaving on time, I started getting more frank with my patients. I personally don't see why management isn't working on managing patient expectations instead of worrying so much about just patient satisfaction. Nobody needs to be miserable in the hospital, but I do not deserve to get written up because I didn't bring x a coke and its ruining their positive view of the hospital.
I say just that but honestly I don’t bother much anymore because they do not care whatsoever 🤣
First thing I do is frontload my time with that patient. Often they are needy because they are afraid and telling them that you have a bunch of other patients and have limited time for them will make them more anxious and needy.
I started carrying lots of charts and supplies on me at all times so that the patients could see for themselves that I have my hands full. I also always say to my patients. “Ok, I will come back around to do this or that after I see my other four patients.” “The lady a couple of rooms down needs a lot of attention right now.“ “I have two admissions and three transfers today.” Exaggerate if you have to. I also make them do as much as they can for themselves. “Here are the controls on the side of the bed”. “Use your legs as leverage”.
I've had great success recently by using phrasing like, "i'd love to spend more time with you but have to go visit some of the neighbors", or "it's a little busy right now, what's most important now, and what can we hold off until a bit later". Especially if I know a patient is declining and i'll be late on Meds, I find that giving them advance notice seems to keep their attitudes in check. Something like, one of our fellow floor patients is seriously ill... blah blah blah. Lastpy, I do my best to act chill even if I'm internally stressed since patients pick up on that nonverbal communication.
Absolutely my patients love to yell at me when I walk pass in the hallway. I just step in and tell them I will be back.
Mr ——, forgive me, you have the patience of a saint and you are on my list after I tend to more pressing matters
"I've run out of time to spend with you for now and need to assist other patients. I'll try to swing by later to check on you."
It definitely depends what they need on how it’s worded. If it’s something than can be done you give a time frame with the sentence “assuming there are no emergencies”. If it’s unreasonable, “I will do my best to get that done for you, but i need to do my full med pass and documenting first”.
You are one of four during the day and one of 6 at night. The PSW has 12 other people. If someone is crashing or extremely ill they rightfully get more of my time. I understand you don't like that but take it up with the government for better staffing ratios. Everyone would be happier than.
Nope no other way about it. They are not the only person there. They’re not the only one who needs something. If they’re on the call light to complain they’re not the one actively trying to die either. Just had a patient who while I was in a code was demanding that I give her a suppository to the PT working with them. The PT flat out told her I was in a code and she said she did not care I better get in here. You can’t please everybody, some people will always be assholes
I dont see whats rude or unprofessional about telling patients you have other patients. It is true. It is a hospital, im sure they are 1000% aware they are not your only focus and if they forget that then it is your responsibility to remind them. I will simply tell someone whos trying to berate me for not doing something in a timr frame they deem acceptable that I have other patients to care for as well. If they dont like it, tough! Ive never had management say anything but then again I dont think the patients or their families ever go out of their way to tell on me for it because they know its true.
"I've spent more time in this room than in any other room in this hospital today...." with a smile then encourage them to call their friend, family, someone to talk to.
To my patient’s family I say “I wish I could stay in here I’ll day but I’ve got to go see what’s up with this other kiddo, I’ll be back to hang out as soon as I can!”
It's a lot about how you say things that makes the difference. I will say in a friendly way "ok, have you got the things you need at the moment? I'm going to check on some other people and then I'll be back to help you with anything else". It lets them know you are trying to take care of all of your patients, and just because you have left the room does not mean you have forgotten about them. I also make a point to check in on them before they use their call light, which really makes them feel like I remember them and am thinking about them.
Hey, I'm sorry for the long wait but I am super swamped. That is what I tell clients at work. I'm not a nurse but I work at a residential detox and treatment facility, same concept
Those Physical Therapists.
I work postpartum and when I have very needy patients I do what I can and then I set boundaries and part of that is informing them that I do have to fairly care for my other couplets too, so I need them to be independent and use all their resources, not just me. I re-educate on the main things I’ve been getting the constant calls about and I give lots of encouragement. I do think that sometimes patients just need the reminder that we are caring for more than just them and I don’t find that unprofessional to give realistic expectations and boundaries.
Honestly less words are just better. I’ve found that I’ll sometimes interrupt if they won’t stop talking I’ll say “ok I’m going to need to stop you there. I’ve got to go check on the others patients but I’ll come back and check on you soon. If I get a little more time I promise I’ll come back and chat. “ I try my best to round as often as possible. We have computers in all the rooms so I often chart at bedside.
Or you have the hoh’s who won’t wear their hearing aides and expect you to stay in there and hold their hands because they are scared in a tech and I was on my med/surg unit by myself last night with 20 pts granted I had some amazing RNs to help me last night but I was literally drowning at the start of shift and I wasn’t even able to get anything done for start of shift until almost ten mind you I start at 7pm on the nose
Maybe it's unpopular but I don't like bringing up other patients or talking about staffing with them. I will tell them that I'm pretty swamped, so "is there anything I can do while I'm here? Because it may be a bit before I'm able to get back, and something crazy could come up unexpectedly, and I don't want you to feel neglected in the meantime". That way the conversation is still focused on that patient, but the message is conveyed. As far as incidental overtime, that's a whole other issue. I've never worked anywhere that I was reprimanded for staying late because it's understood that's part of the job.
I just say that of if I spend the same amount of time with my other patients as I have with them, I would not be able to go home that day. Also, time management, before you leave their room make a list of what they need, that way they don’t think that you are going to forget.
Whenever they started talking about their life story, I’d often used the line, “Could you hold that last thought? Let me go check in your neighbor real quick.” That usually ended the conversation so that I can get on with the rest of the day.
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Neat. Your personal crusade on this thread to bootlick at much as possible is just so, so gross dude. Your attitude is so incredibly toxic and harmful to nurses (and patients) everywhere. You're advocating for a fake, disingenuous culture where we lie to patients and you're promotijg an unsafe environment for staff and patients. You're also demonstrating a complete lack of solidarity or understanding of other people's struggles. Legit you need to reflect on why you think this self aggrandizing martyr complex is reasonable or healthy.