When Nursing is More Than Just Patient Care

The education of every nurse is for the goal of sorting out skills from knowledge. A nurse can’t just have knowledge derived from textbooks and lectures. A nurse can’t just operate from observed skills, either. It’s the combination of both nursing skills and medical knowledge that renders an individual capable of actual career nursing. Add to that the experience that comes with nursing for any stretch of time, and the nursing career takes shape. As the nurse graduates through successive levels of treatment and responsibility, they are trusted by a facility or hospital in the application of special procedures.
Nurses can practice applying their skills in patient care by using “example” patients in scenarios where they are formally performing nursing duties for that “patient”. A nurse that is overly strict and too tunnel-visioned to interact with the patient easily will run into problems in the workplace. Patient fatigue, bruising, lack of appetite, and/or unexplained pain should be presented to the supervisor at once. But a nurse who is too strict and/or distracted by personal chatter with other employees, another patient’s problems, or interaction with family members or guests does their patients a disservice. Maintaining focus is an excellent skill for professional nurses in the workplace.

A Day in the Life of a Professional Nurse

The pace of a day in the nursing profession can be hard to get used to. Thinking about nursing skills and remembering important information isn’t enough. Nurses need to update their knowledge of each patient’s chart, comprehend endorsements from the earlier shift, hand off important duties to qualified staff such as supervisors, certified nursing assistants and licensed vocational nurses. Case management responsibilities may fall to a desk nurse, but the medication nurse must serve as a conduit of patient wishes and advocates for patient care.
The pace of the shift takes its cue from the total number of patients the nurse is responsible for, and the frequency of calls to the bedside from each patient. If the patient needs accelerate and the number of calls spike, it is appropriate to notify the nursing supervisor or the Director of Nurses to staff accordingly. Specific chores such as giving IV medications, assessing new intake admission patients, recording vitals for special needs patients, and delivering special treatments such as dialysis and/or oxygen administration can fill a shift before you know it. (And then there is still the charting to do).
As in every job, timing in and out is important to maintain the integrity of the facility’s nursing acuity. Oversight agencies evaluate the timekeeping rolls to derive the accurate account of the nurses assigned at any one time. A nurse who regularly arrives late or misses an entire day of work creates a practical problem that may take hours to solve. In the case that no other staff are available, other nursing staff may have to increase their workload and absorb that nurse’s patient assignments and duties. This can have a negative effect on patient care and reduce the allotted time each nurse can regularly spend with their patients. Patients will notice and feel passed over or that their case has been “rushed”.
Timekeeping is an essential but irksome chore for every professional nurse. Arriving to work on a timely basis and staying after when needed are invaluable qualities in a career nurse. Flexibility in scheduling makes any nurse a prize who is very attractive in a competitive hiring market. Nurses who arrive constantly on time will be given priority and also will get preferred responses to requested time off. Nurse who regularly call in sick or miss work, for any reason, will find themselves short hours or written off the schedule altogether.
Nursing is not always just about medication or vital statistics. The term “bedside manner” is a joke in some circles, but a very real and desired trait in professional nurses. Each patient needs to feel as if their needs are being met. Positive statements, cheerful questions, and small jokes can brighten up a patient’s day. Nurses can easily underestimate how the smallest word or gesture can seemed magnified to a patient with little outside or family contact. This directly affects the quality of care offered by the hospital or facility. During surveys and in feedback sessions, patients often remark on these issues. Positive feedback, online or via word of mouth, is crucial to any organization today.
Patients prefer to rely on key staff and feel better when the routine of their day is supported. The welfare of the patients is the priority of the nursing supervisor. New staff should maintain the behavior and tone of the other nurses. Otherwise, patients can feel estranged. A proper evaluation of the nursing staff should be their flexibility to medicate and treat each patient in the facility, not just the “chosen few”. (And charting must be consistent as well). Puzzling out idiosyncrasies is not a skill every nursing manager has. An hiring institution bringing new nurses on board expects a concordance to facility norms. To do this cheerfully and in a consistent manner is what every nursing home, private patient, or hospital wants.
Encouragement of activities and interventions according to the care plans in the patient’s charts will help the patient feel supported and well cared for. This kind of goal can help patients handle pain, lessen anxiety, and improve their ability to communicate ills and problems some patients might otherwise feel embarrassed or discouraged from sharing. The duty of care falls to the institution and its staff to observe the entire range of symptoms and conditions noted for that patient, as well as known contraindications and/or medical risks.
If a clinical condition becomes exacerbated, the nurse must be able to note increases in pain, swelling, blood pressure, blood sugar, nervousness sleeplessness, and general well-being, all from exchanging a few words with the patient a few times a day. The investment of a few jokes or special inquiries about personal interest or hobbies can pay off in certitude that a patient can rely on the nurse to note variations in their condition.

Some hospitals and nursing facilities have incentive programs for cross-checking symptoms
The manifestation of certain symptoms can be easily missed unless the nurse has established a rapport with the patient. A nursing supervisor often looks to key nurses who can be trusted to “handle” patients who have special interventions indicated in their care plan. Patients need guidance and instruction how to do things good for their conditions. Even if the nurse thinks the patients already know, reminders keep the patient focused on best habits for their own health.
Nurse should encourage patients on how to best elevate legs, attend community activities, perform approved exercises, work well with therapy professionals and stretch their muscles. Some patients may get in a “rut“ and need to motivate themselves towards physical therapy. But some patients just droop and drift into a pattern of inaction. The pattern of interaction should not be allowed to fall static. Just asking a patient what they are watching on television or what they are reading can bolster a patient’s attitude.
Regular familiarity with the patient, good understanding of their conditions and medications, a working knowledge of how to relate verbally to the patient and make them feel at ease, and an ability to confront your own fears and deal with people in a respectful manner that meets their expectations of an institution are all the traits of a successful modern vocational nurse. It is each nursing student’s responsibility to evaluate their own strengths and weaknesses, and to critique themselves and their peers for the benefit of all.

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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