Dealing With the “Toxic Patient”

New nurses just out of nursing school can be somewhat shocked by the challenges presented by “problem children” in the patient census. While every patient may have the expectation of the full range of services and care a nursing home or hospital provides, some patients do overtax the staff to an unusual degree. It is the facility’s choice whether or not to continue offering care to these patients. But nurses should not ignore symptoms and condition risks, no matter what hullabaloo the patient causes.
What is meant by the “Toxic Patient?”
The “toxic patient” is patient who experiences limited medical problems but exhibits uncontrolled outbursts, exaggerated symptoms, and conducts themselves in an annoying and distracting manner much too much of the time. They can make life miserable for other patients, room mates, visitors, and staff at every level. If one or more exist in any floor or ward, chaos can ensure at any moment in any shift. Important charting, endorsement reporting, or assessment activities can be interrupted. Nurses and CNA workers can start to call in sick to avoid shifts that have become too much work to handle.
The Burden of a “Toxic Patient” on a Hospital or Facility
The burden of a ‘toxic patient” can creep up. Dementia can play a role. If the patient’s aim to is to disrupt or annoy, they may simply escalate behavior on an ongoing basis. Finding out just when the patient will go too far is an ugly surprise. Tension and irritation can build. Nursing supervisors may acknowledge the problem, but depend on a full shift of nurses to cope. Then, nurses start calling in sick at the last moment, and the nurses that do report for work have their hands full. Administrators can experience headaches when the housekeeping staff, nursing staff, and dietary staff start stressing out and run in circles trying to please the “toxic patient”.
Facility Requirements for Toxic Patients
Such patients can require a hospital to engage additional staff just for that one patient. Monitoring one patient is not a cost-effective way to staff a hospital or nursing home, and these costs invariably end up as part of the overall assessment for the care plan of that patient. if no improvement is within view, and no intervention will work, a stalemate occurs between the duty of care and the real-time potential of the facility. Their duty of care commits them to deliver ongoing environmental nursing care, but the pushback from nurses and patients create s a firestorm.
Student nursing textbooks cannot illustrate the challenge of a dealing with a “toxic patient” while balancing the needs of an entire floor or ward of other patients, as well as dealing with the pharmacy, running IV lines, performing dialysis, charting nursing progress notes, and tracking medicine counts. “Toxic patients” have little to no curb on their behavior, choose consistently to break accepted facility or social barriers, and insistently pester nurses and other persons within the hospital or nursing home. Such a patient is completely beyond a home health situation. The patient community of a facility or hospital can be altered negatively just by inclusion of the “toxic patient” in group patient activities.
The “toxic patient” also disrupts the well-being of other patients. On this basis, they become a liability of any facility, because they stretch the resources at any given time constantly enough to cheat other patients of their allotted times with nurses or staff. generally speaking, a “toxic patient” can absorb 9/10 of a nurse’s spare time per shift. And when this demand overlaps the allotted time for any other patient, this “toxic” individual becomes liability to other patients as well. On this basis, patients can be liable for discharge or transfer if they become too irksome a burden to staff and other patients.
The “toxic patient” is one who refuses to heed warnings or “hints’ from the institutional staff. Such behavior is charted and discussed in the care plan meetings. Often a nursing home or long term care facility will meet with the patient, guardian, family or conservator to discuss such behavioral problems, often a psychiatric consult is advised. Yet the family or the conservator of this patient may refuse this. The social stigma maybe overwhelming for the family, and the impress upon physicians to limit psychiatric intervention may weigh heavily. The times leading up to any resolution are seriously taxing for any nurse. There is only so much a place can “suck up’.
But often, even when a patient has a long history of transgressing beyond patient norms, neither medication nor physical restraints are present or advised. Either the family members are in denial, or the physician does not have an accurate assessment of the case. It is important to complete incident reports and contact supervisors when such behavior occurs. Furthermore, sometimes a nurse may have to decide for themselves when it is a good time to call the physician (or social worker) and advise him of the seriousness of the patient’s aberrant behavior.

Circumstances will arise in which a nurse or nurses will look back and wish very much that they had used all their observational skills and cited occurrences involving the “toxic patient”.

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